Reinventing the doctor - week 2

Bambi Francisco Roizen · July 23, 2019 · Short URL:

Join us 9/12 @ucsf; Your future robot doctor; What drove the doctor drought?

Welcome to "Reinventing the doctor" - week 2, it's my weekly curation of news and information around the Internet that's relevant to our topic. We'll be discussing this at our upcoming salon at UCSF in San Francisco. 

Join us on 9/12 and you'll meet me, my co-hostess Dr. Archana Dubey (Global Medical Director, HP) and my co-host Mark Goldstein (Chairman, UCSF Health Hub). 

We'll take a 360 degree view of how the doctor's role in care will change. Joining us are Keith Rabois (Partner, Founders Fund), Matt Gibson (Chief Innovation Officer, Erlanger Health Systems), Kirsten Saint Clair (Director of Urgent Care, Providence), and many more.


In the meantime, brush up on relevant news on the topic. 

Your future doctor may not be human

I'm still waiting for the day when at my doctor's office, I'm greeted by some version of Baymax, the lovable synthetic bodyguard nurse in the movie Big Hero 6 that's a cross between the Pillsbury Doughboy and the Stay Puft Marshmallow Man. But I can't even get Siri to go beyond giving me a list of articles about headaches, when I ask "What can I do about my headache?"

But we're getting there. For now, artificial intelligence tools are arming doctors or medical assistants with the tools to evaluate data and either detect disease sooner or provide better treatment paths. Here are some ways: 

Researchers at John Radcliffe Hospital in Oxford, England created Ultromics, an AI diagnostic system to diagnose heart diseases. And studies show it's more accurate than doctors at least 80 percent of the time. They did this by training software to look at heart scans of 1,000 patients. At Harvard, an AI-assisted “smart” microscope was trained on 100,000 images with dye to make bacteria more visible in order to detect lethal blood infections. In Yokohama, Japan, at Showa University, a computer-aided endoscopic system was created to find potentially cancerous growths in colon. All of these studies had high accuracy rates.

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The role of the Primary Care doctor debate  

At our #Inventhealth "Future of Clinics" event in June, hosted by HP and Vator, we brought together a number of Chief Strategists and Chief Medical Officers to talk about the "setting" of care, meaning where care was being facilitated - either at new brick-and-mortar clinics or new telehealth services. The conversation invariably touched on the role of the traditional doctor. On one side were those who believed the doctor would be needed more and be seen more. Those were One Medical and Heal. The other side were those who thought doctors would be more part of a team and aided with a lot of telehealth. Dr. Pat Carroll was one of them on the latter. Carroll, Chief Medical Officer at HIMS, who was the former CMO at Walgreens, shared an anecdote about a doctor visit his daughter had, which last seven minutes long and ended with a prescription to Klonopin, which Dr. Carroll said was "the worst medication you can give" due to how addicting it is for patients. So his daughter self-diagnosed with the aid of Google. This is what she said to him via text: ‘Dad, healthcare is going to AI-backed symptom checkers to get you to the right place, to get you the right lab test, at the right time. And all my primary care physician did was actually hinder my progress to getting a diagnosis and getting better.'"

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Here's what's driving the doctor drought  

In 10 years, or 2030, there will be 15 percent fewer active MDs in the country. That equates to about a 121,300 doctor shortfall, according to the Association of American Medical Colleges. More than half of that shortfall will be for specialists. 

This is why: The doctor headcount is governed by the number of residency positions, the training grounds for future doctors to get licenses, according to Fortune. These programs are funded by the Centers of Medicare and Medicaid Services (CMS). In 1997, or 22 years ago, Congress froze funding for residencies. The reason: having more doctors, especially specialists, inflated healthcare costs. This led to capping the supply of would-be doctors. Residency positions then rose 24 percent over the past 41 years, during which time the population expanded by 43 percent and those over 65 doubled to more than 55 million.  

Indeed, America's health bill did start rising at a slower pace - 7% from the 1990s through 2007, to 3.9% last year. But the demand for specialists is going up and there's not enough of them.  A 2019 report by Merritt Hawkins, a unit of AMN Healthcare, a top physician recruiting firm, shows that demand for specialists is growing while demand for primary care physicians is slowing. The report is based on the 3,131 job searches the company did in a 12-month period. Nearly 80 percent of its assignments was in medical specialties vs 67 percent four years ago. Searches for primary care doctors (which includes pediatricians, internists) fell to a fourth from one-third. Oh and the doctors we have today are aging fast!

Some 61 percent of all psychiatrists and 60 percent of cardiologists are older than 55 years old. And roughly half of America's neurologists, orthopedic surgeons and urologists are older than that milestone. 

(Image source: truthaboutnursing, havasunews    
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Bambi Francisco Roizen

Author of "Unequally Yoked"; Co-founder Vator and Invent Health; Former Columnist/correspondent Dow Jones MarketWatch; Business anchor CBS affiliate KPIX

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