In a lot of ways, healthcare providers are victims of their own success. Never before in human history have we battled the specters of death and disease so effectively. High demand for healthcare services comes from the often-fulfilled promise of healing, but limited resources inspire inevitable policy and payer battles revolving around access, quality and cost. Clearly, we are all willing to pay a lot for health, as our blossoming national deficits show. But are we getting value for our money? Because medicine is so vital, some believe that it must be regulated, corralled and generally managed to an infinite degree. In turn, healthcare providers are burning out, retiring early, dying and not being replaced. The World Health Organization projects a global healthcare worker shortage of 18 million by 2030.
A loss of meaning is a major source of provider burnout as current regulation causes providers’ work to be heavily administrative. Corralling and controlling come at a cost; the goose with the golden egg has been thoroughly dissected. Providers spend the majority of their time not treating patients but entering data for electronic medical records (EMR), feeding information into programs mainly designed to code and bill. These systems have caused experienced physicians and nurses, who trained to care for patients but are mandated into becoming clerks, to leave the profession in distaste.
Patients are suffering as well. Healthcare is expensive and access is difficult. Often patients are treated as a nuisance by harried professionals and an impersonal system geared for high volume. Most patients anticipate a somewhat miserable clinic or hospital visit: long wait times in plastic chairs under fluorescent lights, fatiguing paperwork in small fonts. Ultimately, being shuttled from one place to the next like undervalued cargo makes for a bitter medicinal pill. All concerned are unhappy, despite the glossy healthcare ads.
Is Direct Primary Care the Answer?
Some providers have revolted against the healthcare industry’s purpose-killing regulations by joining the Direct Primary Care (DPC) movement. Go bare from insurance and you go bare from a lot of hassle. Writing in a patient’s chart suddenly becomes immensely useful because the main purpose is clinical, not proof for billing. Providers aren’t penalized for sitting down and spending time problem-solving with their patients. The volume of patients seen becomes less important, and the quality of the doctor-patient relationship is the main focus. Norman Rockwell paintings of early 20th-century medicine come to mind.
However, 21st-century medicine is much more complex and expensive. Only the most straightforward and least costly medical problems are sustainable with the DPC model; more complex treatments are far too expensive for most patients to bear the cost. But the simpler problems (e.g., urinary tract infections, hypertension, diabetes management) are already ripe for innovation using virtual health—telemedicine and artificial intelligence (AI). It’s hard to market a monthly DPC fee when healthcare consumers can pop in and out of a telemedicine encounter to get their problems solved. Not only are DPC practices competing with easily accessible telehealth, but their small size further reduces patient access. A typical primary care practice manages 3,000 patients, while a DPC practice manages only 700. On a societal level, this seems difficult to justify when primary care providers are already scarce.
How can provider burnout be more effectively addressed? Withdrawing into a simpler time’s model is unsustainable on a broad national scale. As a small market niche, DPC has a place. But for the majority of Americans, it won’t work; the DPC model is simply not scalable.
The Promise and Problems of Healthcare Technology
Information technology has been wearing the black hat in this story so far. EMR systems have crushed providers under the time-sucking weight of unattractive text boxes, mouse clicks and endless, often meaningless, alerts. Can we envision a better future, where technology helps doctors, nurses and ancillary providers do a better job?
Automating the repetitive tasks in healthcare amenable to protocols and algorithms holds promise, freeing providers to focus on the complex and unique needs of their individual patients. But with the use of personal health applications on phones and smartwatches, reams of patient data (e.g., ECG rhythms, glucose values, blood pressures) are currently inaccessible for analysis within current EMR systems. EMR systems are siloed between institutions, making lifesaving universal access to healthcare data a futuristic dream. This could change, however, with the use of Fast Healthcare Interoperability Resources.
Computer learning and AI have great potential for improving access to basic healthcare, facilitating patient education and ensuring provider diagnostic accuracy, among other things. Many patients have relatively straightforward healthcare questions, but they currently have to wait 24 to 48 hours to get answers from their provider. Some of those questions may require immediate intervention, but there may be no reliable system for flagging those problems to the provider. As the technology improves, chatbots may prove helpful in these situations by being an immediate source of basic patient information and assessment.
AI algorithms have a dark side, though, as seen with Timnit Gebru’s recent departure from Google after she published research showing that AI systems could generate racist, unfair results. Inequitable healthcare is already a national problem. If not done right, AI will accelerate those trends. Healthcare consumers should have a voice in how these systems are used and implemented. As healthcare technology continues to evolve, policymakers and medical professionals must thoughtfully consider how best to use it so that it meets the needs of providers and patients alike.