HealthNex: Too Many Specialists in the House

George Chedraoui, IBM Global Well-being Services

Georgec Some of you may have seen the recent NY Times Op-Ed, written by Dr. David Goodman of Dartmouth Medical School, Too Many Doctors in House. Dr. Goodman is a respected practitioner, teacher and author. He makes a compelling argument that our healthcare system does not need more doctors to meet the needs of our growing population; nor to improve our health outcome. We simply need to use the doctors we already have better. Hurray!!!

He goes on to cite examples in various regions to disprove the notion that more doctors per capita equals higher patient satisfaction and better health outcome, as being proposed by the Association of American Medical Colleges. One point I would've emphasized in this article is a means to distinguish between America's need for more Primary Care doctors vs. America's need for more Specialists. Hence, a more appropriate title for this Times article may have been: "Too Many Specialists in the House".

Studies show that having more doctors (including specialists), not only does NOT lead to better outcome, but they tend to lead to more intervention, higher costs, and more hospitalization. And we all know the risks associated with hospitals.....up to 100,000 preventable deaths per year from medical errors.

To put this in perspective, look at these statistics on the trend in the U.S. growth rate of doctors. This was published in Health Affairs in October 2004, and authored by, who else, Dr. David Goodman:

Overall growth rate of all doctors per 100,000 population from 1979 to 1999:       51%
Growth rate of Generalists (Family Practice, Internist, Pediatricians):                45%
Growth rate of Medical Specialists:                                                                   118%

What's more alarming is that the Family Practice specialty only grew at a dismal 18% rate during this 20-year span (25.8 to 30.4); 65% below the overall growth rate of all doctors, and a whopping 85% below the Specialists rate. In my state of North Carolina, 50% of family physicians will be retiring in the next 10 years, and the pipeline to back-fill is pretty much dry. This should concern all of us, as we mostly think of family practice as our primary care medical home, which is typically associated with a more holistic, continual healing relationship between doctor and patient. Primary care has also been associated with increased patient adherence to medical advice, more up-to-date on preventative services such as, immunization and screenings, lower hospitalization, better outcome and lower overall costs.

As a large purchaser of healthcare, IBM is providing employer leadership to address the primary care crisis in the U.S. We are partnering with physician organizations such as, the American Academy of Family Practice (AAFP) and the American College of Physicians (ACP), to transform the way primary care is delivered; make it more meaningful and patient-centric; with focus on true care and prevention. We would also transform reimbursement and pay primary care doctors to do disease management at the point-of-care; by having the tools such as, clinical decision support and electronic health records.

Is this vision too far-fetched? Far from it. Consumers in Denmark, Singapore and New Zealand are already taking advantage of technology-supported primary care. They pay less for it and have better outcomes than we do.

So, yes, here in the U.S., we do have too many doctors in the house. But, we don't have enough doctors who deliver care that matters, care that is connected, care that is patient-centric, and care that fosters a continual healing relationship of the entire person.

IBM HealthNex Patient-Centric Care Dr. David Goodman primary care

Comments

George:

Hurray, indeed. So glad to hear about some of the ways IBM is working to empower the patient-primary care doc relationship. While its easy to imagine how all the technology we talk about will help to create an electronic infrastructure, this need to reinvent the nature of the relationship between patients and the doctors they deal with most personally, is a real underappreciated aspect of "patient-centric" care.

Posted by: Jack Mason | July 13, 2006 at 11:26 AM

Careful George, if the AMA and the specialty societies don't know where you live, they can find out!

Posted by: Matthew Holt | July 14, 2006 at 01:30 AM

Bravo!

I'm very glad to see efficiency discussed in the context of medical services.

Physician extenders could be leveraged to increase efficiencies for MDs. I'm piloting a system in Indiana where doctors build evaluation/treatment plans for "paradigmatic" musculoskeletal disorders. Certified Athletic Trainers access these plans remotely online and are able to evaluate and treat many common disorders at locations convenient for the patient (at the workplace in this pilot).

The plans are conservative, so a patient is referred to the MD if they don't respond to the treatment plan.
Even better, a feedback loop let's the doc know how effective his/her treatment plans are. Treatment plans can be modified/improved for population segments that are not responding.

I'm sure some docs will bristle at the concept, but this systems really extends and improves their knowledge.

I think Clayton Christensen wrote how innovation can push medical procedures to lower skill levels, as they become paradigmatic: "Will Disruptive Innovation Cure Health Care? HBR 2000?"

Ben

Posted by: Benjamin Atkinson | July 14, 2006 at 11:45 AM