Reuters reports today that young physicians today are relatively pessimistic about the future of health care delivery in the United States (via the New York Times). This article reports on a survey performed by nonprofit organization the Physicians Foundation, which cited in its report that the number one reason for pessimism among doctors (average age: 37) today is “new healthcare legislation,” with considerable cynicism towards “government involvement.” 49 percent believe the Affordable Care Act will have a negative impact on physician practice. Reasons tended to revolve around the economic “bottom line”:
“Large amounts of money are being spent on things outside of actual healthcare; CEO bonuses, pharmaceuticals, malpractice insurance premiums, lawyers, etc. This accompanied with the new ‘Customer Service’ initiatives that reward physicians who practice bad medicine is clouding the future of medicine.”
To me, this report illustrates these important points:
1. The delivery of health care in the United States has become extremely fragmented over time, leading to a total systemic breakdown. That physician’s quote above illustrates it all–there is too much money and power floating throughout the health care delivery system that do not revolve around the patient-physician relationship. System dynamics dictates that the more entities in a system, the more complexity. No wonder the health care system in the United States has proven so difficult to fix. The sheer level of complexity with the number of stakeholder groups (patients, physicians, payers, pharmaceuticals, the government, lawyers, need I go on?) and their interactions makes it extremely easy for communication failures to propagate and diverting attention away from what should be the core of health care delivery: the patient.
2. Hacking medicine successfully requires an understanding of these systemic interactions. Regardless of what aspect of health care you are trying to hack, whether its contributing to health and wellness or making costs more transparent; you must remember what stakeholder interactions you are trying to hack and how that contributes to the overall system of health care delivery. Health care delivery in this country will not change overnight by implementing new technologies and innovations, but incremental changes will eventually add up to a critical mass in which the health care industry must sit up and pay attention, less they be rendered irrelevant. Furthermore, once we hack certain interactions in the system, we must remember to expand our scope and determine what other factors have bearing on a person’s health: socioeconomic status? Distance to fresh produce? Methods of transportation? Public policies dictating what types of foods are available at your local supermarket or what types of medical services are available to you? What about farm subsidies; how do they influence health and wellness?
3. Hacking medicine may not necessarily involve technologies, but a total paradigm shift with regards to providers. What concerns me about the Physicians Foundation report is the attitude taken by young and upcoming physicians with regards to their profession. From reading the report, it appears to me that perhaps matriculating medical students may go into medical school with some expectations of what they expect to gain from medical school and come out with a cynical view of what it means to be a physician due to the systemic failure of health care delivery today. How can we as medicine hackers change the perspective of providers such that they feel inspired to practice medicine again, or is that not our concern? Whose responsibility should it be to get more providers optimistic about health care in this country? Without inspired providers, where does that leave us, the patients?
We have a long way to go and it may not be perfect, but I think we’re at the start of something truly amazing. Hopefully many of these questions that I’ve posed in this post will be answered as we continue to hack medicine.