For Physicians the Future Is Not What It Used To Be

April 19, 2011 - Before you delve too deeply into this entry, a word of warning. My wife warns me I am being a little too serious and repetitive fin this blog for her blood. She is undoubtedly correct, but here goes anyway.

My favorite book is The Age of Discontinuity: Guidelines to Our Changing Society (Harper & Row, 1968). I keep it at my bedside for late night intellectual nourishment In the book, the late Peter F. Drucker (1909-2005), a social critic and philosopher, describes four discontinuities in modern society.

1. Genuinely new technologies are upon us. Today these new technologies include the Internet, its various search engines, and the social media, which almost overnight, have transformed how we do business and relate, rate, and berate one another.

2. We face major changes in the world economy – Today these would include the same economic appetites, aspirations, and demands – across national borders, languages, and political ideologies.

3. The political matrix of social and economic life is changing fast. Today’s society is pluralistic, and every major social task is entrusted to large institutions run organized for perpetuity and run by managers. The future does not belong to rugged individualists, but to plugged-in collectivists.

4. Knowledge has become the central capital, the cost center, and the crucial resources of the economy. This changes everything – how we teach and learn, how we react politically and to each other.

Physician Impact

These discontinuities profoundly impact physicians, who are themselves a pluralistic society – aspiring pre-meds and retiring doctors, newly minted, the middle-aged, the old codgers; the entrepreneurs and the arbitrageurs; consolidators, coordinators, integrators, and decentralizers; leaders and followers; women and men; generalists and specialists.

It isn’t easy keeping all of this – and the profession – together. The pressures are immense.

• IPad, IPod, android, Twitter, Facebook, apps, EHRs, EMRs, and PHRs promise instant gratification and monitorization.

• Government overpromises, generates unrealistic demands, and then underdelivers.

• Hospitals beckon. Only they have the capital and infrastructure and marketing skills to make feasible the application of medical technologies.

• Third parties say only they have the IT skills and data to measure and judge outcomes and performance of physicians even when physicians know outcomes often rest more on behaviorally responsible patients and the stage and progression of their disease. Nature generally takes its course, no matter what the physician does.

• Young physicians, leery of the troubles and harassments inherent in running a practice, swirling political controversies surrounding physician motivations and fees, seek refuge in hospital employment. Middle-aged physicians, feeling overworked and underappreciated, either hang in there, switch careers, become employees, or join larger groups. Older physicians , if they can, retire or escape into concierge havens.

My wife is usually right. I tend to be too serious about the deleterious conditions facing doctors. I ought to lighten up. I ought to mix humor and humanity. I ought to br more optimistic. Everything will turn out all right in the end. There is always gloom for improvement.

Tweet: In future, doctors must deal with wireless technologies, government overpromises, becoming hospital employees, and installing expensive EMRs