Doctors are headed for redundancy

By Pascal-Emmanuel Gobry on October 29th, 2013

One of the greatest fallacies of the past few decades is that better technology and globalisation mean that intellectually abstract professions are more promising than the less intellectually abstract. Call it the knowledge economy fallacy.

The problem is that what computers and globalisation result in is intellectual tasks becoming the easiest to outsource, whether it be to a computer or to a developing country. To put it clearly: it’s impossible to outsource an electrician, but it’s very easy to outsource a bookkeeper. The McKinsey Global Institute recently published a list of the most “disruptive” trends. On the list ? “Automation of knowledge work.”

The social dislocation this will cause will be significant precisely because the political and economic elites of the rich world have been telling their people for decades that as long as they earn a degree and do office work, they’ll not only be safe from the pressures of globalisation and technology, they will profit from them. The awakening will be rude.

Pointless PhDs

Perhaps the totemic safe knowledge job is being a doctor. It’s the professional occupation that requires the most years of study. And, particularly in many mothers’ mouths, “becoming a doctor” has become a byword for getting a job with unassailable economic security.

And isn’t healthcare one of the most promising sectors, as our populations age and as we move to an economy driven by services rather than manufacturing? Medicine looks like the epitome of the knowledge occupation secure from the roiling seas of the global economy.

And yet. The problem with medicine, especially workaday, general practice medicine, is that it is immensely wasteful, in a basic way. To get a check-up is to ask an extremely qualified professional to perform work that, by itself, really only requires a couple of years’ worth of education.

The rationale is that while most check-ups might be mundane, you need a doctor to identify the symptoms that reveal serious stuff. And this not a bad argument. The problem  is that doctors aren’t actually very good at doing so – at least, they’re not as good as computers.

The movement towards so-called “evidence-based medicine” is based on multiple studies that show that when you give a doctor and a properly programmed computer a set of symptoms, the computer will beat the doctor at diagnosis.

So if the most knowledge-intensive parts of the check-up, the ones that make a doctor necessary, can be outsourced to a computer, what does that mean for the future of doctors?

Inefficiency everywhere

And there is so much else that is broken with the experience of general medicine. Imagine the following experience. Your young child is visibly sick and crying. You think it’s just a cold, but it might be something more serious like otitis. It’s a Saturday night and, being, like all parents, of the anxious sort, you need an answer now.

If you have a family doctor whom you know well and trust, you might be able to disturb her at dinner on the weekend. But let’s face it: for the overwhelming majority of people that’s a fantasy.

You could, of course, go to the emergency room of your local hospital, spending gruelling hours waiting among a parade of horribles, to finally be told by an over-worked twenty-something medical intern that it’s nothing, which you really knew all along.

Even though it’s nothing, he will still prescribe a battery of useless tests (if you’re in America) or useless antibiotics (if you’re in France). Overall, you’ll have wasted a lot of time – yours, the doctor’s, and that of those with actual medical emergencies – and a lot of taxpayer cash in the process. And if you give your kid the antibiotics, well. You will be hastening the end of the species.

What if instead you could use an iPhone app to describe your symptoms and be reassured by an expert? With our devices’ ever-expanding photo and video capacities, the powers of diagnosis are really very good. (This sort of diagnosis is already here: your correspondent has dispatched a picture of his child’s vomit to her paediatrician via smart phone.)

If the phone is not enough, the app could refer you to the appropriate specialist or clinic, with an appointment and minimal wait time. Some start-ups, of course, are already working on this.

What’s app, doc

Silicon Valley-based HealthTap is really more like an interactive question-and-answer site with doctors, but it’s easy to see how it could evolve into something like a subscription medicine service in the long term.

Even more interesting is New York-based Sherpaa which goes almost the whole hog. For a subscription fee, its doctors, including specialists, will diagnose you, and the app will connect you with the right providers in the real world when you need them.

It’s easy to see how, when an app becomes your primary connection point with medical care, such a service might go from using American doctors to using, first, Indian doctors and, eventually, mostly computers.

Of course, man does not live by iPhones alone. When it comes to something like health, we want a human touch. (Although, if your experience is anything like mine, you’ll have noticed that this is really not what doctors are best at.) We want someone to trust, not just an app.

Which is why a subscription medicine service might not just be an app, but also include some sort of general practitioner, like the old family doctors. This “family doctor” would know you personally, and give health advice that is as related to psychology and general wellness as it is to identifying symptoms (for which she would simply use a souped-up version of the app you yourself use anyway).

This “family doctor” wouldn’t have to be a medical doctor at all. The job description really fits a nurse better.

There would still be doctors, of course. We would still need a bunch of specialists, especially in hospitals and for research. But the “doctor” as we understand it is about to start disappearing, replaced by better business models, better technology and globalisation.

The counterintuitive conclusion to all this for aspiring medical students, by the way, is that if you want to go into healthcare and you also want a secure economic future, it might be a better bet to become a nurse than a doctor.