Squeezing out the doctor? Not by a long shot

Evidence undermines the Economist title. Just like the New York Times and New Yorker long articles, when the Economist speaks, it looks weighty and credible. But the Economist’s Squeezing out the Doctor article is mostly about what the writer has just discovered -- which has been the case for years, but without his knowledge. Take this example, which clearly impressed: “Patients are much happier to monitor themselves at home with gadgets bought online than they used to be [really!], and gadget-makers think there is a huge potential for growth in taking the trend further. Philips is trying to crack Japan with emergency-alert devices for the elderly.” Hmm. Philips has marketed this type of product ever since they bought Lifeline 7 years ago. The PERS industry is a 20-year-old market disconnected from MDs that needs a responder to opt for a next step. And it is reimbursement of doctors (or lack thereof) that hampers progress in the overhyped telehealth market, that everything-but-the-kitchen-sink world spanning ‘robotic surgery to patient-to-patient email.’ 

Delegating tasks does not eliminate oversight. Doctors may have nurses as care coordinators, but that no more squeezes out the doctor than an electrician squeezes out the general contractor. And doctors have little interest in divesting power even when they delegate tasks. Doctors make the most money based on (their own) face/specialty time with patients. With remote monitoring and telehealth pilots a-plenty – see British telehealth study about saving 6000 lives – will the most recent study be the one that causes policy change across the globe?  Don’t bet on it. For another big bucks but low impact initiative, see CMS initial innovation grants -- that went to established large players. How nice, but CMS actual incentives are for doctors-in-your-face and face-to-face, which block any real change. And since doctors (see AMA) are the ultimate influencers of change in health policy and reimbursement, who seriously believes a near-term change is in the works?

The presence of technology does not guarantee change. The Economist article (for which no author, perhaps wisely, is named) demonstrates the gee-whiz naïve view of technology as transformative for changing processes and responsibilities. But that rarely happens unless precipitated by a crisis of resource availability (rural areas) or cost constraint (emerging markets).  Where resources are available and in some cases oversupplied, technology is locked within pilots, with decision makers (see doctors) still awaiting real proof. Meanwhile, in the physical world, see examples where the doctor is being squeezed – but by other doctors. See the competition for lucrative cardiac patients in cities like Boston or New York.

The future telehealth transformation -- it's in the hands of policy-makers (aka doctors). Imagine the title of a future Economist article – “Telehealth Declared Viable by Doctors. Subtitle: Reimbursement debate ends, CMS cites proof positive study, reverses reimbursement ratio for face-to-face visits and remote monitoring. Doctors, far from being squeezed out, benefit by being able to use technology to ‘treat’ many more patients, boosting their income substantially.  Telehealth vendors see endless market opportunity.” Will pigs fly?