The physician of tomorrow must practice differently from the physician of today. Tools, work systems, even patient expectations are changing. As future physicians stride into their workplace, they will need to be:
- trained in evidence-based medicine;
- skilled in panel and population management;
- technologically facile.
Team-oriented health care has grown along with the physician shortage, the expansion of nurse practitioners' roles, the number of physician assistants, and the needed social-medical infrastructure to support care management.
These changes evoke several questions: Will the physician be a coach, a player or a captain? Will the role change depending on the day and the patient? What are the responsibilities of other team members? Other than the patient, who is best positioned to evaluate the team and its performance? Who will make changes in team composition based on skills or chemistry to maintain high-level performance? Are the present models — e.g., surgeon and physician assistant and nurse — sufficient for other care delivery environments?
Observations. Teams generally stay together for periods of time and then disband when they are no longer necessary. But in health care, patients still seek access to systems and their team members for care. Health care entities need to consider how to create high-performing, sustainable teams. Doing so may require that individuals moving into or out of teams have certain skills and that teams shift their expertise focus occasionally to stay fresh and engaged. The premium this will place on health system human resource management is considerable.
Trained in Evidence-Based Medicine
Evidence-based medicine has been quoted with abandon over the last 20 years. Now, with the proliferation of care guidelines, clinical repositories and expansion of health informatics, evidence-based medicine is more accessible, but also more overwhelming. Care team members cannot anticipate being able to find applicable evidence for every problem at every encounter for each patient.
Accessing evidence has to be efficient, and the information has to be targeted, concise and accurate. Primary care physicians and specialists must develop informatics skills, especially if they have to manage growing patient panels and care transitions across a larger care continuum, such as procedures and home care. How will data be transmitted to those specialists? If those physicians are not employed or affiliated with an integrated delivery system or hospital, who will help them monitor evidence-based care? Their own practice? Managed care entities?
Observations. The information technology team will need to upgrade search and filter strategies to personalize patient-specific evidence flow and map it quickly to guidelines or populations. Informaticists, care managers and predictive modeling staff will become part of evolving hospital and health care delivery systems, even as clinicians grow more comfortable with present electronic health records and registries. Health system information leaders will have the additional challenge of accelerating and integrating this process into care delivery.
Furthermore, patient-specific evidence will expand with health information exchanges. Physicians will need to embrace this influx of data about their patients — and quickly. Hospitals and health systems might consider targeting specific informatics skills among its clinicians or offer abridged health informatics training to specific clinicians.
Skilled in Panel and Population Management
Photographs of clinic rooms from the 1930s and today differ only in the presence of a computer. As an industry, we have not significantly changed our delivery model for three generations. But, we now care for more people with more comorbid conditions, and we have more treatments than ever before. This shift requires population management tools — individual and aggregate patient data with health system-informed care algorithms.
Should individual physicians be thought of as practice directors? If so, what skills do they need to bolster their abilities to effect changes in panel and population-level data? Hospitals and health systems should look at present competencies in infection control and antimicrobial stewardship and encourage physicians and other providers to use them as models. Hospital or delivery systems also can offer courses as part of recruitment or employment agreements.
Observations. Using eHealth or mHealth, clinicians can monitor patients between visits. Pharmacists can interact directly with patients to address adherence, obstacles to optimal medication use, patient safety and outcomes. Hospitals and health systems are better prepared than most small medical groups to offer such services.
Information technology in health care has lagged behind that of other industries. Using the clinical information platform for understanding and executing effective care delivery cannot end with the face-to-face visit. Physicians will be asked to complete virtual visits and will need to know how to use videoconferencing and messaging technology.
How will the doctor-patient relationship evolve with multiple new avenues of digital (not face-to-face) communication? Would a subset of physicians feel fulfilled in their jobs with primarily a virtual visit panel? Will patients be fulfilled in their expectations with virtual visits? How will the costs to support technology infrastructure align with reimbursement mechanisms?
Observations. The more skill clinicians have with information technology, the more it will allow patients and providers to benefit from its use. Older physicians, who may be less comfortable with the technology, still make up a critical portion of the physician workforce. For this reason, hospitals and health systems must develop effective strategies to incorporate the technology into patient care. This technology is more than a patient portal. Human factors engineering to look at workflows and patient perspectives — as well as gaming or internal competition strategies — are all ways technology can support patient care.
Stepping into the Future
The evolution of care delivery is on the cusp of fundamental change. New traits in the workforce, competency with information flow, new care management models and preemptive intervention are to be prized in addition to traditional doctor skills. Hospitals and health system leaders who know how to meld these skill sets into their workforce will find themselves with a prized set of physicians who can shape the care of tomorrow.
Bryan Becker, M.D., M.M.M., is a professor of medicine and assistant vice president for health affairs at the University of Illinois in Chicago. John Studebaker, M.D., M.S., is a pediatrician and co-chief medical officer at Forward Health Group in Madison, Wis. Roger Formisano is the vice president for strategy and leadership development for the University of Wisconsin Medical Foundation in Madison.