Wednesday, February 15, 2017

So where is the Creative Destruction?

Assuming the existing paradigm of medical school education is tired and in need of replacement, the next question is why hasn’t it happened? Technology change is all around us. Students have replaced memorization and note cards with the EHRs, phones, laptops and Google. Yet the system is relatively unchanged. How come?

A review of creative destruction is helpful. The original theory of creative destruction (replacement of old with new) was that downturns in the economy spurred such destruction. This “liquidation model” proposed that when things go bad people revisit resource allocation and come up with novel solutions. The application of this model to medicine would infer that the unending growth and riches of healthcare is the problem. Additionally the ability to dump more and more debt onto medical students [thus forcing students to choose high paid specialties focusing on procedures] has further enhanced the riches of the industry. The end result of all this largesse is that the healthcare aspect of the economy has been protected from from the risks (and destructive value) of recession. Without downturn there is complacency and thus stagnation.

So for us to move out the current "Normal Science" and shift the paradigm we would then need something bad to happen in terms of health care. Now since health care is 17% of GDP you can argue either way.

Option #1: No way can that happen; our entire economy will crash.

Option #2: It is inevitable. How much longer can the US remain competitive when it spends twice what any other country spends and still does not provide health care to everyone?

I wish I had the magic ball to predict which one will win. Sadly, based on the above theory we lose either way. If everything stays rosy then medical student changes. If health care in the US crashes then medical student training changes but the system is in chaos.

4 comments:

  1. Brad,
    Interesting subject about the healthcare industry. We never hear about the training of doctors until a tragedy. I wonder why the industry has been so slow to change their ways. Is it because it would require such a huge shift in thinking old vs new?
    I found this article and you might enjoy looking at it. It is very interesting and one part of it addresses new training methods.
    http://med-ed-online.net/index.php/meo/article/view/30662#sidebarRTAuthorBios
    Cece

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    1. Neat article. I would see that approach as yet again dancing around real change. Like the concept of interprofessional teams. To me that implies that the current highly circumscribed definitions of different health professionals is still logical. Doctors are still doctors. The integration with the (stagnant) health care delivery system is also strange to me. Are CHCs relevant? If folks are going to be innovative let's have them outline an entirely different model of delivering care (say with a supportive app, telemedicine, a coaching/empowerment model, and a data system that stores analyzable data on personal and group basis). Now that would be creative destruction. And who better to design that than a medical student who doesn't know any better and is not beholden to the existing system. Let medical students be free to innovate and see what they come up with.

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  2. Tosh R. Comer
    From WCU ENT 601

    Brad,
    I always complain about health care cost but never thought about how to change the medical system so that it could be beneficial to a regular consumer. Well I have thought about it but not in the way that it would help the overall healthcare system.

    I would like to see a public sector of healthcare emerge. It could provide incentives for recent graduates as well as seasoned medical professionals. The incentives would be set up like Teach Away or Peace Corps. You practice for a given period of time in a public funded health facility and get some much off your student loans or gain funding for medical research and trials. The public sector would also be a resource for traveling and gleaning from new to seasoned professionals in a public health network.

    Now when I say public health sector I am taking about more along the lines of the Veteran's Affairs hospitals where we would have our own facilities and clinics outside of the private sectors.

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  3. The Indian Health Service (yes it is still called "Indian") works this way. And folks who get their schooling paid for my military can their schooling for free but they have to serve and equal number of years as well as do their residency in a military hospital (I agree that that isn't an example of what you are describing). So it is doable and your idea is fantastic. Like most innovation in medicine sadly, it won't happen...

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