The factors mentioned above are contributing to fewer young people aspiring to study medicine. This is a worrying thought, particularly as the burden on healthcare systems increases. Could digital health technology be what is required to salvage an inexorable decline by making healthcare a more attractive prospect?
With the parallel changes of increased governance and public demand fueled by an increasing litigation culture driving protocolized care and improved record keeping – in particular, the introduction of electronic medical records – doctors are open to ever greater scrutiny. The result is that the role of the doctor – and in particular the junior doctor – has changed very considerably. On the face of it, this may be considered better for the patient and the health care system although, in reality, evidence that it is a driver for either better or more cost effective care is unconvincing.
Overwhelming volumes of data
In any case, doctors are now responsible for managing the flow and interpretation of ever greater quantities of data from investigations of increasing sophistication, which is progressively replacing clinical acumen and bedside judgment. It is in part the increasingly algorithmic role of the junior doctor in following protocols in response to overwhelming volumes of data that are contributing to the sense of doctors working harder and the job becoming less rewarding.
The European Working Time Directive limiting working hours and the increasing 24/7 intensity of healthcare services has resulted in junior doctors in many parts of the world operating on the shift system. This contrasts with the old system of daytime working with an added “on-call” rota, which led to a sense of belonging to a team with a clear hierarchy and camaraderie that has largely been lost, along with the feeling of personal investment in the management of the team’s patients. As a result of this lack of feeling of belonging, combined with what is generally now referred to as “gig culture” we’re seeing difficulties in sustainability in certain areas of medical practice. The Primary Care system in the UK’s National Health Service (NHS) is a very good example. Previously young doctors training to be General Practitioners aspired to become Partners in the practice, taking on their share in managing their stake in the practice as a permanent home for the rest of their medical careers. Now, general practices are in crisis with a general inability to appoint Partners through lack of interest.
What is the solution for this spiral of increasing burden and inflexibility, all leading to low morale?
Data analytics tools
It may be considered paradoxical, but the answer may lie in making healthcare even more data driven, and even more algorithmic and protocol driven – but with these processes taken out of the hands of the healthcare worker and fully automated using smart technologies. For example, health data science company, Lumiata, has created predictive analytics tools that accurately make predictions and identify insights related to symptoms, diagnoses, and medications for individual patients or patient groups.
DeepMind Health – currently active in hospitals – is developing artificial intelligence systems for analyzing large quantities of patient data and managing work and patient flows to optimize diagnosis and treatment selection and delivery.
Taking as much algorithmic decision-making out of the doctors’ hands would free them up to focus on ‘’being a doctor’’ and apply their highly trained skills to conglomerate the results into a holistic approach to patients.
The problem currently is that we are in a transitional phase. The role of technology has evolved only to the point of forcing data-driven care and governance, without healthcare systems yet able to trust in technology to assist and unburden doctors. There is a rapidly growing number of systems incorporating artificial intelligence that are proving capable, safe and effective in multiple use cases, but not yet approved for widespread implementation. Instead, clinical staff has to deal with all of the protocols, algorithms, governance structures and threats that result from following and failing to follow protocols. They’re handling the data overload as well as the pressures of managing increasingly demanding patient numbers. The algorithmic component of care – estimated to be 70% of the workload of the doctor – needs to be taken on by technologies, which may have the advantages of greater objectivity and knowledge base, are indefatigable, and able to (machine) learn. This will free up the doctor to focus on the remaining 30%. If we can use the power of connected health optimally, it stands to significantly reduce workload – particularly the ‘’non-doctoring’’ parts of the job – resulting in better, more cost-effective and more enjoyable healthcare delivery.
And Trainee Doctors are the engine for this change. The Clinical Entrepreneur Training program, established by NHS England in the UK in 2016, is the largest such national level program in the world. It provides the platform for retaining ~25% of medical graduates who drop off the training programs of the likes of NHS, UCLA, and Stanford, and creates a cohort, the mentality and the structure to improve global health through innovation. In so doing, it is this innovation engine that also will evolve the solutions – such as those incorporating artificial intelligence – that will take us out of the difficult transitional phase in the digitization of healthcare. Trainee Doctors providing solutions for not only their patients, but also for their own principal challenges.
Once embedded, this inevitable division of labor in healthcare – exploiting artificial intelligence – has many more potential advantages. The first is that the solutions are scalable and can easily be deployed across geographies, patient groups and healthcare settings, regardless of local skills and attitudes to healthcare. This produces economies of scale to drive down costs of care, and generates large quantities of centralized data that can reveal unidentified signals and indicators of both diagnostics and therapeutic benefit.
In addition, and very importantly, the significant impact this transformation could have on the role of doctors may be enough to attract and retain more talent to an industry in dire need of enthusiastic young doctors.