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- 1. The Future of Allopathic Medicine Michael M.E. Johns, MD Executive Vice President for Health Affairs CEO, Woodruff Health Sciences Center Chairman of the Board, Emory Healthcare Emory University
- 2. Workforce Projections A Long History of Getting it Wrong! Looming Shortages? Surpluses? • Then – GEMENAC (1977) and progeny through 1980s – Cooper 1994 – Weiner 1994 – COGME 1995 • Now – U.S.Bureau/Health Professions (shortage areas) – Wennberg 2006 (OK as is - just rationalize effort) – AAMC 2006 (increase med students by 30%) • Always – Shortages in areas of greatest need (rural, inner city).
- 3. Workforce Projections A Long History of Getting it Wrong! What do current projections of shortages mean for future professionals . . . ?
- 4. Demand Prices P - price Q - quantity of good S - supply D - demand
- 5. Factors Affecting Your Future Both catalyzing and limiting factors: 1. Lack of universal coverage 2. Costs 3. Demographics (longevity, baby boomers, etc.) 4. Dysfunctional health care delivery and payment systems. 5. Demand for health care services. 6. Regulatory burden 7. Administrative waste ($40 billion/year on paper records alone).
- 6. More factors 6. Quality, safety and service deficits 7. No standard, universal transaction platform. 8. Lack of universal, secure, personal medical records. 9. Ethics/loss of professionalism/focus on profitability vs meeting important health care needs.
- 7. Five Newer factors 1. Rising Societal Expectations 2. Globalization
- 8. 3. Acceleration of technology and knowledge NanoTechnology: bringing together molecular biology, biomedical engineering, imaging, robotics for diagnosis and treatment.
- 9. 4. Public/Private innovation and entrepreneurialism From Medical Home to Health Home
- 10. New Patient Health Home? • WA Seattle Metro Locations “There’s really no secret behind MinuteClinic’s better approach to diagnosing and treating common illnesses: ･ Quick (about 15-minute visits and no appointment needed). ･ Affordable (treatments between $28 and $110, and reimbursed by most insurance plans). ･ Convenient (open seven days a week, located near pharmacies).”
- 11. “Prescription for a Busy Life” Common Illnesses/Pricing Allergies (ages 6+)$59 Bladder Infections (Females, ages 12-64)$69 Bronchitis (ages 10-64)$59 Ear Infections$59 Pink Eye and Styes$59 Sinus Infections (ages 5+)$59 Strep Throat$69 Swimmer’s Ear$59 Flu Diagnosis (ages 10-64)$93 Mononucleosis$69 Pregnancy Testing$49
- 12. Newer factors: 5. Convergence Convergence creates new tools enabling new alignment of how people will work together. Example: iPod •Required acquiring and aligning multiple resources –Technologies –IP –People –Companies
- 13. Innovative Convergence around iPod Tony Fadell, Apple Computer's Senior VP, iPod Division CONCEPT File Transfer Chip Design Compatibility Mobile HDD CONCEPT SOFTWARE Functionality Digital Converter cliché software HARDWARE Planar Lithium Music Production Battery eMagic Storage Flash Memory Chip CONTENT Firewire SHRINK Music (1394) Books
- 14. Emergence Convergence leads to . . . Emergence of new concepts for biomedicine
- 15. Predictive Health “Predictive Health anticipates the course of an individual’s health status, based on leading edge science and technology, and prescribes interventions that proactively optimize wellness” “This revolutionary approach will move from a reactive disease focused system to a pro active health focused system; disease becomes a medical failure”
- 16. The Health/Disease Continuum Normal Normal Pre Early Late Low risk High risk disease disease disease D H Predictive Health I E S A E L A T Contemporary Medicine S H E
- 17. Determinants of Health NIH Roadmap Initiative: NIH Roadmap Initiative: New Pathways to Discovery Research Teams Of The Future Environment Genomics/ Population Metabolomics/ Biology Proteomics Genetics Behavior Molecular Imaging Systems Biology Generic Pathways Bioinformatics Ethics Technologies Disciplines Immunology and Nanomedicine Inflammation Public Policy Development Oxidative and Quantitative Stress Finance and Senescence Medicine Economics Novel Other Generic Regeneration Education Therapeutics Pathways and Repair Building Block, Biological Specific Diseases Pathways, and Networks Cardiovascular High Risk Research Cancer Diseases Molecular Libraries and Interdisciplinary Research Imaging Chronic Lung Diabetes Public-Private Other Diseases Structural Biology Diseases Partnerships Neurological Bioinformatics and Diseases Computational Biology Nanomedicine NIH Roadmap Initiative: Re-engineering The Clinical Research Enterprise
- 18. The Question for the Future The question is not: “What will medicine look like in 20 years?” The question is: “What can medicine be in 20 years?” And: “What can we aspire to be as leaders in fulfilling that vision?”
- 19. The Future of Allopathic Medicine It’s your future. Learn -- to be a leader.
Notas do Editor
- I was sent to a Jesuit school when I was very young, and the first thing they teach you is to challenge the premise. I’m sure that Jordy, who has known me a long time, knows that I learned that lesson well!! So here goes: Is the current prediction of a looming shortage accurate? I have to say that we’ve been down this road before . . . . The physician shortage would be different if we stooped taking a physician centric point of view and recognized the expanded role that NPs and other health professionals could assume. This would take a work load away from the generalists and mollify any potential shortages that are pending. The bottom line is that we have always had shortages in the areas of greatest need . . .
- But what if the current projections are right?
- Well, I guess that means that all of you are in pretty good shape. Remember the old supply and demand curve? Well being scarce will certainly improve your relative mobility and the premium for your work! But I hope that this is not the aspect of this possible future that most concerns any of you, first, because you can’t count on it, and second, of course, because we are talking about a calling here, where it is the quality and humanity of our work that is most rewarding . . . And in case any of you thinks that the road ahead is without road bumps, think again!
- Here are some major factors that both catalyze and limit Lack of universal coverage Costs Demographics (Longevity, Baby Boomers, etc.) Dysfunctional Health Care Delivery and Payment Systems. Insatiable Demand for Health Care Services. Enormous Regulatory Burden and Administrative Waste ($40 Billion/year on paper records alone).
- Widespread Quality, Safety and Service Deficits. Lack of a Standard, Universal Transaction Platform. Lack of Universal, Secure, Personal Medical Records. Ethics/Loss of Professionalism/Focus on Profitability vs. Meeting Important Health Care Needs. Widespread Quality, Safety and Service Deficits. Lack of a Standard, Universal Transaction Platform. Lack of Universal, Secure, Personal Medical Records. Ethics/Loss of Professionalism/Focus on Profitability vs. Meeting Important Health Care Needs
- These ongoing issues are now supplemented by newer factors: First, Societal expectations. Patients and families, and payors too, are demanding more of us and we are demanding more of ourselves, especially in terms of quality, cost and value of our services. Agencies like the AHRQ are facilitating new resources for understanding and measuring quality. Globalization: The world is flat. Health opportunities, yes, but also risks: SARS, AIDS, Pandemic Flu, etc.
- Another factor is the acceleration of technology and discovery, and the continuing growth in our knowledge base. With the amount of new knowledge being generated and published, a professional would need to read 19 journals a night to keep up. Obviously this can’t be done. What we need are new technologies that supplement and compensate for our individual or collective limitations in assimilating knowledge. Technology: One example, which we have here at Emory is nanotechnology. Our joint department of biomedical engineering that we have developed with GA Tech is a model of scientific integration of many disciplines and technologies. This particular technology is point us towards major breakthroughs in a wide variety of diagnostic and therapeutic capabilities . . .
- Need to think differently about medical homes. Need to think in terms of health homes . . . EBM and care teams . . . And for patients, we need to think about whether their health home is in fact the home! We can see movement in that direction already. One example is . . .
- Easy-access clinics that are moving into the neighborhood in new ways. So here we are in Seattle. Feeling a little out of sorts? Feel an ear infection coming on? Don’t want to go wait in an ED? How about seeing the health provider at the “Minute Clinic” in your local pharmacy? Minute Clinic may be the new model of the patient’s health home . . . . And they have the pricing to go with it . . . [next slide]
- I’m told that lots of folks come in and pay cash! Now what if we take this a couple of steps further and imagine the home for care actually transitioning to the home. Why couldn’t we have computer sytems that access sophisticated interactive diagnostic sites where evidence-based algorithms can be accessed by the patient sitting at home, wearing a monitor on his or her index finger? Voice recognition and voice over internet capabilities enable a carefully structured, automated interview, with the patient’s history already in the database, along with all meds, tests and so forth. You could imagine a whole host of symptoms and illnesses that could be managed remotely in this way, thereby possibly eliminating the need for many human providers at that level of patient service. . . .
- New health homes, new technologies, societal and global factors --, all of these factors are converging to shape the future of allopathic medicine. But this doesn’t mean that we are just meant to sit around and wait for these things to happen or just to accommodate to them. The big things that are happening are happening more often by design than by accident. The really smart people and agencies and corporations know that great progress means pulling together the resources you need, sometimes in unexpected ways and with unexpected partners. Let’s take a well known recent innovation as an example . . . .
- [Talk through this slide . . . ] . . . . Well, exactly this sort of convergence is what is beginning to occur in health care . . . .
- And as we’ve seen with the iPod, well conceived and well executed convergence can lead to the transformative emergence -- emergence of new possibilities for medicine and health.
- And perhaps the most exciting thing that I see emerging from so much that I see developing in our science and in new models of care, is the capability to achieve the promise of 21st century medicine in the transition to predictive health. Predictive health is healthcare that is proactive and preemptive. It is care that understands not just disease, but health and is focused on optimizing and maintaining health for a lifetime. It is about what I call maintaining a Square wave life curve . . .
- Predictive health reverses the traditional health disease continuum.
- Here is how convergence is working to shape this future. There are the determinants of health . . . [click] There are the technologies converging as well as [click] The many disciplines The public sector is invested through intiatives like [click] the NIH Roadmap with both pathways to discovery and [click] the fostering of research teams and now the [click] clinical research initiative And then all of this is also converging with new disciplines that are emerging and vital new and expanding private/public partnerships. There is extraordinary work going on in genomics and proteomics, nanotechnologies, molecular imaging, biomedical engineering, transplant biology, vascular biology, robotics, systems and computational biology and in many other areas that promise to transform medicine in this century. We can already see the outlines of new fields of medicine, like regenerative medicine, where tissues and organs would be regenerated from stem cells and through artificial replication. This means that the preparation of health professionals must begin to incorporate a broader array of capabilities: Preparation in computation, physics, mathematics, Professionals who can work easily and creatively and with flexibility in various types of colleagues and in non-traditional settings. Need health professionals with a global perspective. Technological proficiency, including remote and interactive. Ability to work across populations, in diverse social, political, and economic environments.
- And all of this comes down to being part of the team that is leading this developing new era of health and healing. This is about Leadership. SO the question is not what will medicine look like in 20 years? The question is what can medicine be in 20 years and what can each of us and all of us together aspire to be as leaders in fulfilling that vision? The challenges will continue to mount as we become even more ambitious for our selves and for our health system and for our patients. Everyone in this room needs to be thinking about not just becoming a true professional, but about becoming a true leader . . .
- It’s your future. Take charge of it and lead. Thank you.