The Futurist

Jeff Bauer on how in­no­va­tion will trans­form who does what in health­care

Modern Healthcare - - CONTENTS - BY JEFF BAUER

To­day’s fast pace of change might sug­gest that fore­cast­ing the evo­lu­tion of health­care pro­fes­sions over the next 25 years is an ex­er­cise in fu­til­ity.

Af­ter all, I’m a full-time health futurist with 45 years of ex­pe­ri­ence across the med­i­cal mar­ket­place, and it takes me an in­cred­i­ble amount of time just to stay con­fused about what is hap­pen­ing right now. How­ever, 25 years ago I wrote a book about the fu­ture of care­givers— Not What the Doc­tor Or­dered— and its fore­casts turned out to be re­mark­ably ac­cu­rate. I’m ready to look deep into the crys­tal ball again.

If the fu­ture of jobs in health­care can be re­duced to one word, it is di­ver­sity. Medicine and nurs­ing are likely to splin­ter into even more seg­ments. I see no com­pelling data, thought­ful ideas or uni­fy­ing lead­ers with enough power to quell turf bat­tles grow­ing within and be­tween the health­care pro­fes­sions. The re­sult­ing com­pe­ti­tion will con­tinue to erode mo­nop­oly power en­joyed by spe­cific groups of health­care pro­fes­sion­als in the 21st cen­tury.

The num­ber of job cat­e­gories is likely to pro­lif­er­ate as ex­ist­ing prac­ti­tion­ers ex­pand their func­tions and as new types of care­givers are cre­ated. They will pro­vide an ex­panded ar­ray of ser­vices in non­tra­di­tional lo­ca­tions, es­pe­cially homes and work­places. Telemedicine will ac­count for at least one-third of all care­giver-patient in­ter­ac­tions.

Amer­ica’s in­no­va­tive providers are spear­head­ing this di­ver­si­fi­ca­tion as they de­velop new and bet­ter mod­els for de­liv­er­ing health­care, and they are do­ing it in­de­pen­dent of gov­ern­ment-driven re­form. The pu­ta­tive suc­cesses of the Af­ford­able Care Act are sim­ply repli­ca­tions of in­no­va­tions be­gun in the pri­vate sec­tor over the past 25 years. Fur­ther, the or­ga­ni­za­tions that are trans­form­ing health­care are them­selves re­mark­ably dif­fer­ent from each other, re­in­forc­ing the view that di­ver­sity—not one-size-fit­sall re­form—is the fu­ture.

Cre­at­ing new job cat­e­gories

A com­mon de­nom­i­na­tor across new care mod­els is the use of health­care pro­fes­sion­als in un­tra­di­tional ways that ul­ti­mately cre­ate new job cat­e­gories. For ex­am­ple, many physi­cians now spe­cial­ize in in­for­mat­ics or man­age­ment; they be­come CIOs, CFOs, COOs and CEOs—roles with no di­rect patient-care re­spon­si­bil­i­ties. Many ad­vanced prac­tice nurses are fully de­vot­ing their time to re­search, while clin­i­cal phar­ma­cists are get­ting di­rectly in­volved in patient care and drug pre­scrib­ing. We are en­ter­ing a new era in which a care­giver’s ed­u­ca­tional de­gree will not be a re­li­able in­di­ca­tor of the work he or she per­forms. This ex­pan­sion of roles and func­tions is likely to shift the foun­da­tion of li­cens­ing from ed­u­ca­tional train­ing to demon­strated com­pe­tency. Twenty-five years from now, prac­ti­tion­ers with dif­fer­ent pro­fes­sional de­grees will quite likely be tak­ing the same ex­am­i­na­tions to pro­vide a spe­cific type of care. Pro­fes­sion­als will no longer be able to claim sole clin­i­cal au­thor­ity based on years of train­ing. In­stead, reg­u­lar test­ing of sci­en­tific knowl­edge and on­go­ing anal­y­sis of in­di­vid­u­als’ prac­tice per­for­mance will de­ter­mine who can do what.

Pa­tients will gain some un­prece­dented op­tions, such as hav­ing an emer­gency ap­pen­dec­tomy per­formed in an am­bu­lance by a para­medic, or des­ig­nat­ing a nurse prac­ti­tioner or a phar­ma­cist as the fam­ily doc­tor— know­ing that all pass the same ex­ams and meet the same stan­dards of prac­tice. Care­givers will rely ex­ten­sively on data col­lected and an­a­lyzed by wear­able smart de­vices and on lon­gi­tu­di­nal health­care records at­tached, lit­er­ally, to each in­di­vid­ual. In­deed, be­cause of mat­u­ra­tion of pre­ci­sion medicine, a care­giver’s pri­mary func­tion will be in­di­vid­u­al­iz­ing ther­a­pies based on the unique char­ac­ter­is­tics of pa­tients’ dis­eases and pa­tients’ pref­er­ences and abil­i­ties to pur­sue dif­fer­ent ther­a­peu­tic op­tions (in­clud­ing be­hav­ioral changes), and their de­sired out­comes. Uni­form best prac­tices will be a thing of the past.

Two pow­er­ful, non­med­i­cal trends will also in­flu­ence the evo­lu­tion of jobs in health­care over the next few decades. First, global cli­mate change will cre­ate new health­care pro­fes­sion­als as dis­eases evolve in un­prece­dented di­rec­tions. I can imag­ine ar­chi­tects, city plan­ners and evo­lu­tion­ary bi­ol­o­gists de­vel­op­ing the skills to treat our grow­ing en­vi­ron­men­tal ills, re­defin­ing pub­lic health in the process. Sec­ond, Amer­ica’s de­mo­graphic trans­for­ma­tion—ar­rival of the “mi­nor­ity ma­jor­ity” by 2040—will al­most surely lead to li­cens­ing of more health­care work­ers with ori­gins in very dif­fer­ent cul­tures. Care­givers who would be con­sid­ered char­la­tans to­day will be openly treat­ing pa­tients.

Some might ar­gue that fed­eral reg­u­la­tions will thwart de­vel­op­ment of new jobs, but reg­u­lat­ing health­care pro­fes­sions is a state power. I do not fore­see this sit­u­a­tion chang­ing sig­nif­i­cantly. Most health­care pol­icy an­a­lysts thought I was crazy 25 years ago when I pre­dicted in­de­pen­dence for ad­vanced prac­tice nurses, ac­cep­tance of clin­i­cal phar­ma­cists, and adop­tion of telemedicine. All have hap­pened, thanks to states and provider or­ga­ni­za­tions with the courage to pur­sue some­thing new and bet­ter de­spite strong op­po­si­tion from de­fend­ers of tra­di­tion. If this over­all fore­cast re­flects a bias, it is my fer­vent hope that in­no­va­tion will con­tinue to de­fine Amer­i­can ex­cep­tion­al­ism.

Care­givers will rely ex­ten­sively on data col­lected and an­a­lyzed by wear­able smart de­vices and on lon­gi­tu­di­nal health­care records at­tached, lit­er­ally, to each in­di­vid­ual.

Jeff Bauer,Ph.D.,isa health­care­fu­tur­i­s­tand economist­basedin Chicago.Heis­the au­tho­rof Up­grad­ing Lead­er­ship’s Crys­tal Ball (2014)and Para­dox and Im­per­a­tives in Health Care (2015).

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