Is the doctor of medicine degree vulnerable?

I remember when one of my patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack. The patient quoted literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirin’s benefit had less to do with blood thinning than reducing underlying inflammation.

Fast forward to the Economist that has an editorial pointing out that U.S. legal expertise may not require the completion of three years of law school. Why not, it asks, cut the requirement back to two years or, even better, skip the school requirement entirely and license anyone who can pass the bar exam?

And then there’s the Wall Street Journal, where “Notable and Quotable” refers to the “BA Bubble.” Charles Murray argues that a looming oversupply of college graduates may portend a decline in the employment value of a liberal education. Work careers may consist of serving as ”apprentices” and “journeymen” before becoming ”craftsmen.”

All of which makes me wonder if the vaunted doctor of medicine degree may be vulnerable.

Why should physician education be immune from a perfect storm of over-priced graduate education, “alternative” web-enabled learning with on-the-job-training? The declining value of the formal credential may be less about the university degree and more about competency, turbocharged by flexible licensing and a discerning consumer.

Non-physician health care professionals are arguing that their expertise is enough to enable them to deliver babies, administer anesthesia, prescribe drugs and perform surgery. My traditionalist colleagues argue that patient safety is at stake and that lay persons may not be able to discern all of the possible risks, benefits and alternatives. When things go occasionally wrong in the delivery suit, operating room or with a drug, they say a credentialed and experienced doc can make the difference between life and death.

I also remain impressed by the ready availability of medical information in the public domain that is enabling some laypersons to become astonishingly expert.  In addition to the patient above, think about the self-taught parent of a child with a rare condition or the plucky cancer patient who guides the oncologist toward choosing the right life-saving therapy.  Imagine what happens when IBM’s Watson is fully commercialized and available to anyone at anytime.

I understand all the perspectives above, but given the decline of the BA and the law degree, I worry that the medical traditionalists may ultimately end up being on the wrong side of history.

While regulators and the markets sort all this out, this may open another business proposition for care management. As patients with chronic conditions continue to seek ways to better share in their self care, they’ll also be seeking providers that best suit their needs and expectations.  In other words, the population health vendors can not only help with shared decision making, but provider selection making.

Jaan Sidorov is an internal medicine physician who blogs at the Disease Management Care Blog.

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  • James deMaine

    Oops. We’re almost already there. Beyond the qualified PA’s and ARNP’s, we have a plethora of “medical” providers: the homeopaths, natural medicine doctors, TV commercials, the pharmaceutical industry, the artificial joint industry, malpractice lawyers, etc. Despite this however, society does give us a very special status and respect. It’s up to us to maintain it, but not in a defensive mode. Beyond obtaining our “MDeity”, we need to be collaborative with our patients – with a team of qualified professions – the nurses, PA’s, ARNP’s, pharmacists, respiratory therapists, physical therapists, etc. If we can avoid arrogance and hubris, there’s a chance we can not only survive, but thrive.

  • doublj01

    I seriously doubt anyone will breeze through USMLE by reading wikipedia and webmd

  • w_km

    Shear computing power will never (in our lifetimes) replace the doctor’s role in healthcare: decision time. Sure, computing has GREATLY improved our judgment and will continue to do so. It may even contribute to the replacement of MD PCPs with PA/NP PCPs, but ultimately the most qualified among us will always carry the decision-making responsibility when the going gets tough.

  • Chris Betti

    My hope is that computing systems help us to cope with the rapid expansion of treatment options, give us the capacity to help people with rare conditions, and reduce the time it takes to educate more medical staff. These systems are enabling more effective sharing and application of information than ever before. With the assistance of today’s medical talent, we can build even greater troves of accessible knowledge for future generations. What we need is an incentive model that works for both physicians and engineers.

  • buzzkillerjsmith

    When it’s all said and done, you gotta have somebody to sue if it all goes wrong, and that person, the person with ultimate responsibility, has to be highly trained. Midlevels don’t fit that bill.
    Might MDs be partially replaced? Definitely, especially those who opt for the short-term benefits of employment by corporations. But at bottom, this society values health and the inevitable screwups by midlevels with will assure us of a place. This is not to say that doctors would not screw up almost as much, but perceptions are what matter here.

    I think family medicine is on its way out. But a lot of other fields have a better future.

    Any in any case, smart people generally on their feet. Maybe just fewer of them will wind up doctoring.

    • John

      Have to be almost nuts to choose family medicine.

      • Robert Palmer


        • John

          Providing an undervalued undercompensated service where conditions are worsening when there are other choices?

      • buzzkillerjsmith

        Almost nuts? Totally nuts. And yet I did it. Of course this was in the dinosaur days when this mess could not have been predicted.

  • Docbart

    If I get sick, I want an expert, someone who knows what to do without searching for an algorithm on their iPad. When the rich and powerful get sick, you think a mid-level practitioner calls the shots for them?

    If I get into legal problems, I want a full-bore defense by a legal shark. How many rich defendants and litigants rely on paralegals to provide the service they need?

    The experts will rise to the top and those with the wherewithal and the desire for the best will find them.

    • Margalit Gur-Arie

      And that’s exactly what is going to happen. There will be one system full of experts for the rich and powerful with the necessary wherewithal, and another system for most of the increasingly poor and eventually uneducated nation.

  • buzzkillerjsmith

    And perhaps it will not expand the scope. Perhaps we PCPs will all be enserfed by corporate manager who decide, gee whiz, those midlevels are a little cheaper and a lot more docile. Enter primary care at your own risk!

  • traumadoc

    I call these people–computer physicians. and , i also believe this Watson idea will jeapordize the physicians reputation as a well studied human being and also, will make many physicians a laughing stock. who needs a doc when you have Watson and all this updated info on a computer??? PS- worried!!!!

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