What kind of doctor are we breeding in medicine now?

Disruptive innovation is competitive strategy for an age seized by terror.
- Jill Lepore, author of The Disruption Machine: What the Theory of Innovation Gets Wrong

“What do you want me to do with all the stuff in this box?” my wife asked this weekend.

I looked inside and saw my former self: one of BNC and pin connectors, wires, a notebook with sin, cos, theta, and a host of other equations — a project I worked on but never grew — it came from a time of creativity and endless possibilities for me in medicine.  Engineering and computers were how I entered this field: the hope of solving problems, doing things a little better, safer, and maybe faster.  A chance to innovate and collaborate.  A chance to make a difference.

But the world of medicine has changed from one that promotes discovery and creativity to one that promotes productivity and the lock-step over the past several years.  See more.  Do more.  Don’t sway.  Follow the guidelines.  Stay between the lines.  Want to try something new?  The message to doctors is loud and clear now: Don’t you dare!

Every month another set of guidelines and rubrics, as if the guidelines are how we want doctors to think, or rather, recite.  Medicine is rapidly becoming a staid world of groupthink, as we are forced to use the latest disruptive technology to change our medical world.  Bit by endless meaningless bit.  The value-added ideas never end.  There is little ownership now.  Little personal investment.  Punch the clock.  Get ‘er done.  Do what those grey suits say.

It’s the era of the creative destruction of creativity.

What kind of doctor are we breeding in medicine now?  The American Medical Association (AMA) and Accreditation Council of Graduate Medical Education (ACGME) want to shorten studies and push medical students through school based on competencies and “not based merely on a traditional time-based system.”  Time with patients can no longer be trusted it seems.  In the place of time: competencies gained from simulators. Plastics superseding flesh. As though doctors should become technocrats that make a cameo appearance at the patient’s bedside with their smart phone in hand.

Is the hurry up push toward technology and big data really needed or what we’re being sold?   Enter your note, doctor, click another box, you’re being scored now.  Do as you’re told.  What’s that? A little software glitch?  Don’t rock the boat.  Just work around it.  The fix will be here in September. We must do more with less.  Oh, and forget the staff, they’re expensive. Hurry up.  Perfect data, remember?  Your pay depends on it.

Oh, and that idea you wanted to work on?  Sorry, no time or money.  Really doctor, we’re on a time line. Could you move it along?  My kids have a play date.

The disruption machine is moving, alright.

But will we be better for it?

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • Dr. Drake Ramoray

    “But will we be better for it?”


  • QQQ

    Most doctors are fed up with the gutting of their practice.

    Many specialties were simply told by the CMS they have to take a 20 to
    33% pay cut which the CMS declined to give rationale to. And most
    insurance is tied to CMS reimbursement.

    Doctors are sick of the AMA and their respective specialty
    representatives for failing to protect their interest. They are simply
    not doing AMA polls.

    The only docs left to do the polls now are left wing. Docs aren’t
    shifting left. They are just not participating with the failure of

    Wanna lower health care costs? Drugs and Hospital fees. That’s 94% of all of medical costs.

    But you gutted the 6% of the pie that goes to doctors to 4.5%
    Distinctiveizing doctors across the nation and not addressing health
    care costs. It was also the part of the pie that %wise employed the
    most people. 1 Doctor. 1-2 extenders… 1-2 nurses per extender. 1-2
    ancillary staff (reception, billing) per doctor.

    • SteveCaley

      W. Edwards Deming, an industrial theorist, warned some sixty years ago about “Placing blame on workforces who are only responsible for 15% of mistakes where the system designed by management is responsible for 85% of the unintended consequences.” Name that tune, like the beat?

  • Wayne Caswell

    I find it odd that this article shuns tech innovation as a cause of docs lacking time for creativity, innovation, and time with patients. Doesn’t that have more to do with the business model?

    The future of healthcare I see involves remote sensor monitoring, telehealth, mobile devices, 3D printing, big data analytics, personalized medicine, patient-centered medical teams, and an increased focus on wellness. And because of these innovations, I see many traditional doctor functions moving down-market from the MD to the PA, NP, RN, LVN, aide, and consumers themselves. All of this should give specialists and general practitioners more time to spend with patients and apply their creativity. I guess I have a “glass half full” perspective.

    (See http://www.mhealthtalk.com/2013/07/Moore‘s-law-and-the-future-of-healthcare/)

    • James O’Brien, M.D.

      Young doctors are forgetting the benefit of the low tech or are not being taught the benefits of a good hands on examination. Maybe it’s just deemphasized.

      Examining the patient with hands/primitive but effective tools and finding the lesion is quickly becoming a lost art. This is bizarre when cost cutting seems to be a priority.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    With one difference though. The cost of physicians is not rising rapidly and it is actually not rising at all, while the cost of gadgetry (hardware and software) is skyrocketing (how much is Watson selling for?) and it is not adding any improvements in outcomes.
    What is happening here is an attempt to divert individual physician income to high-tech corporate income, while proclaiming uniform mediocrity to be the new excellence.
    All in the name of “productivity” which is the modus operandi in most “industries” and it is destroying the middle class.

    • James O’Brien, M.D.

      Exactly. Crony capitalism at work.

      Is the number of unnecessary CTs going down?

      My personal observation is that a lot of medical IT people strike me as con men.


    Hi Wayne, physicians use internet resources just as much as NPs, which is fine. I don’t know how many times I have heard physicians mention using uptodate.com and other clinical resources in posts on here. Your description of NP skills is a mischaracterization. Its really the same for all of us.

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