I want to build a hospital with no doctors. Any takers? Okay, the investors aren't queing up out the door. Yet.
Let's back up a second. We are looking for ways to cut costs in healthcare, right? So we have to keep all options open.
But we aren't supposed to flush quality of care down the toilet. Okay. No problem.
Doctors cost a lot. Why?
But we aren't supposed to flush quality of care down the toilet. Okay. No problem.
Doctors cost a lot. Why?
Because there aren't many of them and they cost a lot to train. Why?
A few factors. The American Medical Association keeps the number of doctors down like an ol' fashioned guilde from the middle ages. They limit the number of students who get to go to medical schools in toto, and make the process of becoming a doctor long and arduous. Its easy when everyone assumes that every doctor needs to know everything about everything - even though in practice that is not just impractical but with the huge amount of medical knowledge, it is literally impossible, and doctors, just like everybody else, generally know just what they need to know on a daily basis and how to look up the rest of it.
There are a few steps in the process of healing people--diagnosis, treatment, follow up--and each of these can be subdivided again into countless other jobs, each of which requires a precise set of knowledge and skills. Granted, the knee bone is connected to the leg bone, and the body is all connected, does that mean that every medical practitioner needs to be trained for upwards of six years?
You walk into the hospital, or are pulled in on a gurney by those who specialize in emergency responses (EMT's / Paramedics) you are examined by a diagnostician who can identify anything and specializes in medical histories and pathology, but has not be trained to perform procedures. In emergency situations the diagnosticians are "making the call" to an assembled emergency team of technicians. In a hospital visit, the diagnostician triages you and begins a standard file taking all relevant information. Then she builds a treatment plan, or refers you to a particular department (say a cardiac ward) with specialized diagnosticians to build a treatment plan.
Past the diagnastician we find a hospital peopled by proceduralists, nurses, and social workers and their teams. The proceduralists are specialized to know everything they need to know (and how to look up anything they don't) to conduct a handful of procedures. They are trained and certified with a merit badge system on top of a foundational base of extensive anatomy, physiology and basic pathology, from a host of competing institutions of medical studies. Nurses would prep and close surgeries, do diagnostics, and team lead assistants to conduct and monitor convalescence. They would be trained in similar institutions but probably would study for a shorter time and have no procedure merit badges. Social workers are the administrators, customer service, and business people of the Hospital. They liaise with hosptal workers on the one hand, and patients and their families on the other. Some social workers would coordinate teams of proceduralists and nurses, monitoring the activities on particular patients. Others would facilitate people coming into the hospital and post-proceduralists would study the hospital's effectivity while advising the future health and care for the patient and the patient's family.
But, "I want to see a doctor!" Why? A doctor doesn't remember very much from medical school anyways, they know three things: 1) what they need to do their job, 2) how to identify what they don't know, and 3) how to look it up. We want to see a doctor because we are just passed from one person to another and everyone just keeps shrugging and saying "I'm not the doctor." However, in a system designed with no doctors, responsibility for care would fall on a team of proceduralists, diagnosticians, nurses, and social workers whose whole job and raison d'etre would be to collaborate to provide individualized care for each patient. Simply by increasing the division of labor, we can cut costs and increase quality of healthcare.
So is there a doctor in the house? Who cares.
There are a few steps in the process of healing people--diagnosis, treatment, follow up--and each of these can be subdivided again into countless other jobs, each of which requires a precise set of knowledge and skills. Granted, the knee bone is connected to the leg bone, and the body is all connected, does that mean that every medical practitioner needs to be trained for upwards of six years?
You walk into the hospital, or are pulled in on a gurney by those who specialize in emergency responses (EMT's / Paramedics) you are examined by a diagnostician who can identify anything and specializes in medical histories and pathology, but has not be trained to perform procedures. In emergency situations the diagnosticians are "making the call" to an assembled emergency team of technicians. In a hospital visit, the diagnostician triages you and begins a standard file taking all relevant information. Then she builds a treatment plan, or refers you to a particular department (say a cardiac ward) with specialized diagnosticians to build a treatment plan.
Past the diagnastician we find a hospital peopled by proceduralists, nurses, and social workers and their teams. The proceduralists are specialized to know everything they need to know (and how to look up anything they don't) to conduct a handful of procedures. They are trained and certified with a merit badge system on top of a foundational base of extensive anatomy, physiology and basic pathology, from a host of competing institutions of medical studies. Nurses would prep and close surgeries, do diagnostics, and team lead assistants to conduct and monitor convalescence. They would be trained in similar institutions but probably would study for a shorter time and have no procedure merit badges. Social workers are the administrators, customer service, and business people of the Hospital. They liaise with hosptal workers on the one hand, and patients and their families on the other. Some social workers would coordinate teams of proceduralists and nurses, monitoring the activities on particular patients. Others would facilitate people coming into the hospital and post-proceduralists would study the hospital's effectivity while advising the future health and care for the patient and the patient's family.
But, "I want to see a doctor!" Why? A doctor doesn't remember very much from medical school anyways, they know three things: 1) what they need to do their job, 2) how to identify what they don't know, and 3) how to look it up. We want to see a doctor because we are just passed from one person to another and everyone just keeps shrugging and saying "I'm not the doctor." However, in a system designed with no doctors, responsibility for care would fall on a team of proceduralists, diagnosticians, nurses, and social workers whose whole job and raison d'etre would be to collaborate to provide individualized care for each patient. Simply by increasing the division of labor, we can cut costs and increase quality of healthcare.
So is there a doctor in the house? Who cares.
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