With rising health care costs threatening U.S. global competitiveness, Arnold Milstein, MD, urges physicians to focus their efforts on more efficient and effective ways of practicing medicine, rather than lobbying Congress to protect their incomes.
Milstein lays out this “urgent choice” in this perspective piece published yesterday online in the New England Journal of Medicine.
I’ve been following Milstein’s efforts to build the Stanford Clinical Excellence Research Center for the last two years, and I’m impressed with the progress that he and his graduate research fellows have made in designing better, more efficient ways to deliver medical care. His overarching philosophy is summed up here:
U.S. health care needs to adopt new work methods, outlined in the Institute of Medicine's vision for a learning health system. Such methods would enable clinicians and health care managers to more rapidly improve value by continuously examining current clinical workflows, management tools from other service industries, burgeoning databases, and advances in applied sciences (especially health psychology and information, communication, and materials technologies). They could then use the insights gained to design and test innovations for better fulfilling patients’ health goals with less spending and rapidly scaling successful innovations.
By adopting these new technologies and methods, Milstein predicts that physicians’ short-term income drops will be replaced with new income-generating opportunities. For example, with Internet-based video and instant translation services, physicians will soon be about to export their expertise to rapidly developing countries facing physician shortages.
He ends the editorial with a quote from Sir William Osler, the father of modern medicine:
Medical care must be provided with the utmost efficiency. To do less is a disservice to those we treat, and an injustice to those we might have treated.
Which path will physicians choose?