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The Contrarian's Guide to Sick Care


If you find yourself nodding in agreement too much when you hear things about the state of medicine, put a space between the stimulus and the response and consider these 10 points.

We've heard many things about the future of Sick Care USA. Most is doom and gloom with a vocal chorus coming from grumpy doctors. Contrarians love conventional wisdom because it gives them a reason to exist. Besides, it's often a profitable investment strategy. If you find yourself nodding in agreement too much when you hear things about the state of medicine, put a space between the stimulus and the response and consider:

1. The physician shortage might not be real. These predictions are self-serving, often inaccurate, and based on existing care delivery models which probably have little or no chance of being the same in the next 15 years.

2. Doctors in fact make very good business people. There are many examples of private practitioners, technopreneurs, and social entrepreneurs who have contributed enormous value to patients, and, in so doing, to their employees, communities, and to themselves.

3. Electronic medical records in their existing form are not good for healthcare. We are just beginning to build the electronic health data infrastructure and we will see many iterations and products in the future.

4. Private practice won't disappear after all. In fact, one scenario is private practice staging a comeback due to any number of personal, legal, regulatory, and market forces.

5. Residents will opt out of being employed when they are offered a viable alternative to what exists now. Most are looking for a reprieve from the hassles of the business of medicine, a secure paycheck and some work-life balance. New models will offer them turnkey practice opportunities while at the same time allowing them to maintain their independence.

6. Doctors won't continue to be technicians and displaced by technology. In fact, they will evolve as physician entrepreneurs and, in so doing, contribute to patients in many ways other than seeing them face to face for their entire professional careers.

7. Doctors, in fact, won't continue to be depressed, suicidal, and burned out. I see them changing the culture of medicine and medical education and coming to their senses, and resisting convention to create the meaning they sought when they chose medicine as a profession. The primary cause of job stress is loss of control. They will regain it and in so doing improve their mental health.

8. The democratization of medicine in the approaching post-corporate era will force many patients to become patient entrepreneurs and patient scientists, moving the center of gravity from the doctor to the corporation/government to patient consumers.

9. Value transparency will happen. In so doing, it will empower patients to wring out the waste and toxins from the system.

10. Medicine will not be de-professionalized. To the contrary, for those willing to adopt an entrepreneurial mindset, there has never been a more exciting time to a doctor. Medical associations and societies will need to change to be relevant in the post-corporate world.

If I were you, I wouldn't follow the herd. It's not only bad for your bank account, but it's bad for medicine and that is not good for your health.

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