When you graduate from medical school, you'll be entering a profession that's in the midst of change. Today's emerging healthcare trends will be tomorrow's standard practice. Advances in technology play an outsized role, but it's not technology alone reshaping the practice of medicine. The move to value-based models, an aging patient and provider population and the need for team-based care all offer challenges and opportunities for newly minted doctors.
1. Telehealth and telemedicine
One of the most noted emerging healthcare trends in recent years, telehealth refers to a broad scope of remote healthcare services — even a phone call! It encompasses telemedicine, which involves the remote delivery of clinical services. Don't get too caught up in the nomenclature, though: The American Telemedicine Association uses the terms almost interchangeably to refer to the use of remote healthcare technology to deliver clinical services, from video visits and virtual ICUs to remote cardiac monitoring via connected devices such as implantable loop recorders.
Call it what you will, it's not moving as fast is it could. Despite state-of-the-art clinical technology, the United States is lagging behind in telehealth adoption. Reimbursement, regulation and even the definitions of telehealth and telemedicine are still being hammered out; each state does it differently.
These factors may be slowing adoption, but they're not halting it. According to the American Hospital Association, 76% of U.S. hospitals reported using telehealth systems in 2017, compared to 35% in 2010. That's only going to grow as states begin to harmonize their approaches.
It's clear that telehealth improves access for patients who don't live near a hospital or the specialist they need. (This is especially important now that more rural hospitals and clinics are closing due to consolidation.) But it also lowers costs. For example, using telemedicine can divert patients from emergency departments, saving $19-$121 per visit, according to research published in the American Journal of Emergency Medicine.
Additionally, many doctors are finding moonlighting opportunities with standalone telehealth companies such as Teladoc and American Well, which connect patients with doctors over video or phone.
What does this mean for you? Especially with the advent of 5G, telehealth will become a more important part of healthcare delivery. It will be part of your practice, regardless of where you practice. The sooner you decide how to embrace the telemedicine trend, the better poised you will be to take advantage of its benefits. That includes capitalizing on those moonlighting opportunities to earn extra cash to help you pay down your medical school debt.
2. Value-based care
Telehealth will become more important as value-based models move to the forefront. In fact, the shift to value-based care is one of the trends driving its adoption. Think about it: Meeting with patients remotely is more efficient, allowing you to devote more time to patients with the most critical needs.
The fee-for-service model our health system is currently based on means that doctors, hospitals and medical practices are reimbursed based on the quantity of services delivered, not the quality of the care they provide each patient. This has been a source of tremendous frustration; after all, some patients are more complex and not suited for the 20-minute visit. Physicians who spend more time with patients are often penalized.
Value-based models pay doctors based on the value of the care provided, not merely the volume. They provide incentives for more efficient care and, increasingly, impose penalties for failing to meet cost and quality targets. These models continue to gain traction by demonstrating better outcomes at lower costs.
A 2018 report by the Health Care Payment Learning & Action Network found that the percentage of health payments tied to value-based models increased 23% over two years. Physicians are turning their attention to value-based care, too: A 2018 American Medical Group Association survey found growing interest among members, but also concerns, such as insurance companies' focus on penalties rather than incentives.
Value-based models are still being refined, with the goal of finding a risk/reward balance that incentivizes efficiency and improved outcomes while ensuring that physicians are adequately paid. But — barring a total overhaul of the U.S. healthcare system — these models are here to stay. And the efficiency they promise couldn't come sooner.
So, no matter what practice setting you end up choosing, some of your compensation will likely be tied to the quality of care you deliver. (That includes penalties for spending what a payer considers too much.) Expect the need for efficiency to reshape how your predecessors might have coordinated care with their colleagues — and be prepared to get your hands dirty with data as you shoulder more responsibility for tracking and reporting spending and outcome measures. Overall, the pace of change within the value-based care regime means that you may be in for some serious learning (and relearning) as you go.
3. Aging populations
The population is graying and, unsurprisingly, older people are more frequent users of healthcare. By 2030, all baby boomers will be older than age 65, reports the U.S. Census Bureau. As the population ages, the median age is expected to grow from 38 to 43 by 2060.
It's impossible to overstate the potential burden on the healthcare system. Take chronic conditions: While about 25% of Americans have multiple chronic conditions, that rate jumps to over 60% for those 65 and older, according to the Centers for Disease Control and Prevention.
Demand is expanding, but supply is contracting. That's in part because doctors are growing old, too. Those 65 and older account for 15% of the workforce; those between 55 and 64 make up 27%. The Association of American Medical Colleges predicts that the U.S. will see a shortfall of up to 121,900 physicians by 2032.
One way to address the shortages — and support value-based care — is teamwork. Increasingly, nurse practitioners (NPs) and physician assistants (PAs) are taking on many tasks traditionally performed by doctors. It's worth noting that the average age of NPs is 49, according to the American Association of Nurse Practitioners; for PAs, it's 38, reports the National Commission on Certification of Physician Assistants.
All this becomes important as you consider the increasing chronic care burden: Many patients need ongoing follow-up and check-ins. Your team will be able to handle that, allowing you to work at the top of your license and handle the most complex patients.
On the positive side, you've entered a profession where demand will increasingly outpace supply. In many ways, you can write your own ticket. But no matter where that ticket takes you, you'll need to delegate — you can't do it alone.
Emerging healthcare trends: Change and opportunity
From supply failing to keep up with demand to technology deployment failing to keep up with technology development, it's clear that you're entering a profession on the cusp of change. Everything, from how you work with patients to how you get paid, is in flux. By the time you enter your residency, chances are you won't hear, "That's how we've always done it," but instead, "What do you think we should do next?"
And you will be able to answer that question and drive the future of healthcare delivery.