Could Doctors Go the Way of Record Companies?

Watching the AMA defends its turf on issues like doctor reimbursement is like watching the RIAA file copyright lawsuits against teenagers, even as its business model collapses around it.
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Those of us who follow health care may be overlooking the big picture. Most of the profound (and sometimes disruptive) changes of the last half century -- computers, the Internet, social networks -- weren't initiated by the political process. They arose at the intersection of technology, economics, and mass social change. So here's something to think about:

Could the medical profession go the way of the record industry?

Consider the path that led to the current crisis in the music business:

1. An industry with a near-total monopoly experiences a minor disruption (in music's case, with the invention of cassette tape recording).

2. It 'relaxes' and assumes the crisis has past.

3. An even better technology comes along (the Internet) that includes lateral as well as vertical connections. (Individuals could only make tapes for themselves; sharing was possible but cumbersome, until the Net and mp3s made it instantaneous and worldwide.)

4. The industry fails to recognize the long-term significance and risks of this new tech.

5. Enterprising individuals use this new technology to distribute "information" of mutual interest - songs - through "P2P" (peer-to-peer) file sharing.

The result? A massive and ongoing implosion of the music biz. (David Byrne provided an excellent overview in Wired, with some corrections on his blog.)

Could the same thing happen to the medical profession? Many people's immediate reaction will be to say 'no.' They'll list the many barriers to what we might call a 'P2PMed' disruption of our medical economy (with 'P2P' here meaning either 'peer-to-peer' or 'patient to patient'.) Doctors are too respected. Regulations won't permit it. Doctors control access to medications. Medical information is walled off behind expensive, subscription-only medical journals. It's unthinkable.

That's pretty much how the record industry reacted in the 1990s. Let's look at those objections:

160 million people looked up medical information on the Internet circa 2007, according to Harris polling data. Yet they still go to doctors. That's true -- just as millions of people made tape copies of music for decades without seriously undermining musical economics.

Each of these searches was a solitary activity. The difference will come when a new technology allows lateral information-sharing in a way that people trust. It hasn't happened yet, but smart people are banking on the idea that it will soon. I agree with that assessment, although none of the many projects I've looked at so far struck me as a breakthrough. But a lot of folks are working on it.

Doctors monopolize access to medications through the power of the prescription pad. That monopoly's already eroding as online pharmacies provide low-cost 'doctor consults,' a legal work-around that allows -- to an sometimes disturbing extent -- easy access to meds. Where there is demand, there will be suppliers.

People won't spend money based on self-referral. The multi-billion dollar complementary medicine industry demonstrates this is untrue. Most "CAM" (complementary and alternative medicine) transactions are based on self-referral out of the traditional MD/patient relationship.

Medical information is walled off. True, but a backlash against the sequestering of research data is already underway. Case in point: A new publication called The Journal of Participatory Medicine hopes to provide peer-reviewed articles on self care for patients, as board member Kevin Kelly writes.

The Journal's Advisory Board reads like a Who's Who of Internet and medical business pioneers (and it's an open-source publication, meaning its content will be free to all). The Journal goal of helping patients take "responsibility for their own health and healing" (in Kevin Kelly's words) aligns with decades of movement toward a more patient-centric model championed by both the Left (as "patient's rights") and the Right (as with high-deductible "consumer-directed health plans").

Once again, the left/right paradigm is ill-suited for new developments... and don't blame initiatives like the Journal if medicine goes the way of record labels. They're symptoms of broader socio-informational change, not its cause.

Not all doctors would go out of business after such a transition, of course. They're still selling some CDs, too. So who would be most likely to thrive after the transformation?

High-touch practitioners: Empathetic, comforting, and warm doctors.

"Mechanics": The most gifted and accomplished surgeons sometimes use this word to describe themselves. We will need talented neurosurgeons, cardiac surgeons, and other "fixers" for the foreseeable future (at least until the self-programmable nanobots take over).

Innovators: Doctors who are always exploring, changing, and trying new things, staying one step ahead of the curve.

Integrators: Doctors who can bring together seemingly unrelated ideas and solutions, whether in diagnosis or in treatment. Integration is the foundation of creativity, and creative doctors will always be valued.

Who'll fail? Doctors who function by rote, who make routine diagnoses, and who connect patients to other resources based on past relationships and not need. Anyone whose expertise and connections are easily replicated on the Internet (think "travel agents") will struggle to survive.

Watching the AMA defend its turf on issues like doctor reimbursement is like watching the RIAA file copyright lawsuits against teenagers, even as its business model collapses around it. You can't fight your own market and win, and you can't fight yesterday's battles. Doctor groups should look more like think tanks and less like a lobbying groups. (Come to think of it, so should the RIAA.)

Predicting this kind of change is not the same thing as endorsing it. But, like it or not, we should be talking about it now.

Because -- like it or not -- it's coming.

RJ Eskow blogs when he can at:

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