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The Rust Belt has garnered unfortunate attention these last few years. Our recent election cycle made its job losses, poor alternatives, and lowered wages abundantly clear. While the economic benefits of free trade and technology to our society as a whole should be celebrated, we failed to hedge against the downsides. The United States continues to rank far below other developed economies in terms of money invested in labor markets, including retraining, according to 2017 data from the U.K.-based Organisation for Economic Co-operation and Development.
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September 2017While it may be easy to dismiss this phenomenon as unique to manufacturing, these market forces have now turned their focus onto physicians.
An inefficient market with pressing needs, inelastic demand for services, and profitability is an attractive target for technological disruption; healthcare is one such market. Technological advancements have moved medicine forward, expanding our capabilities to provide better care; however, technological advancements seem to have an ever-increasing potential to displace physicians rather than to assist them. The arc of coronary artery bypass grafting (CABG) is a cautionary tale of what can result from inefficient resource allocation in the face of technology. CABG was the dominant form of coronary revascularization for decades. Training programs boomed to supply the proliferation of financially lucrative “heart disease” centers at hospitals, driving down hospital volumes of CABG surgery, even as percutaneous coronary intervention (PCI) was showing increasing benefits and rapidly surpassing CABG in volume (Health Aff. 2007;26:162-168).
What followed were early retirements and an overabundance of trainees with not enough jobs, according to a 2015 analysis published by the American College of Cardiology . Otolaryngology may be following the same path in some respects. What some have predicted will be an undersupply of physicians may be anything but (Laryngoscope. 2016;126:S5-S11). Moreover, instead of the market adjusting price to accommodate any supply/demand mismatch, some of us may be unable to find work in our current capacity.
New pharmaceuticals show remarkable effectiveness against hepatitis C, one of the leading causes of hepatocellular carcinoma and cirrhosis (Ann Epidemiol. 2015;25:183-187). Hepatic and transplant surgeons will invariably become displaced as these drugs dramatically reduce the liver disease burden. More recently, Enlitic, a software company specializing in artificial intelligence, designed an algorithm to detect cancer on chest radiographs. In a trial against three expert radiologists working together, the algorithm was superior at classifying malignant lung tumors and had a better false-negative rate (Economist. June 25, 2016.).