Ultimately, to reduce physician stress, we must find a way to reduce clinical demand without , [+]
Physician burnout is a major problem. However, as I pointed out in a previous article, this is not a uniquely American problem.
A recent report from the Commonwealth Fund compared the satisfaction of primary care physicians in 10 high-income countries. Surprisingly, American doctors ranked in the middle, reporting higher satisfaction rates than their counterparts in Britain, Germany, Canada, Australia and New Zealand.
A surprising fact about burnout
In self-reported surveys, American doctors link their dissatisfaction to specific problems of the American healthcare system: excessive bureaucratic work, disorganized computer systems, and for-profit health insurance. These problems need to be solved, but to reduce the stress of physicians we also need to pay attention to another factor that negatively impacts doctors around the world.
Although national healthcare systems can vary greatly in their structure and financing, all physicians in rich countries struggle to meet the increasing demand for medical services. And this is due to the increasing prevalence and complications of chronic disease.
At the core of the burnout crisis is a fundamental imbalance between the amount and complexity of the patient’s health problems (demand) and how long it takes for physicians to care for them (supply, This article offers a way to reverse both the increase in chronic diseases and the ongoing physician burnout crisis.
Supply vs. Demand: Reframing Burnout
When the demand for health care exceeds the ability of doctors to provide it, one might assume that the easiest solution is to increase the supply of physicians. But this outcome will remain unlikely as long as US Medicare cost increases continue to exceed Americans’ ability to afford care.
Whenever health care costs exceed available funds, policy makers and health care commentators consider rationing. The Oregon Medicaid experiment of the 1990s is a stark reminder of why this approach fails. Starting in 1989, a government task force brought together patients and providers to rank medical services according to need. The plan was to provide only as much money as funds would allow. When the plan was implemented, public reaction forced the state to back down. They expanded the total services covered, driving costs up without any improvement in health or any relief for physicians.
Consumer culture can drive medical culture
Ultimately, to reduce burnout, we must find a way to reduce clinical demand without increasing costs or rationing care.
The best—and perhaps the only viable—solution is to adopt technologies that provide patients with the ability to better manage their medical problems.
American consumers today expect and demand more control over their lives and daily decisions. Time and again, technology has made this possible.
Take stock trading, for example. Once the sole domain of professional brokers and financial advisors, today’s online trading platforms offer individual investors direct access to the market and a wealth of information to make prudent financial decisions. Similarly, technology changed the travel industry. Sites like Airbnb and Expedia empowered consumers to book accommodations, flights, and travel experiences directly, bypassing traditional travel agents.
Technology will soon democratize medical expertise, while also giving patients unprecedented access to health care tools and knowledge. Within the next five to 10 years, as ChatGPT and other generative AI applications become significantly more powerful and reliable, patients will gain the ability to self-diagnose, understand their diseases, and make informed clinical decisions.
Today, physicians are right to be skeptical of large-scale AI promises. But as the technology proves itself worthy, physicians who embrace and promote patient empowerment will not only improve medical outcomes, but also increase their professional satisfaction.
Here’s how it could happen:
Empowering Patients with Generative AI
In the United States, health systems (i.e., large hospitals and medical groups) that heavily prioritize preventive medicine and chronic disease management are home to healthier patients and more satisfied physicians.
In these settings, patients are 30% to 50% less likely to die from heart attack, stroke and colon cancer than patients in the rest of the country. This is because their healthcare organizations provide effective long-term disease prevention programs and assist patients in managing their diabetes, hypertension, obesity and asthma. As a result, patients experience fewer complications such as heart attacks, strokes and cancer.
However, most primary care physicians do not have the time to complete this themselves. According to one study, physicians would need to work 26.7 hours per day to provide all recommended preventive, chronic and acute care to a typical panel of 2,500 adult patients.
GenAI technologies like ChatGPT can help reduce the load. Soon, they will be able to give patients more than the usual advice about their chronic diseases. They will provide personalized health guidance. By connecting to electronic health records (EHRs) – even if those systems are dispersed across different doctors’ offices – GenAI will be able to analyze a patient’s specific health data to provide tailored prevention recommendations. It will be able to remind patients when they need a health checkup, and help schedule it, and even sort out transportation. This is not something that Google or any other online platform can currently do.
Additionally, with new tools (such as doctor-designed plugins expected in a future ChatGPT update) and data from fitness trackers and home health monitors, GenAI will be able to display not only patient health data, but also information about each individual’s health. Will also explain it in context. History and treatment plans. These devices will be able to provide daily updates to patients with chronic conditions, letting them know how they are doing based on their doctor’s plan.
When a patient’s health data shows they are on track, there will be no need for an office visit, saving time for everyone. But if something seems wrong—say, blood pressure readings remain excessively high after starting antihypertensive medications—the physician will be able to adjust the medications immediately, often without the need for the patient to come. And when an in-person visit is necessary, GenAI will summarize patient health information so doctors can immediately understand and take action instead of starting from scratch.
ChatGPT is already helping people make better lifestyle choices, suggesting diets tailored to individual health needs with shopping lists and recipes. It also provides advice on personal exercise routines and mental well-being.
Another way that generic AI can help is to diagnose and treat common, non-life-threatening medical problems (e.g., musculoskeletal, allergy, or viral problems). ChatGPT and MED-PALM2 have already demonstrated the ability to effectively and safely diagnose many clinical issues like most physicians. Looking ahead, GenAI will provide even greater diagnostic accuracy. GenAI will alert patients when symptoms are worrisome, and expedite definitive treatment. Its ability to thoroughly analyze symptoms and ask detailed questions without the time pressure felt by doctors today would eliminate many of the 400,000 annual deaths caused by misdiagnosis in our country.
The result – fewer chronic diseases, fewer heart attacks and strokes and more medical problems resolved without office visits – will reduce demand, giving doctors more time with the patients they see. As a result, physicians will leave the office at the end of the day feeling more satisfied and less tired.
The goal of advanced technology use is not to eliminate doctors. This is to give them the time they desperately need in their daily practice, without further increasing already unaffordable medical costs. And rather than destroying the physician-patient bond, the AI-empowered patient will strengthen it, because physicians will have time to delve deeper into complex issues when people come into the office.
A more empowered patient is the key to reducing burnout
AI startups are working hard to create tools that assist physicians with all kinds of tasks: EHR data entry, organizing office duties, and submitting prior authorization requests to insurance companies.
These functions will help physicians in the short term. But any tool that fails to resolve the imbalance between supply (of physician time) and demand (for medical services) will be nothing more than a temporary fix.
Our country is caught in a vicious cycle of increasing health care demand, leading to more patient visits per doctor per day, leading to high rates of burnout, poor clinical outcomes, and very high demand. By empowering patients with GenAI, we can start a virtuous cycle in which technology reduces the stress on doctors, allowing them to spend more time with the patients who need it most. This will improve health outcomes, reduce physician burnout, and further reduce overall health care demand.
Physicians and medical societies have the opportunity to lead. They must educate the public about how to use this technology effectively, help link it to existing data sources, and ensure that the recommendations it makes are reliable and safe. The time to start this process is now.
