A doctor's time is expensive. They are highly educated, highly trained. But a physician's assistant or nurse, when given clear instructions, the right technology, and an online connection to a doctor, can do many of the same things.
Many primary care physicians use PAs and nurses to improve their own productivity. So-called "doc in a box" operations like CVS' MinuteClinic work well without a doctor in the office.
As Uwe Reinhardt writes today in The New York Times, the heart of cost-effective innovation in the developing world involves delivering care without doctors.
He complains that, thanks to the brouhaha over "death panels" during the health reform debate, cost-saving health processes like these can't be considered in the U.S.
But economic trends can't be legislated against. Productivity drives progress. Productivity means doing more work with fewer people, or less well-trained people. Technology enables this.
Journalists today must do their own marketing, and (when blogging) their own copy editing. We have had to change how we work in response to what technology makes possible, because what technology makes possible soon becomes economic necessity.
Why should doctors be immune to this? They seem to feel they are.
With all the health IT we have available, doctors are still acting as they did in the 20th century. They measure their work by the number of patients they see, face to face. In primary care these visits now take just a few minutes -- the rest of the appointment is spent prepping patients and data for that visit.
Most of the time, however, data is delivering all the value. A doctor's recommended actions could be done through a database look-up. And if it can be done that way, why must a doctor do it?
These are the questions technology is asking. What must a doctor do, what can technology do, and who will decide where the border is between the two?