Fewer doctors? Innovate medical devices and services""

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Rapid diagnostic tests, digital health technologies and human factors will be key as #MyIndustry combats the shortfall in the US of more than 91,500 physicians by 2020 recentlyhighlighted by the Association of Medical Colleges. This shortfall will affect all primary care and medical specialities; the US are not training enough doctors for its’ growing and aging population. This is not a problem solely confined to the US; growing global populations will make the already acute shortage of physicians in countries including China, India, Nigeria and Indonesia substantially worse. A recent op-ed in The New York Times from Scott Gottlieb andEzekiel Emanuel suggested that the situation in the US could be alleviated by changing the way in which healthcare is delivered.

Digital health technologies including remote patient monitoring and minimally invasive surgerywere two of the areas which were highlighted as being able to ease the demand on physicians. Data analytics will also ease the burden on physicians; this could be through post-marketing evaluation of clinical procedures, medical devices which provide clinical decision support and closed-loop systems such as the artificial pancreas.

There are two linked themes which run through many of the suggestions about changing the way in which healthcare is delivered; simplify the provision of healthcare and empower other healthcare professionals to provide services physicians currently deliver.

The provision of healthcare can be simplified by evaluating the benefits which a treatment is providing and making medical devices which perform more functions and perform them in a more intuitive manner. Developing next-generation medical devices in this manner will require a suite of skills from an understanding of the clinical procedures, to the hardware and software which could be integrated into the device and finally ensuring that the device fits intoexisting workflows.

Empowering healthcare professional to provide services currently delivered by physicians will require additional training and access to clinical decision support tools which can substitute for the role of physician. In addition legislation will need to be changed to permit these healthcare professionals to perform tasks currently only performed by physicians. While this strategy expands the number of people able to delivery healthcare, it also expands the number of people liable for litigation. Medical malpractice currently costs about $55.6 billion in the US alone. It will be intriguing to see how this tightrope is walked over the coming years.

These benefits will only be realised when they are broadly implemented by healthcare providers. Monitoring implementation of changes in healthcare provision can provide multiplebenefits. Systems such as time-driven activity based costing have been championed byMichael Porter and Robert Kaplan. They enable a patients’ journey to be tracked; including monitoring which healthcare professionals provide their healthcare, the equipment which is used and the length of time interactions last. This enables standardisation of protocols and more accurate costings.

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