Robotic surgery, gene therapy, and deep brain stimulation are so-called "frontiers" of medicine. Now there's a new frontier--telemedicine. "Research firm IHS Markit estimates that telemedicine visits will soar from 23 million in 2017 to 105 million by 2022" (Associated Press, 2/6/19). By then, one in ten doctors' visits could be via telemedicine. This could be an understatement if practitioners, health systems, and investors keep discovering new ways to expand telemedicine's reach.
Despite reports of burned out doctors abandoning their careers, many other doctors simply want some time off -- perhaps a year or more -- to take a breather, spend time with family, or take a sabbatical abroad. The AMA warns that leaving clinical practice for an extended period of time should not be taken lightly: "Lack of retraining before reentry raises questions about patient safety and the clinical competence of reentered physicians." Doctors need to be aware that, "getting back in the game is expensive, time-consuming, and sometimes nearly impossible. So before you take a hiatus from medicine, ask yourself--can you afford it?" (medpage.com)
For the second straight year, U.S. life expectancy has fallen, according to a CDC report on 2016 data released in December 2017. An American born today can expect to live to 78.6 years, a decrease of about a month when compared to 2015. "It may not sound like much, but the alarming story is not the amount of the decrease but that the increase has ended," according to Steven Woolf at Virginia Commonwealth University. "In 1960, the U.S. had the highest life expectancy in the world. It's lost ground to other industrialized nations ever since" (USA TODAY, Feb. 8, 2018).
Micro-hospitals, hospitals with fewer than 12 inpatient beds, are popping up nationwide in urban and suburban neighborhoods, extending the reach of larger metro hospitals. Strategically located, these ultra small facilities are proving to be an efficient, cost-effective way to bridge the gap between the emergency room and the need for hospital care that doesn't require the infrastructure of a full-service hospital.
At first glance, scoring doctors based on patient satisfaction surveys sounds like a good idea. It's logical to assume that doctors would be more highly motivated to provide the best possible care if they knew they were going to be graded by their patients. Unfortunately, it turns out that patient satisfaction scores may be causing more harm than good.
The shift from inpatient care to outpatient care is the new normal, and hospitals are being forced to deal with the bottom-line consequences. Hospital beds are being replaced by thousands of ambulatory surgery centers, free-standing emergency rooms, and urgent-care centers. “In the early 1990s, outpatient care accounted for only 10% to 15% of hospital revenue. Today, that figure is closer to 60%” (modern healthcare.com).