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No country on earth spends more on medical care than the United States. The USA spends $2.5 trillion a year on healthcare, over $8,500 for each woman, man, and child in the country.
medical_doctor.jpg For this huge expenditure on health, the USA has the most responsive healthcare system in the world. Nowhere in the world are people seen by their doctors sooner after making an appointment, and nowhere in the world do people have faster emergency medical care in the United States.

Day to day healthcare, however, does not work out as well in the United States. The USA is 42nd in the world in life expectancy, and 72nd in the world in overall health. Experts wonder if some of the $2.5 trillion a year Americans spend on treating illness could be better spent.

A logical place to look at cost control is doctor's salaries. Doctors invest many years in arduous training, usually take on debts of over US $100,000 to pay for their medical education, and are required to work long and irregular hours while taking responsibility for life or death decisions. For their hard work, however, American doctors are generously compensated.

•    The average annual wage of physicians who work in hospitals is $176,630.
•    The average annual wage of physicians who work in outpatient care is $221,010.
•    The average annual wage of surgeons is $227,860.

Some doctors, however, earn as little $50,000 a year to work in poorly served areas, and some doctors earn as much as $25,000,000 a year performing specialty operations. The high salaries and fees paid doctors, however much they are deserved, is a prime target for cost cutters. Could doctors be replaced by highly sophisticated computers?

Computers do not need to promote expensive treatments.

One of the arguments for developing sophisticated computers to replace some of the tasks of diagnosis and treatment performed by doctors is that computers not only do not receive paychecks, they do not need to meet budgets. When hospital beds are available, studies have found, women tend to have more hysterectomies than hormone treatment, and the elderly are more likely to receive carotid stents. When specialists reviewed the records of women who had hysterectomies, 70 per cent were found to have been unnecessary. When specialists reviewed the records of elderly persons who had carotid stents, the number of people getting the procedure was found to be 800 per cent higher after Medicare started paying for it.

Doctors make mistakes and people die.

 In 1999, the Institute of Medicine released a study entitled "To Err Is Human." The institute found that in 1999, a number of patients who died as the result of medical error equaled the number of fliers who would have been killed in 390 crashes of jumbo jets. In a study of 37 million record records from the years 2000, 2001, and 2002, Health Grades, the medical quality company found that an average of 195,000 Americans each year die as the result of medical errors.

public_clinic_waiting_room.jpgAmerica is not a land of equal opportunity when it comes to health care.

More patients survive in big city hospitals than in rural hospitals. More patients die in communities where the average family income is under $35,000 year than in communities where the average family income is over $200,000 a year. A person who has a heart attack in Georgetown, Texas, a relatively high-income, urban center, is less than 10 per cent as likely to die during treatment as a resident of low-income, Appalachian Ducktown, Tennessee.

Making matters even worse, nearly 95 per cent of American doctors have a financial relationship with a drug company or a maker of medical devices. Doctors receive kickbacks for prescriptions they write and devices they use implant in patients. Some doctors receive nearly as much income from their drug endorsements as they do from their fees and salaries.

Poor people die because they cannot afford treatment. Rich people die because they receive treatments they do not need. Taking some medical decisions away from doctors, experts claim, might free up funds to treat the poor and protect the rich from receiving procedures they do not need. But can even the most sophisticated computer program really replace a doctor? There are a number of reasons you won't be telling your symptoms to a computer console anytime soon.

Cyber systems offer general medical information, but they cannot yet offer diagnosis, prescriptions, and treatment.

 One of the age-old challenges of practicing medicine is that different people who have the same disease may have different symptoms, and different people who have different diseases may have the same symptoms. Doctors often make the distinction between one diagnosis and another on the basis of nuance, or the subtle "feel" of a disease, and whether it fits their patients. This approach to diagnosis, of course, can lead to error, but no checkbox or multiple choice system, which is what a computer would likely be able to do, can capture all the possibilities doctors learn in their face to face experience with flesh and blood patients.

Cyber systems would also provided biased treatment.

 In the worst case, a computerized system of diagnosis and prescription might be set up to make sure that a particular company's medications were favored for treatment. In the best case, a computerized system, at least at first, would be limited to the information programmed into it.

Computers cannot make ethical decisions.

Doctors are constantly faced with ethical dilemmas. If there are not enough beds, which patient is admitted? If there is a shortage of a vaccine or of a medical device, who gets treated? No machine can be made sensitive to all the factors that go into the resolution of ethical issues, and any computer program used for ethical decision-making could be skewed to favor one group of patients over another.

The notion of replacing doctors with computers is not likely to be realized any time soon. Assisting doctors with computers, however, is on the immediate horizon.

Traditionally, doctors scribbled notes into paper charts carefully guarded from patient's prying eyes. More and more doctors, however, are switching to electronic systems that help the doctor make notes with just a few keystrokes, instantly displaying lab results, medical history, lists of medications, and contact numbers for their colleagues, no longer requiring the tedious task of tracking down a file from a vast shelf of patient records that were easily misplaced and insecure.

Doctors will not lower their salary expectations as the new record technologies are result. The lower overhead for offices and clinics, however, may make it possible to treat more patients at lower cost, bringing more care and better care at least to the poor patients who do not receive the full range of treatment in the current system. Machines will not replace American doctors anytime soon, although nurses, pharmacists, physical therapists, and nutritionists may take on more and more of doctor's daily duties.

  • Brook RH. Physician compensation, cost, and quality. JAMA. 2010 Aug 18,304(7):795-6.
  • Deane JA, Nussbaum SR. Creating a sustainable physician compensation plan. Serving both fee-for-service and capitated populations. Med Group Manage J. 2001 Mar-Apr,48(2):12-6, 18-9.

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