The Future of Allopathic Medicine

Michael M.E. Johns, MDExecutive Vice President for Health Affairs

CEO, Woodruff Health Sciences CenterChairman of the Board, Emory Healthcare

Emory University

Workforce ProjectionsA Long History of Getting it Wrong!

Looming Shortages? Surpluses? • Then

– GEMENAC (1977) and progeny through 1980s – Cooper 1994– Weiner 1994– COGME 1995

• Now– U.S.Bureau/Health Professions (shortage areas)– Wennberg 2006 (OK as is - just rationalize effort)– AAMC 2006 (increase med students by 30%)

• Always – Shortages in areas of greatest need (rural, inner city).

Workforce ProjectionsA Long History of Getting it Wrong!

What do current projections of shortages mean for future professionals . . . ?

Demand Prices

P - price

Q - quantity of good

S - supply

D - demand

Factors Affecting Your Future

1. Lack of universal coverage2. Costs3. Demographics (longevity, baby boomers, etc.)4. Dysfunctional health care delivery and

payment systems.5. Demand for health care services.6. Regulatory burden 7. Administrative waste ($40 billion/year on paper

records alone).

Both catalyzing and limiting factors:

More factors

6. Quality, safety and service deficits

7. No standard, universal transaction platform.

8. Lack of universal, secure, personal medical records.

9. Ethics/loss of professionalism/focus on profitability vs meeting important health care needs.

Five Newer factors

1. Rising Societal Expectations

2. Globalization

3. Acceleration of technology and knowledge

NanoTechnology: bringing together molecular biology, biomedical engineering, imaging, robotics for diagnosis and treatment.

4. Public/Private innovation and entrepreneurialism

From Medical Home to Health Home

New Patient Health Home?

• WA Seattle Metro Locations

“There’s really no secret behind MinuteClinic’s better approach to diagnosing and treating common illnesses:

･ Quick (about 15-minute visits and no appointment needed).

･ Affordable (treatments between $28 and $110, and reimbursed by most insurance plans).

･ Convenient (open seven days a week, located near pharmacies).”

“Prescription for a Busy Life”

Common Illnesses/Pricing

Allergies (ages 6+)$59

Bladder Infections (Females, ages 12-64)$69

Bronchitis (ages 10-64)$59

Ear Infections$59

Pink Eye and Styes$59

Sinus Infections (ages 5+)$59

Strep Throat$69

Swimmer’s Ear$59

Flu Diagnosis (ages 10-64)$93

Mononucleosis$69

Pregnancy Testing$49

Newer factors: 5. Convergence

Convergence creates new tools enabling new alignment of how people will work together.

Example: iPod •Required acquiring and aligning multiple resources

–Technologies–IP–People–Companies

Innovative Convergence around iPod

File Transfer

Compatibility

Functionality

Music Production

Storage

Music

Books

Firewire (1394)

Flash Memory Chip

Planar Lithium Battery

Digital Converter

Mobile HDD

Chip Design

CONCEPT

eMagic

cliché software

SHRINK

Tony Fadell,

Apple Computer's Senior VP, iPod Division

SOFTWARE

HARDWARE

CONTENT

CONCEPT

Emergence

Convergence leads to . . .

Emergenceof new concepts for biomedicine

Predictive Health

“Predictive Health anticipates the course of an individual’s health status, based on leading edge science and technology, and prescribes interventions that proactively optimize wellness”

“This revolutionary approach will move from a reactive disease focused system to a pro active health focused system; disease becomes a medical failure”

The Health/Disease Continuum

NormalLow risk

NormalHigh risk

Predisease

Earlydisease

Latedisease

Predictive Health

Contemporary Medicine

HEALTH

DISEASE

Generic Pathways

Specific DiseasesCardiovascular

Diseases

Chronic Lung Diseases

Diabetes

Cancer

Other Diseases

Neurological Diseases

Determinants of Health

Environment

Genetics Behavior

Oxidative Stress

Development and

Senescence

Regeneration and Repair

Other Generic Pathways

Immunology and

Inflammation

Technologies

Genomics/ Metabolomics/ Proteomics

Molecular Imaging

Bioinformatics

Nanomedicine

Quantitative Medicine

Novel Therapeutics

Education

Disciplines

Finance and Economics

Public Policy

Ethics

Systems Biology

Population Biology

NIH Roadmap Initiative:New Pathways to Discovery

Building Block, Biological Pathways, and Networks

Molecular Libraries and Imaging

Structural Biology

Bioinformatics and Computational Biology

Nanomedicine

NIH Roadmap Initiative:Research Teams Of The Future

High Risk Research

Interdisciplinary Research

Public-Private Partnerships

NIH Roadmap Initiative: Re-engineering The Clinical Research Enterprise

The Question for the Future

The question is not: “What will medicine look like in 20 years?”

The question is:“What can medicine be in 20 years?”

And:“What can we aspire to be as leaders in

fulfilling that vision?”

The Future of Allopathic Medicine

It’s your future.Learn -- to be a leader.