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.
