“The healthcare game is wide open”

Dr. Rosenberg

Health care today is going through a very rapid transformation, racing toward ever-greater precision.

Take the DNA sequencer, for example—by all appearances a nondescript countertop machine that yet, is fast becoming indispensable to modern medicine. When hooked up to a computer, it’s the scientist’s go-to device for deciphering the genome, thereby paving our way toward precision medicine by allowing researchers to uncover the pathways that are affected by many major diseases.

We’re already seeing this sort of movement in cancer and we’re going to see it in other diseases, as well. Anything that has an autoimmune basis will probably fall into the same category, so we’re talking about the bulk of disease. And once we can isolate precisely what’s wrong, we can come up with very specific treatments that are customized to meet the needs of individual patients.

Another key disruptor in health care that has emerged in parallel with precision medicine is digitalization, in its broadest sense. Everybody has a phone, whether it’s an Apple or a Samsung. So prevalent are smart phones among the nation’s teenagers, in fact, that a Health Canada study concluded that they are potent tools for communicating health-related messages.

These developments are going to tremendously change the game, and lead to two things. The first, I call the democratization of knowledge. Interventions carried out exclusively by specialists in earlier years, or by GPs in recent years, can now be done by other health professionals, be they nurse practitioners, pharmacists, physiotherapists, occupational therapists, or social workers. In some cases, care can even be effectively turned over to well-informed family members.

As for millennials or would-be millennials, they are driving the democratization of technology. Seeing as they are going to be the people we’ll be hiring over the next five to eight years, we will have to adapt to their expectations of how their work should be. As recipients of care, moreover, they’re going to have expectations about how and where that care should be provided to them.

This shift in how we will deliver care is driving doctors crazy, and I’m speaking as a doctor.  Disintermediation has arisen as a consequence of these changes, where we are seeing doctors being removed from the equation. Some people will protest, “Well, you’re always going to need a doctor”, and I would agree. The question is, what is that doctor going to do, where are they going to practice, and how are they going to be remunerated?

As part of this whole transformation, it’s becoming clear that the healthcare game is wide open.

And yet we see how deeply instilled are the more outdated models of healthcare delivery. At the McGill business school, where I am a lecturer, I was asked to give a lecture on the role of hospitals and health systems. That talk has evolved to reflect these disruptions in healthcare. I still lecture on health systems, but no longer about hospitals.

It became clear after one or two classes that you could pick out the MBA students who were aspiring health professionals, because those were the people twitching in the back row at the notion that maybe hospitals weren’t that important, which was basically what I was telling them. That is not to undermine a very important pillar in academic health centres—fundamental research. But for obvious reasons, we are also seeing significant segments of patient-centred research moving into the community.

Now that Francine Dupuis and I have been in this new game of system development for nearly four years, it’s clear to us that, in fact, hospitals are not the centre of the universe. Hospitals have specific roles to play, but with every day that passes, more of what patients need is delivered out in the community.

Lawrence Rosenberg, MD, Ph.D.
President and CEO