• Paul DeChant MD, MBA

Dr. Robert Pearl – Fixing Healthcare for the Future

“Any physician who thinks the medicine of the future will look like the medicine of the past is wrong.”


This is how Dr. Robert Pearl, a Forbes Healthcare Contributor, Stanford faculty member, best-selling author, podcast host, and CEO-emeritus of The Permanente Medical Group summed up our fascinating conversation on the future of health care.


Dr. Pearl will give the kick-off keynote presentation at the Healthcare Burnout Symposium in San Francisco this January 24th at the Hyatt Regency Embarcadero. His thoughts will set the stage for the topics to come, as the pace of change in the world has compounded the stresses of COVID to drive clinician burnout.


A Strategic Inflection Point


“We are in a strategic inflection point across the globe, in which the world changes in dramatic ways and will never go back to the way it was,” according to Dr. Pearl. During strategic inflection points, the four types of rules get broken:

  • Normative rules that guide our actions and behaviors

  • Cognitive rules that affect how we think about various problems

  • Technological rules that impact innovation and

  • Economic rules that drive change financial flows


The same is true for medicine, giving us the opportunity to think about and examine what needs to change in healthcare.


Such changes won’t happen in a day, or even a year, but over the course of five to ten years, starting slowly at first and at some point, rapidly accelerating, similar to the initial onset of COVID.


The context of these changes will be in both the system and culture of medicine.


The system is very broken


It’s a 19th century cottage industry, fragmented with doctors and hospitals scattered across the community, paid on a piecemeal basis, in which value is barely measured and hard to assess, with technology from the last century, and no leadership structure in place capable of making meaningful change happen.


The culture has strengths and weaknesses


It’s heroic, as we saw by doctors and nurses putting themselves in harm’s way to care for patients. But this heroic culture comes with a heavy price for patients and for clinicians. The culture of medicine is steeped in esteem and hierarchy, hindering the ability to change, undervaluing primary care and prevention while overvaluing expensive interventional procedures.


These two contexts, the system and the culture, are like the caduceus with two snakes wrapped around a staff, that can’t be easily separated and must both be addressed.


COVID is clearly the sentinel event that along with the impact on patients and clinicians, has changed the healthcare funding to apply significant downward pressure on healthcare financing.


How will health systems respond?


Dr. Pearl sees a few likely scenarios:

  • Virtual primary care first groups are already popping up

  • Business coalitions like the Pacific Business Group on Health are focusing on portions of the system to lower costs

  • Amazon and other tech-enabled companies with large footprints are preparing steadily implementing care innovations


The big evolution will be from fee-for-service (FFS) to capitation. FFS can’t truly control cost. Capitation provides the systems and culture needed to drive change and reduce cost. It places a high value on prevention and primary care, focuses on technologies that add value, stops doing those things that waste the healthcare dollar, and takes the social determinants of health seriously.


The transition won’t be a smooth ride, as there are other growing influencers like private equity focused in creating a return on their investments in physicians, technology, and specialty hospitals who are looking to drive up prices.


Changes to Medical Education


As our conversation wrapped up, we discussed the changes that need to come in choosing and training medical students and residents. The legacy approach was based on the memorization of arcane facts. While necessary decades ago, the body of knowledge has grown exponentially and the ability to access that knowledge through smart phone technology has changed the game and will have major impacts on hierarchy, reimbursement, and teaching approaches in medical education.


If you’d like to learn more, I encourage you to attend the Symposium. You can also find Dr. Pearl at his website, on LinkedIn, and at Forbes.

29 views