Chapter 4: Disrupting the Business Model of the Physician's Practice

INTRODUCTION

Our call for disrupting doctors is not rooted in animosity or envy for these healers and lifesavers. Indeed, two of us are physicians and the third would have died twice, lost the use of one arm, and gone blind in at least one eye were it not for the courageous intuition of remarkable physicians. Rather, we call for disruption only because the disruption of professions is a natural and necessary step in making an industry's products and services more affordable and accessible.

It happens again and again in the world economy. Architects have been disrupted by sophisticated software that enables technicians today to design all but the largest and most unusual buildings. Disney's illustrators have been disrupted by Pixar's technicians, using digital animation. Attorneys are being disrupted by paralegals, and bank loan officers by credit-scoring algorithms. Each of these industries, and others, were defined in eras when the practices of architecture, illustration, law, lending, and so on were in the realm of intuition. In labor-intensive industries such as these the technology-enabled disruption of costly service providers and their business models has been a crucial tool for reducing costs and improving quality.

Figure 4.1 maps how the business models of physician practices will evolve disruptively. It suggests that the typical primary care physician's business consists of four different categories of health-care delivery, enumerated in the figure as follows:¹

1. The straightforward diagnosis and treatment of disorders (generally acute ones) that are in the realm of precision medicine. Examples: ear ache, pink eye, sore throat.

2. Ongoing oversight of patients with chronic diseases. Examples: diabetes, high cholesterol, lupus, tobacco addiction, obesity.

3. Ongoing wellness examinations and disease prevention, which lead to:

4. Preliminary identification of disorders that are in the realm of intuitive medicine—some that might be handled by the primary care physician, but many of which are referred to specialists. Examples: osteoporosis, asthma, appendicitis, cancer, restless leg syndrome.

As suggested in the first component of Figure 4.1, nurse practitioners (and other physician extenders) practicing in retail clinics, should disrupt the precision medicine portion of the physician's practice. The job to be done in these instances typically is: "As quickly and conveniently as possible, please confirm my hypothesis of the disorder and prescribe a remedy." Where the functions in a doctor's office are disjointed because of their conflated business models, retail clinics, as VAP business models, can integrate the steps in this process in a way that optimizes the fulfillment of this particular job, consistently within 15 minutes or less and with no waiting.

The second major change in the primary care physician's practice will be transfer of the ongoing oversight of patients with behavior-intensive diseases to entities with a network facilitator business model (second ...