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Paging Dr. Innovation

What mindset does a physician need to improve healthcare delivery?

I participated in the California Northstate University College of Medicine first-year medical student mixer earlier this month. With 21 other physicians, I fielded questions regarding specialty choice. A prominent common denominator emerged quickly; no one was interested in solo practice. The narrative that the younger generations are following into the entrepreneurial pantheon of Jobs, Gates, Zuckerberg and Bezos, and will be building companies that personify disruption and innovation mesmerized me. I anticipated inquiries on how to form a company, locate a Blue Ocean zone, or change business practices in medicine. I waited for someone to lay claim of not only moving the needle, but causing it to spin like a pinwheel. No one channeled Barney Stinson and wanted to be legendary.

Instead, these students concentrated on scope of practice and job location In the formative first months of their professional journey, they looked for well-traveled paths. The firm grooves of these trails guide, but can also bind one to a predestined course. The financial commitment of student loans loomed as compass and albatross. In fairness, this cohort expressed ideals of compassion and a strong desire to serve. And, they are similar to the medical students I had encountered at UC Davis for the past 15 years. I believe they will contribute as healers, educators, and advocates. However, their scales fixated on individual patient encounters without articulating awareness that Amazon, Berkshire Hathaway, and Chase may alter the dynamics of healthcare delivery to be bigger box.

The trend of individual practitioners is declining. There are a host of reasons, but one may be how applicants are admitted to medical school. “First do no harm” is commonly attributed to the Hippocratic Oath; however, this phrase does not appear in the oath. Yet, the medical establishment has embraced this sentiment so devoutly that it has permeated the selection process of medical students for generations. Entrepreneurial principles in personal statements are deemed as risky outliers. The spirit of innovation is further incapacitated during the clinical years where adhering to the standard of care is the goal. Established standards become the guideposts for thought. Visionaries who can read the shifting landscape and see the winds of change will grow frustrated. Most physicians work in large health systems where compliance and uniformity are valued. They will bind to doing no harm without giving much consideration that stagnation in the medical field may be one of the worst forms of harm.