The Fall of the Doctor & the Rise of the Nurse

Healthcare, and in turn the patient experience, is undergoing and will continue to undergo massive change. All healthcare ecosystem stakeholders are affected and their futures are in flux, raising questions, concerns, and a sense of uncertainty as new precedents and norms will need to be set. However, one factor has arisen to be certain. One stakeholder above all others – the patient – is shifting to the center of gravity around which all others’ fates must be reconciled.

Shifting the patient to the center of the health ecosystem has changed long-held assumptions within the healthcare space, beginning with the doctor as the pinnacle of primary care. However, as patients gain influence and autonomy over their care and the healthcare ecosystems that surround them, the doctor’s role as the central authority is diminishing. In their replacement are the patients themselves and their nurses, who are making up the difference in power and impact.

There are three main points of evidence – demographic shifts, the digital revolution as an enabler of change, and the changing cultural mindset for approaching healthcare – that act as signals and drivers of the current and impending prodigious reshaping of healthcare. In particular, in how they address the loss of power of the physician, and the gain in power of the nurse and patient.

Each of these factors is contributing in the changing dynamics of how health provision and support is operating, and razing long-held assumptions that have traditionally accompanied those operations.

Compelling questions arise. What could this mean for those living and working in health? What are the directions for the future, and ultimately, how should we consider the different approaches that will best take advantage of the opportunities that will emerge?

Demographic Shifts

As baby boomers age and apply increasing demand and pressure on the entire system’s resources, we will need to do more with less, forcing innovation and efficiency.

Growing demand means less money.

An unprecedented amount of older adults will exert a significant demand on health systems. As the population ages, its demand on the healthcare industry will intensify, compounded by increasing chronic disease and longer average lifespans. In 2012, in the United States over half of adults lived with one or more chronic diseases and over 86% of healthcare spending was associated with caring for people with one or more chronic conditions. In turn, this will increase the cost of providing healthcare.

Innovation will be required.

To mitigate the increasing cost burden, health providers will be required to find efficiencies and innovate in order to maintain quality of care at a reduced rate. This will require changing long held practices, and trying new approaches for providing care.

Nurses take on some of the doctors’ tasks.

One strategy that is being utilized to decrease costs is to provide nurses more power and influence in the treatment of patients by shifting the delivery of some services to nurses. In March 2015, Nebraska became the 20th state to adopt a law that allows nurses with advanced degrees to practice particular medical fields without a doctor’s oversight. The law helps rural areas that have trouble recruiting physicians but have high healthcare need due to aging populations to still provide care through nurse practitioners.

Some doctor organizations, such as The American Medical Association, are opposing the law, arguing that nurses do not have the knowledge or skill to provide the required level of care. However, the economics support the nurses. According to the Institute of Medicine, 14 nurse practitioners can be trained for the cost of a single physician, and research shows that primary care outcomes by nurse practitioners is equivalent to that of physicians. What this boils down to is the fact that for certain forms of primary care, nurses are more cost efficient, providing better value to the healthcare system. Eight other states are considering similar legislation, a trend that is sure to continue to meet the growing demand for health services.

For certain forms of primary care, nurses are more cost efficient, providing better value to the healthcare system.

While we are seeing a growing demand on funding being made by the ever-growing and longer-living older segment of the population whose needs are among the most expensive, we then begin to look at the segments of the population who are younger and for whom innovation will become even more imperative. These people will be dependent upon innovation – both of a technological nature and in terms of healthcare culture – for their healthcare needs to be effectively met. Innovate or die. Expect less quality of life or embark on more proactive and preventative demands upon the individual. It is within this mindset that we consider innovation both technologically and culturally.

The Digital Revolution

The democratization of information through the internet has provided power to the consumer like never before. File-sharing platforms, the MP3 format, and accessibility have forever reshaped the music industry. Television has also been drastically altered. The new platforms that now drive these industries have shifted control over content from providers to the consumer, permitting the consumer to choose what they want and when they want it, rather than being restricted to the provider’s scheduling and bundling of products and services. As a result, the consumer is more engaged and in control of their consumption than ever before.

Technology is key to change in the patient/provider relationship.

Despite the differences of the content production context, its user analog to healthcare – the patient – is expecting similar change and with important implications. There is a similar shift of change and control away from providers and towards consumers, especially with increasing emphasis on patient centricity and engagement.

Patient engagement is big business.

Last year Apple released HealthKit, its software platform for collecting health application-related data from Apple mobile devices. Apple’s foray into mobile health does not surprise as the industry’s global revenue is expected to more than double from $10.2 billion to over $23 billion in 2015–2017. By providing a platform for developers in the space, Apple is investing heavily in the expectation that individuals will become more engaged and active in their personal health – and this is a safe bet. We all strive to achieve healthier lifestyles and make our own health decisions, both proactive and reactionary, and in so doing, we gain knowledge and become empowered to guide our own decisions.

Patient empowerment results in control moving from doctor to patient.

On the doorstep of the mHealth boom, we are on the verge of tremendous patient empowerment and engagement. With more information in their pockets, patients who once relied on the physician can now partake in a future in which they can make their own decisions, leaving the physician’s role to a confirmation or opinion to be considered.

Cultural Mindset for Approaching Healthcare

As the power dynamics within healthcare shift, and the traditional role of the doctor loses it impact on patient care, the patient experience will become of increasing importance as a differentiator for health service.

Funding begins to be tied to patient experience.

The Affordable Care Act (ACA) became effective on March 23, 2010, bringing a significant regulatory overhaul to the US healthcare system. It was designed to increase quality and affordability of health insurance, lower uninsured rates, and reduce the cost of federal healthcare for individuals and government. Its intent was to reward hospitals that receive positive patient experience feedback through a series of surveys. Hospitals who wish to maintain or increase funding need to ensure that patients have a positive experience throughout their visits and interaction with the hospital staff. Fundamentally, the patient’s experience is driven by three key factors:

01 / Patient’s perception of the environment (everything from noise levels and aesthetic, to architectural design and flow of service)
02 / Interaction with healthcare providers, hospital staff, and other hospital guests
03 / Ability to have patient engagement

As training is more effective and less expensive than architectural overhauls, hospitals should be looking to improve patient experience through interaction and patient engagement: an option that is trained, not built. According to the ACA, patient engagement is “the active participation of patients and their families in the process of making medical decisions.”

Outside of the hospital, mHealth is on the cusp of providing patient engagement through tracking, analysis, and the quantified self. However, this is only a fraction of a holistic engagement strategy. For healthcare providers, it is fundamental to ensure that patients receive a superior experience and engagement through interaction within the hospital, face-to-face with healthcare practitioners. Outside and inside the hospital, patient engagement is the path forward.

For this face-to-face engagement with patients, no role is more important than the nurse. Nurses spend more time with patients than any other healthcare provider and patient experience satisfaction is highly dependent on these interactions. Given this, nurses truly are the gatekeepers to patient engagement and ultimately the most fundamental factor in patient experience. Not only are nurses spending the most time with patients, that time is also highly valued. Year after year, Gallup polls have shown that nurses are the most trusted professionals in terms of both honesty and ethical standards, even more so than physicians. As nurses have been, are, and will increasingly be the cornerstone of the patient experience, what does this mean for the future of healthcare? At the least, it means patient engagement is bound to the rapidly evolving and expanding role of the nurse.

What Now?

The Uberization of Healthcare

Akin to Uber’s disruption of the taxi industry, this new epoch of empowered patients are beginning to have more access to their own health information, developing their own healthcare knowledge, and are beginning to act collaboratively and collectively using social media. Patients are able to curate their experience, noting and sharing the good and bad. As a result, they are working together to curate bad physician and hospital experiences out of existence – forcing them to react. The use of health and wellness technologies enables the beginning of a more proactive and preventative self-healthcare culture. One does wonder: If healthcare isn’t exempt to this Uberization, can we expect the same types of shift in other sectors, such as law enforcement?

We once had societies in which healers were held singularly in the highest regard, but this is now evolving. The nurse will become a greater part of that healing process, as will the patient. We can expect that technology will be an enabler in this time of need for innovation, but it will be a challenge on both individual and societal levels as we adapt and take advantage of opportunities that will determine our success in the healthcare system of the future. ////

James Aita is the Head of Healthcare Solutions at Idea Couture in Toronto, Canada.
Dustin Johnston-Jewell is an innovation strategist at Idea Couture in Toronto, Canada.
Robin Lobb is the director at Zeroes and Ones Incorporated. He is based in Toronto, Canada.

the author

James Aita

James Aita is director of strategy and business development, North America at Medicomp Systems.

the author

Dustin Johnston-Jewell

Dustin Johnston-Jewell is an associate, design strategy at Coactuate.

the author

Robin Lobb

Robin Lobb is a professor at Georgian College.