Curbside Consult with Dr. Jayne 12/16/24

It’s that time of year when well-known people are delivering their predictions for 2025. I’ve seen plenty of them talk about how “transformative” AI will be. The most commonly cited use cases include the nebulous “operations” and “workforce challenges.”

I’d love to see people put their nickel down and give us a tangible prediction along the lines of, “AI will help us reduce nursing turnover by 10%” or something that’s even remotely measurable. Many of us have been through a middle school science fair, either as a participant or as a parent or coach of a participant, so it shouldn’t be too hard to craft a measurable hypothesis. Unless, of course, you’re just talking to talk and to get exposure so you can “elevate your brand” and figure out how to launch yourself to the next big thing – in which case you’re better off staying in the realm of the nebulous prediction.

I saw one article where an executive was talking about how organizations are going to start collaborating with each other to create networks for delivering more holistic care for patients without having to own all the services. If I’m thinking positively, that means that we might see some health systems considering joint ventures with physician groups or other organizations that can create new options for patients to receive needed care in lower-cost environments. In many communities, though, I doubt we’re going to see much out of this due to the multi-decade turf wars that led to network monopolies with certain insurance carriers, which can make it difficult for patients to get the best care because it might be out of network.

I think of my own city, where a couple of decades ago a handful of otherwise independent hospitals came together in a loose affiliation to try to fight against the two largest players in town. That affiliation lasted less than a decade, with two hospitals spinning back to independence while the others became part of a larger multi-state system. Fast forward again and that organization now owns all but one of those former “independent” members of their alliance. Regardless of current affiliations, the quality measures coming out of those hospitals are largely the same, so I’m not sure what all the merging and unmerging did for anyone other than potentially lowering overhead costs and most assuredly causing confusion for patients.

Executive predictions can also highlight how clueless some individuals are about the current state of healthcare in the US. One mentioned the importance of ensuring that we don’t have a two-tiered healthcare system, with some patients receiving private-pay care and others receiving care paid for through governmental plans. I’m sure she was trying to draw comparisons to the UK and Canada, but it didn’t appear that she was at all aware of the fact that we currently have such a two-tier system in the US right now, in 2024. According to information from the Centers for Medicare & Medicaid Services, the 2022 breakdown for healthcare expenditures was 39% for Medicare and Medicaid and 40% for private health insurance and patients spending out of pocket.

That sure looks like a two-tier system to me, and if you ask a physician who sees the full spectrum of patients regardless of payer, they’ll quickly tell you that patients get different treatment entirely when you try to refer them for subspecialty care. Those with so-called Cadillac insurance plays that pay at the top of the fee scale often receive the quickest appointments, followed by patients with Medicare. In my city, Medicaid patients have ridiculously long waits for specialty care. This means the primary care physician has to try to muddle through and ask colleagues for informal opinions about how to manage a patient for the nine to 15 months it might take for them to actually get an appointment with the appropriate specialist.

When I was in traditional family practice, I literally had patients die while waiting to see a specialist. You can imagine how non-credible many of us find it when someone suggests that care rationing and a tiered system isn’t already here.

I’m sure that over the coming weeks we’ll see even more of these predictions pop up, and I’ll be ready to read them for amusement purposes. What I won’t be reading are content producers that start every single post with either the megaphone emoji or the emergency light emoji. (Side note: the official name of the latter is “Police Cars Revolving Light,” and is that really what you want to have at the beginning of your post?) I’ve decided to change how I’m curating my content in 2025, and anyone using those particular attempts at attention-grabbing for every single post will just go to the bottom of my list. Once in a while, I get it, but after a while it’s just distracting.

There have been a couple of predictions I’ve seen for 2025 with which I can agree. First, I agree with the prediction that while executives say that they’re going to focus on generative AI, only a fraction of them will actually make them a top priority in the next 12 months. I think there are a lot of people out there saying they’re “doing AI” because they don’t want to seem like they’re missing the boat. Or, they may have selected vendors that claim to have an AI-powered solution which is really little more than a souped-up decision tree. There are plenty of those out there, for sure. It’s also difficult to spend on AI when you have things like high nursing turnover that’s directly related to poor company culture, which isn’t going to get better by using AI.

I agree that ambient documentation will remain one of the industry’s darlings in the coming year, because physicians seem to love it. It remains to be seen, however, whether the use of it will lead to improved patient outcomes or clinical quality or true burnout reduction. I’m still skeptical about the burnout studies that I see because a portion of the most burned out clinicians have left the field, which will make the data look better regardless of the true prevalence and severity of burnout. I have a couple of colleagues who are moving away from ambient documentation due to medicolegal concerns, so it will be interesting to see how the industry addresses those.

I personally predict that people in the US will continue to spend plenty of money on unproven treatments in the name of wellness. I had the opportunity to see some financial data on a local med spa, and the amount of profit flowing through there for therapies that aren’t evidence-based is staggering. Vitamin B12 infusions, electrolyte infusions, and even therapies that have been officially debunked are all on the menu and the business is expanding rapidly. Many people don’t have the desire to investigate whether medical things they see on TikTok or other social media platforms are evidence-based and are more focused on following influencers rather than people who have spent decades in school learning the science. Having seen what I’ve seen in emergency and urgent care in the last five years, I don’t see that changing any time soon.

I also predict that the least-paid specialties will continue to be those with the most shortages, a concept which should surprise no one. I guarantee that if you paid primary care physicians based on their actual worth in being able to help prevent disease and reduce disability, and actually supported them appropriately with the ancillary services needed to help patients make lasting changes, people would flock to those disciplines, because they can be incredibly rewarding when you’re working in a supporting environment. When you’re not, though, they can be soul-sucking, and we’ll continue to see people voting with their specialty match preference lists.

Bring out your crystal ball. What are your predictions for healthcare in 2025? Leave a comment or email me.

Email Dr. Jayne.