There's a message here for people far beyond medicine: If you do a single thing—and especially if there's a lot of money in that single thing—you should put a Welcome, Robots! doormat outside your office. They're coming for you.
If the most tenuous jobs in medicine are the ones that are the most specialized, then the most secure positions, naturally, are those that require versatility. So, who are the most-versatile doctors? "We like to say that we can take care of 80 percent of the problems of 80 percent of the people," says Sarah Kramer, a family practice doctor in a suburb of Seattle.
Kramer was one of several family practice doctors who answered my survey about how robots are taking over high-skilled jobs, and her story echoed those of other doctors I spoke to. Kramer, who's been practicing for more than 20 years, sees two dozen patients a day. The appointments range widely in length—she can see someone for as few as 10 minutes, and on the rare occasion when she needs to do minor surgery, the session can last an hour. Every patient has a different complaint, too. "If you've got a sinus infection, if you've got a sprained ankle, if you're feeling fine and you need a checkup for work, if you're traveling overseas and you need some vaccines—I'll see you for all of that," Kramer says.
Technology has changed the way she practices medicine. Most of the patients Kramer sees now consult the Web before they come in, and they're usually familiar with basic facts about what's troubling them. But rather than replace Kramer, the Web has deepened her conversations with patients. When she sees someone who's just been diagnosed with high cholesterol, he'll often know he needs to change his diet and exercise plan. "But often I'll have to help them set their expectations," Kramer says. "I'll say, 'I should tell you, that's a good plan—but we have data about outcomes for patients, and from what we know, you'll still be better off if you added some medicine.' "
There are many diagnostic software packages that doctors like Kramer can use to help figure out what's wrong with their patients, and these systems will likely play a larger role in primary care going forward. IBM plans to use the technology in its Jeopardy-winning Watson computer to scour the world's medical textbooks and reference guides for connections between symptoms. A doctor could input symptoms into Watson and get a ranked list of disease possibilities.
But these machines can't replace Kramer's most important skill—the ability to suss out what's wrong with a patient through conversation. These personal conversations wouldn't be easily automated, and unlike consultations between patients and pharmacists, they probably wouldn't work if conducted remotely, either. That's because they depend on Kramer's ability to read a patient's body language, to gauge his emotional state, to determine how sophisticated an explanation he can handle, and to figure out if there are other factors in his life that may affect his treatment. "People are complicated," Kramer says. "You may have a patient who doesn't just have diabetes—he's got diabetes, plus he's just gotten divorced and he wants to start dating again and is worried about sexually transmitted diseases." No robot on the planet could figure out how to treat a patient like this—especially if you consider that patients often lie, mislead, forget to include pertinent facts, and are maddeningly stubborn.
Now, many of these skills aren't confined to primary care doctors. Wherever doctors are talking to patients rather than simply doing procedures on them, you'll find a kind of medicine that's more immune to robotic upheavals. What's ironic, though, is that the doctors who do procedures—people like super-specialized surgeons—who tend to command the highest salaries. The skills that make Kramer a great primary care doctor—the skills that machines can't match—aren't as well remunerated. (Primary care physicians make a median salary of about $163,000, while some surgeons can make four or five times that.)
The pay gap has caused a nationwide shortage of primary care doctors, as many medical students choose the financial rewards of specialization. It's possible that robotics will change this calculus; if machines begin to decrease the need for—and the salaries of—specialists, perhaps primary care will look more attractive. There's some evidence that this would be good for patients and for the health care system. A 2008 study by the American College of Physicians found that when patients visit primary care physicians more often, they receive better preventive care, they require fewer emergency room visits, and patient mortality rates improve. In other words, by turning to robots, we could keep more humans alive.
Of course, this trend would be terrible for specialists like my wife. But as I'll document in my next story, I've got other problems to worry about: Robots are coming for my job, too.