Jeff Bauer: Not one-size-fits-all—Innovative providers creating new healthcare models

Today's fast pace of change might suggest that forecasting the evolution of healthcare professions over the next 25 years is an exercise in futility.

After all, I'm a full-time health futurist with 45 years of experience across the medical marketplace, and it takes me an incredible amount of time just to stay confused about what is happening right now. However, 25 years ago I wrote a book about the future of caregivers—Not What the Doctor Ordered—and its forecasts turned out to be remarkably accurate. I'm ready to look deep into the crystal ball again.

If the future of jobs in healthcare can be reduced to one word, it is diversity. Medicine and nursing are likely to splinter into even more segments. I see no compelling data, thoughtful ideas or unifying leaders with enough power to quell turf battles growing within and between the healthcare professions. The resulting competition will continue to erode monopoly power enjoyed by specific groups of healthcare professionals in the 21st century.

The number of job categories is likely to proliferate as existing practitioners expand their functions and as new types of caregivers are created. They will provide an expanded array of services in nontraditional locations, especially homes and workplaces. Telemedicine will account for at least one-third of all caregiver-patient interactions.

America's innovative providers are spearheading this diversification as they develop new and better models for delivering healthcare, and they are doing it independent of government-driven reform. The putative successes of the Affordable Care Act are simply replications of innovations begun in the private sector over the past 25 years. Further, the organizations that are transforming healthcare are themselves remarkably different from each other, reinforcing the view that diversity—not one-size-fits-all reform—is the future.

A common denominator across new care models is the use of healthcare professionals in untraditional ways that ultimately create new job categories. For example, many physicians now specialize in informatics or management; they become CIOs, CFOs, COOs and CEOs—roles with no direct patient-care responsibilities. Many advanced practice nurses are fully devoting their time to research, while clinical pharmacists are getting directly involved in patient care and drug prescribing. We are entering a new era in which a caregiver's educational degree will not be a reliable indicator of the work he or she performs.

This expansion of roles and functions is likely to shift the foundation of licensing from educational training to demonstrated competency. Twenty-five years from now, practitioners with different professional degrees will quite likely be taking the same examinations to provide a specific type of care. Professionals will no longer be able to claim sole clinical authority based on years of training. Instead, regular testing of scientific knowledge and ongoing analysis of individuals' practice performance will determine who can do what.

Patients will gain some unprecedented options, such as having an emergency appendectomy performed in an ambulance by a paramedic, or designating a nurse practitioner or a pharmacist as the family doctor—knowing that all pass the same exams and meet the same standards of practice. Caregivers will rely extensively on data collected and analyzed by wearable smart devices and on longitudinal healthcare records attached, literally, to each individual. Indeed, because of maturation of precision medicine, a caregiver's primary function will be individualizing therapies based on the unique characteristics of patients' diseases and patients' preferences and abilities to pursue different therapeutic options (including behavioral changes), and their desired outcomes. Uniform best practices will be a thing of the past.

Two powerful, nonmedical trends will also influence the evolution of jobs in healthcare over the next few decades. First, global climate change will create new healthcare professionals as diseases evolve in unprecedented directions. I can imagine architects, city planners and evolutionary biologists developing the skills to treat our growing environmental ills, redefining public health in the process. Second, America's demographic transformation—arrival of the “minority majority” by 2040—will almost surely lead to licensing of more healthcare workers with origins in very different cultures. Caregivers who would be considered charlatans today will be openly treating patients.

Some might argue that federal regulations will thwart development of new jobs, but regulating healthcare professions is a state power. I do not foresee this situation changing significantly. Most healthcare policy analysts thought I was crazy 25 years ago when I predicted independence for advanced practice nurses, acceptance of clinical pharmacists, and adoption of telemedicine. All have happened, thanks to states and provider organizations with the courage to pursue something new and better despite strong opposition from defenders of tradition. If this overall forecast reflects a bias, it is my fervent hope that innovation will continue to define American exceptionalism.