I came across a great phrase last week: “practicing at the top of your license.” The words come from healthcare – they refer to practicing medicine as a licensed professional. But they also open up a new way of thinking about the future of innovation and employment.
Healthcare is one of the strangest corners of the working world, because it is just about the only one in which technology innovation has done nothing to make things cheaper. Quite the reverse: each new innovation in diagnosis and treatment seems to trigger an arms race in which providers compete to plunk down more millions on shiny toys, with insurers, governments and ultimately patients picking up the tab.
In an intriguing article (“The Robot Will See You Now” in The Atlantic), Jonathan Cohn writes about a new wave of technology innovation in medicine that aims to supplement the judgment of physicians with artificial intelligence. IBM is leading the pack with its Watson computer, which made headlines in 2011 by winning the American game show Jeopardy. The Cleveland Clinic is helping to develop Watson as a training tool for young physicians and ultimately as a tool for diagnosis at the bedside.
Much is expected of Dr. Watson. Human physicians tend to diagnose based on a small set of things they observe, guided by judgment honed with experience. Watson may not have a physician’s judgment or experience, but it has access to vastly more knowledge. So Watson can suggest a range of possible diagnoses that might not even occur to television’s Dr. Gregory House.
“In Brazil and India,” writes Cohn, “machines are already starting to do primary care, because there’s no labor to do it. They may be better than doctors. Mathematically, they will follow evidence – and they’re much more likely to be right.”
So how is this good news for lower-skilled jobs? Unlike medical technology innovation of the past few decades, these changes may well empower lesser-skilled healthcare workers to provide services that only physicians now perform.
One doctor told Cohn, “I think we are transitioning into what I see as super-quality-control officers, overseeing physicians’ assistants and nurse-practitioners, who are really going to be the ones who see the patients.” (For the record, he doesn’t like the future he is forecasting.) Smart information and communications technology will let lower-paid employees deliver a more consistent and evidence-based quality of care. “If technological aids allow us to push more care down to people with less training and fewer skills,” predicted one expert, “more middle-class jobs will be created along the way.” That is, middle-class jobs where people are practicing at the top of their licenses.
Human beings are terrible forecasters of the impact of technology. We always see the dark side first, because it is so easy to recognize. Much harder to imagine are the positive ways we will put new technologies to work to build a future we want. When we talk about the impacts of innovation on employment, we see the machines taking away jobs. But the jobs of tomorrow are taking shape all around us. Community leaders need to keep their minds open to possibility, and steer their constituents toward it.
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