As we enter the New Year, I like to reflect on where we’ve been and where we’re heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care. Doctors and nurses appear stressed and downtrodden, administrators are running scared, desperate to seem « value-added, » and patients are scrambling to get seen in these last two days of 2013. It’s strange really. I thought I’d try to make some realistic predictions of what patients should expect in the year ahead now that the « Patient Protection and Affordable Care Act » (PPACA) begins to sink it’s tap root into the American medical system. Triage With the sudden expansion of the patient pool without a relative expansion of the physician pool, patients can expect a greater degree of triage to occur in medicine when they need to see a doctor. Triage will occur in many ways, but will fall along two lines: (1) treat the most urgent then (2) the most lucrative. Like it or not, these priorities will drive care for most medical facilities, especially our newly minted Accountable Care Organizations (aka, large hospital systems and care networks). Specialists will become purely proceduralists, internists and family practice doctors will see specialty follow-up and manage a team of nurse practitioners and « physician extenders, » and these care extenders will become the front line care team for the more common ailments. In effect, follow-up specialty care will shift down the health care « food chain » to those less specialized in the name of improving « efficiencies » in health care. 

Read more: http://medcitynews.com/2013/12/three-healthcare-trends-will-become-painfully-obvious-patients-2014/

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