Primary care providers and primary care medicine are on the downswing in the U.S., burdened with increasing demands of documentation and numerous complicated quality programs in the face of rapidly diminishing reimbursements. While the tribe is disappearing fast, enter its newest nemesis: artificial intelligence (AI).
You might wonder why AI is detrimental to primary care and primary care physicians. The common notion is that physicians, including primary care physicians, will be able to use AI as an extension to augment their work and increase efficiency. While this might be true to some extent, primary care is also facing an existential threat from AI.
The ultimate danger primary care faces from AI is more or less its eventual replacement by AI. In the short term, this replacement will not be done by any fancy robots, but interestingly by the patients themselves. Primary care physicians usually manage chronic diseases, preventive care, care coordination, take care of minor illnesses, and contribute to healthy living. While important in keeping the population healthy, most of these functions are within the reach of smart algorithms. Patients will be able to perform comprehensive searches about their health and decide what is best for them, thus bypassing primary care physicians. Human touch will be the only factor separating primary care provided by a “human physician” from the care provided by an algorithm run by a supercomputer in the future.
The rise of self-monitoring
General computing power is exploding exponentially with new chips and even quantum computers evolving on the horizon. Millions of powerful chips are being aggregated in chip farms and data centers to unleash unimaginable amounts of computing power. New programs and languages developed by AI companies could scan the internet and find specific information in a fraction of a second to provide answers to consumers, i.e., potential patients.
While these pathways may not yet be possible in complicated cases which might need additional discussions, intuition, and interplay of several specialties, it is quite possible to achieve high levels of accuracy in most of primary care in the near term.
To the query “people not needing primary care,” AI (Google Gemini) answered: “People who are generally healthy with no chronic conditions and maintain a healthy lifestyle, including regular exercise, balanced diet, and appropriate preventative screenings, are typically considered capable of monitoring their own health without needing constant primary care monitoring.”
No chronic illnesses, good health habits, basic health knowledge, and access to technology were cited as the key factors that will allow someone to self-monitor their health. AI still advised regular appointments with physicians for scheduling immunizations and preventive measures. AI also recommended people to be aware of the warning signs such as chest pains and severe headaches. Communication with a doctor is also advised. On repeated questioning, AI gave the examples of diabetes, hypertension, asthma, and heart failure as conditions where various types of self-monitoring could be done even now.
Theoretically, one can also monitor a set of various blood parameters and vital signs on a regular basis to detect any changes for preventative purposes. Even at present, there are internet sites which enable patients to order their own blood tests including unconventional and sophisticated tests such as apolipoprotein B, hs-CRP, and IGF-1. The actual utility and scientific validity of these approaches are unknown at the present time.
Soon, advanced computer programs can direct individuals to freestanding centers or procedural specialists to obtain regular preventive screening. As the AI literacy of the population increases, and more interactive programs become available to help with decision-making, the value of intimate discussions with the primary care provider becomes a moot point, especially to the internet generations such as Generation Y (millennials) and Generation Z.
Future diagnostics and workforce shifts
In the future, technical advances such as whole-body MRIs are likely to become cheaper and safer. Self-motivated and educated segments of the population are likely to use them independently, and regulations are unlikely to curb such usage given the market economy’s strength and history. AI programs will be at hand to advise or tease out these test results and recommend further steps. Diagnosis and even initiation of early medications in most routine medical conditions could be performed by a computer program with minimal or no physician supervision. Insurance companies or the government are unlikely to object, anticipating cost savings.
In addition to the above scenario, physician extenders such as NPs and PAs also will be able to use AI efficiently and accurately to provide streamlined primary care services so that the necessity of a physician with thousands of hours of training and expertise is going to diminish. A well-trained AI program could even double up as the preceptor for a group of physician extenders. Unusual or complicated cases beyond the reasoning ability of the program will be referred to a specialist or the emergency room, completely bypassing the need of a primary care physician.
What can primary care do to withstand these changes? Not much. After years of reduced payments and increased regulations and complicated and confusing programs imposed by federal authorities resulting in financial ruin and a burnout epidemic, we have effectively driven primary care and primary care physicians out of the U.S. health care arena. The advent of advanced AI in health care is likely to make primary care physicians irrelevant.
Maybe this is the natural progression of health care in the U.S. and world over. Maybe this portends the future takeover of health care by AI.
P. Dileep Kumar is a board-certified practicing hospitalist specializing in internal medicine. Dr. Kumar is actively engaged with professional associations such as the American College of Physicians, Michigan State Medical Society, and the American Medical Association. He has held a variety of leadership roles and has authored more than 100 publications in various medical journals and a book on rabies (Biography of Disease Series). Additionally, he has presented more than 50 papers at various national and international medical conferences. Several of his papers are widely cited in the literature and referenced in various textbooks.
Dr. Kumar has been involved in various hospital committees with advanced knowledge of Centers for Medicare & Medicaid Services (CMS) initiatives such as meaningful use, value-based purchasing, and Accountable Care Organizations.
Furthermore, Dr. Kumar has served as a scientific peer reviewer for various medical journals, including the British Medical Journal, Annals of Internal Medicine, American Journal of Cardiology, Physician Leadership Journal, and European Journal of Clinical Microbiology & Infectious Diseases.
