The Other Amazon Effect

I was keen to write about how Amazon Prime Day related to healthcare, but my esteemed colleague Jane Sarasohn-Kahn beat me to it, so I'll turn instead to another set of headlines that Amazon has been generating lately: their "Upskilling 2025 initiative to retrain a third of its workforce.  The company plans to spend some $700 million to retrain 100,000 workers by 2025. 

I wonder if healthcare is prepared to make the same kind of upskilling/retraining investments.  Because it is going to need to. 

Not everyone is wowed by Amazon's initiative.  As Peter Cappelli, a professor at Wharton, told The Wall Street Journal: "It’s not altruistic.  There’s some hard-nosed business-decision-making behind this.”  Or, as Marc Perrone, the president of the United Food and Commercial Workers Union said: 

Jeff Bezos’s vision is clear – he wants to automate every good job out of existence, regardless of whether it’s at Whole Foods, Amazon warehouses, or competing retail and grocery stores.

Let that charge sink in: "he wants to automate every good job out of existence."

As it happened, on the same day that Amazon made its announcement, the McKinsey Global Institute released its report The future of work in America: People and places, today and tomorrow. The report illustrates the trends that Amazon is trying to address, including its finding that: "Nearly 40 percent of US jobs are currently in occupational categories that could shrink between now and 2030." 

Equally important, they point out:

Previous MGI research has found that less than 5 percent of occupations can be automated in their entirety, but within 60 percent of jobs, at least 30 percent of activities could be automated by adapting currently demonstrated technologies.¹ What lies ahead is not a sudden robot takeover but a period of ongoing, and perhaps accelerated, change in how work is organized and the mix of jobs in the economy.

 McKinsey rated health care professionals as among the lowest whose jobs faced displacement (but still around 10%), while "health aides, technicians, and wellness" had higher but still below average displacement risks.  Still, "Office support" workers had the highest displacement likelihood, and I wonder how many "healthcare" jobs would truly fit into that category. 

Credit: McKinsey Global Institute

If your healthcare job does not entail being directly involved in actual patient care, you should probably be thinking about that upskilling (and even those giving direct care may need some).

Let's face it: for all the expensive technology, our healthcare spending mostly goes to people.  U.S. healthcare's administrative costs are rightly criticized as being much higher than in other healthcare systems, and those administrative jobs seem to be growing much faster than clinical ones.  We have complex processes that often don't make sense to patients, and that require constant intervention from people to execute them.  We have many clinical decisions based on personal preferences, not empirical evidence.

None of that can last.  None of that is good for our health.  And none of that should reassure anyone about their healthcare job. 

Three things are clear to me:

1. Administrative processes are going to continue to become more automated, as we seek efficiencies and as technologies continue to facilitate them;  
2. Robots are going to help care for our aging population, as demographic trends overwhelm our labor force;
3. Artificial intelligence will become an integral, even primary, part of clinical decisions and care, as Big Data and A.I. grow more powerful.

All of those spell fewer healthcare jobs.  The bull market in healthcare employment that we've seen for the last 20 years is not going to last much longer.  

Amazon's mantra has always been to focus on the customer, not on profits, but that mantra often seems more observed in words but not actions in healthcare.  Healthcare organizations are certainly looking at their costs, but patients often feel that budget cuts seem to adversely impact the people dealing directly with them instead of all those mysterious people in the back offices.

Technology is going to help change that.  For example, an article in blockdelta describes 15 trends in "medical robots disrupting healthcare," including robotic surgery, endoscopy bots, companion robots, nanobots, and AI diagnostics.  Similarly, John Nostra predicts that "AI will be smarter than the clinician. It will even become compassionate."   He believes clinicians need to focus on owning the compassionate domain rather than the cognitive one.

Whenever I am in a care setting, I try to talk to whomever I'm dealing with about the technology they're using, usually the EHR.  The stereotype often holds true: the older the person, the more they grumble about it, the harder they seem to find it to use.  The thing is, the technology is not going to go away (although hopefully it continues to get better); their job might be.  

In its press release, Amazon noted that its fastest growing jobs have been data mapping specialist (832% growth), data scientist (505%), solutions architect (454%), security engineer (229%), and business analyst (229%).  Few believe they're going to upskill many warehouse workers to data scientists, but, as Ardine Williams, Amazon's vice president of people operations, told The New York Times: 

When automation comes in, it changes the nature of work, but there are still pieces of work that will be done by people.  You have the opportunity to up-skill that population so they can, for example, work with the robots.

So needs to happen in healthcare.  

Healthcare has been focused on finding enough people, and is belatedly realizing it needs to finds more of the right people, with new skills and approaches.  The harder part, though, will be to upskill its current workers to the healthcare system that we're going to soon have.   As Ryan Carson, founder and CEO of Treehouse, told The Journal, 

The big secret is there is no lack of talent.  We just haven’t been looking in the right spots. That talent is often at your own company. They literally already work for you.

Maybe med techs or nursing aides aren't going to become data scientists either, but healthcare needs to figure out its upskilling strategy before it faces a jobs apocalypse.