A while ago my primary doctor showed me the newest version of his office software and said, “Do you see this? They are trying to replace us.” My primary care physician, who is a D.O. and one of the few who buck the trend by staying in private practice, is skilled at explaining, does not routinely prescribe medications when there may be better options, and is an excellent diagnostician. In today’s practice environment, which is predominantly large systems of providers including many practitioners who were formerly in solo or group practice, diagnosis is often algorithmic, and the system has been simplified to Urgent Care, where everyone is given the same prescriptions for their symptoms, and they practice one-size-fits-all emergency medicine. If you have a primary doctor in the system, it often takes weeks or a month or so to get an appointment. You are constantly bombarded with texts and emails about the next vaccination and the next thing you should be getting done for yourself. Doctors are routinely rewarded for staying on time, referring within the system to other providers. There are caring people, but the system is uncaring and one-size-fits-all. Diagnosis is algorithmic, and patients often see the PA or the NP instead of their doctor. When care becomes one size fits all and algorithmic, who needs a doctor when a ChatGPT prompt can listen and fill out the record with the repetitive things everyone asks you multiple times in the doctor’s office? Yes, their jobs may be in jeopardy. It may not happen today, but everyone wants to maximize profits and minimize costs. My friend, who is an anesthesiologist, was working per diem for more compensation than full-time until he found himself displaced by nurses trained to do what he did, while he had to attend to 5 nurses working cases to improve case load follow-through. This ultimately was designed for the Wall Street company that now owned his group to make money and satisfy their financial needs. Patients were merely a widget in their product line in anesthesia. If you are not using your provider skills and everyone is treated the same, yes, a computer can outdo you in diagnosis. In the world I live in, from a chiropractic perspective, a computer cannot perform or think how I do because we do not have one-size-fits-all patients who come in different sexes, sizes, histories, and such. Doctors who lack this type of sophisticated thinking are replaceable; those who are thorough and thoughtful and willing to think outside the box and are outcomes-oriented are not. Hospitals and large systems are not hiring chiropractors in mass yet, but musculoskeletal medicine is a thinking person’s game. People are not algorithms, and we must understand and properly holistically evaluate and treat them, vs. manage them into chronicity, which is what most physicians do now with the disease model, constant monitoring, and medication overuse to manage rather than solve what we suffer from. When your professional art is commoditized as much of today’s medicine is, the doctor becomes a widget taking care of widgets. Those doctors may find themselves replaced by technology designed to do this better and cheaper than they can. Health systems will always need doctors. Our system needs more competition, and care must be patient-based and not based on an algorithm. Our current system is based on this idea right now, and healthcare is getting worse and more costly. There needs to be a better system than just profit margins and efficiencies. We need better care. Outcomes, rather than procedures and chronic disease management, should be rewarded. Insurance companies should get out of the way, as should all middlemen, to reduce cost, red tape, and frustration, so patients can get better care. The system must become health-based so that as we age, our health span rather than our life span is the ultimate goal, which will come at a much lower cost. Check out the article in the NY Times below A.I. Chatbots Defeated Doctors at Diagnosing Illness