What will healthcare look like in 20 years? In this conversation, Jackie Gerhart, M.D., chief medical officer at Epic, Thomas McGinn, M.D., chief physician executive officer at CommonSpirit Health, and Zia Agha, M.D., chief medical officer at West Health, discuss the rapid pace of healthcare's evolution, and what that means for physicians, patients and health systems. From continuous care and workforce challenges to stronger patient relationships and emerging technologies, this conversation examines the changes shaping the next generation of healthcare and beyond.

Tom Haederle

Welcome to Advancing Health. How will AI impact the practice of medicine? The most accurate answer is sooner than you think. Join us today for a different kind of podcast as four physicians discuss what AI holds for medicine, for patients and for themselves.

Chris DeRienzo, M.D.

Welcome everyone to a very special episode of the AHA’s Advancing Health podcast. I’m Dr. Chris DeRienzo , the chief physician executive of the AHA, and I am the luckiest human being on earth today because I am in a room with three of the most interesting doctors in the United States of America. I'm going to ask each of them to introduce themselves quickly, and then we have prepared a one of a kind podcast for you that imagined us to be sitting around one of our kitchen tables over a beer, talking about how AI will impact the practice of medicine over the course of each of our careers.

Chris DeRienzo, M.D.

But first, you got to get to know who these folks are, and so Tom, we'll come to you.

Thomas McGinn, M.D.

How you doing? Tom McGinn, I'm a general internist, and I'm the chief physician executive officer at CommonSpirit Health.

Chris DeRienzo, M.D.

Wonderful, Jackie, to you.

Jackie Gerhart, M.D.

Jackie Gerhart. I'm a family medicine physician at Epic and still practice.

Chris DeRienzo, M.D.

And Zia.

Zia Agha, M.D.

I'm also a general internist, and I'm the chief medical officer at West Health.

Chris DeRienzo, M.D.

And you also live in beautiful San Diego. And so for listeners, I want you to put your imaginary hats on and imagine that you are staring out at the lovely Pacific Ocean. It is an absolutely gorgeous view, and we're just sitting reflecting on the era that we're living through right now, but also what's to come. One of the most frequent questions I get asked when I'm on the road visiting with AHA members is, as a doctor, how do you think your life will change with AI?

Chris DeRienzo, M.D.

And I've got to call it maybe 20 years left in the arc of an average career. And what I typically answer them is faster than you think. I remember one year ago I was doing a panel with this amazing CMO who told me, look, right now we're just beginning to get ambient into our systems and it works great.

Chris DeRienzo, M.D.

And I asked him, how long do you think until not only is ambient documentation listening to the conversation, the beginning to prompt questions based on having reviewed the entire medical record. You think it's three years? Five years, he said. Nine months. And I said, Dave, you got to be you got to be joking me. And here we are about a year later

Chris DeRienzo, M.D.

and he was totally right. So my top line answer is, I think it's going to change the practice of medicine quicker than most folks appreciate. But I'm wondering what you all think. And Zia, I see you looking intently at me. So I want to come to you first.

Zia Agha, M.D.

I think, Chris, the speed of innovation and the speed of change is truly breathtaking. I mean, I remember when EHRs were introduced or barcode technology introduced in the hospital, it was a decade long implementation. I think we're seeing AI go from 40% respondents in the AHA survey to now 81% in one year. So it is definitely catching on really fast.

Zia Agha, M.D.

It's also catching on really fast on the patient side. In our own survey with Gallup, 1 in 4 patients are using AI either before or after a clinical visit.

Thomas McGinn, M.D.

I mean, 100% agree, I think. But I do like to kind of pause a little bit and say, I think what I see now hopefully, and is augmentation of - not replacement. And I think that's a big question mark that everyone has, is this replacing you know, physicians, nurses, APPs? Look the ambient scribing - everyone talks about this now

Thomas McGinn, M.D.

and it it's the first time I've seen physicians banging on my door to get new technology. And they want to change. So I think that's fascinating to see them actually want to do this. And we also realize what we've done to physicians over the years with data entry and documentation that this is really a difficult situation, and we're finally have a relief for them.

Thomas McGinn, M.D.

Now, the question is, will they turn around from their computer and look their patients in the eyes, particularly the young physicians, might be anchored on their laptops and not sure how to turn around. So it'll be interesting to see what happens there.

Jackie Gerhart, M.D.

That's a really good point. I think in taking a step back, we've all heard that different clinicians might be having some kind of an identity crisis, and I think you're speaking to that. But as I've looked at my colleagues, it's more of an identity curiosity. I'm curious what it's going to be like for medical students in the next few years.

Jackie Gerhart, M.D.

I'm excited about what it is for me right now. When I went into medicine, thinking I would do whether that was, you know, a lot of documentation, whether it was curating on pre-rounds and then on rounds and then on post-rounds and so forth, some of the burden has really been alleviated. And I'm finding that there's kind of two types of AI that I'm seeing.

Jackie Gerhart, M.D.

The first is something that relieves friction and really reduces burden. And that's great. And the other is one that's really advancing medicine and trying to help us diagnose faster, treat faster, treat better. And really, I think the best AI is what's combining both of those. And that's what I'm most excited about.

Chris DeRienzo, M.D.

You lift up something that I think about a lot, and I was having this conversation with my eighth grader not too long ago. We were doing her math homework and she said, dad, why do I have to learn this? I will never be without technology and..

Thomas McGinn, M.D.

Scary question, really!

Chris DeRienzo, M.D.

I feel like that's sort of the conversation we're having in many professions, but certainly in the in the profession of medicine, I don't know that memorizing the Krebs cycle should be a gate by which we, we ask students to, to pass through their, their medical careers. But at the same time, I don't think we've answered if we don't make sure you memorize the Krebs cycle, how do you understand what a urine organic acid deficiency actually is?

Chris DeRienzo, M.D.

And I feel like this is kind of one of our biggest challenges right now.

Thomas McGinn, M.D.

The term I'm very worried about, and I think, you know, we're talking about, hey, what's this great thing going to look like in ten years from now? The question is from here to ten years. A lot of things to figure out and de-skilling is the big one for me. And, you know, we - CommonSpirit has, you know, two major academic hubs.

Thomas McGinn, M.D.

I'm a professor at Baylor. I work with the students, I make rounds, and I get worried when I ask people like, what's in that, that order you just put? It's a bundled, it's a bundled order, and they don't know what's in the order because it's bundled. That's not AI, that's just the bundled order. Now when I ask them, well, what's in that AI thing you just ordered?

Thomas McGinn, M.D.

And they can't unwrap it and understand all the different moving parts and the implications, that's a little bit of a concern. So de-skilling is something that we're really focused on.

Jackie Gerhart, M.D.

Interesting. You said de-skilling in the same conversation I often hear never skilling and is correct cycle.

Thomas McGinn, M.D.

That's right. Never skill? Absolutely.

Jackie Gerhart, M.D.

If you think about it, a few of us learn to do blood draws. We've learned to do multiple procedures that we probably never do anymore, even for me in primary care. As we go more virtual, a lot of the learnings that we had were around how do you do the perfect physical exam, and what does technology do to actually enhance the physical exam that you had before?

Jackie Gerhart, M.D.

And I think it's done remarkable things. And in many cases we're trying to figure out what technology to augment humans. But I do still think there's this never skilling component of what are the things that we actually can take away from the physician that maybe just were there because of legacy purposes or because that's how it always was done?

Jackie Gerhart, M.D.

And yeah, I feel like there's this we have this concept of eliminate, automate and rebalance, which is if you can just get rid of the work period, not put it on someone else, but just get rid of it, period. Maybe give it to AI, just get a better workflow and get it out of the system immediately. That's kind of the question I ask before I even start using a certain technology.

Jackie Gerhart, M.D.

Do I even need to be doing this in the first place?

Zia Agha, M.D.

I think I want to take the conversation outside of the patient-physician encounter, because we've talked about that a lot. You know, we see patients and then we say, okay, come back in six months and they say okay, he's going to be fine for six months. What happens when something goes wrong in between? And I think that's really where the opportunity is.

Zia Agha, M.D.

How do we use these technologies to sort of keep our patients tethered to the healthcare system and be proactive?

Thomas McGinn, M.D.

We have a connection centers. We have five hubs to the country that are really well done. They reach out to patients and now we're automating auto reach outs. One vendor did come to me, an AI vendor to show me these outreaches to patients who you can model they might be at risk. Think of an older woman with multiple chronic illnesses just discharged a few months ago.

Thomas McGinn, M.D.

The conversation the AI tool had with the patient was unbelievable, but it was really the purpose would be augmenting between the visits, touching base, looking for signals, and just comforting patients that, you know, hey, just checking in. You just had surgery. You want to make sure you're doing okay.

Chris DeRienzo, M.D.

Chris DeRienzo, M.D.

So technology can allow us to do things we've never done. But it also means, and you hit on this a little bit, Jackie, that there is some things that maybe we don't have to do anymore. And I think the open question, I think about my life as a neonatologist. I don't think that, you know, robots are going to be putting in central lines in the next five years, but 20 years from now, maybe, maybe.

Chris DeRienzo, M.D.

And so what am I doing as a neonatologist if, you know, five years from now, I don't have to be doing what I remember doing as a medical student like you go into the manual chart writing the vital signs. You know, that same shift is transitioning from the electronic space to the physical space in the course of our professional careers.

Thomas McGinn, M.D.

I worry a little bit about this. This never skilling thing is fascinating to me, because training in a big county hospital and putting IVs in patients that were very difficult to access veins, and then an IV team came in and suddenly took over. I mean, it's a different - it's not a bot - but it's...Actually I think we didn't we missed a lot of moments with our patients sitting with them, trying to put an IV in the middle of the night doing work like that.

Thomas McGinn, M.D.

There's some things you lose in that process, so particularly around the patient.

Jackie Gerhart, M.D.

I love the idea of giving back a certain amount of time, or maybe even freeing up time that you never had in the first place. And what will you do with that time? There's been a couple of surveys on would you see another patient? Would you learn more? Would you actually eat or go to the bathroom? I think some of those are just, you know, it speaks to the survival that a lot of us are feeling.

Jackie Gerhart, M.D.

And how does one survive? For me, for example, I started out in general what some might consider country practice, family medicine, where I did inpatient, outpatient, OB, nursing home. Followed all of the same folks that were in my panel and really knew them by name. And I think your point is a good one that, you know, as we take away the administrative burden of what does that mean

Jackie Gerhart, M.D.

to bring you back to your patient, is what other things are there that the patients actually want that we haven't really been listening to? We're still in this age of where, you know, whether it be fee for service or whether it be in front of the patient or whether it be in an institution. I think there's this concept of asking patients how they want their health to be, what their goals are, and who do they want to be tethered with, who is their care team now?

Jackie Gerhart, M.D.

And that might look very different now in the age of AI than it did before.

Thomas McGinn, M.D.

Well, when you listen to these conversations with the AI tools, patients love them. The one thing you'll hear me say when I talk AI, we're rolling out ambient scribing across the system. We as leaders in healthcare cannot make this a throughput engine only. We need to look at the moment of care and are we enhancing it and not just ratcheting up the RVUs only?

Thomas McGinn, M.D.

I mean, you may get 1 or 2 visits in, but you'll also get better visits.

Chris DeRienzo, M.D.

I did a panel not too long ago with the CEO for a large multi-state health system, and he described the primary ROI that their system was measuring on an ambulatory AI rollout for ambient for physician APP documentation was the experience of a clinician and the experience of the patient, because they recognized that the generation we have all lived through has layered technologic burden on as we digitized a manual process, and that we've now spent a good ten years realizing that need to be optimized.

Chris DeRienzo, M.D.

And so we're working through that optimization. But at the same time, anything we can do to relieve some of that burden gives us back time for what, at least for me, have been the most meaningful moments of my clinical career. And I can remember sitting with human to human, having these conversations, making hard decisions. To me, that's my hope for the next 20 years, is that the physicians who are not even in medical school yet, because I guess 20 years from now, there would probably be preschoolers right now or something like that.

Chris DeRienzo, M.D.

So, so the four year old preschool classes, who will be graduating medical students when I am finishing my career, that that most of their time will get to be in those impactful relational settings.

Jackie Gerhart, M.D.

And maybe the measurement changes as we think about - sometimes I'll look at the term to work at the top of your license, and I like that term because I think it tries to imagine what it is that when we're doing our best work. But inherently in that term is the word license. And working at the top of your license means that you literally are getting licensed by an exam that probably was created before AI.

Jackie Gerhart, M.D.

And so what does that mean for your skill set? I think for me, I highly value if I were on a medical school admissions committee, I would value curiosity and judgment and ability to communicate. I think we as clinicians need to be thinking more about how do we take science and be able to translate it and amplify it to the rest of the public so that they can really make decisions?

Jackie Gerhart, M.D.

And I think in this age of democratization of data, when patients have all of this information in front of them, we can really be a helpful guide, not someone that tries to push it aside, but someone that really brings it into how we're going to advance medicine and have individualized, personalized care that can be done faster and more effectively.

Chris DeRienzo, M.D.

So I've got to ask, just like closing thoughts, because we talked our viewers, our listeners through some pretty interesting rollers here over the last nearly 20 minutes. What gives you the most hope about the rest of the arcs of our career? If you had to just sum it up in one thing, Tom, what gives you the most hope?

Thomas McGinn, M.D.

Well, I think we've been talking about this. I think this will free up clinicians to be with their patients. And I use the word caring very intentionally. So I think we've somehow, through our productivity mindsets, kind of knocked caring out of a lot of the health system. And by caring really wanting to be with the patient and care with them in their entire journey.

Thomas McGinn, M.D.

I hope, I really hope this helps us be with them in their journey, because the journey is not a visit.

Zia Agha, M.D.

Couldn't agree more. I think the key word is we are all caregivers and I think if these tools can help us be better caregivers to help our patients. You know, we work at rest with a lot of older adults and sort of dignity, with respect and with the right outcomes is so important.

Chris DeRienzo, M.D.

Jackie, last word comes to you.

Jackie Gerhart, M.D.

I'm really hopeful about reimagining what it means to have health and health care. And for a long time we've thought about it as something that you physically go to. You do a physical exam, you physically go to appointment, maybe even a virtual appointment. But I really liked the discussion we had around this continuous care. And most of the points that patients have in their life and their well-being are not going to be in front of a clinician or a doctor or a hospital.

Jackie Gerhart, M.D.

And so how do we respect those? And in the age of AI, having that be part of the care team and really help them get to what they want for their lives is very promising.

Chris DeRienzo, M.D.

I promised you a conversation with three of the most interesting physicians in the world.

Thomas McGinn, M.D.

You're the fourth one,

Thomas McGinn, M.D.

yes, please, Chris!

Chris DeRienzo, M.D.

You all are far too kind. I promised you a fascinating conversation. This more than delivered and we so appreciate it. Thank you all for listening until next time.

Tom Haederle

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