Medicine=Job Security…Think Again.

You may recall the time in 2011 when IBM introduced Watson, which competed against former winners Brad Rutter and Ken Jennings winning the first place prize of $1 million.

You may have found it amusing, maybe just didn’t really even noticed or cared.  Watson is part of a new wave of Artificial Intelligence that may have many implications in what you do as a doctor and may even replace you!

We have all heard the water-cooler conversations regarding the evils of social media in our workplace but have we stopped to consider a more insidious threat to our livelihood?   The Digital Revolution…

Going back to our pal Watson, during the Jeopardy televised competition, he had no access to the internet during the game, however, had access to 200 million pages of content making up about 4 terabytes of memory, including the full text of Wikipedia.  

In February 2013, IBM announced that Watson’s first commercial application would be for utilization management decisions in lung cancer treatment at memorial Sloan Kettering Center in NYC.

In recent months many reliable media outlets like NPR, TED talks, and a popular entrepreneur podcast have had interesting discussions regarding this topic with excitement and many questions centered around job security and the implications to the world as a market place.  

I agree and cannot argue that this is great for patients and maybe healthcare as a whole!!!   But where does that leave physicians, nurses or even administrators in 10-15 years?

Why 10-15 years?  Well you may have heard of Moore’s Law which basically illustrates the exponential rate at which computer technology evolves.   Technology evolves at a fast growth rate and humans cannot keep up with that!

On April 21, 2017 the NPR TED Radio Hour podcast named “The Digital Industrial Revolution” discusses the current status and future implications of A.I.  

Erik Brynjolfsson, Professor and director of the MIT initiative on the Digital Economy stated,  “If we can eventually create robots to do everything and do it  better, where does that leave us.  We are at the beginning of a new digital age, starts as a small change which grows exponentially.  Over the next 10 years, can we adapt fast enough?Exponential trends take us by surprise.”

The most important invention at this time is “machine learning.”  The full implications of the new digital age will likely take while to take place but they are staggering and they are coming.

Initially, computers will likely replace tasks not jobs, so if tasks for a job are “outsourced,” then where does that leave us?

If you are a radiologist, maybe computers will be able to read images better, however, making the broader diagnosis and communicating to the patient will be better done by radiologist at this time but that can and will likely change.

Perhaps teamwork is the key, where computers and humans can work together.

Marco Annunziata, Chief Economist and Executive Director of Global Market Insight at GE stated, “In next 20 years everything in the workplace will change.   New and different interactions between robots and virtual machines will be common. The industrial internet will bring together, intelligent machines, advanced analytics, and the creativity of people at work.”

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We are already seeing this in Amazon where you get on the app and algorithms suggests products based on your buying behavior and it continues to learn more about you.  The same can be said about YouTube or other social media marketing.

“Industrial machines will have many sensors which will allow them to hear, see and feel more than ever before, generating data, then analytics will sift through data providing insights that will allow us to operate the machines in new ways and more efficiently.”

Annunziata believes it will take about 20 years for these changes to affect the industry and economy.  However, others predict this change in much less time.  The implications of AI will affect practicing physicians that finished residency in the last 10 years.  

There is much attention being given to the risk of unemployment resulting from automation and A.I.  Annunziata is skeptical of the argument that 50% of jobs will disappear in future, transition will be difficult as there will be disruption.  However, you cannot deny that a big change will come.

Maurice Conti, from Autodesk (software co.). Talks about the “Augmented Age:”

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“We are all augmented as we have easy access to data through our mobile device, however, we still need to turn it into knowledge.  Soon many machines will not just answer questions but will start thinking for themselves, coming up with their own ideas and “feeling” their world around them.”

“Tools are making this leap from being passive to being generative, generative design tools use a computer and algorithms to synthesize geometry, to come up with new designs by themselves, all they need is your goals and your constraints.”

For example, you can tell the computer to “solve a medical problem,”  it will then explore entire solutions, every single possibility that solves and meets your criteria.

“I cannot think of a single profession, including professions that require a whole lot of brainpower,, like psychiatry, that couldn’t be replaced by a machine that becomes smarter and smarter,” stated Guy Olson, host of TED Radio Hour.

Jeremy Howard, founder of Deep Learning, Fast A.I. states,

“We went through the process of replacing hunting and gathering with domestication, we went through process of replacing animal energy with mechanical energy,  we are now going through process of replacing human intelligence with artificial intelligence.”

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Deep Learning is based on the way the human nervous system works.  Deep learning relies on neural network and we are already using them.  For example, Skype translation.

A few years ago, Howard built an algorithm for diagnosing lung cancer that beat a panel of the world’s 4 best radiologists.  He humbly rebuts,  “I know nothing about what cancer looks like or doesn’t look like because I have no background in medicine.  So you can imagine the power it provides for good, every time a piece of medical imaging is done, automatically an alert appears saying, this person has an aneurysm or a malignant nodule in their left lung…that would save billions of lives and dollars.”

This kind of technology will allows us to solve a major problem of lack of medical expertise in the developing world.  The world economic forum states there is between a 10X and 20X shortage of physicians in developing world.  It would take about 300 years to train enough people to meet demand.  Deep learning could enhance efficiency.

Howard states, “I did my TED talk 2.5 yrs ago where deep learning was a new technology and at this point computers are better at recognizing what is in a photo than humans are, better at understanding Chinese and English speech than chinese and English native speakers.  We now have deep learning algorithms that are better at building the networks that create deep learning algorithms than humans are.   It only took 2.5 years for deep learning to surpass human capabilities in these fundamentally human areas.”

“Given that the jobs that we have today are going to disappear probably quicker than everyone expects, we need to develop ways of supporting people economically.  In the digital age one cannot say that they are not adding value so therefore they are not worthwhile to society.  You have to say, we think everyone deserves to live in dignity so let’s have a basic guaranteed income to assure that.”

On a separate TEDx talk on December 2014, Brussels, Belgium, Howard stated:

“Google, Amazon, Netflix, Linkedin all use algorithms for deep learning, learn your preferences, and suggest searches, products, movies and people you should connect with.”

“In medicine, a team in boston discovered many dozens of new clinically relevant features of tumors that helped doctors make the prognosis of cancer.

At  Stanford, looking at tissues under magnification and using algorithms, they developed a system to predict survival rates better than pathologists.  They found that the cells around the cancer are as important as the cancer cells in making a diagnosis.”

Jeremy Howard is the founder of Enlitic:

Silicon Valley CEO, and author of the New York Times Best-Selling book, “Rise of The Robots,” Martin Ford, was interviewed on Mike Dillard’s popular entrepreneur podcast, “Self Made Man,” on March 8, 2017 and in this podcast an astonishing prediction was made.  

In just a few year’s time, it will be the year 2025, and that is the year the world will change forever?
Why? Because 2025 is when your computer will have the same processing power as the human brain.
“And then just 18 months later, it will be twice as fast, and then 18 months later, four times faster, as Moore’s law continues its exponential rise.
Combined with the recent developments in AI and physical robotics, the world is about to change in a way that’s difficult to comprehend” states Ford.

Ford adds, “The careers of Driver’s, Doctor’s, lawyers, financial advisors, customer service agents, teachers, truckers, soldiers, and more are all at risk of disappearing within the next 15 years.  Which poses an incredible question when you realize that there will be around 8 billion people on the planet, who all need work, who all need to earn a living, and who all need a purpose.
What will my six year old son Chase possibly be able to do in 20 years, that a superhuman robot can’t? What will your children do, and what will you do?
What can you do today to create financial security for yourself and your children in a world without jobs?
The time to start thinking strategically about these changes is now, because your future will not look like your parent’s.”


Is this why congress has failed to increase funding for residency programs?.  Maybe they have known that soon we will be replaced by machines and AI?

This leaves me with a few questions:

If you are interested in becoming a physician will it be worth the time, money, sacrifice and effort it will take to end up with a $300K debt for which you may not have a job to pay for it?

How will physicians remain relevant in medicine in 15 yrs?

Will hospital systems and insurance companies will be interested in sustaining a market for which humans take an active part as we make mistakes, fail to follow protocol, and are expensive?   I can see it now,  the Aetna and BlueCross/BlueShield Armies of physician cyborgs managing the health of millions.  

One thing to consider is that when there is a major swing in one direction there usually is a swing in the opposite direction.

Take agriculture for example.  Mass production vegetables vs organic produce.

Will there be a large part of population that will want a genuine human health care experience?

Or the other question is:  What will you do to be relevant in this competitive marketplace?

J. Victor Tovar, MD, Founder and CEO of ProMEDeus

October 22, 2017

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