In the middle ages, cities could spend more than 100 years building a cathedral while at the same time believing that the apocalypse was imminent. They must’ve had a remarkable conviction that commissioning these projects would guarantee them eternal salvation. Compare this to the way we think about planning and design today where, for example, we don’t think more than 3 years into the future simply because that would fall outside of this organisational election cycle. Sometimes it feels like the bulk of the work that a politician does today is to secure the funding that will get them re-elected tomorrow. Where do we see real-world examples of long-term planning that will help guide our decision-making in the present?
A few days ago I spent some time preparing feedback on a draft of the HPCSA minimum requirements for physiotherapy training in South Africa and one of the things that struck me was how much of it was just more-of-the-same. This document is going to inform physiotherapy education and practice for at least the next decade and there was no mention of advances at the cutting edge of medical science and the massive impact that emerging technologies are going to have on clinical practice. Genetic engineering, nanotechnology, artificial intelligence and robotics are starting to drive significant changes in healthcare and it seems that, as a profession, we’re largely oblivious to what’s coming. It’s dawned on me that we have no real plan for the future of physiotherapy (the closest I’ve seen is Dave Nicholls new book, called ironically, The End of Physiotherapy).
What would a good plan look like? In the interests of time, I’m just going to take the high-level suggestions from this article on how the US could improve their planning for AI development and make a short comment on each (I’ve expanded on some of these ideas in my OpenPhysio article on the same topic).
- Invest more: Fund research into practice innovations that take into account the social, economic, ethical and clinical implications of emerging technologies. Breakthroughs in how we can best utilise emerging technologies as core aspects of physiotherapy practice will come through funded research programmes in universities, especially in the early stages of innovation. We need to take the long-term view that, even if robotics, for example, isn’t having a big impact on physiotherapy today, one day we’ll see things like percussion and massage simply go away. We will also need to fund research on what aspects of the care we provide are really valued by patients (and what they, and funders, will pay for).
- Prepare for job losses: From the article: “While [emerging technologies] can drive economic growth, it may also accelerate the eradication of some occupations, transform the nature of work in other jobs, and exacerbate economic inequality.” For example, self-driving cars are going to massively drive down the injuries that occur as a result of
MVAs. Orthopaedic-related physiotherapy work is, therefore, going to dry up as the patient pool gets smaller. Preventative, personalised medicine will likewise result in dramatic reductions in the incidence of chronic conditions of lifestyle. The “education” component of practice will be outsourced to apps. Even if physiotherapy jobs are not entirely lost, they will certainly be transformed unless we start thinking of how our practice can evolve.
- Nurture talent: We will need to ensure that we retain and recapture interest in the profession. I’m not sure about other countries but in South Africa, we have a relatively high attrition rate in physiotherapy after a few years of clinical work. The employment prospects and long-term career options, especially in the public health system, are quite poor and many talented physiotherapists leave because they’re bored or frustrated. I recently saw a post on LinkedIn where one of our most promising graduates from 5 years ago is now a property developer. After 4 years of intense study and commitment, and 3 years of clinical practice, he just decided that physiotherapy isn’t where he sees his long-term future. He and many others who have left health care practice represent a deep loss for the profession.
- Prioritise education: At the undergraduate level we should re-evaluate the curriculum and ensure that it is fit for purpose in the 21st century. How much of our current programmes are concerned with the impact of robotics, nanotechnology, genetic engineering and artificial intelligence? We will need to create space for in-depth development within physiotherapy but also ensure development across disciplines (the so-called T-shaped graduate). Continuing professional development will become increasingly important as more aspects of professional work change and over time, are eradicated. Those who cannot (or will not) continue learning are unlikely to have meaningful long-term careers.
- Guide regulation: At the moment, progress in emerging technologies is being driven by startups who are funded with venture-capital and whose primary goal is rapid growth to fuel increasing valuations. This ecosystem doesn’t encourage entrepreneurs to limit risks and instead pushes them to “move fast and break things”, which isn’t exactly aligned with the medical imperative to “first do no harm”. Health professionals will need to ensure that technologies that are introduced into clinical practice are first and foremost serving the interests of patients, rather than driving up the value of medical technology startups. If we are not actively involved in regulating these technologies, we are likely to find our practice subject to them.
- Understand the technology: In order to engage with any of the previous items in the list, we will first need to understand the technologies involved. For example, if you don’t know how the methods of data gathering and analysis can lead to biased algorithmic decision-making, will you be able to argue for why your patient’s health insurance funder shouldn’t make decisions about what interventions you need to provide? We need to ensure that we are not only specialists in clinical practice, but also
specialistsin how technology will influence clinical practice.
Each of the items in the list above is only very briefly covered here, and each could be the foundation for PhD-level programmes of research. If you’re interested in the future of the profession (and by that I mean you’re someone who wonders what health professional practice will look like in 100 years), I’d love to hear your thoughts. Do you know of anyone who has started building our cathedrals?