Wednesday, December 9, 2009

More On the Parallels Between the Airline Industry and Population-Based Care Management

In its various speaking gigs, the peripatetic Disease Management Care Blog has alluded numerous times to the parallels between flying jets and plying care management. Sure, the delays, nuisance fees and cramped seating can make for misery, but you have to admit that the safety record is superb. It's no longer up to just the pilot. It takes a team. Passenger safety depends on systems. Travel quality divided by price times consumerism equals value. While these and some other insights have generally stood the test of time in numerous presentations, some recent media reports have made the DMCB pause.....

First off, WHYY's Radio Times with Marty Moss-Coane had an interesting interview with an experienced pilot. If you're a road warrior, it makes for good insightful listening. But there were two major points of significance to the population-based care management industry:

1) While today's aircraft are backed up with state of the art digital avionics, computerized decision support and automatic safety systems that practically fly themselves, the truth is that the pilot's job has become far more complicated. While there are flight envelope protections, the complexity of today's planes commands ever higher skill sets that are no longer restricted to old fashioned flying.

And so it is for the physicians. They not only need to know to singlehandedly deal with the manifestations of disease, but they also need to navigate wards or clinics full of people through the myriad other issues of a complex health system. Both pilots and docs are now also network operators.

2) Despite their unique talents and the lives that are stake, pilots' compensation has not been immune from the travel industry's economics. Starting annual salaries for the regional jet pilots are now in the unbelievably low range of $35,000. While there are 8 hour rest rules, it's not unusual for pilots to put in 16 hour days with multiple take-offs and landings capped off with an hour to get to their hotel room for 6 hours of sleep so that they can get back to the airport the next day after day after day. It's hard work, sleep deprivation and low pay over many years before they get to fly those coveted international routes with a six figure income.

And so it may be for the physicians. The cost structure of the airlines back in the 1990's became unsustainable. Costs had to be cut everywhere and the industry did what it had to do. Unfortunately, despite assertions that we can preserve much of the status quo with payment reform, information technology, better use of research and rooting out fraud and abuse, our highly paid physicians may end up like our nation's commercial pilots. $35,000? Yikes.

And finally, check out this 'Bring Back the Off Switch' Wall Street Journal editorial. In it, Holman Jenkins argues that we need an analog option to deal with the rare but still possible human-digital interface system malfunctions. It's called an 'off' switch. Lexus cars can accelerate out of control with no way to turn the 'key' and Airbuses' speed sensors were vulnerable to ice build-up, leading to a cascade of errors which may overwelm pilots. Ditto on the healthcare future of our digital home monitoring devices, computerized clinical decision support, drug delivery systems and robotic surgeries (to name a few). The DMCB thinks that one of the roles of a pilot or a physician is to know when to recognize systems failure, turn it off and take control.

For maintaining that skill and knowing when and how to use it, both classes of professionals deserve to be richly compensated by passengers and patients. Whether that happens remains to be seen.

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