We had an interesting lecture at Stanford on computers like Big Blue and their role in medicine. The speakers said that while computers may be able to take over many cognitive activities, it’s unlikely they’ll be able to operate on patients in the foreseeable future. The thrust of the lecture was that people who went into cognitive specialties would have more to lose to computers in the future than those who were in surgical specialties. What are your thoughts about that?
It’s very interesting. I saw a segment on “60 Minutes” on Big Blue where the supercomputer was used during a medical oncology tumor board. Big Blue searched the entire world for appropriate clinical trials and treatments. There’s no way that any individual person could possibly know all of those trials and treatments. That goes hand in hand with what we’re discussing.
I do believe that, yes, surgical skills are still going to be in the hands of surgeons. There will be assistance, just as we use robots and MRI-guided technology now, but ultimately, the final decision will continue to be with the surgeon. I see that continuing in the foreseeable future.
There are so many complexities and split-second decisions that are made in surgery that I’m not sure a computer can accommodate just yet. That being said, there are probably ways for a computer to figure that out as well; for example, what the odds are for certain things to happen based on the anatomy, and the factors involved.
What effect do you think subspecialization could have on unnecessary surgical procedures?
I think there’s always a risk for someone doing surgery when they don’t need to be doing so. Presumably, if someone is highly specialized in an area, they wouldn’t want to embark on a procedure that doesn’t make any sense. Subspecialization may be a way of making sure that surgeries are done for the right reasons. But like any procedure or any financially goal-oriented system, there are always going to be people who will take advantage.
Do you think that major changes in training with earlier subspecialization in mid-residency will be the way things move along?
I think we’re going to have to seriously consider it. It makes sense, certainly with the way we are providing health care and the way we’re using our resources. Look at what’s happened with bariatric surgery. You cannot perform bariatric surgery except in a center of excellence that’s been sanctioned to do so. I see robotic surgery not far behind this. I can’t imagine that it makes sense for every little hospital to own a $2- or $3-million robot to support surgeons who do five or six cases per year; the robot really needs to be in the hands of surgeons who do a lot of volume and understand how to move through the cases quickly and safely. The resources we have are limited, so why would we spend them on surgeons who, frankly, just shouldn’t be doing these cases?
How does subspecialization impact costs of care?
In a lot of ways, it may save quite a bit of money, because we are now creating a better outcome. Presumably, patients are getting the best care possible with minimal potential for morbidity and mortality based on the fact that the surgeons who are doing these procedures are well experienced. Again, why should a low-volume surgeon use up resources and presumably drive up the cost of something if another surgeon who can do the same procedure three or four times over in that same amount of time? We really need to look at this, and I think a lot of the operating rooms around the country are starting to look at how much time surgeons take, what kind of products they use in the operating room, how much each case costs them. This is the future of urology, no question.