Specialists vs. generalists, managing the polarity

By | January 3, 2017

There is no one solution to specialized vs. general care

As I read an article by Richard Gunderman about the proliferation of hospitalist care and what it means for the continuity of care needed in a value- based world, it made me think about the bigger question of which is better: general or specialty care?

We see this question play out in many ways. On the physician front, we see specialization all the way down to single organs, or limb types. We now have hospitalists, SNFists, intensivists, etc. We even see it now in care management, where there are care givers that specialize in transitions of care, others that focus on community needs, and even those that focus on skilled care transitions. This specialization has occurred for a very good reason – when work is done by people who are skilled in a specific function, it’s done more efficiently and with higher quality. The same specialization is seen in other industries as well. The production line model was created on this exact concept.

Though there are definite upsides to thinking this way, there are also downsides. Handoffs must occur, which increases risk for mistakes, and some say that consumers and service providers are not as happy.

But, I think about this issue very differently. Instead, I believe that healthcare’s attempts to find a singular best answer will lead to subpar results.

So here are a set of hypothetical questions: what is four plus four? If you are going to the store today, what are the different ways you could get there? In order to live, breathing is needed, so which is more important to breathe, inhalation or exhalation? The first question is easy because there is only one correct answer that makes all other answers incorrect. But the second question has multiple correct answers, all which are independent of each other (car, bike, walk, etc). And the third question is much more complicated, as both answers are correct, and they are dependent on each other. Some call this type of situation a conundrum; others look at it more as polarity issue. In reality, what we do every day is manage such polarity; however, we seem to want simple, singular answers.

As we think about specialists versus generalists, we should think about it within the framework of managing the polarity and trying to optimize the output. As the output is increased value to those we serve, how do we manage polarities to that end? We must continuously fight the urge to try to solve these issues as pure mathematical questions where there is a singular answer. Instead, we should attempt to optimize a situation that has multiple correct components. Using the example of hospitalists, we should focus on optimizing the value of such care while minimizing the unintended consequences that arise. So we would manage the hand offs, and work with the hospitalists to provide patient-centric continuity with the other team members of their care in the non-hospital arena.

If we change our thinking to this polarity management model, we will create models that truly deliver on providing value to those we serve.