On January 1st I left my three-year secondment looking after a team of psychology and psychotherapy lecturers and returned to my old home in the clinical sciences. And a big part of my new work will be trying to prepare our graduates for a future that is increasingly uncertain and unfamiliar.
For some years now, there’s been an increasing interest in the future of professions like law, accountancy, journalism, and medicine, with a whole swathe of books being published recently trying to anticipate how we’ll need to adapt to the rapid rise of digital technologies.
There is little doubt that artificial intelligence, automation, machine learning, and robotics are going to radically reshape the nature of work for many of us. And this will happen not because “the machines are coming to take over”, but because they will both do some of the things humans do better, but more significantly, they will tackle old problems in entirely new ways.
Automation, innovation, decomposition, labour arbitrage, personalization, and mass customization are just a few of the ways our working lives will be affected by technology.
In 2013, David Graebar wrote an article about the pointless jobs that seem to have been invented just to keep us all working (link). Graebar followed the article with a Twitter question, asking people to tell him about some of the bullshit jobs they did, and some of the responses were achingly tedious, like one respondent whose main task at a Dutch publishing firm was to “Keep a candy dish full of mints. (Mints were supplied by someone else at the company; I just had to take a handful out of a drawer next to the candy dish and put them in the candy dish)”.
Graeber went on to publish a best-selling book last year titled Bullshit jobs: A theory in which he argued that about 50% of jobs could be scrapped and nobody would even notice. Would physiotherapy be one of those?
The 2018 workforce stats for Australia were released yesterday, and they once again showed that professions like physiotherapy, medicine, and pharmacy are seeing more than 90% graduate employment rates, suggesting that these, at least, are not bullshit jobs (link).
But does high rates of graduate employment necessarily mean that physiotherapy, medicine, and pharmacy are any more secure in the face of rapid technological change? Are they any less likely than someone in the visual or performing arts, say, to find themselves on the employment scrap heap when machine learning takes over?
Richard and Daniel Susskind, in their book The Future of the Professions think not. In fact one of their paradigm cases of a profession on the point of radical transformation is medicine.
The Susskinds (father and son) argue that many of the professions ‘are the brink of a period of fundamental and irreversible change in the way that the expertise of these specialists is made available in society’ (p. 1).
They argue;
This state of flux presents some challenges for the various participants in the professional world. Many professionals who are at the closing reaches of their careers hope they can last out and keep tranformation at bay until they hang up their boots. At the other end, prospective entrants to the prpfessions are having second thoughts about committing. Their parents and careers advisors speak mainly of the professions of the twentieth century, but this talk bears little releation to the post-professional possibilities being sketched out by those who take an interest in the decisions of the professional to become. Regulators are hesitant about what it is that they may soon be regulating and, by and large, they are steadfasly discouraging change (p. 105).
So the challenge seems to be to anticipate the kinds of questions to which physiotherapy will be the answer in 10, 20 and even 30 years time.
Interestingly, the Susskinds and others suggest that it will be the creative industries, and not the professions like medicine which demand a high degree of standardization and procedure, that will outperform artificial intelligence and robotics in the future.
Certainly, I know of many physios who feel frustrated by the amount of administration they have to do, and there are many who spend the largest part of their day doing repetitive assessments and treatments. Many would also like to spend more time with interesting and complex patients, but plowing through the bullshit jobs appears to be an unavoidable reality of their work at the moment.
Perhaps the 4th Industrial Revolution will take away all of the tedious parts of the job and leave us with the good stuff. Unless the robots take the best patients and leave us with the paperwork.
Hi Dave. Thanks for the provocation. It got me thinking about change and what drives change in the professions. On the one hand, you could argue that the health professions are changing all the time. For example, you could look at how far we’ve come in the last 50 years with respect to things like evidence-based medicine (putting aside, for a moment, the concerns you may have with EBM), which have certainly changed how we practice and how we think about practice. I’m sure that there are many other examples of change that you’d be more familiar with. On the other hand, you could say that we’ve hardly changed at all since most of the changes have been incremental rather than fundamental. We basically do the same things we’ve always done, although maybe now we do them more effectively.
Either way, your post got me thinking about the change that’s about hit us in the form of machine learning and robotics. I think we’re going to see “clinical reasoning” taken over by embedded AI systems (because reasoning is algorithmic no matter what direction you approach it from). At some point, we’ll lose “touch” as well because the sensors that can be built into prosthetics will far exceed what we can feel and how we respond to what we feel. A robot hand can have many more points of contact (or a single, dynamic point of contact) that can also detect changes in electrical activity on and under the skin, can detect changes in temperature that humans cannot perceive, can use US to actually “see” muscle fibres, etc.
When these changes come what will be left for physiotherapists who pride themselves on their diagnostic reasoning and manipulation skills? I wonder if we’ll be able to adapt as a profession and give up the things that machines will do more effectively. The social component of human relationships has taken many thousands of years to evolve and will most likely be harder for machines to emulate, and for this reason, I wonder if it’s in the context of the relationship between therapist and patient that we need to develop ourselves and the profession. I don’t think that physiotherapy is a bullshit profession (and neither, I think, do you) but I do wonder how much of what we consider to be central to our practice will soon be a dead-end.
Another thought I had while re-reading your conclusion is the fact that so many people find themselves in repetitive loops that are uninteresting. You also say that the “creative” work is most likely to be more resilient to automation. I think it’s interesting to consider that therapists who are engaged in predominantly busy work today may find themselves automated out of 80% of their daily work, while those who try to find creative, novel solutions to complex problems will most likely be more difficult to replace. There are two things this left me thinking; how much autonomy do people have to design their workload and so make space for developing in new areas, and how do we change professional education and development in order to prioritise creativity rather than things like anatomy?
Hi Dave,
I’m a PM&R resident in the US and the idea of physical medicine/physio rapidly becoming another empty-headed secretarial job has been on my mind quite a bit lately. On the outpatient side there’s a decent body of evidence of varying qualities that for chronic pain conditions, general exercise is just as good as any old complicated therapy protocol – I don’t think that eliminates the role of a physio, but it does take the level of expertise needed to treat a large swath of the outpatient world closer to the level of personal trainer. I spend a lot of time learning anatomy, diagnoses, whathaveyou for the purpose of studying for the boards. At the end of the day, I’m not entirely sure it matters to my future practice.
I feel like I am mostly a billing professional and that my job is responding to a series of fairly typical problems with fairly typical solutions, but I also see the healthcare market increasingly selecting out those who try to work outside a rigid algorithmic paradigm because healthcare as “market” necessitates a corporate structure to medicine. Think of how much corporate buzzwordism has leaked into medicine. I think autonomy is a dead thing within the corporate med realm, and it might be that the only people who don’t dissolve into total drone-dom are those who operate with something like a cash practice totally removed from the pressures of administrators or insurers. Except solo work is extraordinarily difficult in a world of gigantic unified health systems (and insurers who now own pharmacies). It has been tough as a resident picking a direction to tread as I don’t know that I totally enjoy the work day of an inpatient setting all that much, but it certainly avoids the cashflow pain of working in outpatient land, especially as an independent doc.