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Editor's Notes: Is the "Genius In All of Us" Smart Enough to Propel MDs into the New Healthcare?

September 24, 2016
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Can physicians adapt themselves to the new healthcare? Some thoughts on the learned experience

I’ve been absorbed lately in an intriguing book called The Genius in All of Us: Why Everything You’ve Been Told About Genetics, Talent, and IQ Is Wrong, by journalist and author David Shenk, which offers a fresh look at how scientists are thinking now about intelligence and achievement. As Shenk reports, a “new vanguard” of a “loose-knit group of geneticists, neuroscientists, cognitive psychologists, and others, some of whom call themselves developmental theorists,” are rejecting notions about genetics that go back to the famous pea-plant experiments that Gregor Mendel conducted in the 1850s and 1860s, notions that hardened over the years into received wisdom around genetic inheritance as something that fully circumscribes lifetime achievement. Shenk instead refers to the as “interactionists,” as he calls them, scientists focusing on the dynamic interaction between genes and environment.

In that context, Shenk reports on a fascinating experiment performed on newborn rat pups from two distinct genetic strains: “maze-bright” rats, which had consistently tested well in maze-running across many generations; and “maze-dull” rats, which had consistently tested poorly in those same mazes, making an average of 40 percent more mistakes. The scientists studying the rats provided different groups of those rat pups with one of three environments: intellectually enriched, normal, and restricted. They expected a small overall impact from environment, but found that in fact, “The final data were quite shocking.” It turned out that the type of environment in which a rat was raised was far more determinative of its level of achievement than was its membership in either of the two genetically distinctive groups.

As a result of some of the research being conducted, Shenk notes, the newest theory is that of the “dynamic environment”—the very active, and iterative, interplay between inherited traits and complex lived environments. And he points out many examples of famous, high-achieving individuals who have succeeded not because of genetics, but because of hard, smart work and self-development.

Reading this book makes me think about the current operating environment for physicians in the U.S. healthcare system. With the policy, payment, operational, clinical, and technological environment in which U.S. doctors are working changing dramatically away these days, as the system shifts from pure fee-for-service reimbursement and towards value-based purchasing and risk-based contracting, many physicians are finding themselves whipsawed by so many concurrent changes.

Which physicians, and physician groups, are going to successfully make the transition from the old fee-for-service world to the new payment-for-value world? Native intelligence most certainly won’t be the differentiating factor: we all know how smart and talented physicians are as a group. But the reality is that it will take strategy and adaptability to successfully make the transition to the new healthcare, not just native intelligence (though it will require some of that, too).

Speaking with physician group leaders for this issue’s cover story on physician groups and risk-based contracts (p. x) made it very clear that the most adaptable, most future-oriented, and most strategic physician groups are going to make it. But I do worry about many physicians and physician groups, as new legislative and regulatory mandates begin to really rock their world now. Encouragingly, those leaders I interviewed for this issue’s cover story are trying out a variety of strategies around accountable care and population health development that are showing the way to their less-advanced colleagues.

So really, it’s not about genetics after all, but rather about the complex interplay between the intelligence and talent that physicians already bring to their profession, and their adaptability and willingness to change, that will determine who will survive, and thrive, in the coming decade of healthcare. It is indeed the “genius in all of us” that they will need to tap to move forward surefootedly into the future.