by Brendan Dunphy, CEO at C-BIA Consulting Ltd. First published at AIMed in response to OPINION: AI will lead to job losses in NHS radiology.
There is nothing new to the discussion of job losses in medicine, especially in radiology, as new technology has been impacting jobs and professions for thousands of years or more.
The technologies evolve, and the cycle-time accelerates, reducing the time we have to understand and absorb the impact and some technologies (such as AI and robotics) may present more radical and fundamental challenges than others, ethical, economic or social.
It might be useful to stand back and look at other professions also facing radical change and job losses from automation and new technology, AI or otherwise.
Comparing radiologists with airline pilots
This is the case for air traffic controllers and pilots, truck drivers and policemen, and I’m sure other healthcare professionals such as those in primary care such as GP’s in the UK.
Human error is the biggest single cause of airline accidents and passenger deaths and there is evidence that removing the pilot and flying the plane remotely (like a military drone) would now be a safer option.
This is even clearer if we add-in deaths resulting from kamikaze crashes instigated by a pilot or onboard terrorist taking control of a plane, 9-11 being the worst example with almost 3,000 killed.
If we assume this to be the case now or soon, why would we still have pilots when they could be replaced by safer (and most likely cheaper and more reliable technology)? There are several possible economic, social and psychological factors:
- Sunk costs: all passenger planes are designed to be flown by pilots so removing the pilot would mean a lot of prohibitively expensive re-engineering of existing planes.
- Mixed mode risk: new pilot-less planes would have to co-exist in the air beside piloted ones for many years creating a risk of collision due to unpredictable pilot behaviour. This is the same problem for driverless cars and one reason that makes developing a driverless car so challenging and expensive- they must deal with all irrational driving and pedestrian behaviour from day one.
- Attachment bias: research suggests passengers prefer to see or hear a pilot onboard even when they understand that a pilot-less plane is a safer alternative. This bias is deliberately enforced by airlines and pilots in numerous small ways, from the uniform and appearance to the tone of voice and language used. As humans, we have a deep need to know who is in charge, especially in unfamiliar or dangerous situations, situations where our dependency on others is high. Removing the human face, someone who can immediately explain what has happened and why in unusual circumstances, could have significant and unknown consequences on passenger behaviour on planes. No technology can replace this role today, or soon. Maybe the offer of free or very cheap travel would persuade some but AI does not offer this, the cost savings are too small to change the fundamental economics of air travel.
- Job protection: pilots are often unionised and would fight to retain their jobs and status – many also like their jobs, they live to fly, not always the case for other professions!
Almost certainly there are more. It’s also worth noting that globally there is a shortage of trained pilots as passenger air traffic is rapidly growing and I understand the same is true globally for radiologists, certainly in the UK.
Patients will prefer AI to radiologists in some areas
If we assume that AI can now outperform radiologists in some areas why would we as patients not prefer the AI to the radiologist in these areas?
Patient power is not well developed in the UK, but it is real and growing, aided by increasingly open data, consumerisation of healthcare provision (patient first), digital devices and access to personal medical data, social media and a host of other techs, regulatory and social drivers.
This is clearly evidenced by the rising number of legal cases brought against NHS Trusts and the increasing payments made by the NHS to successful claimants.
The UK Government has set aside at least £65billion for such claims according to some analysis and the sum is set to rise.
These legal claims may not be on the same scale as in the USA, but the trend is clear; patients are not willing to accept second-rate care and clear errors, whether of diagnosis or treatment.
In this scenario, it is not tenable that hospitals will persist with human intervention in situations where automated procedures clearly outperform existing human ones, especially if also cheaper.
This is particularly true in the UK where the NHS is a perennial political and social topic given a rapidly ageing population, a clear and growing expectation vs. delivery gap and a significant funding shortfall.
Unlike pilots, radiologists have almost no visibility to patients, at most a face behind a machine, an important cog in a complex machine fronted by GP’s and consultant clinicians: there is no social attachment or bond to be preserved or broken.
Unlike with pilotless aeroplanes or driverless cars, there is also no technical contention or reason why new proven AI couldn’t be phased-in over time, gradually replacing radiologists in some areas – relieving recruitment shortages, saving money, improving performance, enabling more time for analysis where required – too often not the case today. This would also allow time to evolve roles, training and expectations of those impacted.
Radiologists need to embrace the change in their roles
Some radiologists may resist but I find it hard to imagine that when presented with the hard evidence, many would want to continue to provide an inferior patient service to that available with AI: they may not take the Hippocratic oath (who does?) but I suspect not doing harm is instinctive in radiologists as it is in other health professionals.
Imaging volumes and applications enabled by new tech will continue to rapidly grow and the professional opportunities associated with this growth significant.
I think most radiologists will make a reasoned response and accept the inevitable and start to plan accordingly, especially those newest to the profession.
By taking control of how and when to deal with the inevitable and preparing radiologists both old and new to 21st century digital realities it will continue to be possible to have a successful (if different) career in a world where less than 50% of the global population has access to any form of professional healthcare and the diagnostic services radiologists provide.
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By Brendan Dunphy, CEO at C-BIA Consulting Ltd.