Different visitors to Bryce Canyon National Park, in southern Utah, have described it as “poetry in stone.” I thought that was a very apt description after my recent vacation hiking throughout Bryce Canyon. Given the crazy pace that so many of us, in our industry, face on a daily basis, an immersion in nature is just the thing for a quick recharge of the batteries. I was unprepared to fully appreciate the unique geologic structure of Bryce Canyon, and will use this as a metaphor to describe changes in nature versus changes in our industry.
First, a little bit of geology, and then I’ll attempt to put all this into perspective as it relates to the daily work of you, our readers.
Bryce Canyon, Zion National Park, and the Grand Canyon are all part of the Colorado Plateau. According to the brochure from the National Park Service of the US Department of the Interior for Bryce Canyon, nearly 90 million years ago, an inland sea divided the continent from the East to the West, which deposited sediment that formed the oldest rocks in Bryce Park. The rocks lie largely unseen below the Claron Formation, which was formed 55 million years ago.1
Approximately 20 million years ago, massive tectonic plate activity began to push up through a tremendous swath of Earth’s crust. This eventually raised the entire region (ie, the Colorado Plateau) nearly 2 miles to form a 130,000-square-mile mesa. Bryce Canyon stands at the northwest portion of this plateau.
But Bryce Canyon is geologically unique in that approximately 200 days of the year, temperatures vary widely between below freezing nights and,1 especially in the summer, very warm afternoons. We experienced early morning temperatures requiring long sleeves and long pants, and by lunch-time the highs were nearly 100°F. Rain from summer thunderstorms creates melt water that, when combined with gravity, causes what geologists call “soil creep,” which is stone fragments that move downhill.
Because Bryce Canyon represents the most complete sequence of sedimentary rocks, which are formed over a vast length of time and space from sediments built up in lakes, inlands, seas, swamps, deserts, and forests, the melt water and gravity create unique geologic bulbous formations described as “hoodoos.”1 The bulbous spires, or hoodoos, are the result of eons of erosion through the sediment, which create freestanding, gigantic structures, many of which have now been named—such as the iconic “Thor’s Hammer” of Bryce Canyon.
The staggering beauty of being able to hike down into the plateau and crawl among the pink, gray, and white cliffs of Bryce Canyon while turning in every direction to see staggeringly huge hoodoos is a unique experience in nature. Bryce Canyon, which is less popular than the maddening crowds that clog Yellowstone and Yosemite National Parks, is a pleasure from a vacation perspective. Yes, it was crowded, but nothing compared with the crowds clogging the roads and hiking trails throughout the more famous national parks.
The hoodoos are difficult to describe in words, but I found them to be eerily awe-inspiring and terrifying at the same time. They are inspiring in their natural beauty, size, and scope, and terrifying because of the notion that centuries from now Bryce Canyon will look completely different as it changes, which is imperceptible to us on a hiking vacation but will be visible 10 generations from now.
Let’s attempt to juxtapose this imperceptible natural change process to the everyday, seemingly light-speed evolution of our own industry. Even in the past few weeks, change appears to be everywhere in healthcare. For example, our colleague, Atul Gawande, MD, MPH, MA, made famous by his writings and his leadership of Ariadne Labs at Harvard University, has been named the inaugural CEO6 of what I and others have referred to as ABC Health.
That is, the leaders of 3 large and significant national organizations—Amazon, Berkshire Hathaway, and JPMorgan Chase—have come together and have declared that they will change healthcare.2 By anointing Dr Gawande in this inaugural leadership role, they have made an important public pronouncement, and have elevated a leader with very modest business credentials. Is it more important to have an articulate leader such as Dr Gawande, or are serious business chops necessary to tackle the nation’s largest and most important industry?
Nearly simultaneously to this announcement, General Electric, which was the most valuable corporation in America in the year 2000,3 has been removed from the small number of corporations that make up the venerable Dow Jones Industrial Average index.
Finally, organizations such as Iora Health4 and Oak Street Health,5 which are supported largely by venture capital, continue to reshape the very face of primary care, just as the hoodoos are changing, but at a much faster pace. I have previously written about Humana and its continued well-documented success in improving community health in the populations it serves at a 20% rate by the year 2020.6 Change is appearing in every sector of our business, but one.
The last bastion of change, regrettably, remains the twin titans of undergraduate and graduate medical education. These 2 types of medical education remain mostly intact, unchanged, and are standing guard, much like twin hoodoos at Bryce Canyon National Park staring down at the future. Perhaps they are the twin tower educational equivalent of the geologic hoodoos I had the great privilege of seeing recently.
Now comes the critical question for the future: Will we have the wherewithal to recognize the market forces of ABC Health, Oak Street Health, Iora Health, and Humana, and look in the mirror and collectively recognize that we are not yet preparing the doctors of the future? What will he or she look like?
Aren’t we responsible to steward the natural resources such as Bryce Canyon, and at the same time lend our collective leadership to steward the creation of the doctor of the future? I’ll have more to say about these twin titans in a future editorial, but I’ll close by once again reflecting on my recent hiking vacation and ask our readers the important question—“hoodoo you think will change?”
David B. Nash, MD, MBA is Editor-in-Chief, American Health & Drug Benefits; Founding Dean, Jefferson College of Population Health, Philadelphia, PA
1. National Park Service, U.S. Department of the Interior. Bryce Canyon: The Story in the Rocks. www.nps.gov/brca/planyourvisit/brochures.htm. Accessed July 11, 2018.
2. Business Wire. Amazon, Berkshire Hathaway and JPMorgan Chase appoint Dr. Atul Gawande as chief executive officer of their newly-formed company to address U.S. employee healthcare. Press release. June 20, 2018. www.businesswire.com/news/home/20180620005747/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-appoint-Dr. Accessed September 17, 2018.
3. The World This Week: Business. The Economist. 2018;427:8.
4. Govindarajan V, Ramamurti R. Transforming health care from the ground up. Harvard Business Review. July-August 2018:96-104.
5. Oak Street Health. We are building healthcare as it should be. www.oakstreethealth.com/mission. Accessed September 17, 2018.
6. Nash DB. 20% by 2020. Am Health Drug Benefits. 2018;11(2):63-64.