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"COVID-22"? What Might Be in Store for Us This New Year

Op-Med is a collection of original articles contributed by Doximity members.

At the end of 2020, I wrote about several significant changes or issues Doximity anticipated for 2021. If you’ve ever read our "prediction round-ups" before, you know that we never get absolutely everything right. As for our 2021 list, with some we were spot on; others missed the mark altogether. Hell, the title of my last piece contained the words “post-COVID-19” (how quaint a thought from where we sit today). In full disclosure, I sit here typing the final edits into this piece one week later than I had originally planned due to me and my entire family having come down with COVID-19 just last week.

When I look back on the year that was 2021, it is amazing to recount just how much transpired.Depending upon where one lives, they may have gone through some form of lockdown to re-opening and back again (on occasion), all while having COVID-19 vaccines rolled out, COVID-19 therapeutics being developed, gene therapies becoming available for certain diseases, a host of new drugs and treatments for other chronic conditions coming on market and telemedicine and virtual care experiencing meteoric increases in their utilization. All of this was just in the health care space and by no means is this even a comprehensive list. Having now turned the corner into 2022, it is equally amazing how, despite such incredibly significant advancements as those mentioned, much feels eerily like it did the last time I put pen to paper for new year’s predictions. We again find ourselves staring down what could be a bleak winter ahead.

Below is a short list of a few of the most anticipated health care changes, innovations, and issues in the coming year – based on content consumed on the Doximity network, user polling, and other discussions amongst members of our community, as well as predictions from various experts in the field. Despite the prospect of some tough weeks ahead and this year’s title containing the words "COVID-22" (an admittedly less rosy take than last year’s), the beginning of 2022 can be approached with a good bit of optimism.  Here are five changes or issues we anticipate being significant in 2022. 

COVID-19 May Be Here to Stay (At Least for Now), But We Will Learn to Manage

Early in 2021, when asked whether or not COVID-19 will ultimately become endemic, 86% of Doximity respondents answered either "Yes, definitely" or "Likely."  By now, we have all learned that the COVID-19 pandemic has not faded away as quickly as we hoped it would, despite the many significant medical advancements we have brought to bear to fight it. Looking back on what many thought may be "a Summer of Freedom" in early summer 2021, we know now that this pandemic may very well be with us for a bit longer than we anticipated. The Omicron variant has again shot case numbers up to record-breaking heights, but there is seemingly a silver lining in that hospitalizations and death rates appear to be substantively decoupled from the record case numbers. Furthermore, some experts are hoping that Omicron may potentially even hasten the pandemic’s end.

In case Omicron does not usher in a true "end" to the pandemic, 2022 promises to offer more options for us to better manage what might ultimately become endemic COVID-19. In a recent podcast interview, Chair of Internal Medicine at UCSF, Dr. Robert Wachter posited “I think we have only a month or so of a pretty bad time, then the sun’s going to come out and I think we’re going to be in pretty good shape…”. He goes on to remark that the combination of immunity achieved through vaccination (+/- breakthrough infections), coupled with the natural immunity attained by unvaccinated survivors of COVID-19, may ultimately drive significant rates of immunity in our population. If this bears itself it out in the context of a "milder" variant (i.e. Omicron) becoming the dominant strain, and additional therapeutic options like Pfizer’s drug Paxlovid coming online, he states “it’s hard for me to come up with a scenario where things don’t look pretty good in February…”. Dr. Wachter goes on to caveat this optimism by saying “unless of course there is some new variant curveball, and there’s absolutely no way of predicting the probability of that.”

When we asked Doximity members whether we will face another pandemic as deadly as COVID-19 within the next 10 years (i.e., a hypothetical "COVID-22," or something else altogether in the near future), 60% of respondents answered it was either highly or somewhat likely. An additional 23% were unsure but remarked that it was certainly possible. As Dr. Wachter admitted that there was absolutely no way we can predict the probability of a new COVID-19 "variant curveball," it is similarly not possible to accurately predict the probability of another wholly separate pandemic, God forbid. Despite appending the appropriate caution to his optimism, Dr. Wachter points out that we may be in a spot where the devil we have gotten to know, namely COVID-19, will become significantly more manageable and we may potentially get there quite soon.

There Will Be Consolidation in the "Virtual Care Industry"

 The COVID-19 pandemic ushered in huge increases in the utilization of virtual care services. This was driven largely by the practical constraints of lockdowns directly preventing face-to-face care from being provided in almost all non-emergent cases. Several other factors aligned throughout this forced experience: legislative restrictions in many instances were eased or removed altogether to enable virtual visits as well as their reimbursement, large groups of health care providers responded positively to and urged expansion of telehealth visits, and patient satisfaction from virtual health care visits appeared comparable to traditional in-person visits.  The main takeaway from this experience appears to be that virtual care / telehealth can be a very useful tool to enhance the provision of safe and efficient care for an increasingly broad variety of conditions into the future.

As a result of the above trends, there was a near Cambrian explosion in the number of "telehealth companies."  As we have seen before in health care with EHRs and even health care systems themselves, we anticipate that there will be significant consolidation in this space in 2022 (and beyond). There are substantive differences between that which is offered by niche condition or specialty-specific services, remote monitoring or diagnostics companies, virtual primary or mental health care services, and the broader communications platforms themselves upon which many of these companies and services operate. A keen focus on ease of use for both clinicians and patients alike, access to the broadest population of clinicians, as well as positive relationships with EHRs and large health systems and institutions will be the keys to winning in this space. There is clearly a demand for telehealth services, and they have provided significant value even beyond the extreme circumstances of lockdown. Assuming some of the legislative and reimbursement prerequisites do fall into place to permit the continued expansion of and reimbursement for virtual care, this will remain a very exciting space to watch in 2022, with the end outcome being improved patient access to quality care.

A "Primary Care Race" Will (Continue to) Take Off

 There has been a virtual gold rush of sorts into the primary care space. A who’s who of large retail companies including the likes of Walmart, Amazon, Best Buy, Walgreens, CVS, and even Dollar General have all either entered the space already or declared their intentions to do so. What the implications of all of this will ultimately be is yet to be determined. There will likely be some improvement in patient access to primary care, which would certainly be a positive outcome. What we do not know is how these models will impact clinicians, overall medical outcomes, ultimate costs, etc. There are clearly myriad strong incentives that have driven this trend towards “retail primary care” to date and we anticipate that this will continue into 2022. Rock Health even reports on “Healthcare’s Middle Children,” an additional set of companies that could similarly enter and disrupt health care in a lot of ways, but that have been flying under the radar to date. It is definitely worth watching this space.

The "Big Tech Contest" In Health Care Will Go On

 Like the movement we have seen of large retailers making aggressive plays into health care, "Big Tech" continues to forge its path into the industry as well. Despite some false starts in the recent past — think IBM Watson, Haven Healthcare, Google Health disbanding, etc. — momentum seems to not only have not slowed down, but it has potentially even picked up a bit. The likes of Amazon, Alphabet, Apple, Microsoft, Oracle and even Facebook all seem to still be moving forward with a variety of health care-focused initiatives. 

We expect 2022 to entail a continued "reorganization" of large tech companies’ health care bets. There will likely be continued struggle with what some refer to as "Big Tech’s Catch-22 in Health," but a lot of these companies appear to be pivoting their strategies to focus on their core strengths, narrowing their objectives to more achievable ends and beginning to build upon incremental wins. Much has been made of Apple CEO Tim Cook’s saying, in a 2019 earnings call, that “there will be a day in the future that we look back and Apple’s greatest contribution will be to people’s health.” What remains to be seen is what exactly this contribution might be. We anticipate we will begin to see and better appreciate the impact of Big Tech’s presence in health care throughout 2022.

The Effects of "The Great Resignation" Will Be Recognized in Health Care and Force (Hopefully) Positive Change

By now, the broader public has become very aware of some societal "side effects" of the COVID-19 pandemic such as trends like "The Great Resignation." While there is still debate as to whether "The Great Resignation" should really be called something else, like "The Great Reshuffle," or if, in the end, it is something that we will even come to celebrate, what has not been as closely investigated is how these societal shifts may play themselves out in health care.

Sure, there has been a laser focus on some of the potential impacts of staffing shortages amongst health care personnel. Most of this attention, in my view, has been aimed at solving the very acute problem of staffing our systems for today – a state of crisis. This approach leaves several questions unanswered. For example, what might be the downstream impacts on health care staffing and the wellness of our health care workforce once the dust settles? Doximity’s own 2021 Physician Compensation Report explored the COVID-19 pandemic’s impact on physician retirement. When we asked clinicians how COVID-19 might have altered their career plans, approximately half reported they are considering employment change due to COVID-19-related overwork (think: burnout). We also found that, after a significant spike in the beginnings of the pandemic, there remains a persistent gap between observed and expected physician retirement rates that represents over 1% of the physician workforce. 

You might be asking yourself how such trends could be harbingers of positive change? Well, I find myself in agreement with CEO of SCAN Group and Health Plan, Dr. Sachin Jain. In Dr. Jain’s 2022 predictions piece in Forbes from last November, he ends on a positive note, dreaming of the possibility of a “post-cynical life.” In this life, he predicts that 2022 might be the year that health care bounces back from pessimism. Despite COVID-19 rocking the health care system (and clinicians like myself therein) back on our heels, there are significant positive trends that should give us all hope: greater recognition of and efforts to combat clinician burnout have begun to show some progress, larger health care organizations have begun to take notice of the financial and organizational importance of clinician retention and, almost as a counterbalance to the persistent bump in physician retirements, I find my spirits buoyed by the record high rates of medical school applications and enrollments. The combination of greater public and organizational awareness of clinician well-being with a flood of fresh clinicians into the system makes me more optimistic that Dr. Jain’s dreams will not only begin to come through in 2022, but that they may have some hope of actually being sustained.

So, there you have it: a new year, and a new set of predictions. As I said at the beginning, I begin 2022 with a sense of optimism. COVID-19 may soon be a very manageable condition, technology, and other industries will begin to leave substantive marks on how we all collectively approach health care, and greater awareness and fresh eyes should hopefully contribute to a healthier health care workforce. Whether I am right or wrong on all, or some, of these predictions, I can guarantee that this time next year we will again be amazed by just how much transpired in 2022.

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