In the new book, The Innovator’s Prescription, the authors propose a number of “disruptive” solutions to “right” America’s health care ship. One of them is to divide medicine into three realms:

1. Precision medicine. Care for diseases that can be diagnosed precisely and for which treatments are predictably effective through algorithm-driven interventions. These are things like strep throat, UTIs, and other common ailments.
2. Empirical medicine. Diseases for which treatment outcomes can be described in probabilistic terms, such as heart attacks and strokes.
3. Intuitive medicine. Conditions that are diagnosed by symptoms and treated with therapies of uncertain efficacy, such as depression, multiple sclerosis and many cancers. This is the realm of specialists working together in teams – a “solution shop” approach to the patient’s particular problem.

The precision medicine part is taken over by nurse practitioners and physician assistants following algorithms of care, along with generalist physicians when necessary. Meanwhile, generalist physician training has shifted to the management of complex chronic diseases and wellness services, as well as the provision of testing, imaging and other services that specialists now provide. Everybody moves upstream in this model and practices at the top – and not the bottom – of their scope of practice.