The robo-surgeon will see you now

Watch out, doctors. (Dustin Fenstermacher - FOR THE WASHINGTON POST)

The Economist has an interesting piece on the Raven, a new, robot-assisted surgery device that has the potential to reduce the cost of speciality care in the United States:

Robot-assisted surgery today is dominated by the da Vinci Surgical System, a device that scales down a surgeon’s hand movements to let him make tiny incisions. That leads to less tissue damage, and thus a quicker recovery for patients. Almost 2,000 da Vincis have been made, and they are used in about 200,000 operations a year around the world, most commonly hysterectomies and prostate removals.

But the da Vinci is far from perfect. It is immobile and weighs more than half a tonne, which limits its deployability, and it costs $1.8m, which puts it beyond the reach of all but the richest institutions. It also uses proprietary software. Even if researchers keen to experiment with new robotic technologies and treatments could afford one, they cannot tinker with da Vinci’s operating system.

None of that is true of the Raven. Originally developed for the American army by Dr Hannaford and Jacob Rosen of the University of California, Santa Cruz, as a prototype for robotic surgery on the battlefield, it is compact, light and cheap (relatively speaking) at around $250,000. More importantly for academics, it is also the first surgical robot to use open-source software. Its Linux-based operating system lets anyone modify and improve the original code, creating a way for researchers to experiment and collaborate

As robot-assisted surgery becomes cheaper, and more widely available, it will be interesting to watch how that affects the physician workforce. Right now, surgeons’ salaries are double that of primary care doctors. A lot of that has to do with their specialized skill set; surgeons perform more complex and costly procedures than primary care doctors and, as a result, bring a hospital more revenue.

But now, robots are getting better at doing what surgeons do: Making small, precise movements. They’re also, as the Economist notes, starting to do it cheaper. While surgeons may continue to operate robot-assisted devices, a lot of their expertise could plausibly be replaced by a less-costly technology, operated by a less-costly technician.

By contrast, robotic replications of primary care doctors’ more diagnostic-based skill set have moved forward at a slower pace. IBM’s new computer-driven diagnostic, powered by the technology behind the Jeopardy!-winning Watson, still remains in pilot tests. Da Vinci devices, meanwhile, have fanned out across the country.

This doesn’t mean that diagnostic robots won’t, at some point, match - or outdo - the skills of primary care physicians. Ezra has previously made the case that primary care doctors will also see their diagnostic abilities challenged by a computer with instant access to every medical journal article ever published.

But, so far, it’s the specialists skills that have proved more susceptible to robotic replacement. And if these trends continue at the same pace, that could put a new premium on primary care providers. It could make their skill set more valuable than it has in the past. Along with a number of policy proposals floating around right now, and some new programs in the Affordable Care Act, robo-surgeons might end up playing a role in closing the physician pay gap.