Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on April 17, 2013


Health care is moving to assembly line medicine which means that physicians are completely interchangeable, or fungible, entities. This does not mean that people will get poor care, but it does mean that the role of the physician has changed from cultivating relationships to following algorithms. In the long run, those attracted to a medical career will be a different personality type than those in the past, as following algorithms is a different skill set than feeling the pleasure of healing relationships. I understand the value of fungibility, yet I am sad about this change.  Adapt or die, comes to mind, and so I will adapt.





Fungibility is the property of a good or a commodity whose individual units are capable of mutual substitution, such as crude oil, shares in a company, bonds, precious metals, or currencies.

It refers only to the equivalence of each unit of a commodity with other units of the same commodity. Fungibility does not describe or relate to any exchange of one commodity for some other, different commodity.

As an example: if Alice lends Bob a $10 bill, she does not care if she is repaid with the same $10 bill, two $5 bills, a $5 bill and five $1 bills or bunch of coins that total $10 as currency is fungible. However, if Bob borrows Alice’s car she will most likely be upset if Bob returns a different vehicle–even a vehicle that is the same make and model–as automobiles are not fungible with respect to ownership. However, gasoline is fungible and though Alice may have a preference for a particular brand and grade of gasoline, her primary concern may be that the level of fuel be the same (or more) as it was when she lent the vehicle to Bob.



4 Responses to “Fungible”

  1. Jon said

    In the book The Most Human Human: What Artificial Intelligence Teaches Us About Being Alive, the author, Brian Christian, discusses many important topics. In addition to looking into the advances in artificial intelligence and how computers are getting closer to passing The Turning Test, he looks into the dehumanization of people who are being forced to act as machines.

    Sadly, your discussion of the upcoming fungible nature of physicians reminds me of the dehumanization that is discussed in this well done book. Adapt or die, yes, but something human dies in that adaption.

    • Thanks, Jon. I am not sure that “something human dies in that adaptation.” I think the personalized aspect of medicine is going to be done, for the most part, by people other than physicians. I still believe in the power of healing relationships, but medicine is so expensive these days, that there is a pressure to change the doctor/patient relationship in order to save costs. Thanks again.

  2. Shelly said

    In your profession, I don’t think one psychiatrist is the same as the next. You are not all interchangeable. Each person has their own charm, appeal, and method of treatment. However I am interested in hearing how you plan on adapting to the fungibility of health care. Thanks.

    • Yes, my work is very personal, but psychiatry, as a changing field, is moving more to the impersonal. As I replied to Jon, therapists will still be important, but the physician-therapist is becoming a rarity. I am thinking about my adaptation very seriously and intensively. Stay tuned.

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