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  • Writer's picturePatrick Mish

Book Review: Why Healthcare Needs Generalists Now More Than Ever


I recently read David Epstein’s book "Range: Why Generalists Triumph in a Specialized World" that challenges the notion that specialization is the key to success in today's rapidly changing world. There are some interesting parallels to what we see in healthcare around complex medical patients that pivot from failing (repeated hospitalizations) to success once they enter a high-quality assisted living operation. With demand for medically appropriate housing to support aging Baby Boomers (i.e. the Silver Tsunami) outpacing supply, we now more than ever need the concepts presented in “Range”.


First some background on the book; Epstein begins by questioning the conventional wisdom that early specialization is the path to excellence. Think Tiger Woods who Epstein uses as an example; Tiger started playing golf at 4 years old, and he played and played and played golf! Many parents and leaders look to this example coupled with the "10,000-hour rule," popularized by Malcolm Gladwell in "Outliers," as the pathway to success. This thinking, Epstein argues, oversimplifies the journey to expertise and high quality outcomes.


Instead, Epstein introduces the concept of "kind" and "wicked" learning environments. In "kind" environments, repetitive practice and focused training can lead to mastery, as seen in activities like golf, chess or classical music. However, in "wicked" environments, problems are complex and unpredictable - just like real life - requiring a broader skill set and the ability to draw from various domains. This is where generalists thrive.


Epstein emphasizes the value of interdisciplinary thinking. He discusses the work of successful individuals like Charles Darwin and Vincent van Gogh, who drew inspiration from multiple domains to make groundbreaking contributions. Interdisciplinary thinking enables individuals to see patterns, make connections, and innovate.


Healthcare is a multifaceted field that involves a wide range of specialties. However, we’ve observed in our highest performing assisted living operations that there are some master generalists owners who are able to think and act across disciplines (physical, social, emotional, spiritual) leading to extremely holistic patient care. These generalist assisted living owners typically have experience as caregivers, which itself requires broad ranging knowledge to be done well, and this is typically paired with years of specialized work in healthcare and a passion for serving others. With this broad ranging skill-set, these owners can better understand the interconnectedness of health issues and provide thoughtful, efficient and comprehensive solutions.


Epstein acknowledges that embracing uncertainty can be challenging, especially in a world that values specialization. However, he argues that individuals with range are better equipped to navigate uncertainty and adapt to change. They are more likely to thrive in complex, rapidly evolving environments.


This is almost always true with medically complex patients. They require unique solutions and creative thinking and a high degree of comfort with dynamic situations. This is why many of our top performing assisted living operators are able to manage a patient with a traumatic brain injury (TBI) that displays highly aggressive verbal and physical behaviors. Their broad understanding of caregiving, say for example of patients with dementia, combined with an unrelenting drive to creatively problem-solve means that a complex TBI patient can thrive in a community setting.


The principles outlined in "Range" can bring significant benefits to the healthcare field and specifically to assisted living operations. Encouraging a more holistic, adaptable, and interdisciplinary approach to patient care, research, and medical education will lead to improved patient outcomes, innovative solutions, and a healthcare system that is better equipped to address the evolving challenges of the Silver Tsunami.



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laura wagner thibodeaux
laura wagner thibodeaux
Mar 28

Being able to find those assisted livings that truly embody these skills takes time. Watching how an assisted living responded to covid or how they handle residents when they have episodes that can be addressed when someone has the experience vs. sending them out to the hospital are all a part of determining who the Generalists are. They are diamonds in the rough.

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