New Medical Specialty – the Telehealth Virtualist?

About a year ago, the Journal of the American Medical Association published an opinion piece from two doctors at New York Presbyterian. In it, the clinicians suggested that the rise of digital communications tools like telehealth argues for a new medical specialty called “the Telehealth Virtualist.”

This new specialty area would offer training in how to detect chronic comorbidities that are not intuitive to the average doctor when using a video conferencing screen. The authors stated, “the more complicated this gets, and the more data that we can get from remote monitoring and tests within the home, the greater the need for people trained to handle these conditions through telemedicine.”

Should telemedicine become a new specialty care offering like a hospitalist or other service line? Are there doctors that would prefer to move directly into the world of virtual care and avoid the traditional visit entirely? Does it make sense to add another specialty offering into an already-siloed industry?

We believe that telehealth should be a tool available to any doctor, and that creating another sub-specialty further fragments our existing structure. While we value the opinions of the opinion’s authors, here is where we think the JAMA editorial missed the mark.

Under the Telehealth Virtualist model suggested by the New York Presbyterian doctors, there could be a medical virtualist for every medicine subspecialty; including the urgent care virtualist, intensive care virtualist, neuro virtualists – and more. Currently, each specialist has its own board, own standards, and own credentialing processes. But we’re evidently not done yet; the Association of American Medical Colleges (AAMC) reported last summer that new healthcare fields are emerging, including:

• The Cancer Immunologist that will harness the person’s own immune system to fight the disease.
• The Nocturnist is a doctor that will practice medicine mostly at night. This role will be similar to a Hospitalist but offered at night.
• The Lifestyle Medicine Physician will work to change the lifestyle choices of their patients. For example, working with a diabetic to increase their exercise and change their eating habits.
• The Clinical Informatics specialist will focus on collecting and analyzing data to improve the lives of patients.
• Finally, the Medical Virtualist, that will focus strictly on offering medical treatment through the lens of a camera or telecommunications tools like telehealth.

While these sub-specialties are interested, are all these new specialty areas really needed, especially at a time when healthcare is increasingly fragmented?

Healthcare specialties are governed by the American Board of Medical Specialties (ABMS), who reports there are currently 39 specialties and another 86 subspecialties. Have these multi-faceted spokes extended from the primary care hub hopelessly ensnarled the patient experience? A scathing op-ed in the New York Times suggests, “There are so many specialty organizations because each develops authority over a niche market and vigorously guards its turf.” While the op-ed suggests greed is the motive behind healthcare segmentation, the end result is disjointedness in care continuity that we now recognize is a problem. With that said, the shear amount of clinical information out there makes it almost impossible for one doctor to be expert at more than their specialty area. Is there balance to be struck?

The question, then, when considering the Telehealth Virtualist role, is whether segmenting telehealth technology among a cadre of specialty-trained clinicians would add to the benefits for patients in using these tools?

We believe that adding the Telehealth Virtualist as a new specialty area would, in fact, pose a disservice to the doctor-patient relationship the technology is actually trying to serve. Here’s why medicine doesn’t need the Telehealth Virtualist role:

• The Internet is the great democratizer – and doctors can mine it.
  Why segment a service line offering that could increase patient convenience while improving the doctor’s bottom line? An entirely new set of telehealth providers, including OrthoLive, have made their way into the forefront of healthcare for 2019. From phone apps to software-as-a-service (SaaS), these innovative technologies have used the cloud to bring back the virtual house call. This, at a time when rising costs and looming doctor shortages threaten our ability to deliver care. The whole point of telehealth SaaS offerings is that they make healthcare delivery more accessible and affordable. This follows the trends that have democratized technology for everyone to use. Telehealth technology is now an easy-to-use, proven technology that should connect all doctors with all their patients, in every medical specialty.
• Medical schools are already training clinicians on how to use the tools.
  Learning webside manner is now a standard part of many medical schools, just like all of the other general physical exam courses in the curriculum. The doctor of tomorrow is already a digital native, fluent in the use of their handheld electronic devices. This mirrors patient trends, which show smartphone adoption is high and only predicted to increase.
• Healthcare is already too fragmented.
  The issue of care continuity is a big one in the American healthcare system. Interoperability is a huge issue, along with simple communication between the patient and an increasingly dispersed healthcare paradigm. The incidence of episodic care without coordination from a primary care provider is on the rise, while chronic care conditions remain one of the highest cost centers in the nation. In the meantime, preventative care suffers in the rural patient that lacks a safety net because of a physician shortage. But there is one technology that could tie a disjointed system back together, and that is telehealth technology. Telemedicine brings care to the patient wherever they are and strengthen the doctor-patient relationship in the process.
• Telehealth was designed to bring patients closer to their physicians, not further away.
  In the case of services such as remote patient monitoring, telehealth can be used to provide more frequent and preventive care to the chronically ill patient. Telehealth is the bridge between primary and specialty care providers and the patients they serve. The technology has been proven to be particularly effective at improving treatments that decrease ICU and inpatient stays while improving long-term outcomes for chronic diseases. The studies illustrate why telehealth should be a generally available tool and not just for the specialty provider.
• Telehealth can help small practices remain competitive with large health systems.
  OrthoLive offers a low-cost telehealth solution customized for orthopedics. It’s a solution that brings telemedicine to even the smallest of practices, increasing their ability to compete with even the largest providers in the field.

Healthcare should not allow the idea of yet another specialty service area to further segment healthcare service delivery. Telehealth technology like the OrthoLive turnkey solution for orthopedic providers was designed specifically to bridge the gaps in care and improve the convenience and cost of helping patients. Talk to the team at OrthoLive to find out how you can put telemedicine to work in your practice today.