Does it surprise you that some clinicians are NOT all that excited to continue to provide care without being in the same room with a patient? Virtual care includes care by video, telephone, email, text/chat, remote monitoring, social media, mobile apps, artificial intelligence and more! More than a decade ago, when I implemented video visits for one region of a large healthcare organization, one-to-one training was provided to approximately 1000 physicians, Advanced Practice Nurses and Physician Assistants who provided scheduled, outpatient care - primary care, medical and surgical specialties. Each of the trainees was given a webcam. One year after training was completed, only 70 of these trained clinicians had provided care by video at least once. Note that reimbursement was not an issue for these clinicians. They were and still are salaried, with incentives based on clinical outcomes and patient satisfaction.
There are several reasons for the lack of interest in virtual care. Unquestionably, at the time, it was ‘one more thing to do!’ Please no! Clinicians continue to have more added to their plate on a very regular basis while they really want to focus on patient care, keeping/getting people healthy! Clearly that is no longer an issue, since most outpatient clinicians have now provided at least some care virtually in light of the pandemic while decreasing their in-person interactions.
Next, and likely the biggest issue: ‘this is not how I was trained!’ The allergists with whom I worked felt fairly consistently that a large majority of patients with asthma seen for follow-up care could receive the care virtually instead of in person. When I asked, an allergy leader ‘when is the last time you saw an asthmatic patient in the exam room for follow-up care and did NOT use a stethoscope?’ His response: ‘never.’ Me: ‘How will you provide that care virtually, without the use of a stethoscope?’ His response: “We generally don’t need it. It rarely changes the treatment plan. It’s just how we were trained to practice.” Many months later, very few of the follow-up visits for asthmatics had been done virtually. My inquiry revealed that these physicians were having a hard time doing things differently, even though most thought the virtual process would be equally effective.
Finally, many clinicians certainly continue to have a concern about missing something if care is provided virtually. At the time of implementation, the leader of the urology department felt certain that men with Erectile Dysfunction could be cared for virtually from the start. Several of his colleagues were concerned that cancer might be missed. A seasoned general surgeon once said to me, well before my involvement in virtual care: “Jan, I do not need to touch a patient’s belly to do a differential diagnosis for abdominal pain.” I never met another general surgeon who agreed with that statement.
Each of these reasons make perfect sense to me. I started my career as a pediatric physical therapist. I very clearly remember choosing between physical therapy and occupational therapy based on PT’s 100% hands-on approach, vs OT which sometimes is more focused on mental challenges (autism, for example). Physical therapists now provide care virtually and I am sure I would not have been excited about it decades ago. I would have been concerned about the lack of ability to feel the joints in passive range of motion. Would it change my treatment plan? Who knows?!!
Unquestionably and understandably, reimbursement will remain the key driver of whether or not clinicians are interested in providing care virtually. AND, even if/when reimbursement is not an issue, as it has not been for the organization for which I worked for a couple of decades, there are other challenges driving the lack of passion for virtual care among some clinicians. Hard to blame them…but hopefully the events of recent months has done much to change their point of view and increase their receptiveness to at least trying to integrate telemedicine options into their practices.
There are so many benefits for the American healthcare system to encourage clinicians to support the growth of virtual care. We could lower the cost of our highest-in-the-world cost of healthcare, we could make it much easier for Americans to receive care, and it is possible that we could improve clinical outcomes as a result.
At the same time, there are so many benefits for the American healthcare system to encourage clinicians to support the growth of virtual care. We could lower the cost of our highest-in-the-world cost of healthcare, we could make it much easier for Americans to receive care, and it is possible that we could improve clinical outcomes as a result.
