A few days ago, an opinion piece in JAMA came to my attention. In it, Drs. Nochomovitz and Sharma called for a new medical specialty to be recognized: the medical virtualist.
As someone with a lot of experience in healthcare – years as a family physician, three terms on the MN State Board of Medical Practice, and my current role as Chief Medical Officer here at Zipnosis – I find this an interesting idea, but I’m unconvinced it’s necessary.
Why We Don’t Need “Virtualists”
First off, let’s talk about what virtual care (or telemedicine) is and is not. Virtual care isn’t a new type of healthcare, it’s a care delivery channel. This is an important distinction. The difference between healthcare services and technology that enables delivery of healthcare services is particularly vital when we look at tricky things like regulation. Typically, medical specialties are designated because of particular knowledge and skills needed for healthcare services, not the channel through which that care is delivered. We don’t have, for example, medical retailists who specialize in care delivery through retail clinics.
The biggest reason for steering clear of a “medical virtualist” specialty is simply that every care provider will need to have the skills and ability to provide healthcare services through online care delivery channels. The authors even recognize this, stating:
“Contemporary care is multidisciplinary, including nurses, medical students, nurse practitioners, physician assistants, pharmacists, social workers, nutritionists, counselors, and educators. All require formal training in virtual encounters to ensure a similar quality outcome as is expected for in-person care.”
I couldn’t agree more with this statement. Factors like healthcare consumerism, the shift to value-based care, and the need to address the quadruple aim will precipitate increased utilization and a growing need for healthcare providers to understand how to effectively deliver care online. It doesn’t, however, follow that a specialty is needed.
Further, their contention is that there will soon be a need for care providers to spend a majority of their time delivering care virtually. The trouble with this, though, is that there already are concierge medicine services, nurse lines, and telemedicine service companies that employ physicians, physician assistants, and nurse practitioners who work online full-time. Depending on the use case and mode of care, some hospitals and health systems may even have providers spending a good portion of their working week delivering care online or over the phone.
What We Do Need
Where Drs. Nochomovitz and Sharma really get things right is in their call for specific training – even certifications – for providers to support safe, effective online care delivery. The authors note:
“Physicians now spend variable amounts of time delivering care through a virtual medium without formal training. Training should include techniques in achieving good webside manner. Some components of a physical examination can be conducted virtually via patient or caregiver. Some commercial insurance carriers and institutional groups have developed training courses. [citation] These are neither associated with a medical specialty board or society consensus or oversight nor with an associated certification.”
Once again, I withhold support for a medical specialty board, but otherwise, I agree with the call for greater training and understanding of the specific skills needed to deliver care online. Up until recently, physicians and other care providers were trained exclusively on the medical and scientific elements of healthcare. Now, medical schools include courses on bedside manner and other “soft skills” that providers need to be effective in caring for patients. Many organizations, such as AAFP (of which I’m a member), offer and recommend training in areas like patient communication to support providers in their professional development.
Encouraging skill development in virtual care delivery would be a similar extension of the training medical professionals receive. The virtual care and telemedicine landscape currently has fewer options available, though that is changing with the AMA from last year stating its support for telemedicine training for medical students and residents. Most recently, the American Telemedicine Association partnered with the ClearHealth Quality Institute to develop and offer training and accreditation options in telemedicine.
Moving care delivery forward through expanding virtual care is going to be increasingly critical for patients and providers. Drs. Nochomovitz and Sharma are clearly committed to forwarding the cause of virtual care. Their ideas for training and the core competencies that clinicians will need to effectively use virtual care to care for patients are well-thought out and comprehensive. However, for the reasons outlined above, I believe a medical specialty would be more of a distraction than a benefit to the healthcare landscape.
About the Author
Rebecca Hafner-Fogarty, MD
In addition to being a primary care physician and serving as Chief Medical Officer of Zipnosis, Dr. Hafner-Fogarty has extensive experience in medical regulation, serving on the MN Board of Medical Practice from 1998-2003, 2004-2010, and 2012-2016. She served as board president in 2009 and has also been involved in medical regulatory activities at the national level.