With an increase of specialty medical care over the last several decades, two physician leaders are wondering whether virtual care should carve out its own specialty known as a "medical virtualist."
In a recent JAMA Viewpoint, two physicians at New York Presbyterian floated the possibility of a new medical specialty that focuses primarily on virtual care, citing increased specialization and the rapid advancement of telehealth and remote monitoring technology. Although telemedicine is gaining a stronger foothold in hospitals across the country, physicians are engaging in virtual services without much formal training, wrote Michael Nochomovitz, M.D., the chief clinical integration and network development officer at NYP, and Rahul Sharma, M.D., the emergency physician-in-chief at NYP-Weill Cornell Medicine.
“It is possible that there could be a need for physicians across multiple disciplines to become full-time medical virtualists with subspecialty differentiation,” they wrote. “Examples could be urgent care virtualists, intensive care virtualists, neurological virtualists, and psychiatric or behavioral virtualists. This shift would not preclude virtual visits from becoming a totally integrated component of all practices to varying extents.”
That concept could help further legitimize telehealth as a viable method of patient care, says Bob Kocher, M.D., a partner at the investment firm Venrock, who serves on the board of several healthcare companies, including Virta and Lyra Health. As virtual care integrates patient-generated data and sensors to augment video consultations, doctors will require more specialized training.
And just as surgeons improve with more experience, medical virtualists will get the necessary exposure to caring for patients via video.
“In my experience, doctors who do virtual medicine full time are able to deliver better outcomes, higher levels of patient satisfaction and have far greater physician satisfaction as they learn how to be comfortable and effective using new technologies,” Kocher said in an email to FierceHealthcare. “Creating a specialty would ensure that physicians who choose virtual practice are trained in the techniques necessary to deliver great care, know the limits of what should be managed virtually and demonstrate competency which will help inspire confidence among patients and payors."
But other experts are hesitant to embrace a specialized approach to virtual care, arguing that the healthcare industry is still experimenting with the new technology to determine where and how it can make the biggest impact.
Eric Topol, M.D., director of the Scripps Translational Science Institute and executive vice president of The Scripps Research Institutes in San Diego, Calif., says he doesn’t see the need for another specialty. Instead, he expects virtual care will become another tool in traditional medical care.
“I do think we should be training medical students (and in residency training programs) on telemedicine visits with patients, which is not part of any medical school curriculum today,” he wrote in an email. “But that doesn’t mean we need a new specialty.”
Atul Grover, M.D., executive vice president of the Association of American Medical Colleges, agrees that education is a critical part of building on the rapid advancements of telehealth technology. But he argues a virtual specialty fails to address the complexities of virtual care that include finding new avenues to train physicians as well as ensuring patients have access to broadband to support the technology.
He also wonders whether the creation of a new virtual specialty could exacerbate workforce shortages by pulling physicians away from other medical specialties.
“I don’t think creating a specialty or getting rid of specialty will fix your problems,” he says. “The question is, how do you carry out this function of virtual care?”
Organizations like the American Telemedicine Association have long advocated for virtual services to be viewed as another conduit to patient care. The idea of a medical virtualist “betrays” that concept, says Nate Lacktman, a partner at Foley & Lardner LLP who chairs the firm’s telemedicine industry team. With telehealth still in the early stages of adoption—and health systems refining its use—he'd prefer providers experiment with the technology before diving into specialty care.
“It’s still early in the process,” he said. “Before we start laying the lines of what could be a turf war, let's just use it and explore it.”
Still, the JAMA article generated some online debate, which may be a testament to telehealth’s emergence into the mainstream consciousness. Regardless of where they stand, experts agreed that the discussion along was beneficial.
“I do think this represents is a step up the rung of legitimization or expansion and adoption of telemedicine,” Lacktman says. “If it were considered a party trick or novel concept, no one would write this article and JAMA certainly wouldn’t publish it.”