November 28, 2017 - Telehealth and telemedicine are becoming so commonplace in health systems that they should have their own specialty. That’s the premise of a Nov. 27 opinion piece in the Journal of the American Medical Association by New York Presbyterian physicians Michael Nochomovitz, MD, and Rahul Sharma, MD, MBA. Their column, “Is It Time for a New Medical Specialty?”, makes the argument that the medical virtualist should be added to the roster of specialties now available to the almost 900,000 physicians with active certifications in the US. That’s because clinicians in almost every practice are using telehealth and telemedicine to treat patients, ranging from the wealthy and self-insured to remote and underserved populations. “Specialty development has been driven by advances in technology and expansion of knowledge in care delivery,” the two physicians write. “Physician-led teams leverage technology and new knowledge into a structured approach for a medical discipline, which gains a momentum of its own with adoption. For instance, critical care was not a unique specialty until 30 years ago.” “We propose the concept of a new specialty representing the medical virtualist,” they added. “This term could be used to describe physicians who will spend the majority or all of their time caring for patients using a virtual medium.” Nochomovitz and Sharma point out that some 70 percent of consumers surveyed are interested in virtual visits, while other estimates indicate as many as half of the medical appointments now held in an office, clinic or hospital could be done via telehealth or telemedicine. That amounts to a global telehealth market valued at about $12.1 billion by 2022. Healthcare providers and telemedicine and telehealth advocates have addressed the concept. The American Telemedicine Association, for example, is publishing practice guidelines and accreditation standards for several telehealth services, while health systems like Thomas Jefferson University’s National Academic Center for Telehealth are establishing telehealth- and telemedicine-specific programs and degrees. The two doctors point out that such a specialty would have to encompass many disciplines, including nurses, medical students, nurse practitioners, physician assistants, pharmacists, social workers, nutritionists, counselors and educators. In addition, the practice may lead to the development of “full-time medical virtualists with subspecialty differentiation,” such as urgent care virtualists, intensive care virtualists, neurological virtualists and psychiatric or behavioral virtualists. Included in that training, as well, is an education in “webside manner,” and how that differs from in-person healthcare. “Medical virtualists will need specific core competencies and curricula that are beginning to develop at some institutions,” Nochomovitz and Sharma conclude. “In addition to the medical training for a specific discipline, the curriculum for certification should include knowledge of legal and clinical limitations of virtual care, competencies in virtual examination using the patient or families, ‘virtual visit presence training,’ inclusion of on-site clinical measurements, as well as continuing education.” “It will be necessary for early adopters, thought leaders, medical specialty societies, and medical trade associations to work with the certifying organizations to formalize curriculum, training, and certification for medical virtualists,” they conclude. “If advances in technology continue and if rigorous evidence demonstrates that this technology improves care and outcomes and reduces cost, medical virtualists could be involved in a substantial proportion of health care delivery for the next generation.”
Telehealth and telemedicine are so ubiquitous in health care that they deserve a separate specialty, New York doctors Michael Nochomovitz and Rahul Sharma have proposed. In their column for the Journal of the American Medical Association, the physicians argued that “medical virtualist” should be a specialty available to physicians, as clinicians now use telehealth and telemedical practices for patients. Much like critical care, which only became a specialty 30 years ago, the techniques now used can be shaped into a structured discipline. The idea is not new. Around 70 percent of surveyed consumers would be interested in a virtual visit option, with some estimates placing up to 50 percent of medical appointments as potentially viable as remote care. The American Telemedicine Association are already formulating telemedicine practice guidelines and accreditation standards, and institutions such as the Thomas Jefferson University’s National Academic Center for Telehealth are creating telehealth and telemedicine specific education options. The specialty would be required to encompass several disciplines of nursing, pharmacy, social work and nutrition, and could be divided into subspecialties, such as urgent care virtualists, neurological virtualists and psychiatric virtualists. The training would have to include “webside manner” instruction, detailing how virtual care differs from in-person care. The legal and clinical ramifications of virtual care, “virtual visit presence training”, and clinical measurements should be included as part of education. The physicians believe that medical virtualists could offer a significant portion of the delivery of health care in future.