The Subspecialist Will Televisit You Now

Steven Fein, MD, MPH
Founder and Medical Director of Heme Onc Call, a nationwide telemedicine-only hematology practice

Prior to the COVID-19 pandemic, health-care providers, payers, and patients had all gradually warmed up to the opportunities for telemedicine afforded by high-speed internet and powerful digital technologies. However, transition to telemedicine in the U.S. had been slow. Now, the outbreak has opened the window of opportunity for rapid and sustained adoption of telehealth out of a need to safely connect patients with doctors.

While diving into this new world seems natural for primary care and urgent-care providers, it is the perfect time for subspecialists to follow suit. The winds of change have demanded a steady movement toward connecting with patients and colleagues through email and text, as well as demonstrating “meaningful use” of information technology resources. Still, there has been resistance to making the leap from traditional in-person visits to either inpatient or outpatient audiovisual televisits. Physicians, entrenched in the system in which they were trained, have been the most reluctant to change, due to the long-held belief that the in-person interaction and physical exams are part of the “spiritual covenant” of medicine. Further, the importance of in-person examination was reinforced by the Medicare reimbursement policies established in the 1990s, which required clinicians to complete physical exam documentation to be paid to practice medicine.

Now that the COVID-19 pandemic has forced physicians to do more non-emergency medical encounters online, subspecialists have an opportunity to make a more permanent transition to telemedicine.

This welcome change may solve many problems that have been developing in health care. For example, there has long been mounting evidence and concern about the shortage of hematology experts. The new workforce of hematology/oncology physicians often have limited training or expertise in nonmalignant hematology disorders. Physician burnout has led many subspecialist physicians to transition to alternate careers or retire early. Meanwhile, the need for more hospital-based hematologists has become increasingly apparent, correlating with the growth of the hospitalist movement. All these factors, along with the decades-long movement to train more primary care providers, have contributed to the shortage.

With too few subspecialists available, rural and underserved populations have limited access to care. Some blood disorders for which patients are hospitalized require urgent evaluation and intervention. Not being able to see the right doctor quickly jeopardizes patients’ lives. Thus, there is a great need to redistribute the subspecialty experts’ time and expertise toward patients who currently have limited access and who have urgent needs.

This year, one solution to these problems has made itself evident, as telemedicine became the only way to address many health-care needs as the COVID-19 pandemic forced many people to stay home. The perfectly timed arrival of improved technology and internet bandwidth to allow telemedicine and the appropriate political circumstances requiring action and willingness to pay the bills have coalesced to enable the health-care system to finally embrace the necessary changes.

As a hematologist, I frequently find myself trying to be in many places at once: seeing patients, reviewing their data, researching their challenging diagnosis, and communicating with their families and providers. Telemedicine lets me to do this more efficiently by seeing patients − located either in hospitals or in their homes − from my computer. I no longer trek through the hospitals to squeeze in a visit before the patient is taken away for a test. I no longer compete with hospital noises and commotion to get through my day. Perhaps most important, I no longer expose the patients or myself to possible infection risks.

Telemedicine enables the subspecialist workforce to expand its reach, restructure work schedules more efficiently, and communicate with experts online, wherever they may be located. After completing a televisit, patients stay connected to their providers by email and physicians provide continuity of care at the frequency that is most appropriate and helpful for each patient’s situation. By seeing patients more efficiently, we have the capacity to treat more people, provide better service, and finally obtain the value-based care that the health-care system has long sought.

Now is the time to ensure that this unexpected but welcome change to subspecialty care stays with us in the post–COVID-19 era. The ability to connect doctors with rural and underserved patients who have long needed better access to care will allow us to appreciate telemedicine’s true value.