An article published in the JAMA Network by Nochomovitz and Sharma suggested that we should recognize a new type of medical specialist, the virtualist (see: Is It Time for a New Medical Specialty? The Medical Virtualist). These physicians would limit their practice to telemedicine, which is to say treating patients on a virtual basis. This is an appropriate suggestion from a credentialing viewpoint given that a number of new sub-specialties have emerged in recent times such as general surgical oncology, interventional radiology, electrophysiology, and pathology informatics. Below is an excerpt from the article:
Early telehealth focused on minor ailments such as coughs, colds, and rashes, but now telehealth is being used in broader applications, such as communicating imaging and laboratory results, changing medication, and most significantly managing more complex chronic disease. The coordination of virtual care with home visits, remote monitoring, and simultaneous family engagement is changing the perception and reality of virtual health care. Commercialization is well under way with numerous start-ups and more established companies....We propose the concept of a new specialty representing the medical virtualist. 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.....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. It is possible that there could be a need for physicians across multiple disciplines to become full-time medical virtualists with subspecialty differentiation. ....Medical virtualists will need specific core competencies and curricula that are beginning to develop at some institutions. 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.
I have been a strong advocate for telemedicine in Lab Soft News and consider this approach to healthcare delivery to be one of the best ways to reduce the cost of care while serving a broader group of patients. I also think that the creation of a new specialty group of virtualists is a good idea and probably inevitable. Physicians and nurses will continue to practice telemedicine and will learn their craft whether or not they have some sort of speciality recognition. I do have a couple of comments on this article:
- It's extremely important that medical virtualists have telemedicine practices and thus serve as role models for their colleagues. However and in addition, most virtualists will probably oversee a team of other health professionals engaged in the same pursuits. Nochomovitz and Sharma refer to this when they say that contemporary care is multidisciplinary. Because telemedicne is now entering a period of explosive growth, the pioneers in the field also need to have broad managerial skills in order to manage teams and proselytize others about the benefits.
- I mentioned above that pathology informatics is a subspecialty of pathology that emerged over the last several decades to meet the need of pathology for specialists in information technology. The proposal for the accreditation of medical virtualists flows from the same sort of logic: new technology enables physicians to diagnose and treat patients at a distance. I thus find it perplexing that information technology is not listed as one of the proposed core competencies of the virtualists. One might think that this was a minor oversight but the virtualist needs to have a deep understanding of the technologies that enable telemedicine visits of all types. With an IT skillset, he or she will be able to better shape the technology to adequately support all types of patient-physician encounters.