In JAMA editorial, physicians push for 'medical virtualist' specialty

By Dave Muoio
Share

As new telemedicine players sprout from the woodwork and employers more frequently offer telehealth options to their employees, a new breed of doctors may be needed to match the technology’s growing popularity. In a recent editorial published in JAMA, NewYork-Presbyterian physicians argued that adoption of a new multidisciplinary medical specialty focused on virtual care would best prepare practitioners to the unique challenges of telehealth.

“Physicians now spend variable amounts of time delivering care through a virtual medium without formal training,” Dr. Michael Nochomovitz, chief clinical integration and network development officer, and Dr. Rahul Sharma, emergency physician-in-chief, wrote in the journal. “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. A professional consensus will be needed on a set of core competencies to be further developed over time.”

Historically, new specialities have been adopted by the development of new medical technologies and knowledge in care delivery, the authors explained. As medical teams begin to integrate these advancements into a more structured approach, recognition and refinement of the budding discipline grows alongside wider adoption.

“For instance, critical care was not a unique specialty until 30 years ago,” they wrote. “The refinement in ventilator techniques, cardiac monitoring and intervention, anesthesia, and surgical advancements drove the development of the specialty and certification, with subsequent subspecialization.”

Both the adoption of new digital technologies within healthcare and the growing consumerism of patients have led to a variety of telehealth offerings, such as second-opinion services, virtual intensive care unites, telepsychiatry, and remote care. According to a survey published earlier this year, 78 percent of American consumers said they were interested in receiving virtual care. Legislation has begun to pave the way for increased telehealth care as well, with nearly every US state updating its telehealth legislation since last year.

But while the growth of telemedicine has led many physicians to begin delivering their care virtually, Nochomovitz and Sharma noted the lack of any formal or regulated training methods designed specifically for this new modality.

“Some commercial insurance carriers and institutional groups have developed training courses. These are neither associated with a medical specialty board or society consensus or oversight nor with an associated certification,” they wrote.

Multidisciplinary positions such as nurses or counselors are prime candidates for virtual training, the authors wrote, but some practitioners may also need to take on the role of full-time medical virtualists for their specific subspecialty. Regardless of whether an individual practitioner becomes an urgent care virtualist or a neurological virtualist, though, all of these caregivers would need training specific to the challenges of telehealth.

“Medical virtualists will need specific core competencies and curricula that are beginning to develop at some institutions,” Nochomovit and Sharma wrote. “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,’ [and] inclusion of on-site clinical measurements, as well as continuing education.”

Despite their advocacy for virtual training and belief that telehealth will continue to grow, Nochomovit and Sharma made a point to stress that virtual visits will not be replacing in-person clinical encounters. To cater to patients’ demands for convenience and value, healthcare teams will need to consist of both in-office as well as remote or virtual resources. Properly preparing practitioners to make use of the latter, they wrote, will require a proactive effort from major health care players.

“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. 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,” the authors concluded.