Is the ‘medical virtualist’ specialty coming to a health system near you?


Photo: Roy Blumenthal via Flickr

The Journal of the American Medical Association not long ago published an online editorial by two physicians at NewYork-Presbyterian that called for the creation of a new medical specialty focused on virtual care.

Others expanded on this idea in a blog post last month on the Health Affairs website, calling for a “virtualist movement“ that involves not just physician specialists but whole care teams devoted to virtual care. This virtual team would include nurses, pharmacists, medical social workers, psychologists, nutritionists and physical therapists.

“Just as the hospitalist movement reshaped inpatient care over the past 20 years, we anticipate the virtualist movement will open new possibilities for directly monitoring, managing, promoting and restoring the health of patients,“ said the author, Kevin Fickenscher, M.D., president of CREO Strategic Solutions; Joseph Kvedar, M.D., vice president of the Center for Connected Health at Partners Health in Boston; and Joseph Nichols, M.D., a clinician in Baltimore.

So what would a medical virtualist do, exactly?

The idea is that these specialty physicians, or a physician-led care teams, would spend most of their time treating patients in a virtual setting. This could include telehealth visits, remote patient monitoring and integrating various data streams gathered about the patient’s health. As specialists, they would be up on the latest technology and communication methods to connect with patients.

The Health Affairs post authors called on medical professionals and educators to convene a task force to reach consensus on skills, capabilities, education and training requirements for virtual-care providers.

Virtual care is evolving rapidly, as telehealth becomes more integrated into care delivery and with the widespread adoption of video-enabled smartphones and fast broadband services. Last month, Kaiser Permanente CEO Bernard Tyson said that 52 percent of the 100 million patient-physician encounters last year at the integrated health system were virtual visits.

With primary care and specialty physicians already doing virtual visits, is there a need for a virtualist specialty? Proponents say yes, mainly because of even greater streams of patient data that would need to be integrated and interpreted in care decisions in a virtual-care environment.

Physician burnout already is a hot topic, and some health systems and medical groups are turning to technology to help identify and alleviate burnout. A virtualist physician or virtualist team potentially could help with some of that information overload, while also being up on the latest technology to reduce click-based tasks.

Authors of the JAMA editorial, Michael Nochomovitz, M.D., and Rahul Sharma, M.D., of NewYork-Presbyterian, noted that medical specialty development in the past has been driven by advances in technology, such as the emergence of critical care as a specialty 30 years ago following advancements in cardiac monitoring, ventilators, surgery and anesthesia. Geriatrics, palliative care and hospitalists are other examples of relatively new specialists driven by technology, care innovation and population trends.

Formal training for virtualists should include techniques on developing a “webside manner,” Nochomovitz and Sharma wrote, pointing out that training programs on effective and compassionate virtual care exist, but there is not yet a standard consensus, oversight or associated certification. Virtual providers conceivably could become subspecialists in areas where virtual visits already have flourished, including neurology and psychiatry.

A shift to value-based care, where providers are paid based on outcomes and not per care encounter, already is accelerating the adoption of virtual care. While there are many aspects to consider, including accreditation, oversight and working across state lines, the virtualist movement is a trend to watch.

Health Journalism 2018 attendees who have signed up for Field Trip 2 will have a chance to learn more about telehealth and virtual care at Banner Health’s TeleICU.

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