Medical virtualist actually sounds like a reasonable sub-specialty – here’s why

Feb 15, 2018

A recent viewpoint article in JAMA suggested that a new specialty may be in order:  the medical virtualist. The author discusses the expansion of telemedicine and digital advances within healthcare, and describes the potential new specialty as follows:

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.

Arguments against the medical virtualist as a specialty

After reading this article, I quickly came across arguments against medical virtualism as a new specialty. Here are the main drivers of this stance:

  • Physicians practicing virtual medicine are diagnosing and treating the same problems that other specialties already diagnose and treat.
  • All physicians should be expected to be competent in virtual care, regardless of their specialty.

I understand where these views stem from. But I think there are strong points of opposition for both of these arguments.

Newer specialties aren’t based on specific diseases or procedures

A simplistic view of medical specialties is that each one has specific diseases that it treats or procedures that it focuses on. For example,

Gastroenterologists treat GI diseases

Thoracic surgeons perform surgery of the thorax

But consider some of the more recent sub-specialties approved by the American Board of Medical Specialties (ABMS):

  • Critical care medicine
  • Hospice and palliative medicine
  • Clinical informatics

Critical care medicine is medical practice in a certain healthcare setting, regardless of the patient’s illness or body system affected. Hospice and palliative medicine is management of a specific patient population, regardless of the patient’s underlying disease. Clinical informatics has even more similarities to the proposed specialty of medical virtualist. So let’s take a closer look at that.

Here is how the American Board of Preventive Medicine summarizes the specialty of clinical informatics:

Physicians who practice Clinical Informatics collaborate with other health care and information technology professionals to analyze, design, implement and evaluate information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship.

Broad, but important.

Like any subspecialty, obtaining certification in these three areas requires that physicians be board-certified in another specialty before they are eligible for certification. Unlike many sub-specialties, though, the initial certification can by any of several specialty boards. In fact, you can get board certified in clinical informatics after initially being certified in any specialty recognized by the ABMS.

Why this trend toward “umbrella” sub-specialties? It seems to be a recognition that there are skill sets and competencies needed by physicians for certain types of work and positions. This is in addition to the specific therapeutic or diagnostic area that we focus on. As the field of healthcare has become more complex, our need for competent physician leaders has grown.

Health technologies change too rapidly to keep up

Health-related data are generated at a dramatic rate. Health technologies evolve quickly. It’s difficult for even the most astute, productive physician to keep up. Telemedicine is no longer just a software system and a video screen that allows a provider to see a patient who’s physically located somewhere else. There are regulations, best practices, peripheral devices, and more to consider. To use telemedicine technologies appropriately while also delivering appropriate care requires a deep understanding of the technology, the medicine, and the interactions between the two.

I don’t feel that anyone is suggesting we permit board-certification without rigorous training via a full clinical residency. Rather, we are acknowledging that the amount of information within medicine has grown hugely, and requiring all physicians to be competent in all new health technologies is not practical.

The full potential of virtual medicine requires the expertise of physicians

Occasionally, the medical field is met with game-changing concepts, such as telemedicine, which have the potential to alter how healthcare is delivered. These technologies and models of care need to be thoroughly incorporated into medical training and there need to be standards and expectations for the medical professionals who have roles concentrated around them.

Based on my own experience practicing telemedicine, training in virtual medicine needed. I frequently come across physicians whose telemedicine encounters are poorly executed. Many do not take advantage what the technology has to offer in order to help their patients.

A formal sub-specialty in medial virtualism is not just a way for physicians to receive extra training and certification. It will assist in demonstrating to patients, insurers, and other practitioners that good healthcare can be delivered without an in-person visit.

I’m excited to read more dialogue about this proposed specialty. It will be interesting to see what comes of it. What are your thoughts? Let us know in the comments below.

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