Future of medicine... Virtual??? What do we think/know?

[Lugh]

When I keep seeing Walmart and Amazon hiring NP/PA providers to care for patients, it makes me wonder where the future of medicine is going. All virtual, no physicians, quick, and disingenuous. I work with doctors and other providers and just about every single one of them HATE virtual visits. People are going to do a virtual visit for ear infections, strep throat, COVID, flu... all without anyway to test for it right there. Or have BP issues, diabetics, ADHD and other mental health issues. These are more than just phone call issues. Full assessments by physicians and providers are necessary to catch other underlying issues that might be causing other symptoms. I want to go into family medicine and this just seems like the end of it. Now I am looking into hospital medicine b/c you can't go to a virtual hospital.

What does the future look like for primary care, virtual medicine, and doctors (physicians, not advanced providers)??

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[Lugh]

Also, if anyone knows some users that might have some views on this please tag them. @Goro @gyngyn

 

[Goro]

When I keep seeing Walmart and Amazon hiring NP/PA providers to care for patients, it makes me wonder where the future of medicine is going. All virtual, no physicians, quick, and disingenuous. I work with doctors and other providers and just about every single one of them HATE virtual visits. People are going to do a virtual visit for ear infections, strep throat, COVID, flu... all without anyway to test for it right there. Or have BP issues, diabetics, ADHD and other mental health issues. These are more than just phone call issues. Full assessments by physicians and providers are necessary to catch other underlying issues that might be causing other symptoms. I want to go into family medicine and this just seems like the end of it. Now I am looking into hospital medicine b/c you can't go to a virtual hospital.

What does the future look like for primary care, virtual medicine, and doctors (physicians, not advanced providers)??

NOT like the nightmare scenario you are indulging in. Really, take two of these:

 

[Lugh]

NOT like the nightmare scenario you are indulging in. Really, take two of these:
View attachment 354289

tbh I am off my zoloft. Thank you for setting it straight.

 

[Mr.Smile12]

I can't see that virtual medicine will supplant in-person visits completely. If I changed PCP's, I can't avoid an actual physical exam by my new provider.

 

[Tenk]

Relax, they have been saying this crap since old timer times. That’s all it’s ever amounted to btw: crap.

 

[Putkernerinthehall]

The NP/PA proliferation would be more concerning to me (as a physician) than the virtual stuff. I imagine the virtual volume will decline as we move beyond Covid. In fact, doctors should push to reduce it.

 

[mrbreakfast]

Now I am looking into hospital medicine b/c you can't go to a virtual hospital.

Ohhhhhh yes you can, in that the patient are physically there, but the doctors aren't. Certain fields have been doing that since before COVID. At most hospitals (not big hospitals, but the average, smaller hospitals) if you walk into the ED and ask to be seen by a neurologist, you're going to meet an IPAD on a stand. For the most part, that's how acute stroke treatment works in this country; the TPA decision is being made by someone hundreds (or thousands) of miles away, who answers zoom and facetime calls from home part or full-time. I believe a number of other specialties are similar.

There's nothing inherently wrong with telemedicine. If I have to examine someone, I'll tell them their next visit needs to be in-person. If not, telemedicine is quicker and lets me see patients who live 4 hours away. It's here to stay.

 

[deleted1100659]

The future of medicine is a LAI formulation of an adderall/xanax mixture called "adderax".

But seriously, people are busy, time is a luxury for many people. Others don't have transprotation or gas money. Telehealth improves access to people who need it.

 

[allantois]

It depends on the specialty, in psychiatry the majority of our work is now telehealth

 

[Browns99]

The future of medicine is a LAI formulation of an adderall/xanax mixture called "adderax".

But seriously, people are busy, time is a luxury for many people. Others don't have transprotation or gas money. Telehealth improves access to people who need it.

Obviously, it has its limitations, so no, it's not the "future" of medicine.

 

[deleted1100659]

Obviously, it has its limitations, so no, it's not the "future" of medicine.

in person visits also have limitations

 

[operaman]

So I use telehealth quite a bit while also insisting on in person visits much of the time. This is actually allowing me to see more patients and to better manage my own time.

For most of my visits I insist on in person simply because I need to perform some kind of exam that will be critical to my decision making. Patients will sometimes ask for the first visit to be telehealth and I will say no simply because it wastes everyone’s time if there’s no way for me to make a decision without an exam. Same goes for any follow up visit where I need to examine something, and this is probably the bulk of my visits.

Here’s where I’m loving telehealth: any follow up where I don’t need to see them in person again. Most common ones are close follow ups after a scan where I’ve just done an exam and we really just need to go over a scan and possibly talk about a surgery. Pre telehealth these were often phone calls that would eat up time and weren’t billable, but now I just schedule them in as short telehealth appointments. So now when I order a scan or a biopsy or something like that, I just make a telehealth appointment for when I expect to have results so we can discuss it. Patients love the improved access without having to fly/drive, park, wait, etc., and I love not spending 1-2 hours after clinic making calls since all of those encounters are built into my regular schedule. Means I can leave at 5pm or earlier most days with all my calls and notes done.

I don’t worry too much about midlevels in my field because it’s more specialized and very procedure and exam driven. The procedures themselves also require a high level of thinking to interpret and most midlevels would be hard pressed to get good enough to get referrals and keep them. Add to this the massive capital requirements and I think subspecialty midlevel independent practice is a tough sell.

Where they are useful is as extenders and assistants - basically anywhere you’d wish you had a resident, a well trained midlevel can help a lot. They’re also amazing on inpatient services with residents because they develop incredible service knowledge and never rotate away or graduate.

 

[allantois]

I have so many patients working from home who are in tech and finance and other fields who absolutely love it (many of them have moved to nice warm areas); I would think long and hard about specialty as well as career choice as there really is nothing glamorous about going to work in a medical office

 

[Putkernerinthehall]

I have so many patients working from home who are in tech and finance and other fields who absolutely love it (many of them have moved to nice warm areas); I would think long and hard about specialty as well as career choice as there really is nothing glamorous about going to work in a medical office

There's nothing glamorous about working from home either! It's nice, especially if late in your career. For young people, mid-career, I'm not so sure it's as much of a positive (job / task dependent, I guess).

 

[allantois]

There's nothing glamorous about working from home either! It's nice, especially if late in your career. For young people, mid-career, I'm not so sure it's as much of a positive (job / task dependent, I guess).

I think it’s a nice option to have. My PCP does hybrid work and only did telehealth during peak COVID. If someone is in a procedural specialty, of course that’s not even going to be an option