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Telemedicine and the impact on fellowship training?

unleash500

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Wondering what other onc clinics are doing with regards to telemedicine and fellowship training. Do you have a three way call/video with the fellow, attending, and patient ? This makes the most sense practically but seems like it would render the fellow with more of a “shadowing” role. Do you have the fellow call patient first, staff with attending, and then call patient back with plan? This fits the more traditional role but is inefficient. Do fellows/attendings typically work from home or do they just work from clinic ?
Also how long does your clinic/hospital plan on utilizing telemedicine ? Is this a permanent path forward ? What patients will you or do you still see in clinic?
 
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DoctorDontStop

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This is completely dependent on Attending. I've spoken to patients using each of of the scenarios you describe. I think going forward, prevalence of disease will dictate how long we do telemed. Some places are already seeing physical patients again with hospital precautions in place. Anyone on chemo needs a close eye, Surveillance patients, not so much.
 
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gutonc

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I imagine insurances are going to stop reimbursing for telehealth at some point and that will be that.
They won't stop. You've been able to bill for virtual visits/phone visits for a long time. But it won't be at the "in-person" rate. When that happens is TBD of course.
 

lulu09

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Mostly did telehealth visits by speaking to the patient, then hanging up (asking the patient to "hang out" in the virtual exam room) to precept with attending (over the phone), and then joining together on a three-way call. It's definitely more work for the attending, but this is essentially the same as the previous staffing model.

IMO telehealth is great for patients on surveillance or gen heme clinic. Don't need to wait for the patients to be roomed and vital'd. I often would even call the patients ahead of time and then breeze through an entire afternoon of clinic in 2-3 hours. You can't do that with physical visits (also in person I think patients in general tend to linger, chat, and also bring up unrelated issues).

Sure, the physical exam is sacrificed and I can think of many cancer patients on active chemo where it's dangerous to go months-years without a physical evaluation, but lets not kid ourselves that the physical exam is of utmost importance in a specialty like heme-onc. The vast, vast majority of gen heme clinic can be done as telehealth, and more efficient too this way (can get through more new patients). I'm actually glad in a sense that COVID was last nudge that really pushed medicine into incorporating more technology in outpatient visits (old system driven by outmoded insurance payment models).

Mostly now we're seeing active therapy patients in the clinic in person, and then pushing all surveillance/stable established regimen patients to e-visits (for onc). Gen heme is almost completely virtual. Mal heme is about the same as oncology. For better or for worse, telehealth is there to stay. I think clinic will remain partially in-person and partially virtual forever (for example, you can alternate e-visits and in-person visits for most patients). Just like Apple when they decided to get rid of the headphone jack -- there's going to be an uproar and people throwing hissy fits about it, but this too shall pass and become the new normal.
 
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