Virtual Medicine: The Lever That Just Might Save Independent Practice


Give me a lever long enough, and a prop strong enough, I can single-handedly move the world.

— Archimedes

Independent medical practice in America is in trouble. It is fragmented, with some 900,000 doctors – 300,000 primary care doctors and 600,000 specialists- practicing in disparate settings. These physicians are located in roughly 580, 000 locations. Some are solo, most are in small groups, and many are clustered around 125 academic medical centers, 100 integrated groups, and 5000 community hospitals.

Doctors are not unified – less than 20 percent belong to the AMA. Some 110,000 are members of Sermo – a social networking organization that tends to house dissident physicians. The MGMA is said to represent 300,000 doctors.

The Physicians’ Foundation, composed of roughly 650,000 doctors in state and local medical societies, in 2008 surveyed 300,000 primary care doctors. The doctors were unhappy. Many said they would leave practice if they could, and the majority said they would not recommend medicine as a career for their children.

Furthermore, doctors are swamped with work, with not enough time for patients, for leisure, or for mastering skills or technologies necessary for their work. Doctors are in short supply, 125,000 to 200,000 short by 2020-2025 depending on whom you ask.

What to do? No easy answers exist. Current reform bills do not fully address the demand-supply crisis. The crisis will be aggravated if 30 million more uninsured and when 78 million baby boomers start coming on board and flooding into doctor’s offices and into hospital ERs and wards.

One lever that might lift the gloom and empower independent practicing doctors is virtual medicine. Virtual medicine has various definitions. I look upon it as independent online physicians linked by telecommunications with each other and with patients. The telecommunication tools allow them to collaborate with each other, access online consultations, diagnose and treat patients at a distance, and instantly gather the latest information in their respective fields. I am talking here about the real-time, on-line world.

Don’t get me wrong. I do not view virtual medicine through rosy lens. Virtual medicine has its downsides – medical legal obstacles, payment conundrums, practice disruptions, funding dilemmas, lack of time for training, and absence of workable, flexible, and profitable business models.

But virtual medicine is worth investigating, if for no another reason that the feds contemplate pouring $20 billion into ubiquitous EMRs over the next 5 years, rewarding those hospitals and doctors who have EMRs, and punishing those who do not. Big health systems, with sufficient infrastructure, have already installed EMRs and sing the EMR praises (although it’s a dirty little secret that about 30 percent of EMRs are “dis-installed” for reasons of dissatisfaction and lack of functionality).

And let’s face it. The world is moving on Internet time. Those not moving electronically fast enough are in the doldrums. Look at America’s newspapers. Many are closing shop, others are going on line, and all are searching for a profitable business model to accommodate the Internet. Or witness the travails of the book publishing world. Book buyers are flocking to Amazon’s Kindle or Barnes and Nobles’ Nook. Google is digitizing the world’s libraries. Independent book stores are shuttering their doors.

Why am I carrying on about the Internet and virtual medicine?

Two reasons.

ONE, in my book Innovation-Driven Health Care (Jones and Bartlett, 2007), I gave numerous practical examples of the positive benefits of virtual medicine,. Besides, I have my book-selling hat on.

TWO, yesterday I had a lengthy collaborative conversation with Ron Pion, MD, a virtual medicine visionary and successful entrepreneur with 30 years or so of hands-on experience and real-world experimentation with virtual medicine. Ron is a clinical professor of Ob-Gyn at the UCLA School of Medicine and heads up Medical Telecommunications Associates, which he uses as a platform to advise these companies.

http://www.medicalhistory.com (symptom presentation prior to visit)

http://www.officeally.com (e-connecting continuum for the small MD office )

http://www.ideallifeonline.com (home-based patient management)

http://www.medencentive.com (reward for responsible performance)


http://www.rediclinic.com (nurse practitioner in retail location)

http://www.hpinstitute.com (J&J acquisition)

http://www.healthmedia.com (Wellness and Prevention)

http://www.med-flash.com (e-Patient Health Record)

http://www.lifeonkey.com (e-Patient Health Record)

http://www.digitalunioncorp.com (collaborative software – low cost, high functionality))

http://www.specialistsoncall.com (brings expertise to the hospital ER)

These companies cover much of the virtual medicine landscape. Their central purpose is to help practicing doctors and their patients adapt and adopt to new realities of the new telecommunications world.

As Thomas Friedman, the New York Times columnist, observed in a recent piece on December 12, “The Do-It Yourself World,”

“In case you haven’t noticed, the U.S. economy today is actually being hit by two tsunamis at once: The Great Recession and the Great Inflection.

The Great Inflection is the mass diffusion of low-cost, high-powered innovation technologies — from hand-held computers to Web sites that offer any imaginable service — plus cheap connectivity. They are transforming how business is done. The Great Recession you know.”

Richard L. Reece, MD, is pathologist, editor, author, speaker, innovator, and believer in abilities of practicing doctors and their patients to control and improve their health destinies through innovation. He is author of eleven books. Dr. Reece posts frequently at his blog, Medinnovation.

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11 replies »

  1. Can anyone list for me the top technology platforms out there attempting to create an electronic or virtual concierge doctor model, or that is helping doctors, patients and others with particular conditions better connect on managing their conditions and get care?
    Also, what are the opinions on Accountable Care Organizations? Will this business model drive a significant improvement in care and volume, and will doctors adopt it in large numbers?

  2. This issue touches on a couple of global issues. People who would otherwise not be in healthcare joined because their job is difficult to outsource due to the office based practice of medicine. Given the right amount of marketing and push, patients will do the virtual visit just as they see mid-level providers. More middlemen in the delivery process only further complicates but those middlemen will be there until they find better pastures. We need to insource (if that’s a word) and give the extra people in healthcare something else to do. Otherwise, the person with the most investment (the physician and specialist) will just leave as the investment seems less worthwhile. What is the system left with then?

  3. “Just a brief comment. When I wrote this blog, I was not thinking about promoting the use of virtual medicine among foreign-trained physicians. I was thinking of virtual medicine to help American primary care physicians.”
    I was thinking of that as well. I think it is imperative that we keep these types of operations within the United States. We are outsourcing many jobs already, and this trend is only increasing. If anything, allowing tele-medicine access to physicians and clinicians outside the US will only push our doctors further away, since we demand everything from them and strip benefits from them 1 by 1.

  4. One more point…This isn’t a county issue – we can deal with that (licensing/quality) in once there are frameworks for virtual med that catch on.
    The US currently uses radiologists in Australia read x-rays at 2am. There are ways to make the global economy work, and not decrease quality of care.

  5. Very well written!
    Virtual and telemedicine have great prospects to connect MD and patients who otherwise would be able to recieve “expert” care.
    Telemedicine has great promise in psychiatry – and being able to get specialist looking, talking, observing patients allows them (children in particular) to get the meds/services they need.
    We need to figure out how to make this work…both as a care delivery system (BILLING!$) and as a means to better engage patients in their care (virtual means we can connect and all the ways! blogs, news letters, podcasts, social networking)
    Lots of great prospects, we need to get these people together to develope (and payment systems up to date to allow the innovation)

  6. Virtual Medicine seems like something that could possibly be beneficial to the world of Health IT . However, I would agree with allowing this virtual healthcare be domestic for the country that it’s in.

  7. Just a brief comment. When I wrote this blog, I was not thinking about promoting the use of virtual medicine among foreign-trained physicians. I was thinking of virtual medicine to help American primary care physicians. I am aware, of course, that about 25% of practicing physicians in the U.S. are foreign-born or trained.

  8. I am not being against domestic PCPs. In fact, if there is anyone in the whole system whose judgment can be trusted the most, I would say it would be the PCP.
    Still, the notion that internet driven therapy stop at national boundaries doesn’t make sense to me.

  9. Yes, sending primary care off shore is a sure bet to cut costs. I am surprised that those cost-effective, well meaning, employer owned health care networks haven’t hit on this notion just yet.
    This should free American doctors from the “plain vanilla” practice of primary care and leave them free to tend to the “secret sauce” of highly specialized, cutting edge medicine. Thomas Friedman would be proud.
    There is only one caveat though: we need to figure out a way to freely sue off-shore providers for malpractice.

  10. Won’t that let foreign doctors and providers come into play?
    Would a combination of a registered nurse at onsite and a doctor in remote location be able to provide same level of service as well?
    Would providers be willing to colloborate with each other? They certainly aren’t as far as offshore providers are conerned as was found in a survey.