The Primary Care Physician Shortage [Part III]: Is The Answer Telemedicine?

May 5, 2014

Though the open enrollment deadline has passed, the number of people successfully enrolled in plans continues to tick upwards. Analysts predict that if the current rate of signups continues, eventually we’ll have as many as 30 million more people who will be newly insured. Right now, we don’t have enough primary care physicians to meet this new demand. There are many possible solutions. We’re exploring 3 of them in a series of posts:

1. Shortening the amount of time it takes to get a medical degree and expanding residency programs to get more doctors into the workforce more quickly.

2. Empowering medical professionals to take on more of the responsibilities of primary care physicians, working under their supervision. These professionals include physicians’ assistants, nurse practitioners, pharmacists, nurses and others.

3. Using technology – telephones, email and telemedicine — even remote monitoring — to extend the reach of physicians — especially for people in remote and rural areas.

This is Part III of a 3-Part Series. Click here for Part I and here for Part II in the series.

So far in this series, we’ve explored ways to get more physicians on the job more quickly and enabling other health care professionals to perform some medical services as the answer to the primary care physician shortage in this country. However, there is one option that doesn’t require adding more people to the mix at all. We’ll give you a hint: it involves the Internet.

According to the U.S. Department of Health and Human Services (HHS), more than three-quarters of rural communities in the U.S. have less than one physician serving every 3,500 residents.

So while adding more doctors to the pool may relieve shortages in urban hospitals or bring more specialists to the suburbs, it won’t have the same effect in towns and villages far off the beaten path.

As a result, many people who live in remote areas must travel hours to get to a doctor’s office or hospital. For them, a doctor’s appointment may never be convenient. The physicians who do work in rural communities must perform a broad scope of services — on any given day handling “everything from atrial fibrillation to pneumonia, and an asthma exacerbation to a cesarean section birth.”

Here’s where the Internet comes in.

Making it possible for physicians to “examine,” diagnose, and treat their patients remotely via devices included under the umbrella term “health information technology” (HIT) may be the answer providing primary physician care to these remote communities. It’s called telemedicine and it’s growing in use and popularity.

Telemedicine has been formally defined as “the use of electronic communication to transmit medical information from one site to another in the delivery of clinical services.” While it has long been used to connect acutely ill patients to specialists in different physical locations, increasingly it’s being used to supplement the knowledge and skills of rural primary care physicians.

According to the New England Journal of Medicine, telemedicine is now used in more than half of U.S. hospitals, primarily to extend specialty care services to remote or underserved areas, and a growing number of federally qualified health centers are incorporating telemedicine capabilities. Recent reports reveal that over 200 telemedicine networks are now operating.The number of U.S. telemedicine service sites recently topped 3,500.

Despite its increasingly widespread adoption, telemedicine faces several obstacles that need to be overcome before its capabilities can be fully realized. These include:

High-speed connectivity: Telemedicine requires a lot of bandwidth and Internet connectivity tends to be the weakest and least reliable in rural areas, making an Internet-based health system less than ideal.

In the summer of 2013, President Obama resolved to bring high-speed Internet to 98% of Americans through schools and libraries by 2018 through an initiative designed to spur growth and educational outcomes. But a side benefit of ubiquitous high-speed internet would be a high-speed Internet infrastructure in communities that could be used for telemedicine.

Privacy: HIPAA regulations require strict security to ensure privacy when transmitting sensitive health data. This has important implications for telemedicine. In a recent case, a psychiatrist was cited for prescribing drugs via the video conferencing application Skype that ultimately resulted in a patient overdose. This prompted the HIPAA board to call for stricter requirements for doctoring via telemedicine.

HIPAA rules continue to evolve and will no doubt affect the implementation of telemedicine in the future.

Cost: Telemedicine requires that rural physicians have access to infrastructure, equipment and devices that can be expensive — potentially too expensive for many rural practices and hospitals to afford. Also, reimbursement policy for telemedicine under government programs remains spotty, although in recent years Medicare has approved select “telemedicine-delivered services” for reimbursement.

While these issues still do not have a clear-cut solution, the potential of technology to solve health problems has not gone unnoticed. The value of the telehealth market is poised to reach $1.9 billion in 2018, compared to approximately $230 million today.

In a recent example, a rural primary care physician was faced with an unusual case — a very sick child with swollen glands. The physician consulted via telemedicine technology with a specialist from the University of California at Davis.. This led to the child being treated locally, rather than requiring that the child be moved to a distant specialist facility.

Other cases have used telemedicine in locations as disparate Lanai, Hawaii and rural Georgia, making it clear that telemedicine has the potential to radically improved access to care.

Because if there’s one thing that travels faster than a rural doctor’s car down a bumpy dirt road, it’s the Internet.

2 Responses to “The Primary Care Physician Shortage [Part III]: Is The Answer Telemedicine?”

  1. We at GlobalMed believe that telemedicine – the real-time, live consultations between a doctor and a remote patient – is the short-term and long-term answer to the physician shortage, especially in rural areas. Even if we could create enough post-graduate residencies, it would take years to produce enough physicians to replace those who are retiring. Having more doctors anyway is no guarantee that they would practice in medically underserved areas.

  2. […] While a number of telehealth programs are focused on follow-up care for patients with chronic conditions across urban and rural settings, telehealth is also rising to the top as a means towards solving rural physician access difficulties. More than half of US hospitals use telemedicine to reach underserved areas, despite some technology and privacy implementation challenges. […]

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