Over the last decades, advances in diagnostic and therapeutic options have greatly improved the care neurologists offer their patients. However, the national shortage of neurologists, particularly those with subspecialty expertise, leads many to wonder whether all patients have access to modern standards. Further, the advances come at a cost to neurologists themselves, who must fulfill increasingly demanding call duties and work hours. While improved outcomes lead to greater physician satisfaction, the provider crunch encroaches upon personal time.
A recent American Academy of Neurology survey showed that 60 percent of the 4,000 responding neurologists endorsed at least one symptom of physician burnout. Worsening clerical burdens associated with maintaining certification, insurance documentation, and reimbursement cuts are making it harder for neurologists to strike a reasonable work-life balance.
According to Herb Rogove, DO, telemedicine can play an important role in improving patient access to quality subspecialty care and increasing the efficiency of physicians. Dr. Rogove is founder and CEO of C3O Telemedicine and now serves as the CMO of InTouch Health, which recently acquired C3O. I had the opportunity to speak with Dr. Rogove about telemedicine and its impact on neurology, and in our conversation he noted that the landscape has changed dramatically since 2008, when he founded C30. “Telemedicine is becoming mainstream and is increasingly integrated into the everyday experience of the patient,” he says. For example, hospitals with telemedicine programs that previously had no access to on-call neurologists now rely upon three-minute page-to-responses and an average of eleven minutes to live audiovisual interface across their 30 hospital partners.
While these enhancements in access and quality of response are impressive metrics of improvement, Dr. Rogove also noted the enhancement of his colleagues’ quality of life. “How do you improve the efficiency of the physician? How can you help the physician achieve work-life balance and satisfaction?” he asked. The flexibility in work hours and reduction in clerical burden offers incredible benefits to physicians asking these same questions. For example, telemedicine offers options for those who wish to continue to provide high quality care but desire to work from a home office.
Increasingly, telemedicine platforms are integrated with hospital documentation and records systems, allowing a single, secure sign-on to provide everything the neurologist needs to care for the patient. The integrated back office support allows the doctor to focus on taking care of the patient rather than on compliance with increasingly complex billing requirements.
Dr. Rogove also regards telemedicine as an appealing option for those seeking “sunset retirement.” Many retiring neurologists may be financially prepared, however they wish to continue to serve patients and derive professional satisfaction from helping others. Many roles in telemedicine allow physicians to determine the hours and type of work they will do and offer the opportunity to tailor their role to their new lifestyle.
The ubiquitous spread of telemedicine programs offers other interesting benefits even for those neurologists who do not wish to practice telemedicine. For example, many neurologists who maintain hospital affiliations may need to interrupt their busy outpatient practice to fulfill Emergency Department call duty. This leads to reductions in productivity as well as dissatisfaction for patients who experience increased wait times or even cancelled appointments as a result.
However, many hospitals augment or replace onsite neurologist call with telemedicine call and relieve this issue. This may enhance the overall satisfaction of both patients and neurologists in these communities. Rather than view telemedicine programs as competition, these physicians enjoy increased availability in their outpatient office and predictable hours for rounding on in-patients. These efficiencies benefit both patients and neurologists.
The evidence-based improvement in outcomes and the continued leaps in telemedicine technology are transforming the healthcare landscape. Patients enjoy improvements in the availability and response times of neurologists, while the neurologists experience increased autonomy and flexibility to balance their time between professional and personal pursuits. While the field at large continues to experience challenges in reimbursement, telemedicine programs continue to offer novel solutions to overcome these hurdles.
Shawn Masia, MD is a board certified neurologist and clinical neurophysiologist.