Virginia Postrel, MDT/Bloomberg
People have been predicting the ascent of telemedicine since the 1920s, but even mass broadband use wasn’t enough to make it catch on. Doctors were too worried about losing income, privacy restrictions limited the utility of software and people were just too accustomed to the old ways of doing things.
Then Covid-19 arrived and everything changed. In-person doctor visits became dangerous for both patients and medical staff. By April 2020, half of U.S. physicians had adopted some version of telemedicine, up from 18% in 2018. Mount Sinai Faculty Practice in New York City reported that it had more telehealth visits on an average day that month than in all of 2019.
As the pandemic wanes, some of those visits will no doubt go back to being face to face. But many won’t — and shouldn’t. Telemedicine is too convenient for both patients and doctors.
Consider surgeons. They don’t immediately come to mind as candidates for virtual visits. But much of their time is taken up with pre- and post-operative care that could be done over the internet. It doesn’t take an in-person visit to prescribe imaging for an upcoming operation or to check in to see how a patient’s knee replacement is doing. Patients can spend less time going to and from visits and sitting in waiting rooms. (I once spent four hours waiting for a busy surgeon to see me for a post-operative checkup.)
Telemedicine is also a convenient way to offer after-hours care, particularly when there’s a time-zone difference. And that suggests another potential positive legacy of the pandemic: loosened regulations to let licensed medical professionals cross state lines.
Almost half of U.S. states have laws allowing out-of-state health-care practitioners to work during emergencies. Others used executive actions to enable medical practitioners from elsewhere to help out during the pandemic. But why limit such waivers to emergencies? It’s not as though human health is different in Arizona and Missouri. State-by-state license requirements serve mostly to limit competition. (The same might be said for limits on internationally trained medical personnel.)
Thirty-three states and the District of Columbia already belong to a compact that allows licensed nurses to practice in any of the member states. Telemedicine services that, for example, provide after-hours triage are able to cover most of the country by hiring nurses who live in compact states.
When Covid-19 hit, compact members found it much easier to keep their hospitals staffed. New Jersey, which had just joined the group, sped up implementation to let out-of-state nurses pitch in as Covid cases soared.
“Expediting the process has absolutely enabled us to move people appropriately where they’re needed,” said Mary Beth Russell, vice president at the Center for Professional Development, Innovation & Research at RWJBarnabas Health, the state’s largest health-care system. That sort of flexibility — for hospitals, health care professionals, and patients — shouldn’t require emergency conditions.
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