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Could eConsults Help with Physician Specialist Shortages?

In a March 18, 2019 New York Times article, Austin Frakt talks about the potential benefits of eConsults for healthcare. In essence, eConsults occur when a primary care doctor consults a specialist about a patient electronically, probably by email, in place of an appointment. In this case the patient gets to avoid the time required to get a specialist appointment, and overall this process allows health systems to “free up capacity…, reducing waiting times for others.”

Frakt identifies multiple ways eConsults may have value for healthcare:

Reducing unnecessary specialist visits – In the article Frakt states that “Studies have found that a large portion of referrals to specialists—upward of 40 percent in some cases—are not needed.”

Saving significant time and expense – Some patients may be spared the effort to travel long distances to specialist appointments, and others might be able to avoid the lengthy delays before such a visit. In some cases these delays can lead to further health complications or even more serious conditions.

Ensuring Medicaid patients receive high quality care – Frakt cites a study that “found that nearly one-third of specialists are unwilling to make appointments with new Medicaid patients.”

Counteracting specialist shortages – Frakt quotes Dr. Mitchell Katz, director of the San Francisco Department of Public Health, and now the president of NYC Health & Hospitals, who shared “A safety net system can’t afford to hire enough specialists to meet demand—eConsults get around that problem by increasing access through enhancing efficiency.”

Shortening appointment wait times – In the case of the Los Angeles County Department of Health Services, after 3 years of using eConsults, “waiting times for specialists had fallen by an average of 17 percent, to 52 days from 63 days. The proportion of appointments scheduled within 30 days rose to 30 percent from 24 percent. A quarter of eConsult engagements between primary care and specialist physicians were resolved with no visit at all.”

Improving satisfaction for both doctors and patients – Not only do eConsults serve to resolve lots of patient problems for patients, but “Patients generally report good experiences and high satisfaction” with them.

Frakt does caution that the danger of eConsults is that this system routes more work and administrative burden to primary care doctors. It’s important to understand that eConsults could become less valuable if any of the clinicians involved are less engaged and automatically refer patients to specialists for review. By increasing the volume of care delivered by a system, eConsults do have the potential to “contribute to rising health care spending.” This can only be justified if they have a documented impact on improved patient outcomes, which has not been shown yet in studies.

Reference

All quotes are from:

Frakt, Austin, “When Email Comes to the Doctor’s Office, Wait Times Decrease,” The New York Times, March 18, 2019, Retrieved at https://www.nytimes.com/2019/03/18/upshot/when-email-comes-to-the-doctors-office-wait-times-decrease.html.

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