PracticalDermatology

Virtualist:(noun) A dermatologist tasked with evaluating patients virtually and developing and implementing an initial treatment plan. If necessary, a virtualist can also refer dermatologic patients who require further work-up or biopsy for in-person care.

Bustling medical and cosmetic dermatology practice seeks “Virtualist” to help triage, diagnose, and design treatment plans. Patient care experience, technical proficiency a must. Full- and part-time opportunities available. Apply Now!

You may not have seen or placed this type of help wanted ad yet, but you will as we seek to improve the quality of teledermatology care, as well as the patient experience.

After some false starts, teledermatology got its foothold during the throes of the COVID-19 pandemic, and this form of care will remain long after we have a vaccine and the public health emergency ends. Most surveys show that a large percentage of patients would even be willing to switch their physicians if their current doctor doesn’t continue to offer telemedicine as an option for care.

One of the best ways we can meet patient demand will be with the creation of a new type of specialist: a virtualist.

By now, most of us are familiar hospitalists. In dermatology, a hospitalist is a board-certified dermatologist who cares for hospitalized patients. A recent study found that dermatology hospitalists can be virtual and still be highly effective at caring for patients.¹ This is welcome news that bodes well for the role of the virtualist in outpatient dermatologic care, as well.

Outpatient virtualists will be able to make certain diagnoses, design initial treatment plans, and refer patients for biopsy or further work-up as needed.

The talent pool is overflowing with dermatologists who are considering, but not completely ready for, retirement. Ideally, virtualists can log in from home for at least a few days a week and assess patients. This also helps reduce waiting room bloat, which will go a long way toward easing patient anxiety about coming into the office, given their justifiable COVID-19 fears. Virtualists will also improve access to dermatologists, particularly in areas where shortages are reported.

That said, more changes will be required to unleash the full potential of teledermatology. CMS removed many hurdles to allow us to practice telemedicine when patients couldn’t get in to see us, but the technology has not kept pace with the access. Yes, we can use video conferencing and chat to treat patients without incurring the wrath of HIPAA enforcers, but our video capabilities are not as sharp as our “store and forward” technology. To catch up, video must become more high-def so that dermatologists can better visualize and examine skin.

Moreover, there is not pay parity for visits that rely on store and forward technology. It is not reimbursed at the same rate as video appointments, despite the fact that it is more effective. Many dermatologists now offer a hybrid by asking patients to send high-resolution photos in advance of their appointment. We review the photos and then perform the consult over video to make sure that quality isn’t sacrificed in the name of reimbursement. Pay parity is needed to help bridge this gap, unless and until the live video technology improves sufficiently.

Teledermatology is here to stay, and by advancing solutions and creating new positions, such as a virtualist, we will be able to provide high quality care to our patients from the comfort of their homes.

1. Gabel, Colleen K. et al,” Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease. Journal of the American Academy of Dermatology. In press.