Frequently Asked Questions
Question: Why does InDoc only hire physicians and not advanced practice providers such as physician assistants and nurse practitioners?
We support the views of the American College of Emergency Physicians, the American Academy of Emergency Physicians and the American Medical Association that while APPs are an important component of the medical team, their care should be provided under the direct supervision of a physician. The services that we provide rely on the ability of our physicians practicing independently.
In particular, we believe that triage should be staffed by medial providers with the most training and experience. Much as a triage nurse is often the most experienced in the department, so too should be the triage physician.
Diagnostic momentum. This is a cognitive error that is common in medicine wherein it is difficult to remove the diagnostic label that has been assigned to a patient by a previous clinician. Therefore, it is important that the first clinician who sees the patient comes to the most accurate conclusions based on limited data. This underscores the importance of having a highly trained and experienced physician in triage.
Question: What are the advantages of having a virtual physician in triage compared to a traditional provider in triage (PIT)?
There are several advantages to using a virtual physician in triage.
While licensed in your state, a virtual physician may be located anywhere in the United States. Since InDoc is able to recruit nationally, we are able to offer our services at an hourly rate that is typically less than what an average emergency physician makes locally. Additionally, this provides hospitals with immediate access to a large pool of highly skilled Emergency Physicians.
The virtual physician is free to fully devote their attention to the patient in front of them without the countless interruptions that an on-site physician would encounter. This improves efficiency and safety.
A virtual physician is able to skip the “low yield” portions of triage (vital signs, allergy review, etc.). As a result, they are able to limit their interactions to focused questions that allows them to see considerably more patients than if they were physically located in the ED.
Because of the powerful queuing system that the platform we use employs, a virtual physician is able to staff multiple sites at the same time. This allows for considerable flexibility in dealing with unpredictable surges and other staffing inefficiencies.
Question: Don’t providers-in-triage – particularly virtual providers – over order tests that are later canceled?
No. In a recent study by Izzo, et al in the American Journal of Emergency Medicine found that less than 1% of orders placed during telemedicine physician intake were later canceled by another provider.
Question: What’s my return on investment for TeleTriage?
This will vary and depends on your starting point. A high volume emergency department with a long door-to-doctor time and length of stay will see more benefit than one who’s metrics are already pretty good at baseline. Departments that have implemented Teletriage have seen a 10x ROI or more. This is an example of the benefits that a hypothetical hospital system may have.
Question: What’s my return on investment for Virtual Inbox Coverage?
In a 2019 study published in the Annals of Internal Medicine, physician burnout was estimated to cost $4.6 billion nationally or approximately $7,600 per physician annually. In a stressed group, this amount is likely much higher. Another recent study estimates that the cost of replacing a physician is approximately 2-3 times that physician’s annual salary. Measuring the cost of burnout to the physician, their patients and their families are more difficult to measure. However, it is abundantly clear that there is a real cost to not addressing this national crisis. See more data on physician burnout here.
Question: Why can’t we just do this ourselves?
You most certainly can and other systems have implemented TeleTriage and Virtual Inbox Coverage themselves. However, consider these factors:
Adding multiple physicians to begin a new program is a large undertaking – as noted above, it can cost upwards of $1 million to add one new physician. Before “going live,” all of these physicians must be hired and on-boarded.
We have experience with the platform that we use and know what works and what doesn’t. When important outcomes such as patient safety and satisfaction are at stake, do you want to recreate the wheel?
While some physicians love this type of work, most would rather physically be seeing their patients. It is important that people are doing what they enjoy, this helps to avoid burnout. All of our physicians have made the choice to practice this unique type of medicine.
If your end goal is to create your own program, we are happy to support you. We can provide interim staffing and consulting as your program gets up and running. Just let us know how we can help.