key: cord-0019377-x1x7m6xp authors: Hammond, Kevin B.; Gunderman, Richard B. title: Pandemic Telehealth Utilization and Radiology as a Career Choice date: 2021-06-16 journal: Acad Radiol DOI: 10.1016/j.acra.2021.05.013 sha: 248a5ffbc9e1c9d1c902857292a162961e701112 doc_id: 19377 cord_uid: x1x7m6xp nan T he COVID-19 pandemic has contributed to a dramatic increase in reliance on telehealth in medicine. Guidelines around social distancing, as well as quarantine and isolation practices, have nudged many patients and physicians to forego face-to-face interaction and begin relying on virtual visits. As other medical fields shift to a telehealth model of patient care, increasingly resembling the computer-based model of diagnostic radiology, fewer medical students are likely to eschew radiology careers based on a perceived lack of patient contact. Telehealth skyrocketed during the pandemic, for multiple reasons. It reduces the risk of disease transmission among both patients and healthcare workers (1, 2) . It also typically saves time and reduces costs, such as transportation, childcare, and missed work (1) . Of course, telehealth is not appropriate in all circumstances, such as when a physical examination is required, but it can substitute for many face-to-face patientphysician encounters. In the month of March 2020, telehealth visits increased by 154% in 2020 over 2019 (3) . Moreover, 93% of these visits were not for COVID-19 care, indicating that telehealth was used primarily in contexts that are likely to persist after the pandemic has passed (3). An even more notable change is the number of Medicare primary care telehealth visits À 43.5% in April of 2020, as compared to 0.1% the same month in 2019 (3). These statistics indicate that a significant portion of care can be effectively delivered via telehealth, and the increased use of telehealth in patient care is likely to persist. Traditional barriers to telehealth have included regulation, reimbursement, lack of internet access, and lack of familiarity and facility with videoconferencing (4), but the pandemic rendered each of these issues more tractable. A return to a pre-pandemic proportion of in-person visits seems highly unlikely. Said one healthcare commentator, "Now that patients and providers have had a taste of the convenience and safety of telehealth visits, it is difficult to imagine that the telehealth genie will ever be put back into the bottle (3)." This shift toward telehealth is likely to influence the level of interest among medical students in diagnostic radiology as a career. Students most commonly opt not to pursue radiology because it appears to offer fewer opportunities for patient contact (5) . Many students conclude that radiologists spend most of their time looking at computer screens and talking into microphones, deterring them from the field. Yet the shift to telehealth in many other medical fields has narrowed the apparent patient-contact gap with diagnostic radiology. Many formerly face-to-face visits are now taking place virtually. Instead of looking patients in the eye and laying hands on them, physicians in other fields are spending more time looking at computer monitors and cameras, talking into microphones and listening through headphones. As opportunities for direct patient contact in other fields decline, the apparent lack of patient contact in diagnostic radiology is likely to loom smaller as a factor in career choice. This turn of events presents radiology educators with an opportunity to encourage more students to consider careers in radiology. For one thing, educators can simply point out to students that the shift to telehealth has narrowed the patient-contact gap between radiology and other fields. Students have only been in medicine for a few years and typically lack the experience necessary to perceive such changes, but it is important for them to base their decision making on accurate information about the changing frequency of patient contact in each field. Educators can also redouble efforts to ensure that students' experiences in radiology are not confined to passive observation and instead give learners a real opportunity to contribute to patient care. Such contributions might take the form of obtaining additional clinical history, correlating imaging findings with other clinical data such as laboratory testing results, and even allowing students to generate reports or convey radiology results directly to referring health professionals. In addition, many radiologic procedures will necessarily remain hands-on and minimally affected by telehealth. Another opportunity for radiology is to highlight for students how radiology functions as a center of excellence in telehealth. Thanks to PACS systems, radiology departments have been interpreting exams remotely for many years prior to the pandemic, and they have in place sophisticated systems for communicating with colleagues and patients. Students who wish to embrace and optimize telehealth might be drawn to radiology as such a center of excellence. Radiology can shine not only as an exemplar of excellence in telehealth practice, but also as a center of excellence in telehealth education and research. Having been deeply immersed in telehealth for decades, radiologists can draw on this expertise in educating learners on using telehealth effectively and developing and testing new ideas for improving the quality of telehealth services across healthcare. Every dissatisfier and disappointment in telehealth also represents an opportunity for investigation and improvement. Radiology can also distinguish itself as a model for what medical consultation should look like in the telehealth era. Radiologists routinely act as consultants for colleagues in virtually all medical fields, often helping to coordinate patient care across multiple specialists. Telehealth places a premium on the ability to connect and coordinate care virtually, and radiology educators can make it a point to show how adept radiologists have become at this work. As a supremely imaged-based field, radiology can also help students grasp the importance of the video component of telehealth. Listening to a patient's story and conducting a thorough interview play an important role, but it is often visual inspection À whether of the exterior or the interior of the body À that makes the crucial diagnostic difference. Radiologists can highlight the vital role of visualization and demonstrate the necessity of optimizing viewing conditions, utilizing such concepts as the signal-to-noise ratio. Perhaps no medical field is better equipped than radiology to demonstrate that physicians can offer high-quality, highvalue care to patients they never encounter physically. Diagnoses can be ruled out or in, differential diagnoses refined, disease extent assessed, treatment planned, response to therapy monitored, malposition of devices and complications recognized, diseases detected at a pre-symptomatic stage through screening, surveillance provided for recurrence, and so on À all without being in the same room as the patient. Finally, radiologists can demonstrate the communication potential of telehealth. For example, video conferencing can be used not only to share results with patients once their examinations are completed and interpreted, but also to prepare patients for what they will experience in the radiology department. Ironically, telehealth can become a tool of hospitality, relieving the anxiety that tends to accompany the unknown and ensuring that patients enjoy the comfort that comes from understanding. Every great challenge is also an opportunity, and while there is no doubt that the COVID-19 pandemic has challenged radiology in myriad ways, it also opened up opportunities around telehealth. Because telehealth acts in important respects as a leveler across fields of medicine, radiology can seize the closing of this gap to enhance its appeal to medical students. Medicine's leader in telehealth prior to the pandemic (6), radiology can continue to leverage its lead after the pandemic subsides, thereby attracting more top candidates into its fold. Centers for Disease Control and Prevention. Telemedicine. 2020. (Available at The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence HHS Issues New Report Highlighting Dramatic Trends in Medicare Beneficiary Telehealth Utilization amid COVID-19 Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA Surveying fourth-year medical students regarding the choice of diagnostic radiology as a specialty Which medical specialties use telemedicine the most?