We applaud the authors and the Society of General Internal Medicine (SGIM) for authoring such a powerful and comprehensive statement regarding the importance, appropriateness of, and priorities for telehealth in the post-pandemic “new normal”—including for trainees.1 To the strong points already made, we would add another important priority for telehealth practice: continuing to allow synchronous virtual supervision of resident physicians and other clinicians-in-training, which before the pandemic had only been permitted in very rural settings.
As reported in specialties such as Emergency Medicine—and practiced by Psychiatry and Dermatology at our institution—virtual supervision utilizing synchronous two-way audio/video communication technology is capable of providing appropriate oversight that can be just as effective as in-person supervision.2
In addition, potential applications are not just limited to training in rural locations or during a pandemic, but include clinics sited in nonclinical community-based settings such as schools, and during severe weather resulting in clinic building closures. Virtual supervision can even create novel opportunities to address trainee burnout by enabling clinical work-from-home arrangements and scheduling residents in virtual clinics—mirroring what has become a widespread possibility for frontline providers everywhere.
We would also call attention to how critical the regulatory framework set by the Centers for Medicare and Medicaid Services (CMS) is to learners being able to practice telehealth. This point was articulated in a letter to CMS from the American Association of Medical Colleges (AAMC) advocating that virtual supervision be permitted regardless of geography.3 The letter highlighted Behavioral Health and Primary Care for special consideration, but we believe that synchronous virtual supervision can be appropriately utilized across specialties. In a very welcome development, in the final rule for the Medicare Physician Fee Schedule for calendar year 2024, CMS would extend virtual supervision until the end of 2024.4 Continued advocacy by SGIM and others would help make the case to make this forward-looking policy permanent.
Declarations
Conflict of Interest
The authors report no conflicts of interest.
Footnotes
Publisher's Note
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References
- 1.Chen A, Ayub MH, Mishuris RG, et al. Telehealth policy, practice, and education: a position statement of the Society of General Internal Medicine. J Gen Intern Med. 2023;38(11):2613-2620. 10.1007/s11606-023-08190-8. [DOI] [PMC free article] [PubMed]
- 2.Schrading WA, Pigott D, Thompson L. Virtual remote attending supervision in an academic emergency department during the COVID‐19 pandemic. Coates WC (ed) AEM Education and Training. 2020;4(3):266–269. 10.1002/aet2.10460. [DOI] [PMC free article] [PubMed]
- 3.Jaffery J. Letter to CMS on Virtual Supervision of Residents. Published online April 26, 2023. https://www.aamc.org/media/66581/download?attachmentAccessed 13 Sept 2023.
- 4.Centers for Medicare and Medicaid Services. Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule. 2023. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule. Accessed 7 Dec 2023.