— It was 11:45 a.m. and Dr. Christopher Bailey’s
laptop was chirping, indicating a patient was on the
this is Dr. Bailey. Can you hear me?" Yes, the
female patient said, she could. She’d been violently
coughing for days and was losing her voice, she
explained. Her eye had turned red and she couldn’t
took a peek at the patient’s swollen throat as she
said "ah" to her webcam and had her tap her
forehead to determine how much her sinuses hurt before
diagnosing her condition: an upper respiratory
infection. Bailey prescribed cough medicine and an
antibiotic, and he offered some practical advice — use
a neti pot to flush her sinuses, keep talking to a
minimum, take Tylenol for the aches and pains.
was great, very informative," the patient said
after the 17-minute consultation. "Thank you so
are bidding adieu to crowded, germy waiting rooms,
opting to video chat with a doctor on their phone,
tablet or computer within minutes of making the request.
400,000 patients had appointments with doctors via
webcam in 2014 and experts expect that number to double
this year. Large employers also have started offering
the virtual doctor visits, via phone or web, as a
benefit to their employees, according to Mercer data.
The growth is driven by the fact that people feel more
comfortable with technology than ever before, experts
say, and insurers are starting to pick up the tab.
firm PricewaterhouseCoopers data estimate that nearly 39
percent of adults would be willing to have an
appointment with a physician via smartphone,
representing a potential $42.1 billion market. About
half of the doctors surveyed by PwC’s Health Research
Institute said more than 10 percent of patient office
visits could be replaced by e-visits. About 37 percent
said one-third of visits could be done virtually.
companies have popped up in recent years to facilitate
e-visits between doctors and patients. Bailey, with a
specialty in family medicine, works for Chicago-based
Doctor on Demand, co-founded by a cancer radiologist and
a technology entrepreneur in 2012 and backed by Google
and TV personality Dr. Phil.
Doctor on Demand app has been downloaded a few million
times since it launched nationally about a year ago. Six
or seven doctors in Chicago are online each day, part of
a nationwide team of 1,400. Combined, the physicians
handle as many as 1,000 patient calls a day nationally,
which last an average of 10 minutes. If doctors work
full time, usually from home in eight- or 12-hour
shifts, they can make $150,000 to $200,000 a year. The
cost to patients is $40, a figure that’s sometimes
covered by insurance or employers, said Dr. Pat Basu,
Doctor on Demand’s co-founder and chief medical
Hand recently used the Doctor on Demand app. Even though
she’s a single mom in pharmaceutical sales who also
runs her own side business, she’d always made time to
go to the doctor’s office to refill her prescription.
it was Christmas Eve when she realized she was on her
last pill and the doctor’s office would be closed the
next day. She’d seen a commercial for Doctor on
Demand, but was skeptical.
skeptical came from … knowing how impactful it is to
sit before someone and have a meaningful
interaction," Hand said, "but I was pleasantly
surprised by the fact that (my doctor) wasn’t
distracted. In a medical office, they’re doing 15
things. They’re not really able to listen to the
patient. But with the video visit, I felt like I had all
of her attention, it was all about me."
on Demand is one of several companies that have seen
growth opportunity in e-doctor visits, including Teladoc,
American Well and MDLive, which recently partnered with
Walgreen to launch an e-visit app.
price for a visit is $40 to $49, not significantly more
than some people dole out for copays, and sometimes less
than a patient with insurance would pay to visit the
doctor in person. That’s increasingly the case as more
employers offer high deductible health plans to
employees, requiring them to meet deductibles of $1,000
or more for employee-only coverage and thousands of
dollars for family coverage before insurance kicks in.
are becoming more cost conscious about out-of-pocket
spending for medical services," Walgreen’s Chief
Medical Officer Dr. Harry Leider said. "If you have
a hard time getting in to a doctor and you’re paying
out of pocket for three, four, five months of the year,
paying $49 for a telehealth visit … looks pretty
video chats are meant for people with short-term health
problems, like bronchitis, upper respiratory tract
infections or rashes, Leider said. It’s not meant to
be used for medical emergencies, such as chest pain that
could signal a heart attack, or chronic conditions like
diabetes, he said.
predictions of an e-doctor boom come as the health care
system faces a shortage of primary care doctors and an
influx of people with health insurance, now that the law
requires people to have coverage or pay a penalty.
growing virtual doctor trend could help unclog emergency
rooms and doctors’ office waiting areas, Basu said. He
sees a day when patients with easy-to-treat conditions
get help via video and in-person visits are left for
those who need more advanced help.
so long, we’ve seen backed-up waiting rooms,"
Basu said. "Doctors get this … ‘My patient just
told me they drove 40 minutes in the snow, waited 30
minutes in the waiting room getting coughed on only to
be told by me to take a couple of Tylenol.’"
evolution of virtual doctor visits has been inevitable,
and tablets that make doctor e-visits so convenient have
become popular in the past few years. The iPhone, for
one, launched in 2007, and the iPad in 2010. Today
people feel not only comfortable with technology,
experts say, but dependent on it.
patients can take a picture of a goopy eye or shine a
webcam down their throats to avoid a trek to the doctor’s
office, they’re increasingly willing to do so.
said his doctors diagnose and treat 95 percent of the
patients who call. The other 5 percent are referred to
specialists or in rare instances the emergency room.
are also more willing to cover part or all of the cost.
can tell you from our discussions with many of the
nation’s insurers — if they’re not providing it,
they’re setting up a mechanism to provide it,"
American Telemedicine Association CEO Jonathan Linkous
said. "I don’t know any insurer who’s said no.
They’re going to have to if all of their competitors
are doing it."
covers some types of telemedicine services, usually for
veterans or people who live in rural areas, but that is
expected to expand, Linkous said.
obstacles facing the industry are rooted in regulations.
For example, patients have to talk to doctors who are
licensed in the state from which the patient calls.
Doctors working for telehealth companies clamor to get
dozens of licenses so they can treat patients from
across the country, an expensive endeavor.
26 percent of doctors have licenses in more than one
state, Linkous said.
said his organization has come up with an accreditation
process for telehealth companies offering virtual doctor
visits. So far 110 organizations have applied and he
expects to hand out the first accreditations by the end
of the month.
said the goal is to push beyond simply providing
assurances that doctors have valid licenses in the
appropriate states. He wants these companies to conduct
thorough background checks to make sure doctors haven’t
had any form of discipline in the past, or had licenses
revoked in one state only to gain a license in another.
a need," Linkous said of accreditation. "You
need to have some code, some way of finding out that
these people are not quacks."
on Demand’s Basu said his company conducts an
"exhaustive background screen" on each
applicant’s professional and personal histories.
medical malpractice is always a concern for doctors,
Linkous said, it’s probably less of a concern with
e-visits, because the medical conditions are less
the technology side, he said, companies still need to
address the potential for dropped calls.
should be some sort of backup plan if there’s some
sort of (connection) failure," Linkous said.
"You’re probably not dealing with someone who’s
bleeding, but you need a backup plan for an interruption
obstacle: Some states — Arkansas, Idaho and Alaska —
don’t allow doctors to prescribe medicines on a
first-time video appointment.
then there are privacy concerns. How do we know those
videos are safe, never to be shared or leaked to YouTube?
says friends at Google helped engineer Doctor on Demand’s
security platform. The company doesn’t record video
from the visits, uses encryption during the video calls
and stores patient health information on secure servers
that meet federal health insurance requirements.
Connolly, managing director at PwC’s Health Research
Institute, said e-visits will become more useful as
complementary devices get FDA approval. Regulators
cleared 24 consumer digital health devices in the first
10 months of 2014, including a disposable biosensor
system that enables remote monitoring of vital signs.
do-it-yourself medical devices await approval this year.
also seeing that some of the newer entrants in health
care and the big pharmacy chains and retailers are
starting to include these virtual doctors,"
Connolly said. "That is the warning sign to the
traditional doctor and hospital groups that if they don’t
find a way to work this into their practices, those
competitors are going to start stealing a lot of the