Timezones, Expats and Doctors

A friend of mine, an extremely talented pulmonary specialist, recently moved to Israel. Like many other expats who like living in one place but working in another, he is commuting. Unlike many others, he is telecommuting.... 6-9,000 miles.

Through an interesting arrangement, my friend is working for a company that provides remote Intensive Care Unit (ICU) oversight during the night shift in US hospitals. My friend does a long shift during relatively normal working hours - for him - watching many monitors in his home office, as well as having voice conversations via phone and Skype with health staff in the ICU.

Before this arrangement, there was no remote or even local additional layer of oversight. So why do hospitals pay extra for this remote oversight? Doesn't this add to the expense?

Turns out, this is a great example of higher service for lower cost enabled by technology.

There are several tiers of hospitals in the world, based on a number of factors but including size of the hospital and size of the locale.

• Large city hospitals, like Columbia-Presbyterian or Mass General, have large ICUs, a large staff of doctors at all levels, and many patients. The population concentration of the large city gives them the necessary staff to cover the unit 24x7, and sufficient patients - and thus billing - to amortize the additional expense. These hospitals don't actually need much more.
• Smaller hospitals in smaller neighbourhoods, towns or cities lack the density of population and thus the quantity of patients and doctors. With fewer doctors available, there are fewer people to handle the night shift; with a smaller patient count, there are fewer people to cover the additional expense.

It is the smaller hospitals that are "underserved" by the previous structure. When staff in the ICU had a question, they would call or page the doctor on-call, often waking him/her up in the middle of the night. They simply do not have enough doctors to fill the night shift.

The new telecommuting technology creates the opportunity for a remote doctor to create a "virtual night shift." The hospital gets multiple benefits:

1. Doctors on payroll no longer are woken up. We call this "quality of work environment."
2. Doctors answering questions are fully awake, no longer groggy or sleepy, leading to fewer errors.
3. Doctors answering questions have been involved in and watching the ICU for the entire shift, giving them much better context and history, leading to fewer errors.
4. Hospitals can be assured of doctors every night and every shift without having 3 or more doctors on payroll.

Hospitals get better results, at lower employee impact, for a small uplift in cost, which is more than compensated by the reduced internal staffing costs, not to mention insurance and liability concerns.

Technology created a "win-win" situation.