By Caitlin Schmidt
When you're sick, sometimes it feels impossible to get out of bed, let alone get to the doctor. And the last thing anyone wants to do is spend hours at the emergency room.
So Silicon Valley is retooling a service that was common almost a century ago: the house call. Several companies have developed smartphone apps that bring doctors to patients, often in less time than it would take to seek treatment elsewhere. With apps like Pager and Medicast, a patient can request a doctor with the push of a button.
In the 1930s, physician house calls accounted for 40% of medical visits, according to a 2011 article in the journal American Academy of Family Physicians. By the 1980s, that number had dropped to 1%, due in part to a lack of funding by insurance carriers.
Elizabeth Krusic, a mother of two young children from Seal Beach, California, knows how difficult it can be to take a sick child to see a doctor. When her daughter developed an eye infection, she took a friend's advice and tried Medicast, calling a doctor into her home and saving the stress of getting her small children ready and out of the house.
The doctor arrived in 30 minutes and had the necessary prescription medication on hand.
"My son was able to sleep during the entire visit, because the doctor came to the house," Krusic said. "The doctor came into my daughter's room and conducted the visit there, where she was comfortable."
The house call also removed the risk that her children would be exposed to illnesses in a waiting room.
Inspired by Uber
In early 2014, Uber co-founder Oscar Salazar saw room for improvement in the health care system and seized the opportunity.
The app he developed, Pager, offers house call services for customers in Manhattan and, starting next week, Brooklyn. Pager's doctors are available from 8 a.m. to 10 p.m., 365 days a year, with an additional after-hour fee for nights and weekends.
Toby Hervey, Pager's head of marketing and business development, said that several aspects of Uber informed Pager's approach. Like Uber, the app is structured as a mobile, location-based service.
"Convenient access to quality health care when you need it is a real problem," he said. "We're using technology to make the house call -- one of the best ways to get personal care -- viable again."
Hervey said customers range from parents not wanting to take a sick child to an emergency room to businesspeople with no time to see a doctor during the day.
A similar company, Medicast, started in South Florida in late 2013, with services now also available in San Diego, Orange County and Los Angeles.
"Long wait times are frustrating for everyone," Sam Zebarjadi, co-founder and CEO of Medicast, said. "With the proliferation of technology and increasing levels of education, we knew there were alternate ways to get amazing health care."
Dr. Kimberly Henderson is a Pager physician and works in the emergency room at New York's Beth Israel Medical Center. For her, the idea of being a part of a new practice of medicine was appealing.
"I believe we will see a shift away from medical practice exclusively in the brick and mortar model," Henderson said. "Medicine will become, or return to being, more mobile."
As the doctor shortage grows and patients struggle to balance their busy lives, telemedicine has become a fast-growing field. Health care professionals offer their services using two-way video, e-mail, smartphones and other forms of technology. Apps, such as Doctor on Demand and Ringadoc, allow patients to speak to a physician via phone or video chat.
Doctors enrolled with the service PINGMD can receive text, photo or video messages from their patients that can be forwarded to colleagues for referrals and are automatically saved to the patient's medical file. Another app, HealthTap, connects patients to 50,000 doctors across the country for verified answers to medical questions. Patients can search the database or ask their own questions and receive responses from multiple doctors, providing them with several opinions.
The American Medical Association says that telemedicine, including house call services, is useful for both patients and the health care industry as a whole, according to its June Report on the Council of Medical Service.
"Telemedicine, a key innovation in support of health care delivery reform, is being used in initiatives to improve access to care, care coordination and quality, as well as reduce the rate of growth in health care spending."
How house call apps work
After a brief video conference, a doctor will assess the patient's need for a home visit. If no visit is necessary or the physician recommends a trip to the emergency room, there's no charge.
"With this system, we're able to provide high quality care that goes beyond the issue at hand," Zebarjadi said. "With the doctor visiting patients in their own homes, it's easy to make observations and discuss other health concerns and lifestyle choices."
"I love the concept of bringing our services to people's homes," said Medicast's Dr. Elisa Malin. "It's a convenience factor, both for the patients and for us as physicians, in the sense that I can choose to be on call whenever I'm available."
Malin also works as a pediatric hospitalist for Kaiser Permanente. She said that a typical house call visit lasts about 45 minutes, as opposed to the average 10-minute visit at a clinic.
"The fact that I get the luxury of time with Medicast patients improves the quality of care they receive."
With both apps, physicians follow up with the patient via phone and are available to answer any questions that may have come up since the visit.
Although the apps are only currently available for iPhone, Pager and Medicast are actively working on an Android app. For non-iPhone users, their services are also available by phone and on their websites. They also have plans to move into other markets in the near future.
The house calls are comparable to an urgent care visit, and cost much less than the emergency room, where many people still go to seek treatment for minor ailments. Both companies offer flat rates, starting at $199 for a house call. Customers can also sign up for a monthly plan that allows them two or four visits a year.
The companies aren't able to accept insurance, but are in talks with various providers to make that option available in the future.
House calls have their advantages, such as privacy and convenience, according to Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons. They also can save on office overhead for physicians. But they do have limitations, she said.
"The doctor's black bag won't have all the equipment available in the office," she said.
Both companies' websites have long lists of conditions they treat, such as cold and flu, sprains, eye infections, pneumonia, abdominal pain and cuts that require stitches. But there are also conditions their doctors cannot handle. You should call 911 or go to the emergency room if you are experiencing chest pain, shortness of breath, or have had a head injury and lost consciousness.