Telehealth to Flatten the Curve: A Plea From Psychiatry Trainees

We are facing an unprecedented public health crisis with increasing COVID-19 cases across the nation. As we grapple with how to protect our patients and ourselves, medical and psychiatry training programs are tasked with maintaining a standard of care for patients while minimizing the risk of COVID-19 transmission among patients and trainees.

In psychiatry, our patient population is already vulnerable, and many are at increased risk for mortality with comorbid medical illnesses and substance use disorders. As physicians, we must protect our patients and maintain continuity of care during this crisis. One of the simplest ways to do this is by providing telehealth visits and significantly reducing the number of in-person visits. Not only do in-person visits increase the likelihood of being exposed to COVID-19, they also undermine calls from public health to abide by physical distancing measures and reduce community spread.

Many psychiatry training programs across the nation have responded swiftly to this crisis by converting outpatient visits to telehealth visits. Other psychiatry residency programs have not yet done so, which may be related to administrative challenges, limited resources, or less awareness of the rapidly changing legal and technical landscape now more favorable to telehealth. Recent changes have allowed rapid dissemination of telehealth across all medical specialties. The Centers for Medicare and Medicaid Services released guidance that allows patients to be seen via live video-conferencing in their homes without having to travel to a qualifying “originating site” for Medicare telehealth encounters, regardless of geographic location. The HHS Office of Civil Rights announced that potential HIPAA penalties will be waived for good faith use of telehealth (including Skype, Zoom, WebEx, and other videoconferencing platforms). Initial patient visits where controlled substances are prescribed can be done via telehealth with the Drug Enforcement Administration suspending the Ryan Haight Act requirement of an initial in-person examination. The Accreditation Council for Graduate Medical Education has aligned with this national shift to telehealth and released guidance to training programs about meeting requirements.

We recognize there may be unique challenges for each institution or clinic, and that some of our most vulnerable patients may require in-person visits. In these situations, it is important to have institutional and department-wide collaboration on how best to implement a model of care that reduces risk to patients and trainees. Some psychiatry programs have established models amid various challenges, and it is important that we foster collaboration across institutions to share best practices.

As physicians, we are deeply committed to providing care to patients during this trying time. We also must balance our standard operating procedures amid the warnings from physicians and scientists across the globe for the urgent need to “flatten the curve” of COVID-19. We urge psychiatry training programs nationwide to convert all outpatient visits to telehealth visits with only rare exceptions. The majority of outpatient psychiatric needs can be managed in this format, especially now when the risks of in-person visits now heavily outweigh the benefits.

Whether in New York City or rural America, we must take action together in an effort to protect our patients, reduce COVID-19 transmission, and preserve our health care workforce. In doing this, we will not only protect our patients but also our colleagues, many of whom may be called upon to care for medically ill individuals. In Italy and elsewhere, psychiatrists, dermatologists, and others have been deployed to medical services. As lessons from impacted countries have taught us, each hour where risk mitigation strategies are inadequate has the potential to lead to substantial downstream mortality. ■

The CMS telehealth guidance is posted here.

The HHS Office of Civil Rights announcement is posted here.

The ACGME guidance is posted here.