Medicine is a multinational industry no longer defined by country boundaries. Its main product is a workforce.

It is time to disrupt our rigid health care so that it can bend

For example, doctors now can work autonomously and remotely from their traditional locations for at least some of their work-time. Radiologists, for example, now read scans and X-rays from anywhere in the world.  Teledoctors deliver responsive, high quality advice and, services and support to remote patients in remote locations. Last year NHSDirect, a telephone service provided by the government in the UK, responded to six million calls. The potential advantages of telecaring include better continuity of care for patients and telecarers. Both groups can benefit being home.

Certainly, there are professional hurdles that need to be overcome: lack of avenues for career progression, isolation, and competing interests of home and work. On the organisational front, payment, regulatory and quality management practices have yet to catch up.

Telecaring brings with it the need for different training and new codes of practice. For example, what responsibility do telecarers have to respond to patient emails promptly, and how do they hand this responsibility over when they go off duty?  Equity is also an issue, especially access of patients to services across the “cyber divide”. We know that people who have not had the educational advantage of higher education have worse health and make less use of the internet. If more healthcare services are shifted to new media, will health inequalities worsen?

Clinical homework is not a replacement for physical assessment and care. Many services, such as surgery, will still have to remain in institutions such as hospitals. So, it is inevitable that with the current workforce shortages, the health care workforce will dichotomize into those workers with direct patient contact and those workers who do not have face to face contact with the patient to deliver effective care.

It is time to disrupt our rigid health care so that it can bend not break through this dichotomy. We need employers to fit jobs to workers rather than the other way around. Increased flexibility is now essential; not only in career transitions but also in accessibility to a variety of workplaces.