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How one tech company plans to revive the house call

(Thomas Trutschel / Photothek)

When Richard Boxer was a little kid, he used to watch his dad, a doctor, head out on house calls in the evening.

"It was in the 1950s and 1960s and he liked it very much," says Boxer, who grew up to become a doctor himself. "He got an enormous deal of satisfaction out of it."

Now, five decades later, Boxer is trying to bring the house call back. He is the chief medical officer at Pager, an mobile app that allows patients to call urgent care doctors to their house. Think of it as Uber for doctors; one of its co-founders, Oscar Salazar, was actually one of the original engineers for the car service app.

Pager, which has raised $3.5 million in venture capital, currently operates in Manhattan and Brooklyn.  It charges $199 for one of 20 doctors in their network to come to a member's house. The company announced plans to expand to five other cities, including San Francisco and Boston.

Pager does not currently accept health insurance, although executives there say they are exploring the option as the company grows. Right now, patients either have to submit the receipt to their plan for reimbursement or pay out of pocket.

Boxer and I spoke Friday about Pager, how it fits into the health care landscape and why now might be the right moment to bring back the house call.

Sarah Kliff: Can you tell a little bit about the theory behind Pager, and how it fits into the current system of how we deliver health care?

Richard Boxer: Pager began with the idea that health care needs to be delivered in a more efficient and convenient way. We do already have a connected world, with telemedicine, but Pager and its founders thought there could be a better way of delivering health care by actually delivering it to people. If you can deliver groceries, why not deliver health care as well? Why not have urgent care on wheels?

If a person is living alone — and 32 million Americans are — or if you have a child who is home with a nanny, why not bring a doctor to that individual?

Oscar Salazar [an original engineer behind Uber], Philip Eytan, and Gaspard de Dreuzy, are all technology entrepreneurs who thought if we could use technology to make it really simple for patients, it could work. And you can see the app has a lot of Uber finger prints all over it.

SK: One of the things I find interesting about Pager is that, even though it uses new technology, it's almost like a throw-back to an older era of medicine when doctors did lots of house calls. But house calls faded away as it became more convenient for doctors to see their patients in the office. What makes right now the right time to bring back the house call?

RB: This is a bit of a "back to the future" situation. My father was what at the time was called a GP, or general practitioner, and was doing house calls in the 1950s and 1960s. He liked it very very much. He got a great deal of satisfaction with the personal interaction. But it ultimately fell out of favor with specialization, and enormous pressure of having things done in the office.

I think at this point, doctors have evolved in what they think is important. This can potentially be more fulfilling than simply running an emergency room or through a very busy office practice. And this is also a supplement to their income. Even though doctors do tend to do very nicely, primary-care doctors may be interested in that.

SK: What kind of interest have you had from doctors in becoming part of Pager's service?

RB: The physicians who are most likely to participate, and have already expressed interest, are individuals who are shift doctors. They're on 12 hours and off 12, for example. Basically, these are ER doctors, hospitalists, and other board-certified young physicians who are not yet really busy. There is an enormous amount of doctors who are interested in supplementing their income or trying a new way of practicing medicine.

SK: Your background is in telemedicine, which connects doctors to patients by video or phone. That is probably an easier way to connect with patients, at least from the doctor's perspective. So why the need for in-person visits?

RB: I was a chief medical officer at Teladoc, and we really created an industry that was delivering health care telephonically and, subsequently, through video. Initially I thought, what kind of doctors would want to do that? But we found that doctors, particularly younger ones, are interested in new technologies and how they change medicine.

I think that's the same here. There's a great deal of satisfaction in having a face-to-face interaction. I'm still a huge advocate for telemedicine, but it does lack that face-to-face interaction. The physical exam is important, along with taking a history and discussing symptoms. Technology is advancing very, very fast, but people still have a desire for personal interaction.

SK: One of the advantages of going to a doctor's office is there have a lot of medical equipment right there. How does that work when a Pager doctor shows up for a visit?

RB: I remember my dad going on a house calls with a large bag, where he would have things like glass syringes that he would have to boil. Now our doctors have an even larger bag and can do most things you need with a non-life threatening issue. And often a lot of the tools you think of in an office, like X-ray machines, aren't really necessary.

If one of doctors does believe it's necessary or there's an issue beyond the scope of the visit, they can call an emergency room. Many of them are associated with emergency rooms already, and could say to their friends there that they're sending in Mrs. Jones. That could eliminate hours of waiting and has great value to Mrs. Jones.

That being said, the vast majority of our patients have symptoms that are easily treatable within the home using simple techniques.

This interview has been edited for clarity and length.

Correction: An earlier version of this article misspelled Pager's chief medical officer's name. It is spelled Richard Boxer.

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