Medical care traditionally has been provided face-to-face with the patient and family. Associated non–face-to-face services, including telephone and electronic communications, generally are not reimbursed by third-party payers and typically are bundled into the face-to-face evaluation and management (E/M) service. Parents have the same perception, expecting free and prompt access to their pediatricians and professional staff. Yet there is a professional model for charging for the expertise and care provided over the phone, as exemplified by attorneys and accountants.

As educated parents want more informed participation in all their children’s medical decision making, there is a de-mand for convenient and timely access to non–face-to-face services including advice, consultation, and treatment by e-mail and telephone. Pediatricians find themselves dispensing more and more advice, prescriptions, and treatment over the phone during and after office hours. This is a significant burden for primary care pediatricians as well as subspecialists dealing with children with special...

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