Twilight of the beeper: Today's technology offers other ways of keeping connected

Harry Steinberg, MD, got his first beeper as a resident in New York in the late 1960s. Any resistance he and his colleagues had to being reachable anytime, anywhere, dissipated as they realized what the beeper meant.

"Freedom," said Dr. Steinberg, a critical care specialist who is now director of medicine for Long Island Jewish Hospital in Brooklyn, N.Y. "This is a no-cell-phone era. Imagine if you're on call and people have no way of reaching you. You have to stay home. Now you become mobile. That was a strong positive, and a positive for patient care."

When inventor Al Gross -- who also created the walkie-talkie and CB radio -- put together the first telephone-paging system in 1949, he created it with doctors in mind. Not long after Dr. Steinberg got his pager, the insistent, high-pitched beep-beep-beep of the little black plastic box became as much a part of the doctor stereotype as golfing.

"When I think of pagers and doctors," said Emmitt Wells, a consulting practice director with Houston-based technology firm Getronics, "I think of Dr. Beeper from 'Caddyshack.' "

By the late 1980s, thanks to cheaper beepers and wider networks, the joy of paging had spread to the general populace. Doctors -- and drug dealers, many analysts note -- spearheaded the age of mobile communication.

And then suddenly, the beeper fell out of favor. Cell phones became inexpensive -- and ubiquitous. Now you could talk to someone immediately, instead of, as Dr. Steinberg remembers, carrying a pocketful of quarters and hunting for a pay phone to respond to a page. The introduction of wireless e-mail devices a few years back appeared to put another nail in the coffin for pagers. Motorola, which in 1974 introduced the first pager for consumers and eventually controlled 85% of the market, dumped its paging operations in 2002, three years after Research in Motion introduced the BlackBerry.

"It's probably been more than five years since I've seen someone using a pager," said E. Michael Lewiecki, MD, director of the New Mexico Clinical Research and Osteoporosis Center in Albuquerque. "I had a beeper, a PDA and a large, bricklike cell phone. Then one by one I got rid of the ones I didn't need. Now I carry a BlackBerry."

But Dr. Beeper hasn't disappeared. Analysts say that as the public threw out its beepers, the devices kept the same loyal cadre of users on the way down as they did on the way up -- physicians.

Dr. Steinberg is one who hasn't given up on pagers. "I'm probably a antediluvian person and probably not what is common today." In fact, he said, his current pager is fairly similar to the 1968 model he received as a resident.

Alexandria, Va.-based USA Mobility, which controls about two-thirds of the U.S. paging connection services market, says 40% of its business is health care. Former Motorola paging executive Kirk Alland, vice president and general manager of pager maker Unication USA, says his company, which makes about half the beepers in use, sells to "lots of doctors," which helps ease market attrition.

"The drug dealers have gone on to cell phones," said Danny Sands, MD, director of medical information for Cisco Systems' Internet Business Solutions Group. "The doctors really haven't."

There are still some tasks for which the beeper is king -- for example, sending alerts to first responders in an emergency. Alland noted that in large-scale emergencies like Hurricane Katrina and the 2007 Virginia Tech campus shootings, cell phone networks melted under the strain of callers, while paging systems continued to work.

"If there's a big emergency with a lot of injuries -- say an earthquake or a terrorist attack -- it's very easy with those paging systems to page every doctor in a hospital with the same type of message with what's happened in a situation, and to report to a certain spot for emergency response," said Daniel Longfield, a wireless industry analyst for Frost & Sullivan in San Antonio. Longfield's wife is an epidemiologist with the Texas Dept. of State Health Services, and she and her colleagues take turns carrying a beeper on weekends.

However, Longfield notes that more advanced systems that can contact personnel through their cell phones or hand-held devices are available and are improving.

Another reason for the beeper's resilience is that some hospitals, despite recent studies showing cell phones do not affect medical equipment, still ban their use inside the facility. Even when cell phones are allowed, a signal can't always be found, while a beeper signal can.

However, Dr. Sands notes that more hospitals are building their own wireless networks, ensuring that a cell phone or a hand-held device can get a signal.

Another point in favor of pagers: If a beeper gets lost or stolen, there is zero risk that any private patient or physician data will fall into the wrong hands.

"That's the nice thing about pagers," Longfield said. "They're so rock dumb."

However, analysts note that many efforts are under way to improve data security on other wireless devices.

But technology superiority or inferiority isn't the biggest issue in physician pager loyalty, analysts say. Physicians are holding onto their beepers for the same reason they welcomed them in the first place.

Freedom.

Beepers give doctors the freedom to determine who to call back when, rather than be inundated with calls on their cell phone or e-mails on their PDA. Many doctors, like Dr. Steinberg, carry a beeper and a cell phone -- the beeper for people to call in an emergency, the cell phone replacing the pocket of quarters as the means to call back.

Dr. Steinberg said the beeper is "that subtle hint you're not as reachable. I don't think people feel that I'm not reachable. Real emergencies -- they get through."

However, Dr. Sands notes that physicians can control any of their technology and not have it control them. He cited studies saying pager users were more subject to communication delays than those using more, well, modern devices. "We don't need to get rid of pagers," he said. "We need to understand there are other things available."

Even the beeper manufacturers know that time is not on their side. USA Mobility, for example, is offering a new software product that allows users to put paging capabilities onto their wireless devices. Dr. Steinberg predicted that soon enough, a younger generation, raised without pagers, will put the beeping black box out to pasture.

"Everybody I see has a BlackBerry," he said. "Everybody."