Seeing a pager in today’s technologically evolved world is like spotting a hand-cranked car engine. In an era where the cell phone has replaced virtually every item in an old Radio Shack catalog, what’s the point of sticking with a device that hasn’t evolved in 20-odd years?

For physicians, the answer is that an anachronistic messaging system may still be best. Even though pager use has dropped from 61 million users in 1994 to less than six million today, hospital employees are helping to keep this seemingly redundant device from obsolescence for two reasons. In an urgent-care situation, they may be more reliable than cell phone reception. Second, hospitals are in no hurry to upgrade telecommunications.

“The feeling has been that in hospitals where the walls are shielded due to MRIs, cells phone aren’t universal,” says Fred Pelzman, M.D., an internist affiliated with New York-Presbyterian Hospital. “And hospitals will just tell you, ‘We use pagers.’ Cost is probably a factor in that.”

By some estimates, more than 90 percent of hospitals in the country use a telecommunications system based around pagers. Typically, a patient, nurse, or physician will phone a number designated for an urgent response; a dispatch center will take the message, then contact the on-call physician. The physician gets a page and returns the call.

It sounds inefficient, and it is. One survey shows that doctors waste up to 45 minutes a day using a relay system. But according to Pelzman, having a dedicated cell phone for messages wouldn’t be quite the same. “You have a pager when a patient is unstable. When a pager goes off, your instinct is to immediately respond. I don’t know you’d get that same kind of jolt if someone left a voicemail.” Compared to cell phones, pagers don’t need recharging—only batteries that need to be changed every few months. They also can be relied upon in cases of a natural disaster cutting off cell towers because they don't use over-crowded mobile phone networks.

Some hospitals are exploring alternative messaging systems like Vocera, a voice-operated badge that allows for near-instant consultations. But for Pelzman and many physicians, the distinctive beep of a pager would be a hard stimulus to leave behind. “When my pager goes off in the middle of the night, I’m wide awake,” he says. “It’s ingrained in my DNA.”