Some doctors, bird watchers, and others still use pagers due to their simplicity; paging company Spok has 800K+ pagers in use in the US, down from 6.6M in 2004
People, as well as organizations, resist the need (habit?) to move from current processes and products to newer ones … Tweets: Gabriel Weinberg / @yegg : Some people still use dialup internet, fax machines, and physical newspapers. Technology that takes a long time to get entrenched into habits and workflows takes a similarly long time to wind down. Lindy effect for all you mental model aficionados https://en.m.wikipedia.org/... https://twitter.com/... Rachel Cohen / @rmc031 : “There are people who just refuse to let their pagers go, including some doctors and bird watchers.” https://www.wsj.com/... Stefanie Ilgenfritz / @stefaniei : “They're like the cockroaches of the healthcare system. ... They won't go away.” Why many doctors - and others - still cling to their pagers. It's a love-hate relationship. https://www.wsj.com/... via @arianapeca2 Amit Paranjape / @aparanjape : The ‘Pager’ is still around... in the US. Pager lovers say the lower-tech one-way communication is less distracting than looking at a phone full of alerts and apps. “I'm screaming to get my pager back.” https://www.wsj.com/... via @WSJ @rarebirdalertuk : “I literally have an ornithological pacemaker on my body” says Dr. Rob Lambert @LucyMcRobert1 Nice to see RBA pagers getting coverage from across the pond in the Wall Street Journal, tho not sure the blinging up thing catch on with birders here! https://www.wsj.com/... via @WSJ Matt Ford / @fordm : Dennis Duffy was ahead of his time. https://www.wsj.com/...
Context & Ripple Effects
Pagers were supposed to be dead decades ago, yet Spok still runs more than 800K of them across the US, down from 6.6M in 2004 — a two-decade decline that has plateaued into a stubborn niche. The holdouts are concentrated where the replacements have failed their users: doctors who found that computerization largely failed to simplify healthcare work, leaving them hating their PCs while the one-way pager just works.
That failure mode is what makes this story more than nostalgia. The devices trying to displace legacy tools keep adding friction of their own — AirPods' always-in design became an annoyance for service workers, and today's [[a:885363|AI-powered wearables like the $199 Limitless Pendant and $159 Plaud NotePin trade usefulness for creepiness]]. Simplicity, it turns out, is a feature new entrants rarely match at launch.
First-order effects
- Spok operates a shrinking-but-durable business: with 800K+ units still in service nearly two decades after the peak, its remaining customers are exactly the users — hospitals, doctors, bird watchers — for whom the smartphone alternative has proven worse at the core task.
Second-order effects
- Vendors pushing replacement devices must beat not just the pager but the accumulated workflow habits around it; the tablet-and-smartphone rounds some hospitals adopted during COVID-era isolation wards show the substitution path exists but demands behavior change pagers never did.
Third-order effects
- If the pattern holds, entrenched low-tech tools decay on a Lindy-like timeline set by workflow fit rather than technical obsolescence — meaning healthcare IT and wearable makers win share only when they reduce cognitive load below the legacy tool's floor, not when they add capability.
The trend: Legacy technology persists longest in professional workflows where its replacements add friction instead of removing it, keeping niche incumbents like Spok alive long past expected extinction.