In an era when just one piece of sophisticated medical equipment can cost millions of dollars, it’s hard for the pager to get respect.

Yet look around just about any hospital and the device, small enough to fit into a shirt pocket, is still ubiquitous.

Coming of age in the 1980s when Pac-Man was the newest rage, the pager has survived and evolved over three decades.

It stubbornly remains a key piece of hospital communication at a time when a doctor without a smartphone has a technology dinosaur vibe.

“We can have a robot assisting with surgery, yet we’re still using pagers,” said April Zepeda, spokeswoman for The Everett Clinic.

Providence Regional Medical Center Everett has nearly a thousand pagers in use.

“They’re a good, reliable means of communication,” said Michelle Arneson, a telecommunications analyst at the hospital.

One pager used by the hospital’s housekeeping department was activated 2,800 times in one month to summon help.

“Our nursing supervisor gets paged all day every day,” Areneson said.

Repeaters help transmit pager signals below ground or in parts of the building heavily reinforced with concrete and steel, spots where cellphones often lapse into dead zones.

“We have doctors that live out in the hills and valleys in the eastern part of the county and their pager will work at home and their cell won’t,” Arneson said.

“Nothing is 100 percent, but they are a more rock-solid type of communication,” she said.

One day, smartphones may take their place and be as reliable, she said. “But when that will be I don’t know.”

Swedish Health Services, which has hospitals and clinics in Snohomish and King counties, has 4,000 pagers spread among a workforce of about 11,000 employees.

Pagers are so reliable because antenna and boosters can be installed on site throughout the organization, said Lori Dunigan, Swedish’s call center manager. “There’s better penetration throughout the hospital,” she said.

Hospital staff use pagers to alert their colleagues to an emergency event, such as a “code stroke,” or to summon response teams to the emergency room, operating room or a patient’s bedside.

In addition to reliability, pagers are head and shoulders above the competition by another measure — cost — with charges as little as $4.95 a month each, Dunigan said.

Dr. Bill Likosky, a neurologist and medical director of Swedish’s stroke programs, has three beepers, “one on my right hip, one on my left hip and the jacket pocket.”

An urgent summons of medical staff used to occur through an overhead page. “Everybody had to know,” he said. “There were so many people working in the hospital, it was a constant din.”

Pager numbers, distributed to hospital staff, allow time-sensitive messages to be sent either to a specific individual or group of hospital employees.

Pagers’ anytime, anywhere reliability is what keeps them a key piece of a hospital’s communication technology.

“They don’t seem to have as many dead spots,” Likosky said. “There’s hardly a place a beeper won’t go off. Cellphones don’t work as well.”

Their downside: “Not every time you get a message that’s important,” he said. “Sometimes it’s trivial, someone who needs a laxative tonight versus someone who may have something irreversible going on. The same beeper gives both messages.

“Too much communication can drive you crazy.”

A pager, like any communication device, sometimes can send some unintended, but potent messages. Like when there’s no response.

“The first thought is why aren’t they responding?” Likosky said. “I paged them twice. The ability to communicate instantly provides an expectation that you should respond instantly.”

Their electronic bleating can also send a subtle, secondary messsage. “If you walk around with three beepers and they’re going off all the time, you may feel somewhat important, I guess,” Likosky said. “Like a siren on a police car, it embellishes you.”

And what if all three are going off at once? “We just hand one to somebody and say, ‘Please answer this for me,’ ” he said.

Pagers have evolved over the decades. “There’s so many makes and models of pagers, and they continually upgrade,” Dunigan said.

They have the ability to send short text messages of about 150 letters along with a phone number. Two-way pagers allow messages to be sent back and forth like text messaging. Duplicate messages also can be sent to an employee’s smartphone.

Some employees who aren’t emergency responders are turning in pagers to use smartphones exclusively. That works for health care workers who don’t need to respond to something instantly, Dunigan said.

Despite their reliability, pagers aren’t problem-free. There can be missed pages, or delays of a minute or two in pages being sent as the requests stack up in a queue, she said.

“There are pros and cons to both tools and which is more reliable,” Dunigan said.

Some people just prefer pagers as their primary contact. “I have physicians who say I’ve had the same pager number for 22 years,” Dunigan said. “They have it printed on their business cards and they’re not going to change that number.”

The prevalence of pagers in hospitals won’t wane soon.

“They’re the most cost-effective tool we have and a major means of communication,” Dunigan said.

Pagers have evolved to meet specific needs “better than anything else we could think of,” Likosky said.

“The fascinating thing is, nothing has really replaced it.”