Shane Peng, MD

Long before COVID-19, telehealth was considered an emergent piece of the health care puzzle. Today, nearly two years into the pandemic, there is no doubt that telehealth has gone mainstream, solidifying the category of hybrid care. Once limited by low adoption rates resulting from limited awareness and lack of favorable reimbursements, telehealth has increased care access and convenience in an environment that has demanded virtual care. However, although much of the discourse around telehealth rightfully focuses on its benefits, the potential drawbacks and limitations are often glossed over, particularly around provider burden.

The reality is that telehealth is not a regular office visit conducted virtually. Rather, it’s an entirely different experience for both the provider and patient. Providers accustomed to treating patients in person have become burdened by being forced to offer virtual care, with its potential technology related issues, informal nature and inability to physically engage with patients. Virtual care also can exacerbate, rather than alleviate, burnout. In the 2021 

® Physician Burnout and Wellness Survey, 80% of physician respondents reported they are burned out, with 31% citing too much paperwork and bureaucratic tasks and 24% reporting too many hours worked and poor work-life balance as the cause. Compounded by the ongoing pandemic and added telehealth appointments, the result is an exhausted and burned-out health care workforce. For those outside of health care, think of the immediacy of Zoom meetings with the added stress of a patient’s health and their concerns always one click away.

The economics of telehealth also can create burdens. Shifting patients from in-person to virtual visits results in lower revenue for providers because they are compensated for the cost of physical infrastructure and human resources. For example, virtual care can be delivered from a physician’s home, typically requires shorter visit times, has no physical examination and has no potential for revenue from ancillary or pharmacy services. Adding a virtual care option also significantly increases costs for health care organizations through technology investments and maintenance, as well as making sure that platforms are interoperable. There are added human capital costs, such as staff being required to register, counsel and support both in-person and virtual patients. In an ecosystem where practice economics are already complicated because of differing reimbursement models and incentives that staff must navigate, virtual care adds another layer of complexity that further inhibits organizations’ abilities to maximize patient outcomes and profits.

As we enter this new phase of the pandemic, telehealth will inarguably continue to be an essential piece of the care experience. With our health care systems once again being pushed to their limits, offerings such as telehealth that properly identify visits that do not require in-person attention will both help save lives and keep health care system costs in check. However, as with the introduction of the electronic medical record, telehealth offers significant benefits but not without challenges to providers. The long-term success of telehealth will depend on the entire ecosystem making necessary adjustments to their practices and creating the infrastructure to adapt to the new reality.

This article was originally published by sister publication Medical Economics.

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Although much of the discourse around telehealth rightfully focuses on its benefits, the potential drawbacks and limitations are often glossed over, particularly around provider burden

Shane Peng, MD

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