Telehealth adds to primary care workload, study finds

© Melinda Nagy - stock.adobe.com

Telehealth became a staple of primary care during the COVID-19 pandemic, but new research suggests it comes at a cost: more physician time.

A large population-based study published in the journal Primary Health Care Research & Development examined 464,119 patients in Israel between 2020 and 2021. They found telehealth use significantly increased the workload for primary care physicians.

Researchers measured workload using Accumulated Annual Duration of Time (AADT), which calculates the total minutes a patient spends with a physician across all visit types in a year. They found that patients who used more digital options — whether video, phone or asynchronous messaging — consumed more physician time overall compared with those who relied solely on face-to-face visits.

Findings — time and visit patterns

Across the population, physician time per patient rose by 2.5% from 2020 to 2021. Patients using synchronous telehealth — phone or video — grew by 5.8%, while those relying solely on in-person care dropped by 8.9%. Women, older adults, patients with chronic conditions and those with higher socioeconomic status were more likely to use telehealth services.

The greatest jump in workload was seen among patients who had only in-person visits in 2020 but used all types of visits in 2021. Their annual accumulated time increased by 56.1%. By contrast, patients who reduced their telehealth use saw time demands fall. Those who used all types of visits in 2020 but switched to only face-to-face in 2021 had a 26.5% drop in accumulated physician time.

Why it matters

The findings challenge the assumption that telehealth saves time or substitutes for in-person care. Instead, it appears to add demand. The authors note that policymakers and health care systems should account for this additional burden when planning resources and staffing.

The study excluded patients diagnosed with COVID-19 to avoid skewed data from mandated follow-ups and quarantines, focusing instead on routine primary care use. Because Leumit Health Services, the HMO studied, pays physicians equally for telehealth and in-person visits, the results reflect patient demand rather than financial incentives.

While telehealth offers clear benefits — reducing no-shows, improving chronic care follow-up and increasing accessibility — it also risks compounded physician burnout. The authors conclude that patients using telehealth create an additional burden on the primary care physician and say that even small increases in time demand, scaled across a health system, may require significant organizational change.