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Our Take

Why many physicians still avoid telehealth

15 Minute Read

Physicians are critical to telehealth’s long-term success. Yet, many physicians still think of telehealth as a Covid-era tool and are anxious to return to in-person care only. Some patients are similarly ready to return to in-person care, further coloring physicians’ views of telehealth’s long-term value.

There are many technical challenges to telehealth. But even when they are addressed, there are challenges to getting physicians to change their practice. Many physicians see telehealth as a threat to their identity, autonomy, and core beliefs about their roles as care providers. These are what we call “adaptive challenges.” Health care leaders must address these adaptive challenges as well as the technical challenges to win physicians‘ buy-in for telehealth.


The conventional wisdom

Physicians and patients alike are anxious to return to “normal”—and for many that means a return to in-person care. Many physicians were willing to adopt telehealth during the pandemic because it was the only option when nationwide lockdowns limited in-person visits. But now that hospitals and clinics are open, most physicians are returning to their pre-pandemic routines where in-person care is the default. Similarly, patients—even those who tried and enjoyed telehealth during the pandemic—assume that in-person visits are the standard modality. Some patients are choosing, and sometimes even asking for, in-person visits in place of continued telehealth visits.

In-person care isn’t simply the default mode of care for some physicians. They actually prefer it because of the technical challenges surrounding telehealth. The rapid adoption of telehealth at the onset of the pandemic meant that many health care organizations were adopting telehealth platforms rapidly and adjusting as they went. As a result, physicians experienced telehealth (often for the first time) with many technical issues including faulty audio and video connection, lack of integration with the EHR, and inefficient workflows and team communication. And all of those challenges come on top of ongoing concern about the future of telehealth reimbursement. Because of these barriers, leaders remain hesitant to invest in and encourage long-term adoption of telehealth, which would lead to a decrease in utilization.

And many physicians don’t consider declining telehealth utilization to be a problem. To them, telehealth represented a substitute for in-person care during the pandemic. These physicians feel that telehealth didn’t substantially improve the care model or add additional benefits to the patient or physician experience. The question on many of the minds of leaders and physicians is: “Why make the change to telehealth when it’s not significantly better than the old method?”


Our take

Physicians have two choices: Accept telehealth or retire.

Patients want, and will increasingly expect, the convenience of virtual care. Telehealth took hold during Covid-19, but the change in care delivery will outlast the pandemic. Now that patients have experienced the convenience of and learned to use telehealth, there’s no going back.

Providers need to keep up or be left behind. Third-party vendors are ready to provide patients with a high-quality digital experience. They will step in if providers can’t fulfill expectations.

Leaders must address both technical and adaptive challenges to win physician buy-in.

Many physicians cite technical challenges such as faulty video and audio connections as reasons to dislike telehealth. But there’s more—physicians are being asked to rethink how patient care is delivered. This leads to “adaptive challenges,” such as:

  • Loss of identity: “I didn’t start practicing medicine to stare at a screen all day.”
  • Loss of autonomy: “I don’t want to be told when my visits have to be virtual.”
  • Quality of care: “Telehealth is bad medicine.”

People prefer to focus on technical challenges because they’re well defined, bounded, and concrete. Adaptive challenges, on the other hand, are personal, abstract, and messy—and that makes them harder to identify and address.

People prefer to focus on technical challenges because they’re well defined, bounded, and concrete. Adaptive challenges, on the other hand, are personal, abstract, and messy—and that makes them harder to identify and address.

Leaders tend to misjudge the prevalence of adaptive challenges.

Because adaptive challenges are personal, they’re hard for physicians to talk about. So, leaders who are responsible for supporting telehealth often think about implementation issues in technical terms. The leaders often don’t know about the difficulties physicians are having with changing practice patterns.

See the physician telehealth hypothetical on page 14 of the PDF to learn how leaders and physicians can identify and talk about adaptive challenges.

For example, a physician might say that telehealth isn’t as productive as in-person visits instead of describing the loss of autonomy they feel as they transition to virtual care. If leaders aren’t looking out for signs that physicians are struggling with adaptive challenges, they will assert that technical challenges are the only barriers left to solve.

Addressing technical challenges is a must—and it can help with adaptive challenges.

Unresolved technical challenges can become an excuse for physicians to stick with what they know: in-person care. Physicians need telehealth platforms to be integrated with EHRs, have consistent video and audio capabilities, and enable workflows that don’t hinder productivity. Without these basic capabilities, there’s little chance of success in addressing the more complex adaptive challenges.

But even when telehealth systems work seamlessly, some physicians will still be hesitant to adopt telehealth. That’s where addressing adaptive challenges becomes most important.

See page 13 of the PDF for a list of common technical and adaptive challenges.


3 tactics to overcome technical and adaptive challenges

These challenges are not easy to solve. Here are some tactics to help leaders address both types of challenges to win physicians’ buy-in and successfully sustain telehealth adoption.

  • tactic

    Track longitudinal outcomes to build the case for telehealth

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  • tactic

    Bring physicians (back) into the decision-making process

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  • tactic

    Support physicians through on-demand peer-to-peer learning

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Parting thoughts

The larger movement toward telehealth, hybrid care, and home-based care brings the opportunity to scrutinize older traditions and may require further evaluation of what exactly is (and is not) needed in a successful care visit.

Health care has traditionally been an in-person activity. Many physicians and patients believe that in-person care is “good practice” and cannot be replicated virtually.

But telehealth is not meant to be a substitute for in-person visits. Instead, we need to recognize how telehealth can add to patient care overall—for instance, by improving convenience and efficiency.

Leaders needs to eliminate the technical and adaptive challenges associated with telehealth to get physicians on board with incorporating digital technology into their practice. Then, patients and physicians alike can benefit from the benefits telehealth has to offer.

Physician telehealth hypothetical

Use this hypothetical example to help leaders and physicians identify and talk about adaptive challenges.

The example purposefully solves for all technical challenges to better isolate adaptive challenges. Because it’s a hypothetical situation, physicians may feel more comfortable bringing up adaptive challenges that would seem too personal in another context.

View the example (page 14).

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