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Telehealth Modality Usage by US Physicians in 2022 Danielle B. Carder, MSc1, Sangha Jeon, MA2, Matthew C. Baker, PhD1  , Xiaochu Hu, PhD1, Michael J. Dill, MA1, and Lisa D. Chew, MD, MPH1,3

1Association of American Medical Colleges, Washington, USA; 2University of California, Irvine, CA, USA; 3Department of Medicine, University of Washington, Seattle, WA, USA

ABSTRACT BACKGROUND: The growth of telehealth care delivery during the COVID-19 pandemic highlighted its poten- tial to enhance access to care and improve patient out- comes. As the healthcare landscape moves toward a new equilibrium in care delivery, few studies have examined physician usage of specific telehealth modalities. OBJECTIVE: To understand telehealth usage dif- ferences among modalities and across subgroups of physicians. DESIGN: Cross-sectional survey of physicians in the United States (U.S). PARTICIPANTS: Physicians in the U.S. MAIN MEASURES: Telehealth modalities, telehealth usage intensity, factors influencing telehealth usage by different types of physicians. KEY RESULTS: More than 70% of physicians reported using telehealth. Our results show variation in the types of modalities used by different types of physicians, with provider-to-provider telehealth modalities having lower usage rates than provider-to-patient modalities. Live video visits with patients was the most commonly used modality (56.5%), while video consultations (17.6%) was the least used modality. “Payment and reimbursement” was identified as the most important factor enabling routine telehealth use (by 41.6% of physicians). CONCLUSIONS: This study identifies and assesses the widespread adoption of telehealth among U.S. physi- cians, particularly for provider-to-patient interactions, and highlights the potential for greater use of provider- to-provider modalities. While variations in usage pat- terns across provider types and specialties reflect the diverse needs and contexts within healthcare, ensuring that these variations are appropriate is critical to avoid- ing disparities in access and utilization. Addressing bar- riers related to reimbursement, interoperability, and training will be key to promoting equitable and appro- priate adoption of various telehealth modalities across diverse clinical settings.

KEY WORDS: physician; telehealth; telemedicine

J Gen Intern Med 40(14):3347–52 DOI: 10.1007/s11606-024-09287-4 © The Author(s), under exclusive licence to Society of General Internal Medicine 2024

Widespread telehealth adoption during the COVID-19 pandemic, driven by advancements in technology and

evolving patient needs, necessitates understanding of the current state of practice, emerging trends, and future direc- tions for care delivery. Researchers have documented both the effectiveness of telehealth as an additional option for care delivery and attitudes towards telehealth in providers and patients.1–3

Telehealth includes a spectrum of modalities, ranging from real-time video consultations to remote patient moni- toring and asynchronous communication. Research has gen- erally focused only on certain modalities of telehealth use, such as video visits and phone visits during the pandemic and willingness for sustained use after the pandemic.4 Each modality offers unique advantages and challenges, neces- sitating an exploration of the frequency with which each of the diverse telehealth modalities is used by different phy- sicians. In this study, using data collected during the pan- demic, we assess telehealth modality usage amongst US physicians, disaggregating by key physician characteristics and specialty, and rank the highest-priority factors impacting continued telehealth usage.

METHODS

Study Data We used data from the Association of American Medical Colleges’ (AAMC’s) National Sample Survey of Physicians (NSSP), collected from May to November 2022. NSSP is a recurring nationally representative physician survey encom- passing demographic information, practice characteristics, telehealth utilization, and factors related to psychological well-being. The NSSP 2022 contains responses from 5917 active physicians in the United States. This dataset was collected following a two-step sampling method: First, all eligible respondents from the NSSP 2019 were invited. Sec- ond, new invitees were chosen through a stratified random sample with proportionate allocation, based on physicians’ sex, age group, specialty group, and rurality. In addition, post-survey weights calibrating NSSP 2022 back to the known physician population based on the American Medi- cal Association (AMA) Physician Professional Data 2022 were applied in this study. Full details on the sampling and weighting have been published online.5 The survey was

Danielle Carder and Lisa Chew are former employees of AAMC, they did the work for this paper as employees of AAMC.

Received August 8, 2024 Accepted December 5, 2024 Published online January 14, 2025

JGIM

TELEHEALTH

3348 Carder et al.: US Physician Telehealth Modality Usage JGIM

approved by Institution Review Board at the American Institutes for Research.

Measures

Current Telehealth Usage. Our analytical sample included 5798 participants who reported whether they currently use each of the following six telehealth modalities in providing patient care: (1) electronic patient communications, (2) live video visits with patients, (3) billable telephone visits with patients, (4) remote patient monitoring, (5) electronic asynchronous consultations with other physicians, (6) live video consultations among physicians. We classified the first four as provider-to-patient and the last two as provider- to-provider, then categorized physicians into four groups based on their current telehealth use as follows: (1) non-user (those who reported not currently using any telehealth), (2) provider-to-patient only modalities user (those who reported using at least one type of provider-to-patient telehealth but no provider-to-provider modalities), (3) provider-to- provider modalities only user (those who reported using at least one type of provider-to-provider telehealth but no provider-to-patient modality), and (4) dual-users (those who reported currently using at least one type of provider- to-patient telehealth and at least one type of provider-to- provider telehealth).

Intensity of Telehealth Usage. Intensity of telehealth usage was calculated as weekly hours spent in providing care via telehealth based on physicians’ responses to three questions: (1) work hours during a typical workweek, (2) the percentage of working time spent in patient care, and (3) the percentage of care delivered via telehealth during the past month in ten percentage point increments from 0 to 100. To measure telehealth-using work hours, we first quantified each of the three questions, converting the categorical response values in (2) and (3), originally collected as ranges, to a quantity based on the midpoint of the respective range, as has been previously done in related literature.6 For example, a participant who reported a telehealth share of care between 1 and 10% of their care was coded as spending 5.5% of care using telehealth. Hours spent in using telehealth in a month were then calculated as working hours per week, scaled by a factor of 4 to match the monthly cadence of the patient care variable, multiplied by percentage of working hours spent in providing care and percentage of care via telehealth. To measure a cross- section of physicians with maximal telehealth usage intensity differences, we then categorized respondents based on whether they reported a higher number of monthly hours than the weighted mean after excluding outliers more than three standard deviations from the mean.

Important Factor in Sustained Telehealth Use Post‑pandemic. Participants were asked to select the most important factor enabling routine post-pandemic use of telehealth in their current place of practice. Options included “leadership endorsement and support,” “physician and staff training,” “regulatory changes,” “patient demand,” and “payment/reimbursement.”

Demographic and Other Characteristics. Demographic factors in the survey include age, gender, physician specialty, rurality of practice, and academic affiliation. Physician specialty was grouped into the following five categories: primary care, psychiatry, medical specialties, surgery, and other. Rurality of physician practice was categorized based on the self-reported percent of patient-care time spent in rural areas: low (below 20%), medium (greater than or equal to 20 percent and less than 80 percent), and high (80% or above). Academic affiliation is defined as having one or both of the following: (1) a faculty appointment at a medical school or (2) admitting or consulting privileges or other affiliation with an academic health center or teaching hospital. Each of these categories and subdivisions were selected based on meaningfulness of telehealth delivery.

Analyses Statistically significant differences across demographic groups were tested using chi-square tests with weight adjusted and performed using SAS version 9.4.

RESULTS

Participants’ Demographic Characteristics and Their Telehealth Usage The majority of participants were between 45 and 65 (57.2%) and men (62.4%). Respondents were distributed across the following specialties: primary care (31.0%); psychiatry (6.9%); medical specialties (17.5%); surgical specialties or surgery (17.9%); and other (26.6%). Nearly half were affili- ated with academic institutions (45.3%) and most spending less than 20% of their time in rural areas (84.9%).

Current Telehealth Usage and Its Intensity. More than 70% of physicians are using telehealth, spanning provider- to-provider, provider-to-patient modalities, and combined modalities (dual modalities) (Fig.  1). About 27% of physicians reported no current use of any telehealth modality (Fig.  1). Physicians reported using nearly all provider-to- patient telehealth modalities more often than provider-to- provider modalities, except for the use of remote patient monitoring (Fig.  2). The most commonly used telehealth modality was live video visits with patients (56.5%), while video consultations (17.6%) was the least used modality.

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Table 1 shows differences in telehealth use by physician demographic characteristics and categories of telehealth use. Physicians between the age of 45 to 65 and women were more likely to use any telehealth modality. Physi- cian telehealth usage varied by specialty categories, being

higher in primary care, medical specialties, and psychiatry, and lower in surgical specialties. A granular breakdown (Appendix Table A2) showed that some individual special- ties had especially high rates of both telehealth use and high intensity proportion, particularly psychiatry, nephrology,

Figure 1 Telehealth usage by grouped modality (n = 5798). Source: Authors’ analysis of the Association of American Medical Colleges’ (AAMC’s) National Sample Survey of Physicians (NSSP), 2022 (n = 5798). Notes: All values are weighted to represent all US physicians.

Respondents chose from “have never used,” “have used in the past but not using now,” “Use now but not often,” and “Use now and often” of each of the six modalities in providing patient care. The former two usage patterns were categorized as “not current users” and the lat- ter two as “current users.” The six modalities include (1) electronic patient communications, (2) live video visits with patients, (3) billable telephone visits with patients, (4) remote patient monitoring, (5) electronic asynchronous consultations with other physicians, and (6) live

video consultations among physicians. The first four were categorized as “provider-to-patient,” and the last two as “provider-to-provider.” Dual users are defined as those currently using both provider-to-patient and provider-to-provider telehealth.

Figure 2 Telehealth usage by modality (n = 5798). Source: Authors’ analysis of the Association of American Medical Colleges’ (AAMC’s) National Sample Survey of Physicians (NSSP), 2022 (n = 5798). Notes: All values are weighted to represent all US physicians. Respondents

chose from “have never used,” “have used in the past but not using now,” “Use now but not often,” and “Use now and often” of each of the six modalities in providing patient care. The former two usage patterns were categorized as “not current users” and the latter two as

“current users.”

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hematology/oncology, pulmonary and critical care medicine, and gastroenterology.

Academic-affiliated physicians reported higher telehealth use than their non-affiliated peers. Medium rural-serving physicians (≥ 20% and < 80% time spent delivering care in rural areas) reported the highest rates of telehealth use and were the most likely to be dual users.

We found a relationship between more time spent using telehealth and the breadth of modalities: nearly 46% of high- intensity users used both modalities, compared to only 35% amongst low-intensity users.

Important Factors for Continued Telehealth Use Post‑pandemic. All four telehealth user groups identified “payment and reimbursement” as the most important factor enabling routine telehealth use (41.6% of the entire study sample, Appendix Table  A3). “Patient demand” (22.7%) and “physician/staff training” (15.1%) followed as the next significant national factors. “Payment and reimbursement” was consistently the most important factor across all age groups, genders, rural status, and 25 out of the 27 measured top specialties, with each category statistically significantly predictive at the p < 0.01 level.

DISCUSSION This analysis revealed that the majority of physicians, regardless of the measured characteristics, utilized telehealth, especially provider-to-patient modalities. However, telehealth usage rates varied across key characteristics. Psychiatrists and low-intensity telehealth users were more likely to use provider-to-patient tel- ehealth. This finding aligns with prior research demonstrating that telehealth is a valuable tool for delivering mental health and behavioral health services, offering patients greater flex- ibility, convenience, and privacy in accessing care for patients.7 Our results combined with the fact that patient demand was the second most important factor for continued telehealth use, sug- gests that physicians recognize the importance of meeting both current and future patient expectations around care delivery.

These variations in telehealth usage imply barriers to pre- paredness for future disruptions such as a future pandemic or other events that may limit in-person care. While not all medical encounters are an appropriate clinical context for telehealth, lacking telehealth capability as an essential tool in a provider’s toolkit may limit continuity of care and patient access, especially in times of crisis.

Electronic consultations (eConsults), asynchro- nous messages between providers, were the most used

Table 1 Telehealth use by Physician Characteristic, 2022. Source: The Association of American Medical Colleges’ (AAMC’s) National Sample Survey of Physicians (NSSP), 2022. Sample size is unweighted. All values are weighted to represent all US Physicians. Responses

represent whether the respondent reported personally currently using each form of telehealth technology in providing patient care. Women include trans-women, men include trans-men and other include agender, genderqueer/gender non-conforming, non-binary, and

other. Within telehealth usage intensity, we excluded those who reported not delivering care via telehealth or those who reported not using any telehealth modalities (“non-user”). The telehealth usage intensity p-value indicates the significant joint difference in the percentages of

dual, provider-to-patient, and provider-to-provider users across high and low intensity groups

N Proportion of physician cohort with each type of tel- ehealth use

Subpopulation differ- ences in any modality usage

Variable Any modality Dual pro- vider and patient

Only provider-to- patient

Only provider-to- provider

All physicians 5798 73.0 28.2 42.6 2.3 Age < 45 1806 69.0 31.1 36.3 1.6 < .001

≥ 45 and < 65 3003 76.8 29.3 44.5 2.9 65 or above 989 67.0 21.3 44.3 1.4

Gender Man 4000 70.3 27.4 40.5 2.5 < .001 Woman 1758 77.6 29.5 46.1 2.1 Other 38 59.3 10.4 48.1 0.8

Specialty Primary care 1858 84.7 31.0 52.7 1.0 < .001 Psychiatry 303 90.8 28.0 61.8 0.9 Medical specialties 1208 85.4 36.3 48.7 0.3 Surgery 1121 61.4 21.9 38.6 1.0 Other 1308 54.6 23.7 24.5 6.4

Academic affiliation Academic 3112 78.0 31.5 44.2 2.3 < .001 Non-academic 2629 68.8 24.9 41.6 2.3

Percent time spent in rural

Low (< 20%) 4814 72.6 27.8 42.8 2.0 < .001 Medium (≥ 20%

and < 80%) 381 81.9 35.5 40.4 6.0

High (80% or higher) 523 71.1 25.7 42.6 2.8 Telehealth usage

intensity High (≥ mean 24 h per

month) 937 100.0 45.9 51.9 2.2 < .001

Low (< 24 h per month) 2130 100.0 35.0 63.6 1.3

3351Carder et al.: US Physician Telehealth Modality UsageJGIM

provider-to-provider modality. The lower usage of provider- to-provider telehealth modalities highlights opportunities to expand the reach of care and improve access to specialty input, especially when patient referrals are challenging. Factors that may contribute to lower usage of provider-to-provider tele- health modalities include insufficient reimbursement models, interoperability and technology challenges, workflow inte- gration, and workload concerns.8 Higher use of provider-to- provider modalities by academic physicians may be related to their access to an enterprise-wide electronic health record that facilitates easier consultations with other specialties. Addi- tionally, higher rates of dual and provider-to-provider only users among physicians practicing in rural areas underscore the potential of these modalities to address challenges in spe- cialty access7, more effectively consult with specialists, and accommodate patient travel and digital literacy.

Encouraging greater adoption will require addressing several barriers through improved reimbursement models and financial incentives, streamlined workflows in the EHR integration, and investments in technical infrastructure and support. Building partnerships and collaborative regional networks that connect independent and integrated practices across geographic areas can also further enhance the use of provider-to-provider telehealth, benefiting providers in diverse clinical settings. Concerns about healthcare equity must also be considered, especially for provider-to-patient modalities, given persistent technology access gaps among some patient populations.9, 10 Optimized reimbursement models and finan- cial incentives of provider-to-provider telehealth modalities, such as the recent change to allow state health officials to cover eConsults under Medicaid and Children’s Health Insurance Program11, as well as reducing interoperability challenges will be key to addressing these equity challenges.

The correlation between using dual modalities and fre- quency of use may indicate that physicians who are more familiar with telehealth are comfortable using multiple modalities to accommodate patient and provider needs. In addition, the high rates of dual modality use among medi- cal specialty physicians, particularly hematology/oncology; rheumatology; and endocrinology, diabetes, and metabolism, likely reflect the complexity of their patient population who may benefit from the flexibility and versatility that multiple telehealth approaches provide.

Our finding that reimbursement was a primary driver of telehealth usage reinforces previous studies emphasizing the critical role of compensating providers for expended resources in adoption and sustained use.12 This factor is especially criti- cal for rural and underserved areas, where telehealth offers a lifeline to specialty services that might otherwise be inaccessi- ble. Aligning reimbursement models with both fee-for-service and value-based care frameworks will be essential to support telehealth’s sustainability across diverse heath care settings.

This study was limited by the self-reported nature of the data, which may contain bias and recall error. Additionally,

the questionnaire was limited in scope to only six modalities, and to five assessed factors for continued use of telehealth beyond the pandemic.

This study demonstrates the widespread telehealth adop- tion among physicians through provider-to patient modali- ties, while highlighting the potential for greater utilization of provider-to provider-telehealth. While it is clear that telehealth will not fully replace in-person care, it remains important to ensure that telehealth is available and optimized for effective and appropriate use to prevent disparities in access, utilization, and quality of care across patient popu- lations. Ensuring long-term sustainability for all telehealth modalities will require overcoming critical barriers such as reimbursement challenges, interoperability issues, workflow integration, and staff and provider training. Strategies such as enhancing reimbursement models, investing in technologi- cal infrastructure, and fostering partnership networks will be essential, particularly for improving access in rural and underserved communities. Future research should focus on understanding the long-term impact of telehealth on patient outcomes and health care equity, optimizing modality use across specialties, and identifying best practices for seam- less integration.

Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s11606- 024- 09287-4.

Acknowledgements: This paper and the research behind it would not have been possible without the contributions of Scott Shipman, MD, MPH. Preliminary data from the project were presented as a poster for the 2024 AcademyHealth Annual Research Meeting (ARM) in Baltimore, Maryland.

Corresponding Author: Matthew C. Baker, PhD; , Association of American Medical Colleges, Washington, USA (e-mail: mbaker@ aamc.org).

Data Availability NSSP data are available upon request and through a data legal user agreement. To request AAMC data, please visit https://www.aamc.org/request-aamc-data. Payment may occur.

Declarations:

IRB Exemption: The Human Subjects Protection Program staff reviewed the project entitled “Telehealth Modality Usage by US Physicians in 2022” on 3/19/2024. This project is exempt from fur- ther IRB review because it does not constitute as human subjects research, as defined in 45 CFR 46. This is a secondary analysis of deidentified data.

Conflict of Interest: All authors attest to having no financial con- flicts of interest.

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