Telehealth has transformed healthcare access, making it easier for millions of patients to connect with physicians without leaving home. New research from the University of Miami Business School finds that sustaining those gains will require health systems to address the operational demands virtual care can place on physicians.
Published in Manufacturing & Service Operations Management, the study examined nearly 4 million physician activity records from an anonymized major U.S. academic health system. It found that telehealth allowed physicians to care for significantly more unique patients while changing how their work was distributed. The findings point to a central operational challenge: expanding access while building the capacity, workflows and support needed to manage additional digital communication, physician workload and financial trade-offs.
"Telehealth clearly improves access to care from the patient's perspective," said Masoud Kamalahmadi, assistant professor of management science at the Business School, who led the study. "What has largely been missing is the physician's side of the story. If you expand access without expanding physician capacity, what happens to the people providing the care?"
More patients without more appointments
One surprising finding was that physicians treated more unique patients without increasing the total number of appointments.
At first glance, that appears impossible.
Researchers found physicians reshaped their schedules. Instead of scheduling as many follow-up appointments and procedures, they devoted more slots to new patients. Much of the routine follow-up care that once required a visit shifted to electronic messages through patient portals instead.
"We found a clear shift away from follow-up visits and toward new patient consultations, with many follow-up interactions moving into digital messaging," Kamalahmadi said. "If you're seeing more unique patients but not increasing the total number of visits, those appointments are being spread across a larger group of people."
How virtual care changes the workload
That shift expanded patient access. It also changed where and when some of the work occurred.
Physicians handled growing volumes of electronic communication, including messages answered outside normal business hours.
"There is actually a term physicians use for this: 'pajama time,'" Kamalahmadi said. "They go home, and instead of finishing work, they are still responding to patient messages in the evening."
The study found that physicians handled roughly 30 additional patient messages each month after adopting telehealth at higher levels. While each message may seem minor, together they represent a substantial amount of work layered onto already demanding schedules.
"We're not saying patients should not have access," Kamalahmadi said. "Physicians have finite capacity. If access expands without addressing that capacity, health systems need to determine how the additional work will be supported."
Financial trade-offs beyond reimbursement
The researchers also identified financial trade-offs for health systems.
Although new patient visits generally generate higher revenue than follow-up appointments, physicians also performed fewer procedures, which are among the highest-revenue services for many health care organizations. That reduction offset much of the expected financial benefit from seeing more new patients.
"We found that the revenue gains associated with seeing more new patients were largely offset by other changes in the mix of care," Kamalahmadi said. "Fewer procedures also matter because those services contribute significantly to health care revenue."
Building capacity around virtual care
Kamalahmadi emphasized that the research supports the continued use of telehealth and the access it provides.
The findings highlight the need to design capacity, workflows and support around virtual care so expanded access does not create additional administrative burden for physicians.
Potential solutions include routing appropriate patient messages to nurses or nurse practitioners, using AI tools to draft responses that physicians can review and edit, setting clearer expectations about response times, and reconsidering reimbursement and compensation models to better reflect digital care.
"Telehealth should remain because patients benefit from it," Kamalahmadi said. "To make it sustainable, health systems have to support the physicians delivering that care and address these operational challenges as virtual access continues to grow."
For Kamalahmadi, supporting physicians and expanding patient access are complementary goals.
"When physicians become overwhelmed, they leave," he said. "Taking care of physicians ultimately helps patients and makes the entire health care system stronger."
