Study: Telehealth could increase physicians’ after-hours work


The use of telemedicine and telehealth increased dramatically during the COVID-19 pandemic. For the physicians who used the technology more intensely during that period, more time was spent on after-hours EHR-based clinical and administrative work.

These were among the conclusions of a study of 2,129 physicians that was conducted at New York University Langone Health.

The report, published in JMIR in July, found that time spent on work-related tasks outside clinical hours, often referred to as “work outside work” (WOW), increased “significantly” for those physicians who spent a larger proportion of their time providing care via telemedicine.

“Our study found that telemedicine was less efficient than in-person-based care and increased physicians’ WOW burden,” the researchers noted. “A number of factors may be responsible for our findings that telemedicine increased the after-hours work burden of physicians.”

The study noted, however, that multiple challenges uncovered in early-stage deployments of telehealth during the pandemic — including organizational and technological inefficiencies in design and deployment — could be a key factor in the increased after-hours EHR work burden.

“These issues have been highlighted elsewhere in EHR and digital health technology implementation research, particularly regarding usability and user-experience barriers exacerbated by the scale and abruptness of the transition to telemedicine due to the pandemic,” the study noted.

The disruption of work norms, including new methods of providing care and scheduling arrangements, could also have contributed to the WOW burden.

“Overall, our results suggest that telemedicine is not [a] panacea for the work challenges facing clinicians,” the report noted. “In fact, our evidence during the acute pandemic and after the acute pandemic suggests that rather than reducing administrative burden, telemedicine intensity may increase it, shifting the work temporally and spatially to after-hours work and home.”


Healthcare’s ongoing digital transformation is both contributing to and alleviating clinician burnout.

Two in three clinicians now say treating patients in virtual-only or hybrid care settings best fits their lifestyle, despite a significant lack of interest in telehealth before the pandemic.

Some in the industry advise clinicians interested in telehealth to look for opportunities that prioritize and personalize their experience as clinicians.


Telehealth adoption is highest among the young, educated and wealthy, according to a December 2021 survey by Rock Health, which revealed an increase in live video telemedicine — and a decrease in satisfaction with telehealth compared with in-person care.

Other studies have indicated telemental healthcare is associated with increased outpatient contact and hospitalization follow-ups

However, that study found that greater use of telehealth among patients with severe mental illness did not affect medication adherence.


“Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively,” the study concluded. “This suggests that telemedicine, as currently delivered, may be less efficient than in-person-based care and may increase the after-hours work burden of physicians.”


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