Abstract
The rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients. To identify physician characteristics associated with the transition to virtual health care in a large regional health care system. This retrospective cross-sectional study uses administrative health system databases to analyze data from all 3473 physicians providing ambulatory care through a large New England health care system, which includes 12 hospitals and their ambulatory practices, from October 1, 2019, through December 31, 2020. Physicians characterized based on gender, popularized generational demographic cohort (Silent Generation, born 1928-1945; Baby Boomers, born 1946-1964; Generation X, born 1965-1980; and Millennials, born 1981-1996), specialty (behavioral health, primary care, medical, and surgical), and hospital affiliation as well as selected patient characteristics (number of visits and proportion of patients with self-pay or Medicaid insurance, aged 65 years or older, preference for speaking a language other than English, from a racial or ethnic minority group, and with an active patient portal). Early adoption of virtual health care. Bivariate comparisons were made, and regression modeling was used to examine characteristics associated with the likelihood of early adoption of virtual health care. Of 3473 physicians conducting ambulatory visits during the study period, 1624 (46.8%) were women, 83 (2.4%) were in the Silent Generation, 994 (28.6%) were Baby Boomers, 1637 (47.1%) were in Generation X, and 759 (21.9%) were Millennials. There were 1649 physicians (47.5%) in medical specialties, 749 physicians (21.6%) in surgical specialties, and 248 physicians (7.1%) in behavioral health. After accounting for other characteristics, female (odds ratio [OR], 1.23; 95% CI, 1.06-1.44), behavioral health (OR, 2.92; 95% CI, 2.11-4.04), and primary care (OR, 1.69; 95% CI, 1.36-2.09) physicians had greater odds of being early adopters, and physicians in the Silent Generation (OR, 0.39, 95% CI, 0.24-0.65) and in surgical specialties (OR, 0.46; 95% CI, 0.38-0.57) were less likely to be early adopters. Patient characteristics were less strongly associated with physician adoption. In this cross-sectional study, there was physician-level variation in the adoption of virtual health care, with female, primary care, and behavioral health physicians in this system most likely to lead the transformation to virtual health care.
Highlights
The transition to telehealth during the COVID-19 pandemic was critical to continue to provide health care to patients.[1,2,3,4] This change has enabled major shifts in access to care, with increased safety and convenience for patients, minimizing potential exposures, eliminating travel requirements, and reducing need for time off from work to complete a visit.[5,6,7] Correspondingly, physicians have made major shifts in their approaches to the delivery of care to make this happen
Patient characteristics were less strongly associated with physician adoption. In this cross-sectional study, there was physician-level variation in the adoption of virtual health care, with female, primary care, and behavioral health physicians in this system most likely to lead the transformation to virtual health care
Female physicians were younger than male physicians
Summary
The transition to telehealth during the COVID-19 pandemic was critical to continue to provide health care to patients.[1,2,3,4] This change has enabled major shifts in access to care, with increased safety and convenience for patients, minimizing potential exposures, eliminating travel requirements, and reducing need for time off from work to complete a visit.[5,6,7] Correspondingly, physicians have made major shifts in their approaches to the delivery of care to make this happen. Physicians’ lack of buy-in and resistance to change have been previously cited as barriers to adoption of video consultation.[10] In addition, a perceived low level of digital health literacy, economic hardship, or limited English proficiency may lead some physicians to refrain from performing virtual visits with certain patient groups. Perceived convenience may play a role, for example, if the need for language interpretation was seen as a potential or real barrier.[11]
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