Physicians' Use of Telemedicine Varies by Specialty

Norra MacReady

December 03, 2018

Telemedicine is being used by relatively few physicians, most of whom are employed by hospitals or work in practices of 50 physicians or more, a survey has found.

The findings reflect a wide spectrum of uses for telemedicine in interactions with patients and other healthcare professionals and suggest that larger practices may be better able to make the financial commitment required to invest in the technology, Carol K. Kane, PhD, and Kurt D. Gillis, PhD, write in an article in the December issue of Health Affairs.

Radiologists, psychiatrists, and cardiologists were most likely to use telemedicine for patient interactions, whereas emergency physicians and pathologists were most likely to use it to facilitate their communications with other healthcare professionals.

Kane, director of the Division of Economic and Health Policy Research at the American Medical Association (AMA), and Gillis, a principal economist in the division, explain that information on current telemedicine use among physicians in the private sector is scarce, despite recent legislation to encourage its implementation.

To get a clearer picture of telemedicine use among physicians, they analyzed data from the 2016 Physician Practice Benchmark Survey of the AMA, a nationally representative sample of physicians who provide at least 20 hours of patient care per week and are not employed by the federal government.

The final sample consisted of 3500 physicians, who were "broadly representative of the US physician workforce," the authors write. For example, 33.2% of the survey respondents were women, very close to the 33.6% that is the percentage of women in the general population of physicians. Also, 56.1% of the survey respondents practiced in states in which there were parity laws, compared with 56.6% of the general physician population. However, "slightly fewer" physicians in this sample were located in nonmetropolitan areas, compared with their colleagues in the general population.

Overall, 15.4% of survey respondents reported working in practices that used telemedicine in patient interactions, and 11.2% were in practices that used it for interactions with other healthcare professionals.

When broken down according to specialty and type of interaction, 39.5% of radiologists reported working in practices that used telemedicine in physician-to-patient interactions, followed by psychiatrists (27.8%) and cardiologists (24.1%). Emergency medicine physicians (38.8%), pathologists (30.4%), and radiologists (25.5%) were most likely to use telemedicine for interactions with other healthcare professionals.

Of the telemedicine modalities studied, videoconferencing was used most frequently, cited by 12.6% of physicians, followed by the storing and forwarding of data (9.4%) and remote patient monitoring (7.3%). This may be related to the fact that videoconferencing "is the modality most often referred to in defining telehealth in states' parity laws and is the most commonly covered modality in states' fee-for-service Medicaid programs," the authors write. Its adaptability to a variety of functions in interactions both with patients and healthcare professionals may be another factor in its relatively wide use.

When analyzed by practice size, use of telemedicine for patient interactions ranged from 8.2% of respondents in practices of one to four physicians to 26.5% among respondents in practices of 50 physicians or more. Of respondents in solo practice, 8.9% reported using telemedicine for physician-patient interactions, compared with physicians in larger practices (10.2% to 21.2%) and physicians who worked directly for hospitals (27.6%). A similar pattern was seen for telemedicine interactions between physicians and healthcare professionals.

The authors also found some differences according to practice location: physicians in nonmetropolitan areas were more likely to report the use of telemedicine for interactions with healthcare professionals, compared with their metropolitan counterparts (16.8% vs 10.9%).

This survey suggests "that despite regulatory and legislative changes designed to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier, especially for small practices," the authors conclude.

Additionally, the finding that physicians in nonmetropolitan locations were more likely than urban physicians to use telemedicine for interactions with other healthcare professionals "suggests that even when not practicing in a Health Professional Shortage Area, physicians are using telemedicine to alleviate access issues when relevant subspecialists are not available."

The survey did not provide estimates of telemedicine use as a percentage of all interactions, the authors write. "As a result, variations in this 'intensity' of use would be masked in our data." Also, physicians were asked to report on telemedicine use within their practice, not by themselves personally, which raises the possibility that telemedicine use had been overestimated.

A small percentage of physicians did not know whether telemedicine was being used in their practices. They could not estimate the frequency with which physicians in a practice used a specific telemedicine modality for any of the functions reported in that practice.

The authors have disclosed no relevant financial relationships.

Health Aff. 2018;37:1923-1930. Abstract

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