Prevalence and Factors Associated With Family Physicians Providing E-visits

Michael R. Peabody, PhD; Mingliang Dai, PhD; Kea Turner, PhD, MPH, MA; Lars E. Peterson, MD, PhD; Arch G. Mainous, III, PhD


J Am Board Fam Med. 2019;32(6):868-875. 

In This Article

Abstract and Introduction


Purpose: The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors.

Methods: A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits.

Results: The overall prevalence of offering e-visits was 9.3% (n = 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system–owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners.

Conclusion: Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.


Telemedicine has long been a part of the medical vernacular, beginning with the April 1924 issue of Radio News magazine, which depicted a patient using a television and microphone to communicate with a doctor. Since that time, telemedicine—which leverages communication technology to deliver health care at a distance—has grown in use and received increased support through grant funding, payment models, and legislation.[1–3] One form of telemedicine that holds promise for transforming health care is the electronic visit or e-visit. E-visits typically involve the evaluation and management of a patient by a physician or other health care provider through a Web-based or other electronic communication system.[4] E-visits have the potential to reduce access barriers, such as lack of transportation or rural residence, since patients can access health care from their home. E-visits could also improve the efficiency and quality of health care by reducing the number of in-person office visits and improving documentation of patient-physician communication.[5,6] While there are notable advantages of e-visits, studies of health care systems that have implemented e-visits suggest that this technology may be underutilized.

Studies examining adoption of e-visits suggest that a small percentage of physicians have adopted e-visits;[7–14] however, a large nationally representative study has not been conducted. Adoption rates may lag due to implementation barriers, such as lack of reimbursement, practice guidelines, or quality measures.[5–7,15] Health care providers have also raised concerns regarding liability (since care is delivered without seeing the patient), workflow integration, and increased physician workload, particularly if patients inappropriately or excessively use e-visits or do not provide sufficient information and followup is needed.[5,6,16,17] Among health care systems that have adopted e-visits, there is evidence demonstrating the benefits of e-visits. Studies have shown that implementation of e-visits has reduced office visit utilization and health care spending and improved patient satisfaction.[7,13,15,16,18–22] Comparing the quality of care delivered in office visits versus e-visits, researchers found no differences in the frequency of follow-up visits (a proxy measure for treatment failure or misdiagnosis).[12,23] To explore whether e-visits might have unintended consequences, such as increasing physician workload, researchers have examined the appropriateness of e-visit use among patients and found that patients appropriately used the service and provided sufficient information for diagnosis.[24,25] Researchers have also found that e-visits require less provider time than in-person office visits.[11]

It is still unclear how many primary care physicians have adopted e-visits or what factors influence providers' adoption rates. Prior studies exploring telemedicine more broadly (ie, not e-visits specifically) have found that organizational-level factors, such as teaching status, nonprofit ownership, system affiliation, and rural location were associated with telemedicine adoption.[1,26] Research on electronic health records (EHRs) have found that provider-level factors, such as age and physician specialty, influence EHR adoption.[27,28] For e-visits, it is likely that a similar set of factors influence e-visit provision. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors.