Study Links Physician Characteristics to Telehealth Adoption

Physicians were grouped into four categories of telehealth adoption: innovators, early adopters, majority adopters, and persistent nonadopters.

Female, behavioral health, and primary care physicians were more likely to be early adopters of telehealth during the coronavirus pandemic, a recent study found.

In the first year of the pandemic, telehealth expanded dramatically at health systems, hospitals, and physician practices. While telehealth during the pandemic has been associated with several benefits such as convenience for patients and limiting exposure to the coronavirus, variable adoption by physicians raises concerns about access to services.

The recent study, which was published by JAMA Network Open, is based on data collected for more than 3,400 physicians at Mass General Brigham, which is a Boston-based health system that includes Massachusetts General Hospital and Brigham and Women's Hospital as well as 10 other hospitals. The data was collected from Oct. 1, 2019, to Dec. 31, 2020.

The researchers examined several physician characteristics and their impact on telehealth adoption such as gender, specialty, and generational cohort. There were four generational cohorts: Silent Generation, born 1928-1945; Baby Boomers, born 1946-1964; Generation X, born 1965-1980; and Millennials, born 1981-1996.

Physicians were grouped into four categories of adoption: innovators conducted virtual visits before March 15, 2020; early adopters conducted virtual visits during the week starting March 15, 2020; majority adopters conducted virtual visits on March 22, 2020, or later; and persistent nonadopters conducted no virtual visits through Dec. 31, 2020.

The recent study features several key data points.

• Female (odds ratio 1.23), behavioral health (odds ratio 2.92), and primary care (odds ratio 1.69) physicians were more likely to be early adopters of telehealth
   
• Silent Generation physicians (odds ratio 0.39) and surgical specialty physicians (odds ratio 0.46) were less likely to be early adopters
   
• 13.8% of physicians were innovators, 45.0% of physicians were early adopters, 35.6% of physicians were majority adopters, and 5.6% of physicians were persistent nonadopters
   
• Physicians in younger generations were more likely to be innovators and early adopters
   
• When examining the data by specialty, behavioral health (30.2%) and primary care (9.4%) had the highest proportion of physicians who were innovators
   
• The older the generational cohort, the more likely physicians conducted audio-only virtual visits: Silent Generation had a median of 41.5%, Baby Boomers had a median of 35.6%, Generation X had a median of 30.2%, and Millennials had a median of 28.5%

"In this cross-sectional study of more than 3,400 physicians providing ambulatory care in our large regional health system, the overwhelming majority of physicians (94.4%) transitioned to include virtual health care in their practice by the end of 2020. There were minor differences by generational demographic cohort, and female physicians and behavioral health physicians were the most likely to be early adopters," the study's co-authors wrote.

Interpreting the data

The study's co-authors offered two explanations for why female physicians were more likely to be early adopters of telehealth.

"The toll of the pandemic on women in caregiving roles has been well described, and this group may have found that virtual care provided a flexible solution that enabled them to balance or maintain their many roles. Although many things happened simultaneously during the early weeks of the pandemic, we note that the peak of early adoption coincided with the state-mandated school closure date of March 16, 2020. An alternative potential explanation may be found in communication practices. Female physicians have previously been shown to have more patient-centered communication and to spend more time with their patients, and it is possible that their earlier transitions to virtual health care were a result of being more responsive to their perceptions of their patients' needs with rapid changes early in the pandemic," the study's co-authors wrote.

The study's co-authors also offered an explanation for why early adoption of telehealth was prevalent among behavioral health physicians. "Behavioral health visits may be more amenable to virtual care given that they are typically less reliant on an in-person physical examination or procedure. It is also likely that patients with behavioral health needs had particular challenges forgoing medical care when in-person visits were restricted at the onset of the public health emergency, and thus these challenges motivated their physicians to make a rapid transition to virtual care."

The study's co-author's hypothesized that generational differences would play a major role in telehealth adoption, but the data showed modest correlations.

"The only generational association that we noted was that the small number of physicians in our system from the Silent Generation were less likely to be early adopters. However, more than 90% of those older physicians ultimately did transition to providing virtual healthcare at some point in 2020, and membership in the Silent Generation was not associated with persistent nonadoption. When considering physicians in the Baby Boomer generation, we found that they were as likely to be early adopters as physicians in the Generation X or Millennial groups," the study's co-authors wrote.