By Aakanksha Deoli and Esther Martinez

Telehealth has been found to increase healthcare access, especially among vulnerable populations. During the pandemic, it ensured continuity of care while limiting exposure and kept mild cases outside of the hospital. While there are many potential benefits associated with telehealth, the administrative burden of telehealth and its consequences on the clinical workforce must be further expanded upon.

Physician burnout has been exacerbated since the onset of the COVID-19 pandemic. A Mayo Clinic Study found that approximately 62.8% of physicians showed at least one manifestation of burnout in 2021 compared to 38.2% in 2020. Another study suggested that physicians who used more telemedicine during the pandemic were found to be more heavily engaged in electronic health record (EHR)-based work after-hours compared to others. There are three main reasons telemedicine could increase dissatisfaction among clinicians and worsen burnout: increased documentation, interoperability and a lack of workflow optimization, and a hike in asynchronous messages in the patient portal.

The increasing reliance on electronic health records, or EHRs, has in turn created an increase in required documentation, as many existing documentation requirements for clinicians were designed with paper-based systems in mind. EHRs are digital versions of records containing patient information, such as their medical history, laboratory results, treatment plans, and more. EHRs provide a discernible advantage as they extend access to all authorized users and can be translated into multiple languages, ideally making them more efficient than physical health records. However, it is estimated that for every hour of face-to-face clinical work a physician completes, they must spend two hours on EHR-related tasks. Another study which included over 2,100 physicians published in JMIR Medical Informatics demonstrated that physicians who provided more telemedicine visits also experienced a higher EHR-based ‘Work Outside Work per appointment (WOW)’ burden.

Interoperability with EHR and lack of workflow optimization are often responsible for physician burnout as well. Although 95 percent of U.S. hospitals report using a certified EHR program, many hospitals use several systems across different departments. In addition, many physicians do not find the EHR system user-friendly, further aiding their dissatisfaction with it. When asked what they would do to deliver better care, 62 percent of physicians out of 624 polled in a 2018 survey responded that they would make the current EHR system more interoperable. In a study done by Mayo Clinic, physicians graded useability as an ‘F’ when evaluated using a standardized metric of technology usability.

Furthermore, the study found a strong ‘dose-response relationship’ between EHR usability and physician burnout. EHR usability and interoperability are essential as evidence suggests that virtual appointments increase after-hours EHR work. Interoperability can be improved, and the clerical burden on physicians can be mitigated by adopting common telehealth standards instead of system-specific standards, simplifying the training process for prospective and current healthcare workers.

A highly optimized clinical workflow is often divided into three main categories: scheduling, patient visits, and appointment follow-up. This is vital to ensure a smoother patient and physician experience. Automating tasks like appointment reminders, using online intake forms, integrating EHR with telehealth, standardizing the primary workflow, and incorporating adequate training in the medical and other relevant education programs are all examples of optimizing the telehealth workflow.

Instant messaging is another potential telehealth-related contributor to physician burnout. The Mayo Clinic and Yale researchers found that clinicians spent more time managing their inboxes during the pandemic. The study reported that between March 2020 and June 2021, messages per day increased by 2% for primary physicians, 8.4% for medical physicians, and 29% for surgical physicians. Furthermore, the study also reported an increase in the patient medical advice requests (PMARs) received. For instance, the PMARs increased by more than 50% for primary, medical, and surgical physicians for the same timeframe.

Telehealth offers instant messaging to patients, and unlike office visits, instant messaging can be utilized at any time. Initial observations from a small study sample found ‘consultations outside of work hours’ as one of the top disadvantages of instant messaging associated with telehealth, reported by 68.6% of primary physicians (n=153) and 60% of medical specialists (n=48). Furthermore, it increased workload during work hours (71.9% primary physicians and 56.3% medical physicians). The detrimental effects of extended work hours on physicians are well documented and put them at risk of developing anxiety, depression, and deterioration of their personal life. A study in the Journal of Internal Medicine which included over 2,100 Primary Care Physicians identified the following as plausible ways to reduce burnout with increased patient messages: screening inbox for actionable and relevant messages, optimizing inbox functionality, leveraging teams to support with the overload, and providing sufficient time to physicians to respond to patient messages.

Among the many advantages of telehealth, it shows the potential to help with physician burnout. However, there exists substantial evidence that it is worsening clinician burnout. A greater focus on physician needs and satisfaction by seeking active feedback and providing ongoing support is required to reduce the overall manifestations of burnout with telehealth.


Aakanksha Deoli, MHA is an Instructor of Teaching and UG Internship Coordinator at Edward J. Bloustein School at Rutgers, The State University of New Jersey.

Esther Martinez is an undergraduate student at the School of Arts and Sciences at Rutgers, The State University of New Jersey.