Problem Definition: Telehealth visits are widely recognized for their capacity to improve patient access to care. However, less is known about how already overworked physicians are adapting to this increased demand, particularly against the backdrop of an ongoing physician shortage. Our study investigates the impact of telehealth adoption on physician workload and the resulting implications for physician burnout and healthcare revenues. Methodology/Results: We analyze approximately 4 million activity records from 467 physicians across three departments (General Medicine, Neurology, and Dermatology) of a major U.S. healthcare system between 2019 and 2023. Leveraging granular variation in telehealth adoption, we use a difference-in-differences approach to compare high- and low-adopting physicians. We find that telehealth adoption resulted in a substantial expansion of physicians' patient panel; yet, surprisingly, this growth occurred without an increase in visit volume. Our analysis uncovers the likely mechanisms underlying this shift: physicians reallocated visit slots from follow-ups and procedures to new patient consultations and increasingly managed follow-ups through asynchronous messaging. These findings suggest that while telehealth expanded patient access, it also substantially increased physicians’ workload and reshaped their clinical workflows. Our subsequent analyses indicate that this additional workload may have contributed to physician burnout and attrition. Moreover, the shifts in clinical workflows contributed to substantial revenue losses for the healthcare organization. Managerial Insights: Telehealth's potential to expand patient access may come at the cost of increased workload and shifts in physician workflows. These changes can contribute to physician burnout and attrition as well as revenue losses for healthcare organizations. Healthcare organizations should develop strategies to manage the increased workload and also reconsider physician compensation models to better align individual incentives with organizational goals. Meanwhile, policymakers should revise reimbursement models to adequately compensate telehealth services, including asynchronous messaging. Without such reforms, the long-term sustainability of telehealth may be at risk.

Telehealth services became popular due to the COVID-19 pandemic, yet their operational impacts on healthcare organizations are not well-understood. Patient behaviors can vary significantly between telehealth and in-person appointments, introducing new challenges and opportunities for healthcare delivery. We examine two key behaviors contributing to nonadherence to medical appointments: No-shows and unpunctuality. Analyzing 412,415 telehealth and in-person appointments across a major US medical system from 2020 to 2022, we find that telehealth appointments reduce no-shows by 3.0 percentage points (23.1%) and late-arrivals by 11.4 percentage points (35.6%), indicating significant improvements in appointment adherence. We also find that telehealth is particularly effective in improving adherence to follow-up appointments but may be less suitable for initial consultations with new patients. In addition, telehealth improves adherence most among demographic groups with historically lower in-person attendance—women, racial minorities, Medicaid patients, and younger adults—underscoring its potential to reduce disparities in access. Our analysis suggests that while telehealth may increase patient revisit rates and create extra work for providers, the gains from reduced no-shows, particularly for follow-ups, lead to a net boost in provider productivity. Finally, we explore the best strategies to integrate telehealth into a provider’s daily scheduling template, showing that scheduling telehealth appointments before in-person visits enhances operational efficiency compared to the opposite sequence. Policymakers should recognize telehealth’s capacity to improve appointment adherence, reduce disparities, and enhance productivity, and support its adoption through appropriate regulations. Healthcare organizations should strategically deploy telehealth to address the root causes of patient nonadherence. By offering telehealth appointments to patients facing barriers to in-person care, they can simultaneously optimize both access and productivity.