Study finds balancing traditional patient visits with e-visit technology often leaves physicians making up the difference

August 20, 2020 | By Clare Becker | Back to blog
WSB’s Hessam Bavafa. Photo by Paul L. Newby II

Doctors required to treat patients through both traditional office visits and digital e-visit channels may be logging more hours and cutting into their own personal time to keep up, a recent study suggests.

Hessam Bavafa, an assistant professor of operations and information management at the Wisconsin School of Business, and co-author Christian Terwiesch of the University of Pennsylvania, found that a physician’s number of hours containing work (defined as conducting an office visit or e-visits) nearly doubled with the adoption of an e-visit channel, with significant portions of of the burden shouldered on weekday nights and weekends.

The study examined how e-visits impacted primary care physicians within a large health care system between 2008, the year the system first incorporated digital visits, and 2016. Using data from more than 3.3 million patient visits—both in-office and via e-visit—the findings suggested that e-visits substantially increased the number of hours containing some kind of work obligation by physicians, with only 49% of the extra hours taking place during the actual workday. The remainder of the time was made up by work on early mornings or weeknights (37%), or on the weekend (14%), essentially creating “work after work” (Kossek, 2016; Schieman & Glavin, 2008).

The study also found that after-hours work was mostly a result of increased e-visits. A physician in 2016 conducted e-visits outside of regular business hours approximately 31% of the time. But when that same care provider had a day with a high e-visit load, the probability of of e-visits taking place during personal time jumped to 63%.

Going beyond the medical setting, the study can be viewed in a broader context of professional service organizations and their use of multichannel service delivery models, says Bavafa. The notion of a “single server” professional such as a physician or lawyer delivering services across several channels is relatively new to the literature. The patient or client needs expertise from that specific person, which adds further strain to the already considerable workload.

“It’s not just the addition of this new extra channel, it’s the fact that only the doctor can deliver the service needed,” Bavafa says. “It’s a departure from a retail multichannel delivery model, for example, where another server can step in and take care of a customer across any of the channels to help offset the volume of work.”

The convenience and flexibility of secure patient portals and e-visits ensure that telemedicine and technology are not going away anytime soon, so it’s critical that health systems find ways to manage any “work after work”-related stress and burnout, both for themselves and for the patients they serve.

Bavafa says that while their study was limited to an e-visit focus and could not address physician burnout, it’s an area open to further exploration and research. Similarly, new channels require new managerial responses and an understanding of how the changes will affect professional servers.

“I think we’re still at the beginning of seeing how professional organizations will navigate many of these multichannel delivery systems and how individual servers will be impacted. Our study can also be applicable and valuable to other fields and professional settings outside of health care where these same considerations exist.”

Read the paper: “Work After Work: The Impact of New Service Delivery Models on Work Hours,” published in Journal of Operations Management. “Work After Work” won the Journal of Operation Management’s Best Paper of the Year award.

Hessam Bavafa is an assistant professor in the Department of Operations and Information Management at the Wisconsin School of Business. He also holds an affiliate appointment with the Department of Family Medicine and Community Health in the UW–Madison School of Medicine and Public Health.


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