why are telehealth companies treating healthcare like the gig economy?
Telehealth is experiencing significant growth.
Driven by recent global events, a large number of physicians across the United States are now providing consultations online, and a growing number of individuals are becoming accustomed to receiving medical guidance remotely. Considering the clear advantages, many professionals believe telehealth is a permanent fixture in healthcare. Seema Verma, head of the Center for Medicare and Medicaid Services, stated, “This crisis has propelled us into a new era,” and further emphasized, “There is no turning back.”
The current focus is determining the future direction of telehealth. While it has proven invaluable during the pandemic, it holds the potential to deliver even greater benefits in the coming years. However, we are still in the initial phases of its evolution. To fully unlock telehealth’s capabilities, we must address the significant shortcomings present in its current delivery methods—deficiencies that could potentially compromise patient well-being.
Established telehealth providers, such as Teladoc and similar services, were initially designed for a time when telehealth was not widely utilized, primarily serving immediate needs like minor illnesses or skin irritations. They generally function by offering a form of generalized, randomized care. Patients access the platform, wait for availability, and are connected with the next available physician. While marketed as a convenient virtual house call, patients may find the experience resembles being processed through a system with limited personal agency.
This model is attractive to insurance providers due to its cost-effectiveness. However, patients may experience negative consequences. Physicians operating within this framework are compensated based on volume. Time spent thoroughly understanding patients—their histories, lifestyles, and establishing rapport—reduces the number of patients they can see and, consequently, their earnings. The system prioritizes patient throughput over comprehensive care.
Strengthening this existing model as telehealth expands would be a concerning development, as it contradicts the fundamental principles of effective healthcare. Traditionally, healthcare has centered on fostering an ongoing relationship with a primary care provider—someone who understands your overall health, and whom you trust to guide you through complex medical decisions.
The randomized triage approach disrupts this connection, replacing it with a series of impersonal interactions akin to those with a ride-sharing service—courteous but transactional, brief, and fleeting. Healthcare, however, should not be equated with the gig economy.
As a medical professional, I am concerned about the potential consequences of scaling this model. Each transfer between physicians increases the risk of crucial information being overlooked. They will lack understanding of your typical emotional state, your family dynamics, or your living environment—all vital factors for accurate diagnosis and treatment. This absence of comprehensive data can lead to poorer health outcomes. The healthcare system has historically been structured to minimize these handoffs—and adopting a telehealth infrastructure that increases them would be a detrimental step.
What, then, constitutes a more effective strategy?
We are witnessing the very beginning of telehealth’s integration into the U.S. healthcare landscape, and I cannot claim to have a complete answer. However, I firmly believe that patients are the most effective managers of their own health. A superior telehealth approach empowers patients by giving them control. When provided with options and given the opportunity to express their preferences, patients clearly indicate their desires.
Data collected by my organization demonstrates a strong preference among patients: nine out of ten individuals would rather schedule appointments with a provider they select themselves, rather than being assigned a doctor at random after waiting in a virtual queue.
Furthermore, when given this choice, the majority of patients—approximately seven in ten—opt to connect with a local physician when scheduling a virtual visit. Patients intuitively recognize the potential need for in-person care at some point and understand that choosing a local provider facilitates a seamless continuation of care between virtual and physical appointments. They do not want to be forced to choose between telehealth and a continuing relationship with a trusted healthcare professional—and they should not have to.
Currently, none of the established telehealth companies prioritize this essential aspect. Instead, they are focused on rapid expansion while maintaining their randomized triage model. While this strategy may yield short-term gains, long-term success will depend on actively listening to, responding to, and adapting to patient needs.
Experience indicates that patients will favor the provider that offers them the greatest control over their healthcare. That is where I am focusing my efforts.