It took a pandemic to get there, but covid-19 is giving us a sense of how much of our work we can do without tethering doctors to an exam room. At my hospital, we still run a daily “non-covid” clinic for patients who need to see a doctor in person. Any primary care physician in our large group can refer a patient to come in.

To my astonishment, no more than 5 percent of our hundreds of daily telemedicine visits are being referred for these in-person visits. No doubt the deadly virus lurking in any corner pushes down the number of referrals: It’s understandable that patients might want to avoid in-person visits and doctors might be reluctant to push them. But we never thought the number would be that low. When the non-covid clinic opened, we staffed it with six doctors, but only two patients showed up. Now, it turns out that a single doctor can manage the typical afternoon’s load, though we staff two so that there is no pressure to rush visits…

The dominance of the office visit, driven purely by how we pay for health care, distorts so much of what doctors do. Last year, a young woman scheduled an appointment with me solely to have her birth control pills refilled. Perplexed, I told her that next time she could just call in for her refill and save time. She looked confused and told me that her previous doctors would not refill birth control without an office visit, or even worse, a pelvic exam. Her reproductive health was basically held hostage to generate a bit more revenue, an infuriating perversity born of tying doctors’ paychecks to office visits.