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telemedicine visits. As one physician summarized, “You lose that personal connection where I think if someone was in front of you, they would feel a little more comfortable expressing some of their concerns with you” (P13). However, this sentiment was not universal. One physician noted that some patients were more comfortable sharing personal information during telemedicine visits: “I think people seem to be more frank and more likely to make statements than when it is face to face; ... it feels a little bit less intimidating to have a separation of video, ... particularly for topics considered taboo, like sexual questions” (P10). Physicians Feel More Comfortable Refusing Patient Requests during Telemedicine Visits Several physicians indicated that virtual encounters sometimes made it easier for them to refuse patient requests that they deemed unwarranted. As one physician mentioned, “With telehealth I feel more comfortable telling a patient I am not going to give them their benzodiazepines or their pain medications. They have a video in front of them instead of the person’s right there yelling at me” (P10). Telemedicine Visits Tend to Be Shorter than inPerson Visits Most physicians noted that telemedicine visits tended to be shorter than in-person visits. As one S64 JABFM February 2021 Vol. 34 Supplement http://www.jabfm.org on 6 July 2022 by guest. Protected by copyright. http://www.jabfm.org/ J Am Board Fam Med: first published as 10.3122/jabfm.2021.S1.200517 on 23 February 2021. Downloaded from provider pointed out, “I typically limit the small talk on the telehealth a bit more. ... I’ve been doing a lot more shorter visits” (P8), whereas another mentioned that “with video visits [patients are] quicker to get off the video. I think patients are wanting to take less time” (P4). On the flip side, a few physicians mentioned that some patients did not realize that telemedicine visits were time limited. One physician observed, “It is kind of easy to lose sight of how much time you have with your provider on the telephone or the video if you are not actively paying attention to it” (P13), although physicians commented that it was easier for them to end telemedicine visits, as opposed to in-person visits. Physicians mostly voiced satisfaction with these shorter visits, although one physician noted that they may not be conducive for building relationships with patients: “The conversation[s] seemed a little bit shorter. A patient in clinic ... there are moments where there’s space for more conversation about not necessarily medical [problems] but just to get to know the patient a little better” (P15). Careful Consideration of Physician Workflows Is Needed to Avoid Burnout Some physicians worried that telemedicine could promote physicians’ provision of on-demand care and lead to potential burnout. “I kind of dread for the future of medicine because what is going to stop us from booking appointments at 9 PM, right? If doctors do not have discipline to control our passion for taking care of people then we might be doing appointments at odd hours; ... it could be difficult to maintain work-life balance” (P3). A major stress-inducing new element in workflow that physicians identified was having to balance schedules that mixed in-person and telemedicine visits because the combination often resulted in physicians running late for visits. As one physician observed, “Schedules are all over the place. And then when someone does not ... check in on time, then you get backed up on both ends” (P6). Physicians also expressed that it was difficult for them to switch back and forth from 1 type of visit to another. Insurer Reimbursement for Telemedicine Can Reduce Physician Burden Physicians expressed that a significant benefit of insurer reimbursement for telemedicine visits is that it allows physicians to be reimbursed for evaluations that they normally provide for free.