From Rooms to Zooms: The Hidden Costs of Hybrid Work in Primary Care

With A Jay Holmgren, Maximillian J. Pany, J. Michael McWilliams, and Robert S. Huckman

Many workers have hybrid schedules with a mix of in-person and virtual meetings. Though hybrid schedules may have benefits, the need to manage two distinct work modalities can introduce new frictions. We examine these frictions in the context of hybrid primary care practices, which offer both in-person and telemedicine visits. Using data from a large academic medical center, we find that transitions between visit types can burden providers and negatively impact patient experiences. Specifically, when a provider has an in-person visit scheduled immediately after a telemedicine visit, the in-person patient is 67% more likely to abandon the visit before being seen, and the visits that do occur are 25% less likely to begin on time. These disruptions also result in less comprehensive visits and a higher likelihood of after-hours work. Dedicated telemedicine-only blocks in provider schedules help avoid these costly transitions but also lead to reduced capacity utilization when there is insufficient demand for telemedicine visits in that time window. Indeed, we find that telemedicine-only appointment slots see a 10% lower booking rate relative to similar slots without such restrictions. Telemedicine visits are often framed as a tool for improving patient care access. However, we show that, depending on how they are incorporated into hybrid schedules, they can lead to negative care experiences, chaotic clinic days, and even reductions in patient access. Our findings also demonstrate the tradeoffs associated with dedicated virtual blocks and highlight potential changes to managerial practices and workflows to improve the performance of hybrid work schedules.