JMIR Publications

ABSTRACT

Background:

Emergency departments (EDs) face persistent challenges related to overcrowding, boarding, ambulatory care access barriers, and workforce strain, contributing to compromised patient care and high rates of physician burnout. Virtual care has emerged as a potential strategy to alleviate pressure on emergency care systems. In 2020, the Veterans Health Administration (VA) launched the national Tele-Emergency Care (TEC) program, in which patients calling a call center can be connected with an emergency medicine clinician by phone or video. TEC clinicians work hybrid schedules that include both virtual and in-person shifts. Although virtual care may help address ED capacity and clinician burnout, perspectives of emergency medicine–trained clinicians remain limited.

Objective:

To examine the experiences of emergency medicine clinicians participating in the VA’s TEC program.

Methods:

As part of a national mixed-methods evaluation of the VA TEC program, we conducted semi-structured interviews with clinicians delivering emergency care through TEC between February 2025 and June 2025. Participants (n=15) were recruited via multistage purposeful sampling from 4 of 18 regional TEC programs that varied in geography, volume, duration, and operational model. Interviews explored experiences providing care in a virtual environment, including perceived benefits and challenges. We performed a descriptive qualitative analysis.

Results:

We interviewed 14 physicians and one nurse practitioner with formal emergency medicine training. Interviewees described four primary themes: (1) clinical decision-making in a virtual environment; (2) development of the provider–patient relationship; (3) clinician job satisfaction and professional well-being; and (4) challenges. Participants reported perceived opportunities to avoid ED referral, provide more focused patient interactions, and improved job satisfaction related to flexible virtual shifts. Reported challenges included filling primary care gaps and performing care coordination tasks.

Conclusions:

TEC represents an emerging model of emergency care delivery that clinicians perceive may expand access, prevent avoidable ED visits, and promote workforce sustainability. Our findings can inform implementation of similar emergency telehealth services in other health systems.