The rapid expansion of telemedicine during the COVID-19 pandemic significantly changed how mental health care is delivered. However, new research suggests that the shift to virtual consultations has done little to improve access to care for patients in rural and underserved communities.
Researchers from the Brown University School of Public Health, Harvard Medical School and McLean Hospital analysed nationwide Medicare billing data to examine whether increased telemedicine use allowed psychiatrists, psychologists and therapists to reach more patients in areas with historically limited access to mental health services. Their findings, published in JAMA Network Open, show that while telemedicine adoption increased sharply, the impact on rural access was minimal.
Marginal increases in rural care
The research team analysed Medicare billing records from 2018 to 2023 covering 17,742 mental health specialists across the United States. Providers were grouped based on the extent to which they used telemedicine to deliver care.
The results showed only small differences between specialists who frequently used telemedicine and those who relied on it less. Providers with the highest telemedicine use treated just 0.9 percentage points more patients from rural areas and only 0.1 percentage points more patients from areas with limited access to mental health professionals. They also saw 2.6 percentage points more patients living at least 20 miles from the provider.
“We had thought the dramatic shift from in-person care to telemedicine among mental health specialists would lead to them caring for substantially more patients in rural communities,” said study author Drew Wilcock, a lead research scientist at Brown’s School of Public Health. “Unfortunately, we just don't see it.”
Fewer new patients
According to the researchers, the modest increase largely reflects existing patients who relocated farther from their providers but continued treatment through telemedicine.
The study also identified an unexpected side effect. Mental health specialists who used telemedicine more frequently treated 3.6 percentage points fewer new patients overall. This suggests that virtual care may help providers maintain ongoing relationships with existing patients, but at the same time may limit their capacity to take on new patients.
Policy barriers remain
The researchers argue that regulatory barriers continue to limit telemedicine’s ability to improve access to care, particularly in rural areas. One key obstacle is the complexity of obtaining licenses to practice across multiple states.
“Currently, it is too administratively burdensome for a mental health physicians to get a license in many states,” said lead author Jacob Jorem of Harvard Medical School. “By changing how states license clinicians and making it easier for them to practice across state lines, this could help specialists reach more patients in rural communities.”
Telemedicine’s potential still significant
Despite the modest impact observed in the study, the researchers stress that telemedicine still holds promise for improving access to care.
“The potential of telemedicine can't be ignored,” said study author Ateev Mehrotra, professor of health services, policy and practice at Brown. “But simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care. For telemedicine's potential to be reached, we need policy interventions to address those barriers. Improving how we license physicians is a critical first step.”
The findings highlight that technology alone is unlikely to solve structural access problems in healthcare without accompanying policy reforms.
