Virtual care has reshaped medicine since COVID-19, but the shift to the screen comes with real trade-offs.

In this episode, Sarah Matt, M.D., MBA — practicing physician, health technology strategist, author of "The Borderless Healthcare Revolution" and a recent addition to the Medical Economics editorial advosory board — joins Managing Editor Todd Shryock to explore what's actually at stake when care moves online. She explains what gets lost in a virtual encounter, why certain patient populations actually do better with telehealth than in person, and why reliable internet access has become a social determinant of health.

Matt also pushes back on the idea that individual physicians are responsible for bridging the digital divide, arguing that health systems need to own that problem, and that technology vendors need to start designing with patients at the table rather than on their behalf.

Her closing advice for any practice navigating the virtual care landscape: be flexible, because one size fits nobody.

Music Credits:
Sleepy Sunday by Buurd - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:22 | Cold open Matt opens with a provocation: reliable internet access has become a social determinant of health and should be treated as a utility.

0:22 – 1:17 | Introduction Austin Littrell introduces the episode and previews the conversation with Matt.

1:17 – 2:24 | How virtual care has changed clinical practice Matt describes the spectrum of virtual care since COVID-19 — from fully remote telehealth-only practices in primary care and women's health to hybrid models that blend in-person and virtual visits.

2:24 – 3:22 | What's at risk in a remote encounter Matt explains what physicians lose when care moves to a screen — the contextual cues of a full in-person visit — and notes that patients lose the ability to read their provider too.

3:22 – 4:12 | Building trust and rapport virtually Matt argues that digital empathy and in-person empathy require the same skills: small talk, active listening and genuine relationship-building matter whether you're in a clinic or on a video call.

4:12 – 5:21 | The role of preparation in virtual visits Matt is candid about the reality most physicians face: limited prep time, limited environmental control and a chart review that often happens seconds before the visit. She says preparation is a shared responsibility between provider and patient.

5:21 – 6:47 | When virtual care actually works better Matt points to older adults using iPads for virtual discharge as one example where virtual care improved communication — noting features like volume control, lip reading and transcription. She also highlights reduced commute stress and the ability to reference notes as patient-side advantages.

6:47 – 9:06 | Virtual care, equity and the infrastructure gap Matt is hopeful that virtual care can raise the floor for access but flags a hard reality: for patients without reliable internet — whether urban poor or deeply rural — the infrastructure gap is its own barrier. She uses a snowstorm analogy to make the point that technology can't fix an unplowed road.

9:06 – 9:57 | What individual physicians can do Matt says systemic problems require systemic solutions, but urges physicians to stay open across all communication channels — while also protecting their own well-being, because a burned-out physician helps no one.

9:57 – 10:47 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

10:47 – 12:32 | Digital literacy on both sides of the screen Matt describes a generational knowledge gap affecting both patients and providers, and calls for communities and health care organizations to draw on expertise from all levels — from medical students to senior clinicians — rather than deferring only to leadership.

12:32 – 13:32 | Physician responsibility vs. system responsibility Matt pushes back on placing the burden of technology adaptation solely on individual physicians, arguing that health systems need to own the responsibility of enabling providers with tools that don't get in the way of care.

13:32 – 14:51 | Designing virtual care for the people who actually use it Matt's core design principle: stop assuming you know what patients need and start including them in the process. Whether the population is rural farmers, non-English speakers or urban transit riders, solutions built without them will miss the mark.

14:51 – 15:25 | One guiding principle for virtual care Matt's closing advice: be flexible. Virtual care is not one-size-fits-all for patients or for physicians, and recognizing where it works — and where it doesn't — is the starting point.

15:25 – 15:57 | Book plug and closing remarks Matt points listeners to her national bestseller "The Borderless Healthcare Revolution" as a roadmap for improving health care access, and encourages everyone to identify one thing they can do to improve access today.

15:57 – 17:05 | Outro Shryock closes the interview. Littrell thanks listeners and reminds the audience to subscribe and visit MedicalEconomics.com and PhysiciansPractice.com.

S1 Ep135: The promises and limits of virtual care, with Sarah Matt, M.D., MBA

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