Secure Messages, Video Visits, and Burnout Among Primary Care Providers in the Veterans Health Administration: National Survey Study.

Background: Telehealth use, including video visits and secure messages, expanded significantly in Veterans Health Administration (VHA) primary care during the COVID-19 pandemic. However, primary care provider (PCP) burnout also increased during this period. Each modality may have affected primary care workloads differently (either by substituting for or complementing in-person visits) and thereby had varying effects on PCP burnout. Objective: This study aims to examine the associations between PCP burnout and the volumes of video visits and secure messages within the health care systems in which the PCPs practiced. Methods: This study examined the associations between telehealth modalities (ie, video visits and secure messages) and burnout as reported by 17,034 PCPs in 138 health care systems in VHA from 2020 to 2023. Individual-level data were obtained from annual cross-sectional surveys, and health care system-level data were drawn from administrative data sources. We created logistic regression models using generalized estimating equations to analyze the relationships between individual-level PCP burnout and average volumes of health care system-level video visits and secure messages per 1000 patients, controlling for age, sex, race or ethnicity, and VHA tenure as well as health care system complexity and year. We then predicted the marginal means of PCP burnout by video visit or secure message volume, based on the model results. Results: From 2020 to 2023, average PCP burnout, across repeated, annual cross-sections, increased from 42.1% to 52.7% (survey response rates of 68%-74%). Most survey respondents were aged 50 years and above (9607/17,034, 56.40%), female (10,189/17,034, 59.82%), non-White (9460/17,034, 55.54%), and with less than 10 years of tenure in the VHA (10,990/17,034, 64.52%). Over these 4 years, median annual video visits per 1000 patients in health care systems increased from 15.9 (IQR 8.4-25.5) to 227.6 (IQR 127.1-320.7), and median annual secure messages per 1000 patients increased from 23.4 (IQR 9.4-65.5) to 35.3 (IQR 11.0-87.0). In our fully adjusted models, video visit volumes in a health care system were not related to burnout, but secure message volumes were related to burnout. Burnout was significantly higher among PCPs in health care systems receiving additional secure messages per 1000 patients (odds ratio 1.001, 95% CI 1.000-1.002). On average, PCP burnout increased by 1% point for each additional increase of 43.7 (95% CI 14.0-73.4) secure messages in a health care system. Conclusions: Video visit volumes in a health care system were not associated with PCP burnout, but secure message volumes were associated with PCP burnout. As video visits and secure messages continue to grow, solutions to better manage message volume (eg, automation and provider-led quality improvement) are needed to mitigate the concurrent rise in PCP burnout.