Telehealth and the work behavior of mental health clinicians.

Introduction: Telehealth delivers more than half of mental health care in the United States amid persistent mental health workforce shortages. However, little is known about how telehealth relates to clinicians' work behavior, specifically their visits per clinic day and probability of turnover. Methods: We examined mental health clinicians working at the Veterans Health Administration who collectively delivered 26 million visits. We regressed clinicians' monthly visit volume (supply), number of clinic days worked (input), visits per clinic day (throughput), and probability of turnover (retention) on the proportion of their mental health visits delivered via video. We used variation in broadband availability as an instrumental variable for video visit use. Results: A 10 percentage-point higher proportion of video visits was associated with no significant difference in total visits, 0.9 fewer clinic days per month (8.5% of the sample mean), 0.5 more visits per clinic day (6.2% of the sample mean), and a 0.4 percentage-point lower probability of monthly turnover (46% of the sample mean). Among psychologists and social workers, higher video share was associated with more visits per clinic day and fewer clinic days, whereas psychiatrists showed fewer visits per clinic day. Conclusion: Telehealth may shape clinicians' work behavior, including visits per clinic day, allocation of clinic days, and retention.