Since the 1960s, telemedicine has experienced an exponential increase in utilization. From outer space to orthopaedic offices, telehealth can provide patients with effective and efficient care. The COVID-19 pandemic ushered a push for more telehealth access, which has been further fueled by both growing patient populations and geographic barriers. To keep up with a nationwide demand for specialized medical care, providers are conducting more virtual visits, especially after the pandemic.

The results seen in this survey demonstrated increased utilization of telemedicine among orthopeadic trauma surgeons since the COVID-19 pandemic. A variety of applications have been established, including post-operative visits, general follow-up, minor wound check, and the effective discussion of test results, among others. Moreover, surgeons are able to follow more out-of-town patients, allowing for continuity of care. Results demonstrate that the use of telemedicine has not slowed down providers’ clinics and has been utilized by patients of all ages. Telehealth allows providers to see the same number of patients, if not more, without overcrowding a clinic schedule. This study found that the effectiveness of telemedicine is perceived by surgeons to be similar to that of in-person visits, which has been illustrated by previous studies (Aminoff et al. 2021; McDonnell et al. 2022). There was no disparity in the care provided by surgeons who utilized telemedicine for patient visits. The majority of surgeons felt they were able to highlight the most important and critical aspects of patient care through telemedicine with the same efficacy as if the patients presented to the clinic in person.

The flexibility of telemedicine has allowed various specialties and individual providers to incorporate remote patient visits into their practices while also maintaining professional effectiveness, clinical efficiency, and personable patient care. Various studies since the widespread implementation of telemedicine have demonstrated an increase in patient follow-up effectiveness and no difference in surgeon satisfaction when comparing telemedicine visits to in-person office visits (Chaudhry et al. 2021; Chin et al. 2022; McDonnell et al. 2022). Within the surgical arena, telemedicine was previously considered low priority, to include the orthopaedic and neurosurgical fields. However, because of the drastic healthcare impact of COVID-19, there was a necessary shift to telemedicine, especially in the outpatient setting (Nie et al. 2022). According to a small cross-sectional study in 2021, 80% of physicians stated that they would continue to use telemedicine after the resolution of the COVID 19 pandemic (Nies et al. 2021). In fact, compared to medical specialties, physicians in surgical specialties were noted be more pro-telemedicine post-pandemic (Nies et al. 2021). The patient encounter has changed not only in the outpatient setting but also changed within the operating suite. For example, surgeons have reported the benefits of telemedicine through the form of teleguidance, such as increasing the feasibility of intraoperative surgical consultations. According to a survey conducted in Sweden in 2022, surgeons applauded the use of virtual intraoperative consultations for more complex procedures, reporting that teleguidance had moderate to large contribution to the decision making and successful outcome of procedures in roughly 80% of cases. Overall, most surgeons were satisfied with the implementation of video consults (Aminoff et al. 2021).

Overall, there appears to be a generalized consensus that telemedicine provides a similar satisfaction to in-person visits. From a surgeon’s perspective, results from the survey highlight that telemedicine appointments are considered to be satisfactory for surgeons. Studies by Chaudry et al. and Wahezi et al. found that there was no difference in surgeon satisfaction levels between the use of virtual and in-person visits (Chaudhry et al. 2021; Wahezi et al. 2021). Similar satisfaction between in-person and virtual visits has been described for patients in other telemedicine studies (Chin et al. 2022). Reasons for patient satisfaction with telemedicine include that virtual visits do not require driving or transportation, are more flexible for personal schedules than in-person visits, and are more accessible to people in rural areas (Chin et al. 2022).

On the other hand, results from this survey emphasize that most providers had little to no experience with telemedicine prior to the pandemic, and increased utilization raised concerns in regard to providing the best patient care through virtual medicine. Responses stressed that providers find it difficult to discuss and review diagnostic tests, especially if diagnostic imaging cannot be shared across screens. Surgeons have reported occasional glitches when using telemedicine, and thus patient visits were occasionally interrupted due to technological difficulties, which may require booking more time per virtual visit to accommodate for potential technological glitches. These findings are supported by the current literature (Aminoff et al. 2021; Chin et al. 2022; Scheidt et al. 2022). Not only can technological difficulties prolong appointments, they also may become a cost burden to the patient. In fact, one study states conducted at Wayne State claims that orthopaedic virtual visits did not offer cost savings for patients because visits were noted to take longer, on average, than the average length of an in-person visit (Livingston et al. 2023).

Additional concerns exist regarding the limitations of a physical exam via virtual visits. As such, it is imperative to look at telehealth as an adjunct to the traditional face-to-face interview rather than a replacement (Brimioulle et al. 2023). Studies by Chin et al. and Scheidt et al. have previously exposed the limitations of using telemedicine for first-time appointments, citing the need for a proper physical exam (Chin et al. 2022; Scheidt et al. 2022). It is important to emphasize that no surveyed orthopaedic trauma surgeon reported using telemedicine for new patient visits, further highlighting the importance of an in-person physical exam. Overall, our results agree with previous studies that providers prefer face-to-face interactions over virtual visits, yet the clinical and educational effectiveness of both visits are similar (Chaudhry et al. 2021; Chin et al. 2022; Wahezi et al. 2021).

Within the survey, several surgeons predicted that telemedicine would become the norm and become embedded in our day-to-day medical practice. However, concerns remaining on the limitations of telehealth in certain populations indicate that telemedicine could be better utilized for a specific subset of patients. Telehealth may be most beneficial for the elderly population and those in rural communities. For example, elderly patients can be triaged remotely, avoiding the need for transportation and long emergency department waits. Simple wound care and weight bearing questions can also be addressed. General follow-up questions can be answered by board-certified orthopaedic surgeons through a 15-min virtual appointment, potentially saving time for both patients and surgeons. Most surgeons seem to believe that telemedicine is best utilized for general follow-ups, pre-op appointments, and post-op consultations (Wahezi et al. 2021). These reasons mirror a study by Scheidt et al. where video consultations for low acuity ailments helped reduce the number of patients in the hospital or in clinics (Scheidt et al. 2022). Therefore, it is important for surgical subspecialties to accurately assess referrals to determine whether the patient can be initially evaluated over video conference or better off with an in-person visit (Brimioulle et al. 2023).

This study adds to a growing body of literature regarding the use of telemedicine, specifically in surgical specialties. The limitations of this study are inherent to the methodology of a survey questionnaire. Responses to each survey question are highly variable and subjective to recall and observer bias. Additional limitations include the low number of respondents and the inclusion of only Orthopaedic Trauma Association members. Future studies of telemedicine in orthopaedics should incorporate other orthopaedic subspecialties and compare their results to those seen in this survey, analyze telemedicine utilization rates in the years post-pandemic, compare results to different surgical subspecialties, and potentially compare between specialties that are more clinic oriented (e.g., dermatologists and neurologists) versus surgical based.