Online Consultations Become the New Normal: What Barriers Must Doctors Overcome to Fully Embrace Internet Healthcare?

The National Health Commission held its regular press conference last month, highlighting typical cases of the application and development of nationwide health informatization and providing specific explanations on “Internet Plus Healthcare.” At the conference, Mao Qun’an, Director of the Planning Department of the National Health Commission, stated that the commission would “further leverage the advantages of ‘Internet Plus’ to support routine epidemic prevention and control.” Meanwhile, it will “deepen convenient and beneficial services through Internet Plus Healthcare, improving public satisfaction with medical consultations and treatment.”

In the current era of normalized epidemic prevention and control, online diagnosis and treatment services are also becoming increasingly routine. As physicians constitute the core resource on the supply side of internet healthcare, their level of participation will ultimately determine the quality of service.What factors are driving physicians’ adoption of online practices? What obstacles must be overcome to secure their full endorsement of internet-based healthcare?

Chen Qiulin, Director of the Health Economics Research Office at the Institute of Population and Labor Economics, Chinese Academy of Social Sciences, believes that the factors driving physicians’ adoption of online services are multifaceted.

During the pandemic, a large number of hospitals suspended outpatient services to prevent cross-infection associated with in-person visits. However, patients requiring in-person care, including those with chronic diseases needing long-term medication management, still required medical services.“Some public hospitals that previously had no internet-based operations have launched online diagnosis and treatment services by establishing their own internet hospitals or joining third-party internet healthcare platforms.” Meanwhile, “third-party internet healthcare platforms attracted doctors to go online by offering free clinic services during the pandemic.” Furthermore, “some internet platforms recognized the opportunities brought about by the pandemic’s progression and expanded from non-direct medical services to core healthcare businesses such as online consultations; the incentive measures they implemented also facilitated doctors’ transition to online practice.”

Based on relevant data, as of June 30, 2020, VCBeat’s research indicates that there are currently approximately 577 internet hospitals in operation.Among them, the number of newly established internet hospitals in the first half of 2020 was 215. This figure is essentially close to the total number of newly established internet hospitals for the entire year of 2019, which was 223.While the pandemic has accelerated the development of internet hospitals, it has also hastened doctors’ transition to online practice.

More direct data may come from third-party internet healthcare companies.Data from Ping An Good Doctor’s 2019 annual report indicated that its in-house medical team comprised 1,409 members at the end of 2019, an increase of 213 from the end of 2018. In the first half of 2020, the size of its in-house medical team reached 1,836, representing an increase of 427 from the end of 2019. Notably, the growth in the in-house medical team during just the first half of the year was twice the total growth recorded for the entire year of 2019.

In the first half of 2020, Ping An Good Doctor signed contracts with 5,978 external physician experts (holding the title of associate chief physician or above at Grade A tertiary hospitals) during the pandemic. At the end of 2019, the number of contracted external physician experts stood at 5,381. This represents an increase of 397 contracted external expert physicians within just six months. Meanwhile, other internet healthcare platforms, such as Haodf Online and WeDoctor, also experienced growth in their number of online physicians during the pandemic.

“The pandemic accelerated doctors’ adoption of online consultations, but such participation may be sporadic. Whether the temporary shift to online practice during the pandemic will evolve into a long-term trend remains to be seen. Some doctors may discontinue online services once the outbreak is brought under control,” said Chen Qiulin in an interview with VCBeat. “HoweverAs more physicians gained experience in delivering services online, coupled with policy-driven initiatives by public hospitals to launch digital health offerings, doctors have come to recognize the value and role of internet-based healthcare. Consequently, a growing number of physicians are choosing to go online and provide medical services on an ongoing basis.”

The pandemic has acted as a catalyst for physicians to go online and continuously provide telehealth services. Some hospitals, particularly specialized ones, have sought to attract larger patient populations through internet-based healthcare, further encouraging physicians to join these platforms. However, the ultimate reason why physicians have actively embraced and participated in internet healthcare is that it meets their diverse needs.

With the introduction of a series of policies, including centralized drug procurement and the elimination of drug markups, the “hospital revenue reliant on drug sales” model has collapsed. However, ensuring that physicians receive reasonable compensation for their inputs remains a issue requiring long-term consideration. In January 2017, the “13th Five-Year Plan” for National Health and Family Planning Human Resource Development pointed out that, within the bounds permitted by national laws, regulations, and policies, medical personnel may earn income through part-time employment and multiple salaries. It also encouraged and supported medical science and technology professionals to achieve career success through innovative practices, while enjoying corresponding social status and economic benefits.

One of the roles of internet healthcare platforms is to help doctors earn transparent income with dignity by leveraging their professional expertise. This is particularly evident in internet healthcare companies.

Platforms such as Ping An Good Doctor and JD Health have established their own in-house medical teams. In August, JD Health announced that its full-time team of general practitioners comprised over 300 physicians, while Ping An Good Doctor reported a figure of 1,836 during the first half of the year. These physicians often come from prestigious Grade A tertiary hospitals in China; one reason they choose to become full-time doctors for internet-based platforms is the more substantial income these platforms can offer. Furthermore, by engaging external specialist physicians for multi-site practice on their platforms, internet healthcare companies also provide additional financial rewards for doctors within the public hospital system and other traditional institutions.

ButThe ability to generate revenue is merely the fundamental prerequisite for physicians to participate in internet-based healthcare., this is not the primary reason why physicians participate in the field of internet healthcare.

The hospital system, with its distinct hierarchical structure, enables renowned specialists to attract significantly more patient volume than ordinary physicians. It has become increasingly difficult for general practitioners to build their own reputations. Chen Qiulin stated that, at the same time,Whether they are ordinary physicians or renowned medical experts, all must confront an ultimate question:When leaving one’s current hospital to join another, physicians often discover that their former patients remain loyal to the institution rather than to themselves. Patients typically seek consultations at renowned hospitals with well-known doctors, not the other way around.

By providing online medical services through internet hospitals, physicians can build a reputation among patients and gradually enhance their personal brand. Even after transferring to another hospital or retiring, they can continue to maintain highly engaging interactions with their patients.For young physicians, internet healthcare helps break down the traditional, rigidly hierarchical hospital system. By providing high-quality online services to specific patient groups, they can build their brand and reputation digitally, rather than being constrained by the hospital’s internal structure, thereby achieving a greater sense of professional fulfillment.

Starting in the second half of this year, internet healthcare companies such as Ping An Good Doctor and AliHealth have been intensifying their efforts in medical services, aiming to empower physicians by helping them build reputation and establish personal brands. Last month,Ping An Good Doctor has explicitly proposed the creation of a dual-platform ecosystem serving both physicians and users, launching the sub-brand “Ping An Yijia.” By establishing “Physicians’ Home,” it aims to provide one-stop solutions for doctors, while simultaneously delivering services to patients through private physicians and family doctors. This move can be regarded as one of the key indicators of internet healthcare platforms intensifying their focus on the “physician” side.

To build their professional reputation, physicians are shifting their focus from diseases to individual patients, fostering better doctor-patient relationships and thereby delivering higher-quality medical services. This trend has also strengthened patient stickiness and increased willingness to pay in the internet healthcare sector.

While helping physicians enhance their reputation among patients, internet healthcare platforms also play a crucial role in efficient patient management. Outside the hospital setting, patients often struggle to control their conditions due to a lack of effective medical care. Although some hospitals have implemented measures such as telephone follow-ups, limited staffing often prevents them from providing comprehensive coverage.

Internet healthcare helps address this issue. Internet hospitals, which are affiliated with physical medical institutions, can effectively facilitate the transition between offline and online services, thereby better assisting physicians in patient management.

Among internet healthcare companies, similar to Ping An Good Doctor, which assists physicians in reviewing patient information and accessing their relevant diagnosis, treatment, and medication records by providing a physician workbench. More importantly, perhaps,Internet healthcare platforms can provide users with 24/7 online consultations, as well as a comprehensive suite of services covering the entire medical journey, including outpatient appointment scheduling, registration, referrals, accompanied visits, and hospitalization arrangements. Moreover, these platforms are no longer limited to addressing immediate medical needs; by offering private physician and family doctor services, they enable long-term, continuous health management and provide lifecycle-wide health solutions.

Especially for patients with chronic diseases, internet medical platforms can effectively improve patient compliance and help them manage their conditions more efficiently through accessible services such as private physicians and family doctors, thereby overcoming the limitations of traditional offline care where doctors often struggle to provide continuous support. For healthy individuals, internet healthcare companies can also help them maintain their well-being.

Acquiring an adequate number of appropriate cases for scientific research is an effective pathway for physicians’ career advancement. In traditional brick-and-mortar hospitals, although renowned experts attract significant patient volumes, such patient flow is not precisely targeted. Physicians still require considerable time to accumulate sufficient cases for research purposes. Chen Qiulin stated,“Renowned specialists at major hospitals have distinct demands for internet-based healthcare: they seek patients with complex and refractory conditions to accumulate sufficient case data for scientific research, thereby advancing medical science.”

For young physicians, the challenges extend beyond recruiting patients for research; they also include how to communicate effectively with senior experts and how to secure opportunities for academic exchange.

The advantage of internet healthcare platforms lies in enabling physicians to more precisely reach the patients they need. They can even recruit patients directly through online channels, thereby enhancing patient-physician interaction. This greater precision is made possible because internet healthcare platforms have gradually established a relatively comprehensive healthcare system through mechanisms such as tiered pricing and a service spectrum ranging from general practitioner care to specialist services. When patients enter systems like Ping An Good Doctor, they first interact with general practitioners, then with specialists from various hospitals, and finally with experts from renowned physician studios.Through a multi-tiered screening process, physicians can devote more energy to their areas of expertise and conduct corresponding research activities. The platform itself also serves as a channel connecting junior and senior physicians, providing them with opportunities for academic exchange.

Historically, poor patient adherence in offline settings has led to potential deviations in the real-world effectiveness of pharmaceutical interventions. Through more efficient online management and improved patient adherence, physicians can obtain data that is more precise and effective than previously available. The transformative changes brought about by internet healthcare will better support physicians in conducting scientific research.

Internet healthcare offers advantages, enhancing the value of physicians and encouraging their online participation. However, challenges persist as doctors continue to transition to digital platforms. Chen Qiulin points out that the primary factor is a matter of mindset.“The phenomenon of physicians resisting digitalization is also prevalent in Europe and the United States. The root causes lie in physicians’ self-perception and the established norms of the medical industry. Some physicians do not regard internet-based healthcare as a legitimate form of serious medical practice. This divergence in professional philosophy has led these physicians to reject online engagement. Furthermore, “some renowned specialists are simply too overwhelmed with their existing workload to allocate time for additional activities.”

Furthermore, “some hospitals and local governments believe that doctors’ participation in third-party medical platforms will affect their primary duties, and thus prohibit doctors from joining such platforms. In practice, however, they are making every effort to encourage doctors to engage with platforms operated by the hospitals themselves.” Regarding multi-site practice on third-party internet healthcare platforms, Chen Qiulin stated, “This arrangement presents certain irrationalities for hospitals. Nevertheless, the state supports and permits physicians to engage in multi-site practice, with the aim of enabling them to serve a broader population.”“To address the challenges associated with multi-site practice, ‘the ideal mechanism is for physicians to establish contractual relationships with hospitals, thereby regulating their online practice behaviors.’”

To better facilitate physicians’ adoption of online practice, policy support and incentives are also required. Meanwhile, training in online medical practice should be provided to help physicians transition more effectively to digital platforms, enhancing their professional capabilities while transforming their mindsets.

However, Chen Qiulin also expressed his concerns.He believes that the process of getting doctors online should not be rushed, nor should they be forced to go online.“By leveraging technological and model innovations, online healthcare creates new value while enabling physicians already on digital platforms to maximize their professional impact. It also raises public awareness of the role of internet-based medical platforms, which will ultimately encourage more physicians to voluntarily join these platforms.”

For physicians practicing on online platforms, the evaluation system of internet healthcare will be more favorable to those who deliver high-quality medical services. For society as a whole, this will encourage physicians to place greater emphasis on patient communication, ultimately driving systemic improvements in the overall quality of medical care.