It was the hope and prediction during the COVID-19 pandemic that telemedicine would bring needed mental health care to the remote areas of the country. The technology has been widely accepted and common place, except in rural America.
A new study published March 5 in JAMA Network Open demonstrates that the great shift to virtual care during the pandemic has done little to help psychatrists and other mental health professionals reach patients in the underserved rural areas.
The Digital Divide Remains Unchanged
The study found that specialists who used telemedicine the most saw only a very small increase — less than one percentage point — in patients from rural regions compared to specialists who rarely used video calls. The finding was that very few new rural residents were added to a clinician’s caseload but rather existing patients who moved away from the city and kept their doctors remotely.
Researchers at Brown University School of Public Health in Providence, Rhode Island analyzed Medicare billing records for more than 17,000 mental health specialists between 2018 and 2023 in all regions of the United States. They looked at the share of their visits to patients living in rural, low-access-to-care or distant communities.
According to the study author, “We had thought the dramatic shift from in-person care to telemedicine among mental health specialists would lead to them caring for substantially more patients in rural communities.” “Unfortunately,” he added, “We just don’t see it.”
A surprising finding was that telemedicine might actually be making it harder for some people to find a doctor. Specialists who relied heavily on virtual visits saw their patient panel shrink, seeing 3.6% fewer new patients overall. This suggests that while video calls make it easier to maintain long-term relationships with current patients, it’s not opening up slots for anyone new.
The Problem is Not the Technology
The researchers argue that the problem isn’t the technology, but the legal paperwork. Currently, a doctor in one state often cannot treat a patient in another without a separate, expensive license. It is currently too administratively burdensome for a mental health physician to get a license in many states.
The Brown study demonstrates that more must be done to improve access to care. Simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care. For telemedicine’s potential to be reached, a change in policy is needed to address those barriers. Facilitating how physicians licenses are obtained can be a critical first step.
Sources: Brown Univ: https://www.brown.edu/news/2026-03-05/telemedicine-mental-health
JAMA: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2845954