3.4.2. Professional Development and Work Environment

Clinicians' concerns, such as lack of medical skills practice and loss of competence, were raised in the Fernemark et al. paper [37]. GPs worried that digital care visits often

deal with simpler cases where physical examinations and more complicated medical manipulations are unnecessary. They were concerned that by working exclusively with digital care visits, they would lose some of their skills and competence [37].

#### 3.4.3. Workload and Workflow

Clinicians in several studies reported that digital care visits require a higher level of concentration compared to traditional visits [45,54,57]. Over 55% of therapists said digital care visits require a higher concentration level in the Cioffi et al. study [54]. Therapists from another study pointed out that 30% of them experienced less engagement, that they had to work harder because they needed to monitor technical aspects of the session, that it tended to non-verbal communication ( difficult for 80% of the therapists), and that disruptions during the visits occurred for 92% of the respondents [57]. Therapists in the Hardy et al. study experienced "clinician fatigue—lethargy, tiredness, and discomfort" and claimed digital care visits were more tiring [45]. Similarly, other studies reported that treating patients online is more tiring as the clinician needs to compensate for the absence of physical presence, focus harder, and use senses other than touch to assess patients, as well as often helping patients with technology issues and dealing with a sometimes higher workload [45,49,54,56,57]. Healthcare professionals from the Cioffi et al. and Fernemark et al. studies felt it was more difficult to structure their time when working from home, and they were unsure as to when and if they should take breaks [37,54].

Around one-fifth of the physicians who participated in the Gold et al. survey replied that they experience increased stress while working with digital care visits [50]. Some identified that the type of digital care visits conflicted with their views on how care should be delivered [50]. Johnsson et al. and Paulik et al. discovered that clinicians feel administration and preparation for digital care visits takes a lot of time, because they must adapt certain treatment techniques to a new setting [36,49]. Other authors found that clinicians experience a lack of administrative support, and they need to schedule visits and do other tasks, that a secretary or a nurse could take over, instead of focusing on treating patients [35,36,41].
