On October 1, unless Congress acts, millions of Americans will lose access to telemedicine. A proven tool that has kept patients safe, doctors present, and costs down will vanish not because it failed, but because lawmakers failed to make it permanent. That would not just be bad policy. It would be malpractice by Congress.

I think of a patient of mine in northeast Georgia who lives 90 minutes from my clinic. He drives past other doctors to see me because of the trust we have built. If he has a question about his medication, asking him to spend three hours on the road for a five-minute conversation is not just inconvenient, it is bad medicine. A virtual visit allows me to answer his question, continue our relationship, and spare his daughter the afternoon she would otherwise lose from work to drive him. He is just one of many patients I care for who travel long distances to see me. Telemedicine makes those distances disappear.

He is not alone. During the pandemic, telemedicine visits surged more than 700 percent nationwide. By late 2023, more than 12 percent of Medicare beneficiaries were using telehealth, and surveys show over 80 percent of patients who try it report being satisfied. These are not just young people. My 90-year-old patients log on with ease, grateful they do not have to arrange rides for what can be safely handled online.

Telemedicine was not a temporary fix. It was a godsend, the tool that kept patients connected, chronic illnesses managed, and emergencies diverted during the darkest days of the pandemic. And it has remained a lifeline ever since.

Critics argue telemedicine weakens the doctor-patient relationship. The truth is the opposite. What undermines relationships is forcing patients into cars instead of conversations. My patients expect me to be present when they need me, not only when they can take time off work or arrange transportation. Telemedicine does not replace the relationship; it protects and strengthens it.

It also protects equity. For rural patients, it eliminates hours on the road. For low-income workers, it prevents lost wages. For immunocompromised patients, it avoids unnecessary exposure. Denying these groups access does not level the field, it deepens the divide.

Outdated licensing laws make the problem worse. I may be sitting in my office in Georgia while my patient is sitting on their couch in South Carolina, but unless I hold a license across that border, I cannot legally see them. These artificial barriers fracture relationships and make no sense in a modern health system.

Telemedicine also protects physicians. Burnout is at record highs, and the United States faces a projected shortage of up to 86,000 physicians by 2036. Telemedicine is one of the few tools that reduces wasted time, keeps clinicians in the workforce, and focuses energy on what matters most: patient care. To cut it now would be reckless.

And it makes financial sense. Studies show telemedicine lowers ER use and hospitalizations, saving families, employers, and health systems billions. Cutting it would not only harm patients, it would drive costs higher for everyone.

The harm is not theoretical. Without telemedicine, patients suffer. A woman may miss an early cancer diagnosis. A grieving spouse may go without timely support. A patient with diabetes may miss lifesaving adjustments to their care. These are not inconveniences. They are failures of care.

Congress has had five years to act. Instead, it has punted, patching telemedicine through temporary waivers. Patients cannot plan their care on waivers. Physicians cannot invest in technology or staff when the rules may vanish at the stroke of a pen. Other countries have already embedded telehealth permanently into their systems. By hesitating, the United States signals to families, innovators, and physicians that access is negotiable.

This is not a partisan issue. It is not red or blue. It is rural and urban, young and old, employer and employee. Telemedicine has become a lifeline across the country, and every American deserves the certainty that it will be there tomorrow.

On October 1, the choice is clear: permanence or failure. Congress must act now to make telemedicine permanent. Patients cannot wait. Physicians cannot wait. The time for temporary fixes is over.

Medicine has always been about presence. Telemedicine is presence, scaled, modernized, and humanized. To strip it away now would not only be bad policy. It would be malpractice by Congress, a deliberate decision to abandon a proven, life-saving tool, leaving delayed diagnoses, untreated illness, and broken relationships in its wake.

Ryan Nadelson is chair of the Department of Internal Medicine at Northside Hospital Diagnostic Clinic in Gainesville, Georgia. Raised in a family of gastroenterologists, he chose to forge his own path in internal medicine—drawn by its complexity and the opportunity to care for the whole patient. A respected leader known for his patient-centered approach, Dr. Nadelson is deeply committed to mentoring the next generation of physicians and fostering a culture of clinical excellence and lifelong learning.

He is an established author and frequent contributor to KevinMD, where he writes about physician identity, the emotional challenges of modern practice, and the evolving role of doctors in today’s health care system.

You can connect with him on Doximity and LinkedIn.