A 24/7 virtual care service means freedom from on-call hours

It's something we've all been through: that fever that spikes in the middle of the night, that cough that just keeps getting worse during the holidays, or that prescription that needs refilling over the weekend. These are common occurrences that primary care providers have always had a system to handle—the on-call hours. When the office is closed, there is at least one doctor on call to cover urgent patient needs, any time, day or night.

But, often, that convenience for patients has meant that, at the other end of the line, a primary care provider had to be ready to answer urgent calls, any time, day or night, outside of their traditional office hours. They might have had to stealthily sneak out of their child’s birthday party or wake from much-needed sleep to meet the needs of their patients. While primary care providers know the importance of being there for their patients, blurring the lines between professional and personal lives contributed to a feeling of burnout.

“During the work week, I could get two to three calls a night, and depending on if it was flu season, maybe 20 calls over the weekend—you’d have to be next to your phone at all times,” said Aileen John, DO, a family medicine doctor at Penn Family Medicine West Chester and a regional medical director of Penn Medicine Primary Care.

Now, when a patient calls after hours, instead of reaching their doctor during their personal time, they are automatically rerouted to Penn Medicine OnDemand, a 24/7/365 virtual care service, where a provider is ready and available to meet with them. It’s their job to be available even when traditional primary care offices are closed.

As of January 2026, 63 Penn Medicine practices across the greater Philadelphia region, Chester County, and central New Jersey, are using the after-hours call coverage by Penn Medicine OnDemand. (Lancaster General Health and Doylestown Health have their own versions of after-hours care, with the intention to further integrate the programs.)

Penn Medicine is the first health care provider in the region to roll out this type of after-hours call coverage and eliminate the requirement for primary care providers to be available for evening and weekend call coverage.

The result has been impactful for both patients and providers, some might say, a life-changing result.

Coming out of the COVID-19 pandemic, leaders with Penn Medicine Medical Group, the team who oversees Penn Medicine primary care, wondered how they could leverage newly expanded telehealth services to accomplish other goals in the health system. The group saw an opportunity to improve after-hours care for both patients and staff.

Jeffrey Tokazewski, MD, medical director of Penn Medicine OnDemand and lead family medicine physician at Penn Medicine Voorhees, along with the primary care leadership team, championed the call-coverage concept.

“Patients now have access to a one-on-one appointment with an experienced clinician 24/7/365, and it’s predictable work at predictable hours for the OnDemand providers—it’s a win-win situation for patients and providers,” he said.

Primary care clinicians want patients to see Penn Medicine OnDemand as an extension of their office. Just like any primary care practice, Penn Medicine OnDemand treats common ailments such as colds and flu, sore throats, stomachaches, headaches, infections, and minor injuries. The OnDemand team also has access to patient records in PennChart, so they can see any active medical problems and the patient’s list of prescriptions. After the appointment, the OnDemand provider will work with the primary care team to communicate the details of the virtual visit and coordinate follow-up care.

Penn Medicine OnDemand practitioners come from a variety of backgrounds including primary care, surgery, trauma, and oncology.  The doctors also receive specific telehealth training and collaborate based on specialty.

“We are a passionate and experienced group, and we love what we do—patients are getting very good care when they come to us,” said nurse practitioner Hayley Cassidy, CRNP, who joined the team during the pandemic and found it so fulfilling she has remained on the team.

In fact, Penn Medicine OnDemand providers have some of the highest ratings in the health system from patients. “The high ratings show a willingness to create a rapport with patients and ask the right questions,” Cassidy said.

“Many diagnoses, whether you’re in-person or virtual, come from asking the right questions and actively listening to the patient,” she said.

And now that patients can easily get an answer to their question through the virtual service, John has seen a decrease in emergency department visits across patients in the practices she oversees as one of Penn Medicine's regional primary care directors. Helping patients avoid an emergency department visit when it’s not necessary helps everyone: reducing costs, reducing wait times, and ensuring patients are getting the right care in the right place.

The change has been huge for physicians who once had dozens of interruptions when not at work.

In a 2024 survey of the first 17 practices to implement it, every single physician reported their on-call experience was better after Penn Medicine OnDemand started taking calls.

The primary care leadership team estimates that call volume has been decreased by at least 95 percent for clinicians, and the calls they do get are only from their colleagues— for example, a critical lab test result or an emergency department provider calling about a mutual patient.

Penn Family Medicine West Chester, where John sees patients, was one of the first practices with OnDemand coverage. The first weekend, she wasn’t sure if her on-call phone was working, because she wasn’t getting any calls. She estimates that her weekend call count went from 20 calls to maybe two or three.

Not only did her patients feel supported because they were receiving that prescription or guidance on managing symptoms sooner, but she immediately noticed an improvement in her work-life balance—and the well-being of the other providers she works with.

“I am passionate about improving the well-being of our providers—so I am passionate about this program.” John said. And personally speaking, “I love seeing my patients—I would see 40 patients a day if I could,” but “now when I am home, I get to spend that time with my husband and three daughters.”

The work-life improvement is critical for the sustainability of family medicine, she said.

As a medical director for her region of primary care practices, she is often recruiting new doctors fresh out of residency to her practices. One of the first questions she receives is, “What is the work-life balance like?”

“When you accept a job, it is not only about the paycheck, but can they have a well-rounded, flourishing life outside of seeing patients?” she said. She can now confidently say that being on call is no longer going to disrupt their lives outside of work.

John has seen the ripple effect from this program in her own family. Her oldest of three daughters decided not to follow in her mother and father’s footsteps—her dad is a neurologist— and pursue medicine because “she would watch me working for hours at night and didn’t want that lifestyle,” John said.

But since Penn Medicine has made changes to improve provider wellness, her middle daughter wants to be a doctor.

“She noticed me being present with my family. I started cooking, exercising, and doing things I enjoy again,” John said. “That is what is inspiring her to pursue a future in medicine.”