Why virtual allied health is no longer a nice-to-have for regional and remote Australia.
A particular silence falls in a consult room when a family from a town six hours from the nearest paediatric speech pathologist realises the waitlist is now measured in years, not months.
I have sat in that silence more times than I want to count. And every time, I have thought the same thing: we have built a health system that works beautifully if you happen to live near a tram line, and quietly fails the seven million Australians who do not.
Around seven million people live outside our major cities. That is not a rounding error. That is roughly the population of Denmark, spread across a continent, and we still design our services as if they will one day drive to Melbourne for their next physio appointment.
They will not. And they should not have to.
This is the part where I usually lose people at a conference. Because the moment I say “virtual allied health”, the room splits neatly in two.
Half nod along. The other half fold their arms and tell me, politely, that telehealth is a compromise – a watered-down version of the real thing. A patch we tolerated during the pandemic and should now quietly retire.
I argue they have it exactly backwards.
What the evidence actually says (and why we keep ignoring it)
In 2024, a Monash-led rapid systematic review pulled together 52 randomised controlled trials, roughly 4470 patients, comparing allied health delivered via telehealth against traditional face-to-face care – physiotherapy, occupational therapy, speech pathology, psychology, neuropsychology.
Musculoskeletal conditions, stroke, PTSD, depression, chronic pain, aphasia after brain injury – the kind of clinical territory where you would expect the physical presence of a clinician to matter enormously.
The finding was almost boring in its clarity. Across knee range of motion, pain scores, health-related quality of life, language function, depression, anxiety and PTSD, telehealth-delivered allied health produced outcomes similar to face-to-face care. Satisfaction was comparable. Adherence was comparable. Safety was comparable. In several sub-analyses, telehealth quietly outperformed the in-person arm.
Read that again: 52 randomised trials. And the profession’s polite scepticism persists.
I have thought a lot about why.
My honest view is that the resistance is not really about evidence. It is about identity. We trained in rooms with people. We were shaped by touch, hands-on assessment, and the shared cup of tea in the waiting room. So, when the data tells us the room is optional for a large slice of what we do, it does not feel like liberation. It feels like a small professional grief.
That grief is real. But it cannot be the reason a nine-year-old in Longreach waits three years for speech therapy.
Four things the world has already worked out
Scotland is a country of 5.5 million people. It is rugged, island-strewn, with the same recruitment problem we have.
NHS Scotland built Near Me (their national video consulting platform on Attend Anywhere) and scaled it across every health board.
What began as a pandemic scramble has become the default channel for a growing share of outpatient and allied health contacts, including group-based rehabilitation delivered simultaneously to participants sitting in their own kitchens across the Highlands.
The Scottish government’s own evaluation found overwhelmingly positive patient experience and, crucially, that the service had already become “business as usual” rather than a pilot.
Norway has a fjord-carved geography that makes the Kimberley look convenient.
The Norwegian model has leaned into digital home monitoring for chronic disease, with a trial demonstrating improved patient safety, better self-management, and reduced hospital readmissions.
The WHO Europe office now cites Norway as the reference model for how a small, sparsely populated country turns geography from a disadvantage into a design brief.
Ontario is a Canadian province where “rural” can mean a fly-in community above the 50th parallel.
Peer-reviewed work has tracked how telemedicine adoption in rural Ontario climbed sharply and stayed climbing after the pandemic, particularly for allied health and mental health contacts where the marginal cost of a video visit is trivial compared with a chartered flight.
In the US, analysis of telehealth combined with remote patient monitoring in rural aged care has reported a 27% reduction in cost of care, a 32% reduction in acute and long-term care costs, and a 45% reduction in hospitalisations.
Those are not marketing numbers. They are outcomes that would make any Australian hospital CFO reach for a calculator.
Four countries. Four different systems. One conclusion. Virtual allied health is not a compromise. It is a legitimate model of care that outperforms the alternative in the settings that matter most to us.
Related
The Australian problem we are still not naming
Here is the uncomfortable bit.
Australia does not have a rural allied health workforce shortage as we often describe it. We have a distribution failure.
Between 2013 and 2023, the allied health workforce in very remote Australia grew by around 183%. On paper, that sounds like progress. In practice, the base was so low, and attrition so brutal, that the lived experience of a family in Cloncurry or Ceduna has barely shifted.
We keep trying to solve this with the same three levers – scholarships, rural training pipelines, and overseas recruitment.
Each helps a little. None of them will ever close the gap, because the gap is not really about clinician numbers. It is about the geometry of the country.
It’s not feasible to have an occupational therapist in every town of 400 people, and that’s why children often don’t get early intervention.
Virtual allied health changes the geometry. A senior clinician in Adelaide can hold a caseload in APY Lands communities that no fly-in-fly-out model would ever sustain. A paediatric speech pathologist in Brisbane can carry regular sessions with a family in Weipa without either of them missing a school pick-up. A rehab physiotherapist can supervise a stroke survivor’s home exercise program in Broken Hill three times a week rather than three times a year.
This is not replacing on-the-ground clinicians. Let me say that clearly, because it is the argument that gets thrown at me most.
It is a hybrid model. The physio who visits Cloncurry once a fortnight becomes far more useful when their virtual colleague is holding the caseload the other 13 days. The local Aboriginal Health Worker becomes a genuine partner rather than a stopgap, because they now have a specialist available on screen in real time instead of an inbox that answers in a week.
The thing we need to stop pretending
We need to acknowledge that a two-hour drive to a physio appointment is not an acceptable feature of the Australian health system. It is not. It is a tax we levy on people for the crime of living outside a capital city, and it produces measurably worse health outcomes across almost every domain we care about.
We also need to stop pretending that “digital” is somehow the opposite of “human”.
The most human thing a health system can do is show up when someone needs it. A video call at 4pm on a Wednesday, from a family’s kitchen table, with a clinician they have built a relationship with over 18 months, is not a lesser form of care.
In many cases it is the only form of care that was ever going to reach them.
Where I think this goes next
If I had one bet to place on the shape of Australian health delivery by 2030, it would be this.
The best rural and remote services will not be the ones with the most clinicians on the ground. They will be the ones that have designed the cleverest hybrid of local presence and virtual reach, with allied health at the centre of that design, not bolted on at the edges.
They will treat Medicare telehealth items as infrastructure, not exceptions.
They will invest in the connectivity, the assistant workforce, the digital literacy, and the trust-building that makes virtual care actually work at scale.
The technology is ready. The evidence is ready. Four countries have already shown us the pattern.
The only question left is whether we are ready to stop apologising for virtual allied health, and start treating it as what it actually is: the most important piece of equity infrastructure the Australian health system has built in a generation.
Simon Taylor-Cross is a healthcare consultant, and chief commercial officer for Atidia Health. Formerly he was a director (NSW and ACT) of the ForHealth Group.
This article was first published on Mr Taylor-Cross’ LinkedIn feed. Read the original here.