This study aimed to create a holistic understanding of the physician experience in relation to telemedicine. This study examined a Tele-NICU and a Tele-ER program at a large metropolitan pediatric specialty hospital with a Level IV NICU that provides telemedicine consults to 16 remote sites across Texas. Twenty-four semi-structured interviews were conducted with physicians and nurses at remote hospitals, physicians who provide consultations from the pediatric specialty hospital, and managers of the tele-specialty programs. These interviews were coded using the consolidated framework for implementation science to contextualize program strengths and weaknesses and reviewed to make recommendations for future program development. Remote site participants reported that the programs are useful when they are in need a second opinion and providing reassurance to patient's families. Barriers to program use include issues with the tele-carts, insurance acceptance, and hesitation to request a consult. Study findings demonstrate the need to treat each tele-specialty programs as independent to suit the differing needs of both remote sites and the consulting physicians. This study demonstrates the importance of understanding physician's perspectives, culture, and the role of hospital settings in telemedicine program acceptance and refutes telemedicine as a monolithic solution to limited healthcare access.