<p>Telemedicine is a key instrument for addressing healthcare disparities, yet the intercity telemedicine system (ITS) remains underexplored. Here, leveraging large-scale consultation data from online healthcare platforms, we reveal the spatial structure and city roles within China’s ITS. First, the ITS shows the structure of a highly interconnected network, enhancing systemic efficiency but also generating new inequalities by concentrating resources in major hubs and limiting patient choices in cities with fewer medical resources. Second, the ITS partly deviates from the traditional hierarchy where patients primarily seek care in the nearest major administrative center; instead, it moves toward connections driven by specific medical expertise and patient needs, while still partially reflecting the logic of face-to-face healthcare. Third, city roles within the ITS are structurally differentiated, characterized by patterns where a few dominant hubs centralize most activity while many others remain on the margins, alongside the rise of cities that leverage digital platforms to attract medical demand from diverse regions outside their own provinces, despite having relatively limited physical healthcare resources. This reflects the dual mechanism of online healthcare platforms: concentrating flows toward top-tier hubs—marginalizing smaller cities in supply roles—while enhancing service accessibility in low-resource cities and expanding the outreach of ordinary cities.</p>