The sustainable development of Internet hospitals and e-health platforms relies on the participation of patients and physicians, especially on the provision of health counseling services by physicians. The objective of our study is to explore the factors motivating Chinese physicians to provide online health counseling services from the perspectives of their online and offline reputation. We collect the data of 141029 physicians from 6173 offline hospitals located in 350 cities in China. Based on the reputation theory and previous studies, we incorporate patients’ feedback as physicians’ online reputation and incorporate physicians’ offline professional status as physicians’ offline reputation. Results show that physicians’ online reputation significantly and positively influence their online counseling behaviors, whereas physicians’ offline reputation significantly and negatively influence their online counseling behaviors. We conclude that physician’s online and offline reputations show a competitive and substitute relationship rather than a complementary relationship in influencing physicians to provide online counseling services in Internet hospitals. One possible explanation for the substitute relationship could be the constraints of limited time and effort of physicians.