The Wonders of Telemedicine

This article The Wonders of Telemedicine for a Doctor was originally posted on the White Coat Investor on August 7th, 2024

By Dr. Julie Alonso

There has been a lot of buzz about side gigs in recent years in the physician sphere. Whatever you call it—moonlighting, a side hustle, a second job, after-hours work, etc.—side gigs can provide a nice added cushion for savings or spending. Hopefully, most attending physicians already have a solid salary that provides for all of their needs and many of their wants, but it’s enticing to earn some extra money on the side to pay off those student loans faster, save up for a home project, invest more, or even take a nice vacation.

If you want to increase your income, there are countless options outside of medicine (real estate, starting a business, selling something . . . ). An easier route may be to use your skills as a doctor to expand your income. Unless you have a really profitable non-medical side gig, it’s going to be tough to get paid more than a physician rate on a small scale.

This is where telemedicine can come into play as a viable option, and it can be done from the comfort of home.

The Basics of Telemedicine 

My field of psychiatry is likely the easiest to find jobs in telemedicine, but opportunities exist for many other specialties, including pediatrics, IM, FM, urgent care, dermatology, radiology, IM subspecialists, and even hospitalists. There are different setups for telemedicine companies—such as ones that are directly connected to patient care vs. ones that recruit doctors to work specific contracts with a clinic, hospital, etc. It’s important to know how the work is structured and what the details are for each site.

Some key components to think about when evaluating a platform to work with are flexibility, compensation, liability coverage, and schedule.

Picking a Telemedicine Platform

Here are some pertinent questions when picking a telemedicine platform:

Flexibility

• Does the company let you make your own schedule or set your own hours?

• Is there a set shift or schedule assigned to you each week or month?

• Is there an ability to put in requests for specific shifts?

• Is there a non-compete regarding working for other telemedicine companies?

• What are the expectations for holiday, after-hours, and weekend work hours?

Compensation

• Is the pay per shift, per hour, per consult/patient visit, or a hybrid of these?

• Does the company cover medical license, DEA, or other professional fees?

• Are there any other benefits that can be considered compensation (i.e. CME money)?

• Are there any fees to pay back if you leave sooner than anticipated?

Liability and Coverage

• Is malpractice included as part of the contract? If so, what type—claims made vs. occurrence?

• Is there a nurse line or other support services for patients when they have questions or need help scheduling appointments?

• How do patients communicate with you (if they're ongoing) and what are the policies and expectations around the patient portal?

• Is there a minimum number of states where you need to be licensed?

• Can patients see a different doctor on the platform for refills if you are not available?

• What is the contingency plan if a patient needs to be seen in person emergently or if there is a patient who is not appropriate to receive care via telemedicine?

Schedule

• Is there a minimum number of hours the company expects per week or month?

• How long are the appointment times?

• If you have to get your own malpractice outside of your full-time position to cover your telemedicine work, many malpractice carriers offer a “part-time” discount in rates, so make sure to inquire about that.

Work Specifics

• Does the company require board certification? This may make it harder for residents to moonlight at these companies.

• Are you required to work in an office site? I’ve seen telemedicine job listings where you're not allowed to work from home, which may be a dealbreaker.

• What is the level of care setting you will be working in and what does the work typically entail (i.e. outpatient, inpatient, consults, emergency, urgent care, etc.)?

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I’ve been doing telepsychiatry as a side gig for about five years. I work for two different telemedicine companies: for one, I am doing outpatient general psychiatry treatment for children and adults, and for the other, I am performing disability evaluations. I picked these specific companies mainly because of the flexibility that they offered. I can set my own hours with no minimum number of hours. I can designate whether I am taking new patients. Because I am paid per consult, I can set my preferred appointment lengths to spend enough time with my patients. The EMR and e-prescribe are all integrated into the platforms. There is a nurse line for support and patients can see another doctor, if necessary, if I am gone on vacation. When I interviewed at companies, I compared all of the factors above, including compensation rates, malpractice coverage, workload, and flexibility. While no telemedicine platform is perfect, I’ve enjoyed my experience.

More information here:

Begin Your Self-Employment Freedom by Downshifting Your W-2 Job

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Private Practice vs. Employed

Some doctors have success opening a private telemedicine “micropractice,” where they see a small number of patients on their own pre-determined schedule. This could be a half-day or a couple of evenings a week, for example. The advantages of this are that you have full control of your practice setup and schedule, and you keep all of your profits. The disadvantages of this for a small practice are you will likely still need to pay for services such as an EMR, e-prescribe, etc.

Working for a telemedicine company can have its advantages too. For example, you likely will not have to worry about setting up or paying for an EMR platform or other equipment, and you will hopefully have a steady stream of patients.

Tax, Savings, and Retirement Advantages of Telemedicine

If you have a W-2 employed position AND you start doing telemedicine on a contract (1099) basis, there can be numerous tax advantages. If you are working from home, there may be deductions you can take for whatever equipment you are using (computer, cell phone, headset, internet plan, home office) for your telemedicine work. You also can contribute a portion of your 1099 earnings to an individual or solo 401(k). This is in addition to your contributions to your employer-sponsored 403(b) or 401(k) plans so you can enhance your retirement savings each year and decrease your taxable income on the side gig earnings, as well.

With contract income, taxes are typically not taken out, so be aware of the need to file estimated quarterly taxes, especially if you are already in a high tax bracket from your W-2 job. I keep track of my earnings in an Excel spreadsheet so I have an estimate of how much I have earned. Another cost benefit is the time and money saved by working from home. As I’ve gotten older, I continue to appreciate time as a valuable asset. With telemedicine, you do not have to factor in commute time, and you also save on gas, your car's wear and tear, and insurance. I joke that my commute is walking up my staircase.

More information here:

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Work-Life Balance

Although making extra money is tempting, it’s important to make sure not to overdo it. It may be a reasonable tradeoff to use some of your evening hours or weekend time, especially if it is to meet a certain financial goal. But be cautious that it’s not at the expense of a large chunk of your family or leisure time. The nice thing about many telemedicine jobs is that you can titrate up hours if you have more time or want to earn extra money for something short-term, or you can decrease the hours if you have a particularly busy time in your life.

During the pandemic lockdown time, when after-school and social activities were shut down, I increased my telemedicine hours. There was also a surge in demand for telemedicine and mental healthcare in general. We weren't spending money on travel, and I used this extra income to pay off the rest of our car loan, finish off the rest of my student loans, pay down a large chunk of our mortgage, and save/invest the rest. As my children got older and their extracurricular activity schedules came back in full force, I could then cut back on some of my telemedicine time to be there for them.

Job Stacking for Doctors: A Modern Approach to Work-Life Balance

Diversify Income Stream

Having a steady or PRN telemedicine gig can help provide some security in the event of a job transition period, layoff, or move. It can also be good if you are taking some time off work but still want to maintain a minimum level of income.

For those who really enjoy it, there are plenty of opportunities to do telemedicine full-time, whether as an employed position or on a contract basis. I love doing telemedicine work from home and all the ease and advantages that it brings to my life. Telemedicine has allowed me to see my patients while still being home for my family. That has been an immeasurable benefit.

Note from SimpliMD: Maximizing Your Professional and Financial Life

Telehealth provides you with a great opportunity to combine W-2 and 1099 income through job stacking, and this can significantly enhance your professional and financial life. By leveraging the benefits of both employment types, you can optimize your taxes, increase your retirement savings, and enjoy greater flexibility and security in your career.

Join me for More Insights

Want to learn more about optimizing your professional and financial life through novel professional jobs like telemedicine that are location independent? Enroll in my course, "How to Create a Practice Without Walls," and discover strategies for job stacking that allow you to thrive as both a healer and an entrepreneur.

Revolutionizing Physician Work: Embracing Location-Independence.