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Telemedicine Update, Any feedback?

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  •  Wings3496 
    Participant
    Status: Physician
    Posts: 25
    Joined: 11/05/2016
    Earnest refinancing bonus

    TelaDoc, and a northern midwestern state.

    #158337 Reply
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017

    If you’re done in 8-9 minutes total with loading and notes and etc how long is the actual encounter?

    #158351 Reply
     ebotrd 
    Participant
    Status: Physician
    Posts: 10
    Joined: 10/25/2018

    I just signed on with one and it’s going ok.  I’m a little slow right now trying to get the notes and all the telemed-specific type instructions straight, and also building my “favorites” list of prescriptions, but after a couple of weeks I feel confident I’ll be able to see 3 patients per hours.  As I get faster 4/hr seems like it’ll be doable.  Pay varies by weekday vs weekend, day vs night, and scheduled hours vs just “on demand” (whenever you feel like working a few minutes), but averages around $28-30/pt.  $100/hr for a family med doc in an urban area doing routine outpatient care is actually pretty competitive from what I’ve seen.  Best medical licenses to have seem to be CA, FL, TX – should stay busy with at least 2 of those 3.  Also they cover the malpractice $1M/$3M.  I’ll update you all if this is still an area of interest.  I’m also pending on signing on a 2nd telemed company just out of curiosity to compare/contrast.  I like it so far. I work out of a corner of my closet LOL.

    #179976 Reply
    Liked by snowcanyon
     snowcanyon 
    Participant
    Status: Physician
    Posts: 204
    Joined: 10/22/2018

    AmWell told me they really needed TX and FL licenses. Not surprising as they are big states with cumbersome licenses. No info on Teladoc, although my colleague said they were incessant and he would get calls constantly. He would take the bonus-heavy shifts and claimed he made well over $200 an hour.

    Looking forward to hearing more. Telemed is definitely on my list of side gigs. Best of luck.

    #180041 Reply
     Kencufc 
    Participant
    Status: Physician
    Posts: 20
    Joined: 08/12/2017

    My telemed side hustle is really going well now.  I made way more money in 2018 than I thought I would and even have completely stopped using one company.  I have state licenses in AZ, AL, CO, UT, KS, WA, WV, WI.  It took quite an upfront investment to get licensed in all these states,(maybe around $3500) but I have made that amount over a few times since July 2018.  My goal was to get enough volume that I could basically sign in whenever I want and do a few visits.  I’m certainly there although winter cold/flu volume is very high.  It will fall down in the summer months.

    I’ll be able to put down a good amount for an i401K and also bough some nice new home office furniture and a really good laptop that I will be able to deduct or depreciate (have to figure that out with the accountant!).

    #180047 Reply
     snowcanyon 
    Participant
    Status: Physician
    Posts: 204
    Joined: 10/22/2018

    Awesome!

    Hope you don’t mind my asking a few questions. Are you going to keep all your licenses? How cumbersome was the compact process? Why did you nix one company? How much are you making an hour, average?

    #180067 Reply
     Kencufc 
    Participant
    Status: Physician
    Posts: 20
    Joined: 08/12/2017

    I initially credentialed at 3-4 companies just to see which one was the best fit for me.  My volume is such at my preferred companies that I don’t need to work at more than 2 at the most.  Sort of like learning a new EHR, the process just slows down with unfamiliarity.

    The IMLC is great.  The process was simple and took less than a week for the state licenses to be issued.

    The hourly pay is variable.  AmWell offered shifts in 2 hour blocks over the holidays at $30/hr plus whatever you make in your visits.  When I got paid 30/hr plus visits seeing maybe 3-4 /hour, the pay was about $200/hr!  However, slow days may be more like $80/hour so it just depends on volume.  At teladoc, they pay $23/telephone visit, my average time is something like 6-7 min/visit, it’s reasonable to do 5-6 visits per hour.

     

     

    #180320 Reply
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017

    I guess I just don’t see how you see a patient over the internet for like 3 minutes and are confident in the diagnosis. I mean even a cold I feel like the patient could talk for more than a few minutes. a PCP takes 15 minutes for mundane visits and in reality is probably longer than 15.

    Like what diagnoses do you treat? Are you treating real infections that require antibiotics or is it basically all conservative care stuff?

    #180331 Reply
    Liked by octopus85
    fatlittlepig fatlittlepig 
    Participant
    Status: Physician
    Posts: 414
    Joined: 01/26/2017

    i guess it’s all good and fine until you prescribe cough medicine for someone with pneumococcal bacteremia and they log off and get septic and admitted to icu. for 30 bucks a patient? fatlittlepig would pass.

     

    #180392 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 1197
    Joined: 01/03/2017

    I guess I just don’t see how you see a patient over the internet for like 3 minutes and are confident in the diagnosis. I mean even a cold I feel like the patient could talk for more than a few minutes. a PCP takes 15 minutes for mundane visits and in reality is probably longer than 15.

    Like what diagnoses do you treat? Are you treating real infections that require antibiotics or is it basically all conservative care stuff?

    Click to expand…

    I don’t have any involvement with telemedicine but my guess is at least 80-90% is URI or sinus stuff where people just want an antibiotic. I guess we’re lucky as physicians because a fair amount of minor urgent care type stuff will get better no matter what you do.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #180418 Reply
    Liked by Zaphod
     Allixi 
    Participant
    Status: Physician
    Posts: 48
    Joined: 03/16/2016

    It amazes me that FLP can go to sleep at night or get out of the house in the morning, with such extreme aversion to any form of risk.

    #180452 Reply
    Liked by HikingDO
     Kamban 
    Participant
    Status: Physician
    Posts: 1788
    Joined: 08/01/2016

    It amazes me that FLP can go to sleep at night or get out of the house in the morning, with such extreme aversion to any form of risk.

    Click to expand…

    I am not sure of that but in the current case I partly agree with him. If with documentation it takes only 9 mins per patient I am not sure how much audio or video time do you really spend with the patient ( unless you are underestimating the time and say 5 mins when in fact it takes 20 mins).

    The med malpractice risk is too high for $28. Secondly are we going to be any better in the encounter than the CVS Minute clinic NP’s who do the same thing.

    I would rather spend 25 mins and get paid more or work a couple of shifts in an urgent care and make the same amount with less medmal risk.

    JMHO

    #180487 Reply
    Liked by Zaphod
     Panscan 
    Participant
    Status: Resident
    Posts: 352
    Joined: 03/18/2017

    Ya I just don’t see how you’re adding value seeing a patient for like 3 min. For a visit to take 9 min total including loading and documentation that has to entail like 3-4 min per patient.

    Let’s say somebody is crazy jaundiced but crappy webcam doesn’t show it or you don’t notice because you’re focused on their URI. Are you responsible? I mean even basic things like a URI I’d want to look in someone’s throat or mouth… Idk I’m just not really sure what you could actually diagnose with 0 patient exam besides what can be seen with crappy Webcam video. I can say it’s likely a cold but hard to be sure without feeling for adenopathy, looking in mouth or nose, etc etc. Seems like stuff like this is disrespectful to quality primary care. Good primary care isn’t from diagnosing URI it’s catching the more severe thing that looks like a URI.

    #180492 Reply
     Allixi 
    Participant
    Status: Physician
    Posts: 48
    Joined: 03/16/2016

    I would agree that telemedicine is probably better for established pts, and less so for pts you know nothing about. Perhaps they can be more integrated into Primary Care practices in the future.

    #180497 Reply
     snowcanyon 
    Participant
    Status: Physician
    Posts: 204
    Joined: 10/22/2018

    I haven’t done telemedicine, but we get a ton of medical advice calls in our ER asking what a rash is and should they come to the ER. I agree telemedicine is not terribly useful, and it’s depressing that Big Medicine is obsessed with it as some kind of miracle, but it’s really great to be able to tell patients that they should call the telehealth line (and pay for it, instead of getting free advice from us) if they can’t decide whether to come to the ER or not.

    At best, I think telehealth functions as a triage system. At worst, it’s just z-pack dispensing.

    #180498 Reply

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