By Dr. Julie Alonso, WCI ColumnistThere 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.)?
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:
Locum Tenens: What Physicians Need to Know
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:
Where Do You Pay Taxes If You Work Remotely?
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.
More information here:
The Gender Role Reversal: Being the High Earner of My Family as a Woman
Justifying and Cash-Flowing a ‘Selective Extravagance’
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.
What else should people think about when it comes to telemedicine? For those who are doing it, has it made your work life better? Has it increased your income?
Nice piece, and I agree with your premise. Telepsychiatry has been great for me, but I far prefer having my own private practice. My own practice went completely virtual when COVID hit, and the convenience has radically improved my quality of life. But working for a company would remove one of the things I have loved the most about my work: complete autonomy. I have always loved the ability to run everything in my practice as I please. And I don’t need an EHR. I use paper: old-school. And I strongly suspect the pay is better when working for oneself.
I imagine the intention was to suggest telepsychiatry as an add- on to an employed position. But anyone considering that might also consider full time private practice via telemedicine.
nice artilce
Thanks for the comment! I agree that there are pros/cons to having your own telemed private practice vs. working for a telemed company. Even among telemed companies, there are various levels of autonomy and control over one’s schedule and appt. lengths, etc. I picked companies that lean more to the autonomy side where I can set my schedule and there are not high minimum hours expectations. I’m sure the pay is better if you are fully autonomous and not using an EHR. However, there are different drawbacks to both options and additional resources/benefits that may be provided by a company as I detailed in the article.
Very interesting article, I have always been interested in pursuing some form of telemedicine side job but I worry about continuity until I read your piece including the disability evaluation company. This is very attractive to me because while it certainly is a service that is needed by many, it really doesn’t require continuity care. I’m very interested in learning more about this particular niche in telemedicine, can you share some details about the company you work for? or at least how you discovered them? Thank you!
bumping hoping to get a response from the author
This was emailed to me from Julie:
Hi Nick, thanks for the comment! I remember coming across several opportunities to do disability evals when I was looking years ago. Some of them are subcontracted out to telemed companies. The company I work for sends out open opportunities for all types of clinical work (including disability evals) based on what states you are licensed in. A colleague of mine was able to find an option just recently after I discussed it with her. Are you a psychiatrist? I know more about psych evals, but I also know that there are opportunities for other specialties such as neuro cases, worker’s comp cases, etc. If you want more details about the company I work with, please e-mail [email protected] and we can connect.
How much do you make per hour with psychiatry telemedicine?
Hi Greg, I think this can vary widely based on the kind of clinical setting (inpatient, outpatient, consults, acute/crisis care…), the pay structure, volume of patients and appointment lengths. Generally for hourly positions I’ve seen a range of $150-$200/hour. If you have a cash-pay private practice, it can be much higher or insurance-based would depend on the contracted pay rate.
dont forget if you do this full time you dont have the office overhead which can be 50-70% of revenue
Yes, you can potentially save a lot in overhead expenses by doing solely telemedicine. You can avoid the costs of renting an office space, utilities, furniture, equipment, insurance, etc. There is also a safety factor that is invaluable, especially in psychiatry.
Helpful article.
Is there a useful way to sort out the more reputable telemedicine companies from the others?
I see a flood of them on LinkedIn and other sites
My personal situation is that of seeking part time telepsychiatry, not more than 1-2 days a week on average. I’d prefer evaluations to carrying a patient panel, if that helps you help me narrow down
Thanks
Hi Richard, thanks for the question. I’ve found that asking colleagues who work for telemed companies is one good way to screen potential jobs. If they are satisfied, that is a good sign. Ask about what they like or do not like about their current telemed job. If you are on FB, there is a telepsych group for psychiatrists and people post regularly asking about good companies to work for and companies to avoid. I’ve had a bunch of docs reach out to me via private message to ask for more details about my current telemed jobs. I would say to read the fine print of the job description and ask a lot of questions in the initial interview before committing to anything. It sounds like a job that does emergent/crisis assessments, psych consults or inpatient coverage would fit your desires better than an outpatient telemed clinic job. I think those short-term eval jobs are a bit harder to come by but there are definitely some out there. Good luck!
thanks for taking the time to reply; I wonder if there is a movement toward “certifying” telemedicine companies, sort of like JCAHO does with hospitals or NCQA with outpatient places.
I know I am looking for something hard to find; your thoughts are helpful.
I left my full time job in 7/2022 and kept my panel of patients for telehealth. It was a seamless transition as we had been doing some telehealth throughout the pandemic years.
Half time is 7:30-5:30 two days a week and I can purchase (expensive) medical/dental/vision insurance and still have access to my matching 401A.
The rate is in the range the OP mentioned and the work is not too challenging. In office clinicians provide coverage for our many vacations.
It has worked out well and having Thursday to Monday off every week makes it feel like I’m actually retired, even though I’m technically working half time, from our basement.
Working from home: no commute, no clothing budget, no overhead, no administrative tasks, and 30” breaks every 2.5 hours for paperwork. Easy peezy lemon squeezy.
This sounds like a great setup for you! Thanks for sharing. I agree that doing a couple of days a week of telepsych as you near retirement can be a nice transition and a way to keep some income, plus have more ownership of your time. If you want, you can even travel and work your 2 days a week from anywhere, like the beach! The savings can be significant with all the things you list that you no longer need to spend on. I have a closetful of professional clothes/shoes that I rarely use anymore.
Very informative read
I am IM and Geriatrics board certified – working 0.8 FTE as a Geriatrician faculty.
Would welcome extra income opportunity for those college fees for kids and use the extra time on hand, without loosing the one extra day i dont work for my regular job.
Please help connect me to tele medicine companies who may be able to ise my experience and expertise?
We’ll see if we can find some find some advertisers/partners to help.
Hi Zahra, I would recommend joining the physician telemedicine interest group on FB if you are on social media. People post about positions for different specialties. You may also try looking on LinkedIn and put an alert for “telemedicine” as a key word. Your IM specialty society may also have telemed job listings. I know that APA (psychiatry) sends out regular job postings if you sign up for emails or can view listings on their site so hoping you could find something similar.
Hi Dr. Alonso,
Very informative article. Can you please provide me with the contact information of the two telehealth companies you work for.
Thanks a lot,
I started full time in telemedicine in 2018 with HIMS when the outpatient practice I was working for was filing for bankruptcy. I was feeling burnt out with in person Family Medicine 8 years post-residency. I have worked for several larger telemedicine groups and am currently a full time salaried staff physician for SteadyMD. I also run my own PLLC seeing primarily ADHD patients in 3 states (current volume for about 3 years). The side business (cash pay) really brings in a nice supplemental income and is a great business model. I love treating and advocating for ADHD. Telemedicine is amazing for work life balance and I feel overall less frazzled all the time not having to commute, worry about tasks at home during a few hours in the evening, and generally seeing patients virtually is just less taxing.
I’m starting an obesity medicine practice, 100% telemedicine. Do you have any recommendations for an EHR? I’ve already been through AthenaHealth, Practice fusion, and eClinicalWorks. Thanks very much.
Thank you for breaking down the basics of telemedicine! It’s a game-changer for modern healthcare.