There are many healthcare companies and startups dabbling in the telemedicine space, and as such many telemedicine opportunities for physicians to get involved. While many physicians are interested in these jobs due to flexibility, the ability to work from home, and the potential for some alternative side income streams, telemedicine positions these days have become quite variable in what the job requirements, compensation, and liability are. As such, it’s important for physicians to know red flags to look out for, what to ask about what is required and expected of them, have a good understanding of liability and malpractice coverage both during their work and after they leave the position, and what kind of volume and compensation to expect. Below, we’ll cover the various aspects of telemedicine jobs we think are most important for physicians to be aware of before taking a telemedicine position that they are considering.
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Questions physicians should ask when considering and before accepting a telemedicine opportunity
As there are lots of things to consider before accepting a telemedicine opportunity, we will separate out questions we think that you should ask by questions about the company, responsibilities and expectations, logistics, compensation, and liability. Ask as many of them as possible to understand what you’re signing up for beforehand. We often see doctors on our online physician communities wishing they'd asked some of these prior to taking a telemedicine job. You don’t want to end up in a situation where you spend a lot of time, energy, and potentially money getting licensed in multiple states and then realize it’s not for you, or one where you only get 3 cases a year. On the other hand, asking these questions may solidify that this is the right opportunity for you. With the large variety of jobs in this space, if you do your due diligence and are persistent, we hope you find one that fits what you need!
Questions to ask about the telemedicine company
What does the telemedicine company do, what niche are they looking to fill, and what is their business model?
Telemedicine is here to stay, and plays an important role in expanding access to timely and affordable care. However, with the hundreds (thousands?) of companies innovating in the telemedicine space, every company is different about their approach towards what is safe, what is legal, who should provide what care, how to prioritize profits, what they think they should pay physicians for their expertise, and what is good medicine. While not everyone will agree on each of those things, ultimately you have to feel good about the care that you’re providing and that you’re being compensated appropriately for your expertise.
It’s important to understand the company’s mission and what their business model is before deciding if you want to be a part of it. Many physicians have mixed feelings about the role of telemedicine in certain disease states or treatment of certain conditions. For example, you may believe that certain diagnoses require an in person visit and can’t be well evaluated virtually, or you may not believe in mass prescribing of certain drugs without more thorough history and physicals or laboratory testing or imaging. Knowing how the company gets paid will offer some insight into what they will be prioritizing, and your values should be in alignment.
How long has the company been around?
Is this an established company or a startup? Having an established company offers the safety of being able to ask your colleagues about their experiences and track record, but given the demand for positions within their companies, sometimes have worse compensation or less favorable employment terms. New companies eager to recruit and with fresh investor money may offer better terms. However, while the idea of getting involved in a company at the ground level definitely has its pros and excitement, there are some significant downsides. You may not have as much volume, there is a higher likelihood that it will fail and that you wasted your time getting licensed and onboarded, and you may get stuck paying for tail insurance if the company goes under.
Who are the founders and who is in the leadership?
We are biased, of course, but we think having physician leadership in these companies is key to maintaining patient care at the top of the priority list, and to establishing safe protocols that are evidence based. Based on the feedback of members of our physician communities, many companies that don't have physicians in leadership positions may see opportunities for revenue that aren’t based on evidence based medicine or that prioritize profits over patients, which can lead to discomfort as the physician employee. Look at the founders’ background, track record, and personalities to know if these are employers you want to work for. See if they’ve set up prior telemedicine companies, and if they have and failed, see why they failed. Make sure there are no questionable activities that led the companies to have to shut down and reinvent themselves under another entity, as we’ve seen that a few times in this space.
Questions to ask about telemedicine job clinical responsibilities
What your role will be in patient care (triaging acuity, providing prescriptions, creating treatment plans)?
It’s important to understand why you’re being hired. Is your role to be the primary caregiver or to sign off on other people’s care? Is the end goal for you to come to a diagnosis, to triage who needs to go to the hospital, or to prescribe a medication? Do you feel comfortable that you will have the information you need to do the job that as being asked of you?
Who your patients will be, and how are they being referred to the platform?
Are these patients who have primary physicians or medical insurance and being referred to you for after hours coverage? Are they finding you off of the internet because they want easier access to a contraceptive, a particular weight loss drug, or another prescription? There is no right or wrong here, but you should understand what your patients will be expecting of you and whether or not you’ll feel comfortable saying no to them if they’ve paid for something that you don’t think is in their best interest medically. Asking this question will also clarify what kind of follow up they will have after your telemedicine visit.
Are you the primary person seeing the patient, or are you signing off on someone else’s work?
While many assume that they will be the person seeing the patients when they are looking for telemedicine positions, this isn’t always the case, and increasingly is becoming not the case. Many telemedicine platforms, in efforts to scale or to contain cost, employ other non-physician clinicians such as NPs or PAs to do the consultations with the patients, and have physicians on backup to answer questions or sign off on management. Make sure you feel comfortable with the liability that rests on you in these situations, understanding that you are ultimately responsible for any consequences of the care that is delivered regardless of whether or not you saw the patient. As you may not have the benefit of having a close working relationship with the other non-physician clinicians the same way that you might if you were supervising them in your clinic, you may feel less comfortable signing off on their work.
What clinical guidelines are they following?
As we know, there are many different guidelines written by different groups. You want to make sure that the guidelines the company expects you to follow are in line with the evidence based medicine that you are comfortable with.
How do you follow up on patients if necessary? Who handles the follow up with the patients you see after you're gone?
It’s important to know what happens to the patients when you sign off at the end of the day. Is there a system in place for following up on patients that you want to check in on? If you’re gone for a few weeks, is there someone else that will be monitoring them or dealing with any issues that come up? If they are going back to their primary care physician, this may be less of a concern, but as more of these platforms offer a one time service, it is important to feel comfortable with any patient safety issues that may arise as a result of your treatment recommendations, prescriptions, or follow up needs.
Are the treatment options available to you heavily influenced by the company or limited by formulary or political concerns or business relationships?
Again, we all want to practice medicine in a way that we can stand by our Hippocratic Oath. Understand what the company's business relationships and priorities are and what you are able to do and not do. Are you going to be pressured to recommend certain treatments or medications, and are they ones that you believe in? Depending on the state that you’re working in, since you may be licensed in several states, you will want to know about any politics or laws that preclude you from a treatment option you may want to recommend.
How long does the average consultation take?
It’s important that you understand how long you’ll have with each patient for several reasons. You want to know that you’ll have adequate time to treat the patient, and that you’ll be compensated adequately for that time. $30 for a consult is one thing if you’re doing a 10 minute consultation, but another if you’re doing a one hour consultation. When they quote you hourly rates, you should understand how many patients they expect that you'll see during that hour, and assess if you think you can see the number of patients you would need to to hit that target and still feel like you were practicing good medicine.
Questions to ask about telemedicine job logistics
Are the consultations synchronous or asynchronous?
This refers to whether you’ll be reviewing patient information in real time and interacting with the patient in real time (synchronous) or if they’ll be submitting information and you’ll be reviewing it separately after the fact (asynchronous). While both models usually allow you to get in touch with the patient if you need further information, the asynchronous positions generally offer more flexible schedules since you don’t need to be available at a specific time. However, these may also be roles like approving prescriptions or signing off on encounters that have been staffed by non-physician practitioners, which every physician may feel differently about as discussed above.
Do you have specific shifts or can you log on when you want?
Many physicians dream of totally flexible telemedicine platforms where they can login during their free time and have access to a neverending waitlist of patients waiting to be seen, but the reality is that this is not usually the case these days. Many of the larger established companies have regularly employed physicians or other healthcare professionals who take the vast majority of the cases in set shifts, and the per diem login people may or may not have any extra patients waiting to be seen. Remember, the company will try to make as much profit as possible, meaning that it’s in their best interest to get more work out of their employed practitioners over using one where they have to pay every time a patient is seen. They also need to ensure adequate staffing so that they’re not just relying on a physician being logged in when they need it, so may require you to sign up for shifts. Smaller or new companies may not have much patient volume yet, so you may find yourself signing up for a shift where you have to be commited to being available, but only get paid a small amount of money if you're getting paid per patient encounter.
What kind of technology do you need and will they provide it? What’s the backup if something goes wrong?
Working from home sounds great until a system goes down or your software on your home computer isn’t compatible with the company’s latest upgrade, etc. You also need to know what you require to do your job, who pays for those things, and how you get support if something goes wrong. Are there regulations about how data is stored, or any other practices that you need to be compliant with? How easy is the software they offer to navigate to find information and to complete your notes? Is there a new technology that you will have to learn to navigate?
Questions to ask about telemedicine compensation
How are you being paid, and how much?
Are you paid a salary? A monthly stipend (more common in oversight agreements for nonclincal positions or medical director positions)? Per patient seen? An hourly rate? If you have a physician advisory position in a startup telemedicine company, do you get stock options?
Compensation varies widely in these opportunities and you should make sure you’re getting a fair rate that values your expertise. We suggest that you say no to those companies that devalue your expertise because they think you just want some bonus cash, because we feel this is dangerous for both patient care and for our profession. Make sure you’re adequately compensated both for your time and the time it took for you to become a physician. Check our physician compensation databases to see what your value in this space is. Also check out our negotiation tips, tactics, and strategies to learn how to ask for your worth.
What will your tax status be?
Are you going to be paid as a 1099 contractor or a W2 employee? This will change what your obligations to them are and what your access to deductions and retirement plan contribution options for self employed income will be. Depending on your goals for a side gig, you may have a preference for one or the other. As a note, most of these positions tend to be 1099 positions.
Are there benefits?
If this is your full time gig, you’re going to want to know if there is access to a comprehensive benefits package when considering your total compensation package.
What’s the time off policy, and how many shifts are expected of me?
This is also going to vary a lot by company. The bigger the company, the more flexibility there tends to be for backup options. However, there may also be more rigid requirements as these companies need to ensure there will be physicians available when they need them. If this is not a “sign on when you want” type opportunity, understand the shift requirements and vacation policies. Some companies may not require a set schedule, but may require that you take a certain number of shifts a month.
How long are the shifts and are there any expectations of me?
For telemedicine shifts, especially those paying on an hourly basis, you should understand what volume the company is expecting from you per hour. Though they may not say you have to see ‘x’ number of patients and won’t say that you should sacrifice patient care, if you chronically are underperforming per their expectations, they may decide to stop using you. Know ahead of time whether you think their expectations are realistic.
Do you get paid more for weeknights, weekends, or holidays?
Don’t forget to ask about this. A lot of telemedicine work happens after hours and you should get compensated for taking less desirable shifts.
How many state licenses do I need, and who pays for them?
Many companies require many state licenses, which can get expensive. You’ll want to understand which states they want you to have, as well as the licensing requirements for each state. This can be a lot to manage, and many bigger companies have their own in house teams to both assist you with getting licensed and maintaining your requirements. Ideally, they also pay for your licenses. Factor in the time and money involved with this when asking for your compensation or considering whether you want to get involved.
Learn more about commonly asked for state licenses for telemedicine.
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Questions to ask about liability
Is malpractice insurance offered?
Many telemedicine companies offer some form of malpractice insurance, but not everyone. If they’re expecting you to buy your own policy, consider how many cases you’d have to see to break even on those costs. Also if they’re expecting you to use your existing policy, check with your carrier if you can.
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What type of malpractice insurance coverage is offered, and how much coverage does it give?
There are several types of malpractice insurance policies. You can read much more detail about malpractice policies for physicians here. Make sure that the coverage limits are sufficient for the states you’re practicing in. There are several group policies used by these companies that have maximum coverage limits for the group as a whole, which may be fine if there are 5 physicians but risky if there are 100 people to whom that coverage limit apply. Dig in deeper and ask lots of questions.
What happens if the company shuts down or goes bankrupt? Is there a provision in place for tail insurance or am I out on my own?
Unfortunately, this is one of the big risks of working with a startup in the telemedicine space. Ask this question and understand that you may not be in a position to enforce what you’re told. You may end up having to pay for an expensive tail insurance policy, so factor that into the risk and compensation that you demand for signing on for this work, and make sure you’re paid adequately during the time you’re doing the job.
Conclusion
While telemedicine jobs are in high demand with physicians in our communities, it’s very important to note that not all telemedicine opportunities are created equal. There are many questions you need to ask so that you understand exactly what you’re signing up for and what to expect, the liability you’re undertaking, and whether you’re being compensated appropriately. Understanding the business model and the stability of the company is important, as is feeling that you can provide clinical services in a manner that you are comfortable with.
Additional telemedicine resources
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