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Digital Nomad Physician

I’m surprised by how many physicians and medical students contact me on this blog to inquire about my digital nomad ways. I became a digital nomad physician in 2016 which seems appealing to other medical professionals who want to be location independent. In this post I’ll discuss what a digital nomad is and how to become a digital nomad physician. I’ll also discuss the advantages and downsides to this.

Digital nomad

A digital nomad is someone who can work from their laptop or from a cell phone and chooses to live like a nomad. They often spend a few months in each location and then move on. Their possessions are minimal and even though they might have a home base, most are essentially homeless.

The advantages of a digital nomad is that they can work and travel at the same time. Traveling, being the fetish of the century, is something these digital nomads can check off on their bucket list.

The main thing for a digital nomad is having access to a good internet connection and having a place to work from. Though many end up working full-time, being location-independent seems  priceless.

It’s rare for anyone to be a true digital nomad forever. Most eventually settle down and grow roots. They get married and have kids so that they can then get divorced and uproot themselves against their will. Ah, love!

Traveling and working

The logistics of traveling and working can become a headache after some time. If the internet goes down or you have to deal with timezones then traveling and work can quickly clash. Many digital nomad types are workaholics so they don’t mind working full-time or more as long as they have new travel destinations to explore.

Working part-time and traveling, however, is much simpler than working full-time. Especially if you can work whenever you want. This is ideal as a physician since your hourly income is rather high. The media editor or internet marketer may have to spend 60 hours online to earn $10k/month while you only have to spend 15.

Still, simple things such as the time you spend in transit can be a problem, even if you’re a physician. Maybe the apartment or hotel you stay out will be too loud. Maybe the internet connection or cell reception will cut in and out.

I was in Barcelona when I was doing a telemedicine shift and my home internet connection went down. My cell phone didn’t get reception inside the apartment but I could go outside on the public benches and use the hotspot. I went outside only to be greeted by loud kids playing in the park (as they should) and mosquitos gang-raping my face and neck.

Finishing that shift was a nightmare but, in a weird way, an adventure which I still remember fondly.

Digital Nomad Physician

If you want to get a feel for doing telemedicine while being location-independent, you can take a look at my international telemedicine tutorial which is for sale on this blog. But, don’t worry, I know parting with $15 can induce explosive diarrhea, which is why I’ll be talking about all sorts of telemedicine shit in this post. You can also check out the many other posts I have published on the topic of telemedicine and being a location-independent medical professional.

Being a digital nomad physician means that you can travel while practicing medicine. You can live in Spain in April or live in Florida in December while seeing patients from NY or AZ.

Telemedicine has been growing in the US as well as internationally. Teladoc and Doctor on Demand and American Well and Roman have been pushing this concept aggressively. I have seen patients on all 3 of these platforms and even though the function is the same, the form varies from one company to another. Choosing the right gigs is critical if you’re going to travel and work, simultaneously.

The options for a digital nomad physician are as follows:

  • become a per diem physician for multiple telemedicine companies
  • become a full-time employee at a telemedicine company
  • start your own virtual practice
  • start or run a telemedicine company
  • do healthcare consulting (I won’t discuss this in this post)

A digital nomad physician as of 2019 is either a family medicine doctor or an ER doctor or an internal medicine doctor. Pediatric, dermatology, ophthalmology, psychiatry, and radiology are coming online as well, but each has their own limitations for the time being.

To be a digital nomad physician you would want to ideally have multiple state medical licenses. You would want to have more than 1 telemedicine client so that you always have patients to see when you want to. And you would want to develop your skills on the side to eventually become a medical director or project manager in this space – if you’re so inclined.

If you’re a specialist, no matter what kind, there is definitely a niche you can fill in the telemedicine world, even if not platform exists for you yet. If you would like to brainstorm on options with me, contact me through clarity.fm and let’s set up a time to discuss strategies.

1. Per diem telemedicine

The easiest way to become a digital nomad physician is to get credentialed with a telemedicine company. There are a ton of them out there, here is a tiny list:

All these companies allow you to be as mobile as you like in the United States. You can see NY patients while you’re enjoying a zero-income tax state such as NV. Some will even allow you to live in another country. For that list and more details, refer to my international telemedicine guide.

Though some companies are okay with you living abroad while completing telemedicine visits – Oscar, DialCare, JustAnswer – most prefer that you stay stateside. Why? No good reason other than that’s how the overly conservative lawyers interpret the laws. I have a good friend in the telemedicine space who is an MD/JD and the laws can be interpreted any which way and there is absolutely no reason to keep your ass glued stateside.

I recommend being per diem because the income potential as a full-time or part-time telemedicine doctor isn’t that much sexier. And to boot, you won’t be allowed to see patients for the competition when you’re part or full-time.

2. Your own virtual practice

A lot of my colleagues are still trying to desperately go after the insurance companies and brick and mortar businesses. Nothing wrong with that but that’s definitely a 1980’s play with all the headaches you can imagine.

Sure, you could run a Medicaid factory but unless you know what you’re doing, you’ll likely face some jail time before you manage to make a profit. A Medicare practice might make more sense – starting it as a FFS and switching it to a MA plan later. At least this is more legit but you’d still have to compete for those Medicare dollars.

If you can find a niche – bald men with Peyronie’s – obese women with acne – children with atopic dermatitis – insulin dependent Type 2’s – then you can make a killing in that space. You no longer have to compete with 1,000 different telemedicine companies which are spending virtual dollars and bleeding green. You can market your own keywords and SEO optimize it to get the fattest traffic possible.

Do a Google or DuckDuckGo search for telemedicine for men and my blog will come up on the first page. That’s the power of SEO. That’s because I started talking about it when it first became a thing. You can have the same thing for “theNailSpecialist” or “PsoriasisMD”. You don’t have to be a dermatologist or orthopedist to dabble in those spaces – you just need an MD or DO degree.

Marketing your own virtual telemedicine practice can be an amazing source of income because you can charge a much higher premium for your care. You can find the kind of patients who will need you chronically and therefore is willing to stick with you long-term. Imagine a patient who pays you $100/month. Now imagine 100 of those. And now imagine the difference you’ll make in their life because all they need from you is to manage the one disease which bothers them the most.

Got other ideas, happy to discuss them with you and tease out a good business plan around it.

You can sit in any chair, on any soil, in whatever time zone you fancy, and you get to run your virtual practice from anywhere in the world. You can earn US dollars while you are spending Mexican pesos. You can live in Scotland for 6 months with a tourist visa and then fly off to Australia for 3 months – all while seeing your patients online.

Or you can click here for a massive list of telemedicine platform marketed to physicians.

3. Telemedicine medical director

There is a new space in telemedicine which hasn’t even evolved yet. In fact, very few physicians have hopped into the telemedicine space which has made it a ripe space for NP’s and PA’s. This will hurt physicians in the long-run but such is the allure of green in brick and mortar – the golden handcuffs, the aroma of wage slavery.

As more physician extenders enter this space, there will be a need for physicians to supervise these individuals. Not just that, but as telemedicine companies expand and hire more clinicians, they will need more medical directors – far more than a brick and mortar clinic.

Telemedicine hasn’t even grown large enough to include MA’s and RN’s – we’ll get there and it will get just as crowded and complicated as a brick and mortar once billing and insurance and warm handoffs and specialists all get into the picture.

If you want to carve this pretty little niche out for yourself then I suggest that you get on those weekly calls with your telemedicine company and speak up. Volunteer to help out with projects. Write copy and offer suggestions for better UI/UX.

13 replies on “Digital Nomad Physician”

I love this post- thank you for writing it!

I am just getting into telemedicine and planning on moving to another country in a few months. I am going to keep a US address through traveling mailbox but do you know if my traveling mailbox “address” will be the state in which I will pay taxes?

If you will be living abroad then you won’t have a residence in any state and so state income taxes won’t be an issue since you’ll also have a the foreign earned income exclusion (FEIE). Still, you’ll have to file a non-resident tax form which isn’t hard to do. Here is a great article on the topic because it gets a little complicated.
In a roundabout way, yes, you can use your TM address as your state of residence but your previous state may argue that and force you to prove that you are a resident of the state in which you have your TM address. This isn’t terribly hard to do if you are even borderline creative.

What specialties lend themselves well to doing telemedicine? I continue to enjoy your articles!

Right now it’s in the following order of most to least:
-family medicine
-emergency medicine
-pediatrics
-internal medicine
-radiology
-dermatology
-psychology
-psychiatry

But I suspect that a lot more specialties will go online soon. As you can imagine, an endocrinologist would be even more perfect as a telemedicine doctor than a family doc. It’s just that we are waiting for the insurers and CMS to offer the right reimbursement for those specialties when done online.

Once that happens and once direct to consumer testing becomes more prevalent, it’ll be a very interesting virtual medical scene.

I’ve looked into a number of these; they all seem to want a ton of nights and weekends, which is what I’m trying to get away from in EM. Any thoughts/suggestions?

I haven’t really seen that honestly. Most are quite flexible with their times and since more docs pick up shifts on the weekends and nights with these telemedicine companies, it’s the daytimes which are rather wide open and when the call volumes are highest. Most telemedicine companies don’t even have nights – they cut it off after 8-10pm. Weekends, yes, but the volumes on weekends is usually lower.

I love the flexibility of telemedicine.
Happy to take you through the details of how it works and which ones allow you to pick up whenever you feel like it and which ones you have to schedule ahead of time for. You can of course find all that information on this website since I’ve reviewed and worked for every single big telemedicine company out there or you can connect with me through Clarity.

Good luck

Thanks Dr. Mo. As usual, so helpful.

To set up a telemedicine practice, other than having a platform and potential patients, one would need to get malpractice coverage for the state you plan on practicing (I was going to start with part-time coverage). It seems that the telemedicine platforms allow for e-prescribing and referrals, but do you know if it’s possible to integrate lab testing? Am I missing anything?

Many states don’t require malpractice unless you are dealing with insurance companies or CMS.
I have my own telemedicine practice and don’t carry malpractice.
You can integrate anything you want using API’s. Think of API’s as little apps or extension to the base telemedicine platform. That’s why I really like VSee as I’ve written about them. Milton, the CEO, is very open-minded and can help you integrate any 3rd party API into your platform for viewing labs or images or damn near anything else you can think of.
Are you thinking about starting your own?

I am think about starting my own practice. Good to know about malpractice, although I assume that would leave me open to being sued. I experienced that in residency, so not fun…
I had started a free trial with VSee and I should revisit it and talk to someone there about all the potential functionality. Also, the fact that VSee’s CEO has the same name as my father must mean something!
Thanks

Let us know how you’re planning on marketing your TM practice, curious what you have in mind.
I think the VSee platform is awesome and you can do a lot with them.
I think the chance of a lawsuit from TM is much lower and the payouts will be much smaller. I’m not saying that you should skip it but I would build your practice first and do a few test runs before committing to a policy. Once you’re ready for that, I have some companies I can recommend.

Telemedicine is really popular in the US and healthcare consulting has been done by physicians in all countries for a long time. Working from your computer is inevitable and even here in Spain where the people are vehemently against US style healthcare, they are opting to have “telephone visits” with their doctors and they just want to get their medications as fast as possible. They want their MRI’s and xrays and CT’s. Even the doctors I talk to here, they want the same for their own family members. We know in the US that this kind of medicine, this shotgun approach, is detrimental but Europeans will have to learn it for themselves.
In the meantime, consider creating the wave instead of waiting to ride the telemedicine wave wherever you’re living. There are a lot of things you can do as a digital nomad physician.

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