The past few weeks I have been busy testing out my various systems to see if I can generate a truly location independent income doing telemedicine. I set the balls in motion over a year ago when I wrote this post.
Why not just work at a physical location a few months a year? Dunno, that seems too easy. Why not complicate things and get some added benefits such as:
- living in a cheaper city/State in the USA
- travel without being a tourist
- live abroad during retirement
- start a business in another State
- pay lower taxes
- add an extra layer to my diversification plans
- take advantage of a weaker currency
My Travel Plans
My plans are still in the development stage. I have gotten my ticket to Spain and should be there by the time this post goes out. Getting a longer term visa is still a big problem since the common 90-day visas are prohibitive.
With more time in one location I can come to know the culture, language, and its people. Europe is high on my list, however they don’t have any reciprocity for US medical licenses so it would be a grueling process to get licensed there.
Australia and New Zealand would be easier to settle down in and still have my medical license as a backup plan in case I run into any financial trouble.
It’s important that wherever I end up, I still be able to practice medicine. I don’t want to lose my clinical skills since I barely work these days. The last time I was in an urgent care was over a month ago.
I have a few other countries in mind:
Testing My Location Independent Income Strategies
It’s not just about finding telemedicine gigs, there is more to it. I need to make sure the companies are okay with me performing the work from another country. It’s also important that the technology will work with me being overseas.
The final issue is banking and taxes. I have to make sure that I can use banks which are okay with me living abroad or at least don’t care where the fuck I live as long as I have a permanent US address.
Some companies mail me a check, most deposit it directly in my checking account, some use PayPal, and others use some random fucking payment service.
I need to be careful that neither of these companies decides to list my foreign address on any of their payments because I don’t want to deal with any headaches until I’ve had enough time to research all the laws. For now none of them will be privy to my ass being on another continent.
If I get a direct deposit then I need to transfer it from my main US checking account to an international bank account which has a US location. It gets complicated. Basically, if I start constantly withdrawing from my main US checking account while overseas then my bank has the right to close that account.
This isn’t going to be a big problem because I doubt that I will have my visa situation figured out for another few months, by which time it’ll be a new calendar year. I prefer to make tax changes with calendar changes to make tax filing simple.
If I somehow manage to get a residency in another country then I’m definitely going to see if I can contribute to a tax-deferred account in the US and to one in another country.
Thankfully the internet is far more reliable and fast in other countries which is necessary for the popular video visits.
Some apps and web-based software might not work overseas. I won’t know that until I try it out but it’s common for companies to put blocks from overseas access to prevent hacking. To get around this problem I can use a VPN which isn’t too expensive and would allow me to route through a US based location but at much lower speeds – from what I understand.
Some companies require me to make phone calls to patients. This could be a little bit of an issue, I have to factor in the cost of making a lot of long distance phone calls. Not a major hurdle but a factor nevertheless.
I’ll get into the hardware issues below, right now only KP enforces hardware security on top of their proprietary software.
My List Of Location Independent Income Sources
These are the companies which I’m working for right now. The list has dwindled down from 6 down to these 3. HealthTap got kicked to the curb because they are just scandalous and Remedy is absolutely awesome but I needed to exit the clinical role in order to pursue my consulting role with them.
Kaiser Permanente Telemedicine
This one poses a few problems. I need the following equipment in order to make it happen:
- KP issued laptop
- A secure physical router which needs to plug into a WiFi router
- A HIPAA compliant cell phone
For now I’m going to take these with me since I am hoping they will work overseas. I have spoken to my chief and on a local level we want to try this pilot to see if it’s feasible to have providers see patients from outside of the US. I am still part of another pilot program which continues to pay me handsomely for very little work.
The location independent income here will be somewhere in the $100/hour range. They make providers sign up for 5 or 10 hour shifts. I’m currently the only per diem who is given the privilege of doing telemedicine without needing to commit to F2F visits. Let’s see how long that will last.
JustAnswer Virtual Consult
This is my favorite platform to work on because it’s asynchronous. A person can post a medical question and I can reply to it at my convenience. They can reply again when it suits them and we rinse and repeat until they are satisfied with my expert opinion.
Interestingly, JA has offered to let me be an expert on their auto mechanic platform as well which is even busier than the medical platform. Now that’s diversification!
The work is easy, I log in anytime I want, no shifts assigned and I just pick off the questions which appeal to me. Each question pays somewhere around $8-20. If you take a phone call you get an extra $25.
Here is a my current standing for the month of August. I started doing questions on 8/2/2017 and today is 8/5/2017. Some questions are still ongoing so they haven’t gotten paid out yet.
Here is the breakdown of how much time I have put in each day:
8/2 – 55 minutes
8/3 – 35
8/4 – 20
8/5 – 45
That’s a total of 155 minutes = 2.5 hours. I have earned $172 for this amount of time. It’s not bad. I’m usually working on a post or hanging out at a coffee shop while doing this. I haven’t even gotten paid for any of my 8/5 visits.
I need to write a JA hack post – how to get the most out of JA. The income seems like chump change but it adds up and you can make it easy on yourself.
American Well Video Consults
Okay, I’m embarrassed to say that I never really put much effort into this one and it’s my loss. Today I went to town on AmWell and put on my clean underwear because I wanted to look presentable on video.
I logged in for only 1 hour and got 3 consults @ $60 each. I have the option of signing up for shifts as well but I prefer to use the “Ask Me” feature because I can fuck around online while I wait for a consult to come in. I then get a notification on my cell, a notification on my web browser and a loud annoying ring from the laptop – got it, there is a patient.
What really surprised me is how delightful the patients were. See, these folks use their health insurance so it’s a streamlined process. For all 3 patients I even had their medical history because they have used the system before. And all 3 were super simple. In total I spend maybe 30 minutes which includes charting and electronically sending the scripts to the pharmacy.
Patient #1: needed tx for acne
Patient #2: needed refill of HTN meds
Patient #3: needed reassurance about a rash she had
I get $60 for each patient. That’s a total of $180. The income is a 1099 so I get to write off every fucking thing possible against that income (what I love about 1099s) or I can stash it away in an Individual 401k or SEP IRA.
So How Much Could A Healthcare Professional Earn?
I could see my MD, DO, NP, PA colleagues retiring immediately or taking work breaks for a couple of months/years and traveling from country to country. With the P2P market in full bloom, one can rent a place, rent a vehicle from a neighbor, and earn a location independent income while away from home.
It depends on whether you want to work full-time while abroad or just 1-2 hours a day.
If you will be doing a minimum of 5 hours a day then I suggest contacting JA or AmWell and having them put you on the schedule. For AmWell it’s easy, they simply assign you a shift and give you a portal where you can pick up shifts. For JA they will give you faster access to questions before others if they know you will be dedicating several hours.
I would say it should be incredibly easy to pull $3,000-6,000/mo from JA and another $5,000-10,000/mo from AmWell. These are gross income numbers so you would need to account for tax. If you are going to contribute to retirement accounts then account for 30% taxes, if you aren’t then factor in 50%.
I know these ranges are broad but I should have a better idea after a couple of months living abroad and pushing each platform to the max.
If you have some money saved up already and can use that as a supplement to working just a couple of hours a day then you are set. Unless you have a very lavish lifestyle.
Doing virtual medicine for 2 hours a day with JA and AmWell should earn you somewhere around $3,000-5,000/month. Hopefully you have some passive income from your investments as well in case the market is hot and you can just enjoy the profits from your portfolio.