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Location Independent Income With Telemedicine

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.

Banking

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.

Taxes

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.

Technology

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.

Full-Time Work

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.

Part-Time Work

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.

17 replies on “Location Independent Income With Telemedicine”

Very interesting, Dr. Mo. Being able to practice US based medicine in some form from just about anywhere in the world is pretty remarkable. I would say you are a trailblazer in this realm.

Have you found your way to Spain yet?

Best,
-PoF

Dr. Mo, very interesting. How does the liability side of being a telemedicine doctor work?

Anytime you are licensed to give specific advice you are liable for it. If I am licensed or unlicensed but have professional health care training and give advice to someone on the street then I am liable for it. Hence such pressures to ratify good samaritan laws.
I am following the TM scene closely and so far there doesn’t seem to have been a successful lawsuit on this platform. And we should note, telemedicine has been around since the early 90’s. We used to do it as residents if you recall – remember the mommy pager?

Ironically, as I am writing this comment reply I have another window open where I am replying to a woman about her chest pain which woke her up 2x last night and radiated to the left neck and arm. She wanted to go to a chiropractor but was advised by her husband to seek medical attention.

I always view TM as giving professional medical advice but not really diagnosing someone. However, in very obvious cases or where there is very good followup it’s quite easy to make a diagnosis and dispense the proper medication.

The TM platforms which I’m on, I have rarely had the need to prescribe any medication whatsoever. I think most patients just want medical attention but that doesn’t mean medication. Hope that helps.

A year ago I spoke to a doctor who is the urgent care docs for movie stars and high profile people in West Los Angeles. He’s based out of Beverly Hills and he’s been doing telemedicine since the early 90’s and he said he still struggles with what to do for dysuria/urgency/frequency but we both agreed that sometimes just waiting it out is perfectly fine in the suitable patient. He recalled a few odd cases but never a big miss or something dire.

AmWell is a massive platform, you don’t just see AW patients but other networks which contract through them. On weekends it seems I get a higher volume of the $60 visits but there are still plenty of $30 or $35 visits.
Just like any system you can learn to game it. I figured out that if I leave myself as “available” versus “ask me” then I get a higher volume of patients. And when I’m on “ask me” I can choose which cases I want to take ($).
Having multiple state medical licenses can help as well.

Does it work for subspecialties ?
I am a rheumatologist and I wonder if it would be possible to have enough consults just on my area of expertise.

If you are referring only to JA then I think you’ll have a smaller selection of patients at first. But if you sign on there then JA will market your specialty and so you’ll get more referrals and a higher payout per patient.

Alternatively you could build your own platform for rheumatology. With a Google Adwords campaign you could easily drive enough patients to your site who are looking to have their Rh questions answered or who want a second opinion. You don’t need to start from scratch and can have other platforms build it for you for not much money.

Or you could be the specialist for groups such as AmWell who employ specialists. There are also new telemedicine platforms popping up left and right and quite a few are targeting nice audiences (specialties).

Thanks so much for your posts. There are very informative. Do you know what the rules/laws are concerning practicing telemedicine from abroad, other than restrictions placed by the telemedicine companies themselves? Do you know if state medical boards have mentioned this in their regulations or CMS?

There is no rule or law restricting it position from practicing overseas. I am sure that they are fighting hard to enact such laws. After all, we wouldn’t want positions to earn US dollars and spend them in another country. But, neither CMS nor the medical boards have any laws regarding this. So far, the only regulations I have seen have been from the medical groups themselves and from what I have found out so far, it’s their lawyers who say it has to be so.

Dr. Mo,
Are there states where you have to have seen the patient in person first versus being able to do a first visit virtually? My current license is in Washington but I’m wondering if some states are better for telemedicine than others?

The rules and laws are incredibly hard to interpret. Each medical group hires their own lawyer and has their own take on it. But yes, some states are far more open to telemedicine while others require you to first establish a patient-doctor relationship with a patient before prescribing medications. Now, is it likely that the medical board will go after you because you prescribed a medication to a patient for a UTI, quite unlikely.
Easy states are washington and california – you can do a telephone visit and it’s more than enough. But other states might require you to do video only if you’ve never seen that patient in-person before.
Connected health curates a few rules based on state at http://www.cchpca.org/state-laws-and-reimbursement-policies.
American telemedicine is another great resource at http://www.americantelemed.org/main/policy-page/state-policy-resource-center.
But the best place is to just ask the particular telemedicine company you want to work with. Another resource might be Vsee which is a really hands-on telemedicine platform supplier to physicians. They are very informative and helpful.
I saw your website you listed, tell us a little about what you do at your clinic if you don’t mind.

Hi Dr
I am a retired psychiatrist living in Barcelona but was told by recruiters that I cannot do telepsychiatry from outside the USA.
Can you help me with how I can do it?
Muchas gracias!

It can be tough convincing telepsych companies to let you do the work from another country but some companies are likely okay with you doing it. For example, DialCare has allowed me to do telemedicine from another country because they are desperate for physicians.
Alternatively, you don’t have to tell anyone where you live and use a VPN to protect your private information but that’s a personal decision.
You could try approaching new telepsych companies who are new in this niche and trying to compete and offer them your services. There is absolutely no law against you doing this from another country.
Or, consider setting up your own and market it – use Vsee.com as your platform for $300/month which has the EHR built into it.

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