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Income Potential With Teladoc

Yesterday I finished a 13-hour telemedicine marathon on Teladoc to see how much can I earn on Teladoc and how many patients I could see.

118 patients and a total income of $2,798 for the day.

~$215/hour.

All this income was earned on a single telemedicine platform – Teladoc. I debated running different platforms simultaneously but as you can see, there was plenty of traffic.

I am a Family Medicine board certified physician licensed in:

  • Oregon
  • Washington
  • California

Most of my patients came from CA, followed closely by WA and very few from OR.

The day was supposed to start at 5am but checking the telemedicine app from my bed showed no patients so I snoozed until 7am.

If I kept going until 10pm then I could have seen another 25-30 patients but decided to stop because my mind was slowing down.

I saw patients from 7am until 8pm without any breaks and it didn’t feel all that stressful. I hit a tiny wall around 2pm but did some push-ups and squats and got back in the game.

I have a solid workflow when it comes to Teladoc.

Preparing for the Day

The night before I shopped for groceries to have food and coffee ready for this marathon workday.

I chopped all the veggies up the night before so I just needed to prepare some lentils and stir-fry some veggies to have my meals for the day.

I’m convinced that if you want to maximize your income on Teladoc you have to approach it systematically.

The menu:

  • organic dark roast in a french press (breakfast)
  • organic macadamia nuts (snacks)
  • red lentils with chili seasoning (lunch)
  • massive organic romaine lettuce salad with mustard/mayo (lunch)
  • organic loose-leaf green tea
  • organic corn tortilla and organic tempeh wraps x2 (snack)
  • 2 cups of organic almond yogurt (snack)
  • organic broccoli, mushroom, nutritional yeast stir-fry (dinner)
  • oven baked sweet potato fries (dinner)

What my patients didn’t know is that they were on mute while I was preparing my meals.

This actually works quite well because I find it very helpful to let patients talk as much as they need in order to feel heard.

Gadgets for Efficiency

My phone’s battery ran down to 10% twice but my laptop did well. I would just set the phone on the charger and use Siri to voice activate the calls “Dial *67….”

I had pulled out my backup laptop just in case and it was ready to go.

The home WiFi went out twice during the 13-hours but fortunately I had my cell phone’s Hotspot to use as a backup. Each episode only lasted minutes.

I could have always just completed the visits using the telemedicine app on my cell phone if I didn’t want to tether.

It was exhausting on my ears to have my bluetooth headset on for as long as I did so I switched to wired headphones for a while.

Exercises Between Patients

I love the shit out of my exercise bands and am addicted to them.

I set up all my bands to do squats, deadlifts, chest, and shoulders. I usually will mute the patient and do my exercises or do my routine while waiting for a patient to come online.

Comfort

My studio is tiny but I have about 4 different sitting/lounging areas for when I write, do telemedicine, or read. This is incredibly helpful to prevent you from feeling exhausted.

Forcing yourself to switch from chair to sofa and then to the bed is helpful to keep your muscles and joints comfortable.

By the end of the day I had a slight spasm by my left scapula and my right eye was slightly achy which is rarely happens – I suspect it was the 13 hours staring at an LED screen.

Patient Volumes

I frequently get asked on this blog if telemedicine has enough volume for physicians to earn a decent income and I the reason I did this experiment was to resolve that question.

To maximize my teladoc income I needed to see a lot of patients. But it had to be the right mix. If I saw all video patients I’d probably burn out.

I chose a Monday to do this experiment because I figured the volumes might be a little higher.

By 11:00am I had seen 39 patients ($917).

By 2:30pm I had seen 67 patients ($1,575).

By 6:00pm I had seen 96 patients ($2,256).

The Busy Times

From 7:00am-11:00am it was non-stop and I didn’t even have enough time to take a sip of water.

It was once again very busy from 6:00pm-8:00pm.

On this platform you can see patients at your own pace so I could have taken as many breaks as I wanted but the point of this experiment was to maximize my volume.

I was switching between video and telephone in the beginning but found video too cumbersome and gave it up by 2:00pm.

Slow Times on Teladoc

From 11:00am-noon and from 2:00pm-3:00pm there was a pretty decent lul with maybe just a couple of patients per hour.

It was obvious that there were doctors ready to pounce on patients because when a patient would come up on the queue, they would be snatched up immediately.

Rumor has it that this telemedicine platform pushes local patients to local doctors first before opening the visit up to out-of-state doctors who are also licensed in the patient’s state.

Average Patient Pace

For the entire 13 hours I averaged 9 patients-per-hour.

This is fairly consistent with my previous predictions and experiences. And any telemedicine platform with a decent volume should allow you to move at this pace quite easily.

Looking at the whole 13 hours I don’t feel that this pace was excessive and though I was a bit worn out, I didn’t feel burnt out.

Case Outliers

There were only 2 patients who took up a lot of time.

The first was a very nice man who wanted to vent about the medical system and we chatted a little about how price-shopping can save a family a lot of money in healthcare. That was a 12+ minute conversation.

My very last patient – the main reason I stopped for the day – was an older guy who had scabies and rightfully was a little emotionally involved with the matter. It took me 21 minutes to finish that conversation.

Income on Teladoc

Teladoc reimburses physicians $23.50 per telephone visit and $28 per video visit.

I did only 5 video visits and the rest of the 113 patients were done through telephone. I had to convert 2 of the video visits to telephone because I wasn’t able to connect with the patient.

The total income for this day was $2,798 which is more than I expected.

Had I started at 5:00am and ended by 10:00pm I suspect I would have seen ~160 patients for a total potential income of $3,700.

Even though the money is pre-tax I am planning on giving up only 15% to taxes which includes both federal and Oregon state as my 2017 income taxes demonstrated.

Income Potential

It would be very fair to say that earning $2,500 a day is quite feasible using a busy telemedicine platform granted you have the 3 state licenses which I have.

Working 3 full days a month would give you an easy income of $8,400. With the advantage here being that you can choose which 3 days you want to work.

Charting

I don’t chart as anemically as other physicians do on this platform but I don’t go overboard either. There is a balance, for sure. I want to maximize my income on Teladoc, but I don’t want to be a bad doctor – whatever that means.

Charting is the one place you can lower your risk when it comes to telemedicine and the risk we expose ourselves to proportionally decreases our income potential.

I use a combination of typing and voice dictation to complete my charting which is a very efficient way to get through patient visits quickly.

The only time I slow down is when I do a video visit and can’t type while I’m talking to the patient.

Patient Cases

Telephone visits: 115 (97%)

Video visits: 3 (3%)

URI cases: 58 patients (49%)

GU cases: 10 (8%)

Refills: 11 (9%)

GI cases: 7 (6%)

Pediatric cases (age <18): 27 (23%)

Geriatric (age >70): 0

Derm cases: 10 (8%)

Eye cases: 4 (3%)

MSK cases: 2 (2%)

Psych cases: 2 (2%)

Sent to ER: 0

Sent to UC: 4 (3%)

Work/School notes: 4

Unhappy patients: 3

Pissed off patients: 0

Failed calls: 8

Pain medication refills: 0

Interruption by nurses, pharmacy, staff: 0

Commute time to work: 0

Filling out forms for patients: 0


For the most part the patients were grateful, kind, and respectful. This is a huge career satisfied which might prevent burnout. The income potential with Teladoc is high enough that I can practice medicine the way I see fit.

If I had to generalize, the California patients were more demanding and the Washington patients were a little more likely to want antibiotics for 1.5 days of sniffles.

Most UTI and Vaginitis cases were simple but I had 2 pregnant women with likely UTI’s whom I sent to the UC.

The other 2 referrals to UC were because the patients were trying to convince me that they had PNA’s and needed antibiotics. I didn’t think they did but I also don’t prescribe antibiotics for a telephone-diagnosed PNA.

There were several patients who were upset and acted a little pissy because they didn’t get the antibiotics they requested. 2 of them hung up the phone without saying goodbye.

As for the pediatric patients, I must say that I was pleasantly surprised because the parents were mostly agreeable. I don’t treat AOM with abx without visualizing the TM and suggested to the parents to wait it out – I didn’t get a single parent pushing back.

Failed calls were patients I would call who wouldn’t pick up the phone. This telemedicine company’s procedure requires us to leave a voicemail which is tedious. 8 patients is quite a lot and I don’t get remunerated for these failed visits which lowers my income potential.

Prescriptions

No Rx: 57 (48%)

Antibiotics: 36 (59% of all Rx given)

Refills: 11 (18%)

Sinus infections, UTI, Conjunctivitis, and Vaginitis were pretty much the only cases for which I prescribed antibiotics.

I pick my battles wisely when it comes to antibiotic stewardship. I can’t sleep well at night without letting the patient know that they don’t need the antibiotic. I also can’t let myself get burnt out by battling 49% of the patients.

Software & System Glitches

Overall everything worked quite well. Far smoother than seeing the same number of patients in an Urgent Care F2F.

Teladoc’s platform performed reliably and only left me hanging for 60 seconds. I closed the window, opened a new one and it was fixed.

I had only 1 pharmacy issue because the patient thought they were getting an antibiotic and so the pharmacy team reached out to me via email and I addressed it.

As I mentioned before, my home WiFi went out twice during this 13-hour session. Each time it went down for only minutes and I was able to use my backup method to complete the visits.

My Observations

Dealing with mothers and wives can be exhausting. Fortunately on telemedicine I can tell them that I can only talk to one person at a time.

Young adults are so much easier to deal with that jaded adults.

Community doctors are retiring in high numbers it seems. I got multiple patients who were using this telemedicine platform because their doctor had retired at the beginning of the year. I recognize the bias, of course.

Community doctors still have outdated prescribing habits. Ironically, it’s because of their clinical habits which allows this kind of income potential in telemedicine.

  • Seeing patients on 12-15 different medications is common.
  • Many patients are still given Z-packs for sniffles.
  • Lots of Cipro given for UTI’s.
  • AOM still treated with antibiotics.
  • Many pediatric patients are diagnosed with sinusitis.
  • Conjunctivitis always managed with antibiotics drops.
  • Beta blockers still used for hypertension control.

Early Retirement Lifestyle

Here is how I envision the perfect physician lifestyle. I get up in the morning and do 12-14 hours of telemedicine, earn $3,000 for the day and I will have enough to live off for at least a month.

I get to choose the days I want to work which is a huge bonus.

I don’t see any reason for a Family Medicine or Urgent Care physician to suffer inside a large medical group when this income potential is as lucrative as it is.

The income potential on Teladoc and other telemedicine platforms is enough to justify switching over if you’re not enjoying your current workflow.

I will continue to encourage my physician readers to lower their overhead, live on less, and enjoy the shit out of their life. With such a telemedicine income potential, many of us can have the kind of lifestyle many others only dream of.

Why would I work for a large medical group and earn $120-140/hour while abiding by all of their rules and exposing myself to all of that risk when I can earn $215/hour from kitchen counter?

39 replies on “Income Potential With Teladoc”

Dr. Mo,

I love your posts!

A few things: what type of exercise bands do you use?

Also, as an NP, do you think I can make good money doing exclusively per diem telemedicine even though I’m just starting my journey to financial independence? My wife and I own a small home well below our means and have one low car payment. I’m currently working 8 minutes from my house but I really don’t like internal medicine and I miss urgent care and ED, where I used to work. Would it be fairly safe to do per diem with one of these companies (I’ve emailed Oscar, do you know any others that hire NPs), if I”m not ready to retire yet (like you with your retirement 401k full and ready)?

Thanks!

I have a Black Mountain sets with grips and adjustable bands for tension.
I have a Bionic Flex which is a circular flat medium band for doing chest/light squats.
And a thick circular Lifeline, really heavy duty for doing deadlifts.

Even though there are mostly MD/DO’s doing telemedicine, it’s more likely that PA’s/NP’s will end up owning that space because physicians continually carve out more expensive lifestyles for themselves and telemedicine will always pay a little less than conventional medicine.

I think switching to Urgent Care is a great idea especially how exhausting IM can be.

Kudos for your low overhead. And yes, absolutely, I think you’ll have a higher chance of achieving financial independence sooner and more efficiently by taking on a per diem gig than you will working for the man.

Start writing these large telemedicine companies. Talk to the CMO’s and Medical Directors and let them know how good you are and what you can bring to their platform.

Every telemedicine company that I have mentioned on my blog is utilizing NP’s or PA’s in one form or another. I can’t give too much away because some of that information is internally protected so just take my word for it.

Oh and Anthony, get rid of that fucking car loan man! WTF!? (Said with a lot of Dr. Mo love)

Hey doc,

I just found this post and I appreciate the input. Any updates on income potential and sustainability?

-Fellow FP doc

It seems that telemedicine is growing and so are patient volumes. But it seems that many physicians still have their heads down and suffering in large medical group plans because of the higher income and the promise of benefits. So these telemedicine companies are bringing on PA’s and NP’s.
So I would guess that the income potential is higher.
As for sustainability, a 9-year track record of telemedicine is pretty solid and it’s the only way more technology can penetrate healthcare.

Hi Dr. I want to ask that how much does tele doc pay to psychiatrists per visit as psychiatrist visits take longer than usual visits. So a psychiatrist can only see about 4 to 5 patients per hour which does not guarantee a lucrative income ( about 90 to 100 dollar per hour)

I don’t have that information. But I would think that having your own virtual psychiatry clinic would be far more lucrative than what Teladoc is willing to pay you. Though it might be good to go on Teladoc and learn from how they do things and then set out to beat their value delivery.

Hi Dr.
Asking on behalf of a friend.
Can internists also earn such type of income on Teledoc i.e can an internist see about 9 patients per hour for 23.5 per patient as Internists visit take almost as much time as family physician visits?
Thanks in advance.

The platform is agnostic to the board certification of the specialist. That said, most providers end up seeing around 4-5 patients per hour. I think it’s unbearable to go that slow. You can accomplish so much more. Lucky for you guys, I sell a course on how to see more patients on telemedicine.

Enjoyed your blog on telemedicine. My question: does one need to be licensed in multiple states in order to work in this field?
Thank you for your reply.

Not at all. But depending on the volume of patients you want to see, it might be good to be either licensed in a high-volume state or be licensed in multiple states.

Whats the income potential for psychiatrist in telemedicine (from overseas) as US lisenced MD? Not as much as FM?

How about EM physians?

Don’t know, few psychiatrist have taken to the online space but it seems to be growing. The hourly income is certainly much lower but I’m not sure about the volume.
I would think it’s less than FM since there are many more cases that FM can handle.
EM is the same as FM since they would see the same kind of complaints.
However, moving forward into the future, it’s much more likely that we’ll see primary care moving online and less and less of the acute care stuff.

Hi dr.
Do you think that a US trained radiologist licensed in New York and Maryland make a good income on teledoc (like 400k to 500k) and quit his day job? Is the job security good?

I didn’t know teladoc has teleradiology. But I doubt you’d make anywhere near 300k doing teleradiology.
There are teleradiology companies out there where your pay might be pretty decent but don’t think it’d be anywhere near 1/2 mill.
That said, I’m sure more such opportunities are popping up and as for job security, it should be quite solid.

Greetings.
Can telephysicians on teledoc work from anywhere in the worldor is there any restriction? Can a family physician practice telemedicine on teledoc while residing in UAE and make 200k to 250k?

They generally have restrictions but I expect those restrictions to change soon. Furthermore, you have the constitutional right to your privacy which includes your location. If you want to work from China or Turkey, you can do that and Teladoc has no right to track you.
Most docs doing telemedicine can’t make even $120k because of the volumes they see. However, if you can improve your throughput then you can earn about $200/hr which should equal $400k a year. That’s exactly what I outlined in my Faster Telemedicine course.

I am a board certified family physician lisenced in CA with 5 yrs experience. I am now thinking of quitting my day job to work on teledoc.
1. Can I make as much as you made from teledoc for the rest of my life?
2. Will experience have an effect on the no. of patients I would see as I dont have much experience?
3. Is it worth quitting my day job and work on teledoc for the rest of my life?4. Will I be able to see 10 to 11 patients in an hour as CA is a high volume state?

1. Teladoc is a business, a public company. If they go out of business then that would curtail your plans. If they stay in business then yes, your income would only grow and not shrink.
2. It’s not experience, it’s practice, and having a good system as I’ve outlined in previous comments.
3. Why do you want to quit your day job? I think it’s always best to transition slowly. you can listen to my podcast on some strategies to slowly transition from full-time to per diem to telemedicine.

Can Neonatologist also work on teladoc?
If yes then what income should one expect?
Is it realistic to make 300k+ working full time on teladoc(40 hours?

You can do tons of work as a neonatologist on telemedicine!
Imagine how many patients are discharged but still have 1,001 questions and wish that they had a concierge style neo whom they could run things by.

Wow! I wish that I was a doctor. I work on the scheduling side.. and boy oh boy.. how great it sounds to be on the doctor side.. money wise that is.. I wonder if I’m too old to go for it lol! I have to work about 180 hours over the course of two weeks 7 days straight.. each week in order to make that kind of paper. Im so jealous. 😉

Indeed, the grass is always greener. But be careful what you wish for. And yes, definitely possible to go into medicine late, many of my medi school classmates at UCLA were in their 40’s.
A reductionist mentality where you pear things down to nothing but the income is why many consumers in the US are so unhappy with their lives and why so many millionaires are not fulfilled.
I’m much more fulfilled earning about $3k a month as a physician and living on $1,500 than when I spent $25k/mo and earned $24.5k/mo.

CAN GI DOCTORS WORK ON TELADOC?
CAN THEY MAKE 300K PLUS WORKING 30 HOURS A WEEK AS GI DOCTORS MAKE MOST MONEY FROM DOING PROCEDURES?

There is no place for pure gastroenterologists practicing GI on Teladoc. It will likely be something that will develop in the future. But exactly as you said, most specialists earn their money from injections and procedures and surgery and so they won’t generate that kind of income doing the same work online. Unless the GI doc wants to do general medicine work which is still the bread and butter of medicine – then it’s possible to make quite a high income.

As a gynecologist how busy are the calls.can I do on the side of my practice in the evening’s.
Do you need multiple state licenses.

I would expect to be ridiculously low. Instead of working for a company like Teladoc where you’re getting a tiny income per patient while taking all of the risk, it’s better to build out your own virtual telemedicine platform. That’s what a lot of the doctors on my website are leaning towards. You can use already existing software like doxy.me or vsee.com and you can recruit your own patients.

Do you have to be licensed in many stAtes to get a good number if patient calls ? Is income directly proportional to state licensures?

They do offer that to some physicians from time to time. But there is no policy for that. I would ask if you’ve been with them long enough.

I see that the malpractice coverage they offer is “claims made” with only a three year tail. If you are seeing peds I would think a longer tail would be needed. Have you considered what you will do about malpractice coverage when you eventually leave this position?

Most of us never “leave” per diem gigs. You essentially jump from one to the other, or do several simultaneously, and maybe eventually come back to one. Finding tail that’s longer than 3-4 years is quite rare. And that’s why my advice to telemedicine and Urgent Care doctors is to practice with a very unique model of triaging the patient first and making sure there is adequate follow up and proper dispo.
Many doctors and APC’s jump on telemedicine practicing it the same way they would in-person medicine. Which means they’ll oder meds and order tests. The problem is that once you order a medicine, a diagnosis is pretty much a guaranteed assumption and it’s hard to defend against that in the future. And once you ordered a test, if they patient doesn’t do it, you’re held liable even for that.

Thank you for this detailed overview of Teladoc. It is very helpful and informative.
Remember the saying: There are 3 kinds of people. Those who make things happen. Those who wait for things to happen and those who keep wondering what has happened. It is time to start thinking now. Which one of those 3 people your organization wants to belong to ?

Now is the time to start thinking how your organization is going to jump on the band wagon and start building the future of Telehealth and customize it for the benefit of your patients and organization and become a leader in Telehealth rather than a follower.

https://www.linkedin.com/pulse/20141130003627-176621943-telehealth-telemedicine-3-kinds-of-people/

Thanks for this blog. I did teladoc a few years ago on the side and liked it but ended up taking a full time gig in practice. I’m thinking about getting back into it as I wanna be a digital nomad(obviously not now due to covid). One of the things I never really considered was my own private telemedicine practice. You mentioned something about doxy.me in a previous post. As I am a FM trained physician, would you recommend sticking to telemedicine companies or starting your own telemedicine practice? And if I were to start my own telemedicine practice, would it be only for UC telemed cases or do people do it for chronic disease management too?

Thanks!

I like the idea of doing telemedicine for another company while you’re building your own label. I don’t see the value in seeing patients at $23 a pop indefinitely. Nor is there value in working for a company for 100/hr. There is more value and career satisfaction by building your own patient portal and custom virtual practice. I just created a course on how to start your own virtual private practice as I have done with my medical health coaching practice.

Dr. Mo,

More power to you, but it is completely mind-blowing to me that physicians are willing to take these consults at $20-$30 a pop. In my opinion it completely devalues the field and our training to work for such low pay. I am also a full-time Telephysician (Subspecialist), and I make $3000-$4000 in a 24 hr shift in a combination of base pay plus seeing less than 20 patients per day. I average around 2 patients per hour (none scheduled, all emergent calls) with each encounter taking 15 minutes on average and with the bulk coming during the day so that during a huge chunk of the 24 hr shift I am asleep and still getting paid a base hourly rate to be on-call.

Nobody in my group would be willing to see > 100 patients a day for this amount of pay. We must demand fair compensation and not be the physician always willing to do it for a “dollar less”.

I like what you’re saying here James. Demanding fair compensation is important. It’s not sustainable to see patients at $23 per visit. But one thing I like about the US economy is its potential free market design. A company can charge whatever they like and the consumer will choose how much they are willing to pay. It’s the $23/visit which is creating the value disparity which makes the more informed consumer aware that they aren’t going to get the best service for $23.
At the same time, this cheap pricing model is also a way for female physicians, burnt out physicians, or others who have been marginalized by mainstream medicine to earn some income. It’s not great income but it’s enough for them to be able to reinvent their careers and potentially leave a very toxic workplace.
If we park ourselves in such a model then, yes, that would be bad for patients and medicine. Unfortunately, in such a terrible system, such a predatory system, as is the current professional medical system, we need such avenues.
To really rethink this model of reimbursement, much like a mechanic who works on your car, you and I should be charging for the work we do after it has been done. A complex case with multiple medical issues and a potential higher risk of complications and malpractice should be charged maybe $400/visit. While someone who needs their benazepril refilled should be charged maybe $10.
The majority of these patients at Teladoc are simple, quick, urgent care style visits. I am not saying “easy” – that wouldn’t be the right descriptor. At Kaiser I was paid $120/hr for full-time work. I would see 3-5 patients per hour during that shift. That’s $30/patient – not a lot better, and often a lot more risk.
Anywho, thanks James, you brought up great points worth digesting.

Hi Dr Mo.
amazing info as always. I wanted to ask a question.
Can a UK trained GP work at Teladoc? If not then what are the requirements of working at Teladoc.
Thanks in advance.

I believe they are rolling into international markets but they have a different brand for that – I don’t recall the name but I’ve talked about it somewhere else before. To work under their Teladoc which is a US based business and is traded on the stock exchange (public company) you need to have a US medical license.

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