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.
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:
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.
- 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.
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.
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.
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.
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.
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.
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.
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.
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?