Even though we are seeing more patients per hour in the clinic than ever before, doctors still work 40-50 hours per week. The medical establishment comes up with more diagnoses and more medications and we get more work for the same pay.
Full-time telemedicine, on the other hand, has the potential to offer a much more viable quality of life for physicians. Of course, it can also save patients thousands of dollars and disincentivize the insurance-based practices we have come to adopt.
But it’s illogical to expect a physician to work 40-hour weeks doing telemedicine when the cost savings is far greater with telemedicine, regardless of what marketing campaigns try to make you believe otherwise.
Doing Telemedicine in 2023
Most direct-to-consumer telemedicine companies, such as Teladoc, expect you to see a patient for $23 for a telephone visit and $26 for a video visit. You can certainly game the system well by blowing through patients but that’s tedious and will add to burnout.
You can run your own full-time telemedicine practice by focusing on a niche topic or keep it general but offer the patient more value. Somewhere around $150 for a 30-minute visit likely will be a good start.
Some telemedicine companies are popping up which are charging more per hour for a higher quality of care. Parsely health is such an example. I haven’t checked but I doubt that they reimburse their clinician at much higher rates.
Fortunately, we are seeing more specialty-based telemedicine practices coming online. However, I don’t expect that the healthcare savings will be passed on to physicians. That’s never happened in the history of organized medicine.
Working 40 Hours Per Week Doing Telemedicine
No way is healthy or sustainable to sit at a computer screen 8 hours per day, 5-6 days per week doing anything, much less telemedicine.
Virtual visits save healthcare a lot of money. They save the patient from unnecessary travel and exposure to communicable diseases. They also prevent unnecessary interventions which are more common in an in-person visit.
So where are these savings? In the pockets of the health insurance and hospital groups. If telemedicine was built out then the CEO will get a bonus, not the doctors who staff the calls.
I’ve sat down writing this article for the past 2 hours without a single patient in my urgent care here in Pasadena, California. It’s dead. And another hour on this computer and I’ll go bananas.
If you think you can sustain working full-time telemedicine at 40 hours a week, you’ll end up like our engineering brethren. Maybe they are earning $150k-$500k a year but being stuck in front of a computer screen for that many hours, is just not sustainable long-term.
Telemedicine and Healthcare Savings
One of my patients in my private telemedicine practice needed a consult for her DIP osteoarthritis. I suggested a virtual visit which would have cost her $250 with a physician in Spain who speaks perfect English.
She decided to go to an in-person appointment instead with her regular insurance. She paid $300 out of pocket and was sold a rather expensive custom hand brace.
X-rays were also taken and even a steroid injection was offered, though fortunately refused by my patient. She still will receive a bill for the rest of the service, I’m sure.
A virtual visit incentivizes the physician to work with what they have and only recommends further testing if necessary. Often just the time between the ordered test is enough for the matter to resolve.
Full-Time Telemedicine in Primary Care
Primary care in the US is basically lab tests and prescription medications. The patient gains more weight and their diabetes worsens. Call me cynical or perhaps I’m just echoing the voices of my physician colleagues.
If telemedicine was used to its actual potential then I could offer more advice because of fewer distractions. The calls could be recorded for patients to listen to for review.
The patient doesn’t have to drive to the clinic. The clinic doesn’t need any mortar & cement, much less parking spaces, a front desk, or medical assistants. Do the math on that – where are the savings going?
4 hours per day. That’s all that a primary care physician needs to spend with today’s technology and available support to manage patients. While still earning a healthy full-time salary.
For our tax dollars, we are getting less and less. The money in circulation is inflated and my hourly urgent care rate of $120 hasn’t changed in a decade.
Poverty has risen and houseless people and those without proper support for mental health and addiction are left on the streets. The tax dollars which were supposed to support these individuals is not making it there.
Health insurance premiums and out of pocket expenses and wait times are outrageous. The disease-de-jour is often the only condition that gets all the attention while chronic care and prevention fall by the wayside.
Patients are priced out of traditional health insurance but are also getting far less in return.
Cash-Pay Telemedicine Options
But this is when cash-pay services or fee-for-service options become attractive. At this point, most health insurance plans are good for preventing major hospitalization events.
For primary care visits and urgent care appointments, the wait times are impossible. Seasonal infections are the most profitable and that’s what healthcare systems focus on.
Patients are looking to manage their chronic conditions and other acute issues by seeing clinicians who can save them money and offer them value.
It is absolutely possible for a physician, pretty much any specialty, to run a full-time telemedicine practice. It requires some creativity which means the barrier to entry is high. That’s good. That keeps reimbursement high as well.