IM sub-speciality fellowship moonlighting

[deleted1164820]

I am planning on moonlighting when I join fellowship. I would like to take advantage mostly only on the weekends. I would be on call only on 1 in every 4th weekend. the fellowship is pretty chill and work load is very light even on work week. I can be out by 4-5 pm on weekdays as well. What would be best possible state outside of my home state of Texas which would allow me to do telemedicine moonlighting?

Has anybody has any experience on Telemedicine moonlighting?
The reason I am posting here is I would like to apply for license for the state that generously allows me to do Telemedicine. I am told some states are not that liberal in telemedicine opportunities.

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[MD46]

I did my fellowship in Texas, had ample moonlighting within the state and program allowed it. Hospitalist night shifts paid very handsomely and was pretty chill also some weekends in more rural areas with tiny hospitals paid extremely well as well. Even though not telemedicine but basically admitting and taking care of 5-6 people the whole weekend was pretty sweet.

 

[rokshana]

do check with your PD to see if you can moonlight, especially in the first year.
any time spent moonlighting does count against your duty hours.

 

[deleted1164820]

My PD has allowed all fellows to do moonlighting.

 

[deleted1164820]

I did my fellowship in Texas, had ample moonlighting within the state and program allowed it. Hospitalist night shifts paid very handsomely and was pretty chill also some weekends in more rural areas with tiny hospitals paid extremely well as well. Even though not telemedicine but basically admitting and taking care of 5-6 people the whole weekend was pretty sweet.

Which city did you do ?

 

[chessknt]

Why do telemed if you live in a populated area? Always pays less...

You'll be working nights if you want to get good moonlighting in. Ask fellows where you are going who moonlights then go ask them. They might have something set up you can work in to or at least connect you locally. There was a guy where I trained who had a whole 3 day weekend gig set up where he would fly out for the 3 days, be on call 24/7 get paid 8k, then fly back. I opted for the local option but he was willing to share it.

 

[deleted1164820]

I want to moonlight locally, but I was wondering if I can do telemedicine shifts/consultations when I can at my convenience.

 

[NotAProgDirector]

I want to moonlight locally, but I was wondering if I can do telemedicine shifts/consultations when I can at my convenience.

It depends. You must be completely off to moonlight. If you're on "home call", you cannot moonlight at the same time even if your call is relatively quiet. And you certainly can't do this while you're actually at your fellowship doing work. If it's a day off, you can do whatever you want -- assuming your program allows moonlighing.

You'll also need a full license in both the state you are moonlighting from (i.e. home) and the one the patient is in. And malpractice of course.

 

[chessknt]

I want to moonlight locally, but I was wondering if I can do telemedicine shifts/consultations when I can at my convenience.

It does exist but the rates you are going to see are going to be less than half of what you could make doing in person moonlighting.

 

[NewYorkDoctors]

If you found some private practice internists who would have you cover some acute visits or do some phone tele health visits and pay you under the table then no such moonlighting rules apply as no one will ever find out . Just saying .

 

[deleted1164820]

thanks, Good Answers all. One last question, Which state license should I sign up which I can get it faster so that I will get more telemedicine opportunities? I am based in Texas and I am expecting that its going to take a while to get Texas medical license and I need some finanicial coverage meanwhile.

 

[chessknt]

thanks, Good Answers all. One last question, Which state license should I sign up which I can get it faster so that I will get more telemedicine opportunities? I am based in Texas and I am expecting that its going to take a while to get Texas medical license and I need some finanicial coverage meanwhile.

Find the opportunity first then apply for license(s) where needed. Backwards and expensive to get random state licenses then look for something in those states.

 

[deleted1164820]

Find the opportunity first then apply for license(s) where needed. Backwards and expensive to get random state licenses then look for something in those states.

Is there any particular state that is more liberal towards Telemedicine opportunities than the other?. Since I am new to this process I am also concerned to take a license in a state which may most likely will end all the Telemedicine opportunities down the line.

 

[gutonc]

Is there any particular state that is more liberal towards Telemedicine opportunities than the other?. Since I am new to this process I am also concerned to take a license in a state which may most likely will end all the Telemedicine opportunities down the line.

States have been changing their telemed rules on a nearly weekly basis for the last 4 years. The odds of getting someone here to correctly predict the next billion dollar Powerball numbers are much higher than getting a correct, or even useful answer to your question.

As @chessknt suggested, find the opportunities, THEN get the licenses.

Personally, I think telemed on it's own is a massive waste of time and money for you. It pays poorly and the opportunities aren't all that expansive. Sure, lots of places may be looking for people, but the number of encounters is pretty small.

 

[Angler]

Has anybody has any experience on Telemedicine moonlighting?
The reason I am posting here is I would like to apply for license for the state that generously allows me to do Telemedicine. I am told some states are not that liberal in telemedicine opportunities.

You may not be looking for a meaningful experience, so this may not apply to you. After I retired (from a long career in primary care), I decided to do telemedicine to stay sharp. This was from April 2020 until mid 2021. I only had a CA license.

There was low volume, because every doc and their uncle wanted to do telemedicine. No way could anyone make a living doing it. What really made me quit was the quality of the encounters. Maybe due to Covid, but 90% of the patients wanted a Covid test (before at-home tests were available) or they wanted a work note. Then they wanted a Covid antibody test, when that became in vogue. At least there were no drug seekers; we weren't allowed to prescribe ED meds or controlled drugs.

Not for me.

 

[NotAProgDirector]

Although rules may vary by state, in general if you're located in TX and doing telehealth visits in another state, you will need licenses in both states. During the pandemic the rules were loosened, so you only needed one. But those exceptions have expired.

 

[deleted1164820]

Appreciate all the answers. Very useful information!

 

[Angler]

Find the opportunity first then apply for license(s) where needed. Backwards and expensive to get random state licenses then look for something in those states.

If you are serious about telemedicine, it's best to contact the providing company, like Teledoc, Amwell, or Plushcare to name just a few. I'm thinking that most of them are not hurting for docs, and compensation is consequently low. They will actively help with licensing. If you really want to make some bucks, you need lots of states. There is a coalition of states that have cross licensing (IMLC), which might help.

Absolutely, make sure you have malpractice paid for and that there is a tail. Telemedicine has very low risk for malpractice, but you never know.

 

[collegestud2013]

I am planning on moonlighting when I join fellowship. I would like to take advantage mostly only on the weekends. I would be on call only on 1 in every 4th weekend. the fellowship is pretty chill and work load is very light even on work week. I can be out by 4-5 pm on weekdays as well. What would be best possible state outside of my home state of Texas which would allow me to do telemedicine moonlighting?

Has anybody has any experience on Telemedicine moonlighting?
The reason I am posting here is I would like to apply for license for the state that generously allows me to do Telemedicine. I am told some states are not that liberal in telemedicine opportunities.

There seems to be still some supply/demand imbalance in telemedicine right now in that providers and health systems are getting into it a lot faster than patients; as a result pay for employed positions on a per encounter basis is still low, and volume can sometimes be low. I guess that's the price you have to pay for the convenience to work from anywhere. It's still hard for most to get the volume to make it a full time job, but if you are just doing in PRN to make some money during your time off would try going for PRN positions with the larger corporate groups like Teladoc, which will usually also cover your malpractice.

As for getting licensed in other states, would start with states with large populations to get the most volume; you already have Texas so Florida, NY, California would be the best best. I think Texas is part of the IMLC so getting licensed on other IMLC states should be easier.

Though if you want to do clinical moonlighting in fellowship, the easiest to get start would likely be in-house opportunities in your institution; for example, many have weekend hospitalist/nocturnist shifts that need coverage.