Is There Any Money to be Made in Telehealth with EM Training?

[HemorrhagicShock]

Is anybody here doing well in the telehealth space, or do you know anyone who has cornered a high-margin telehealth niche?

I'm not looking for the obvious generalized stories ("Yea, just be an NP and push Viagra on HIMS or Roman, then swim in Lambos and Models"), but actual individualized stories or perhaps a bootstrapped business that now has a reasonable/sustainable recurring revenue. Or maybe this doc found a particularly lucrative or reliable-volume telehealth operation and continues to do it today as a main gig or per diem.

I'm afraid I can assume the answer here for the EM-trained crew, but when I see teleICU gigs paying $250-300/hr (I have EM- and IM-trained CCM friends who make these rates) it just pains me even more that EM is so few options outside of the ED to make more than $300k/year.

Is starting an N=1 telehealth practice even feasible in 2024 for an EM doc looking for an entrepreneurial effort? While the demand and market seem to be there, start-up costs and regulatory burden almost make this seem as onerous as starting a full brick-and-mortar operation.

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[RustedFox]

Hey! - An honest-to-God thread!
This place was dead.

 

[carbonizedeyesockets]

You want 300/hr for less work, less acuity, and less risk? You can’t have your cake and eat it too. If it was viable option, we’d all flock to it. There’s a reason that doesn’t happen. It’s a paying option that offers flexibility and less risk, but also less pay (But still can offer an income > 90th%ile of jobs). Not unexpected, it’s a trade off.

 

[HemorrhagicShock]

You want 300/hr for less work, less acuity, and less risk? You can’t have your cake and eat it too. If it was viable option, we’d all flock to it. There’s a reason that doesn’t happen. It’s a paying option that offers flexibility and less risk, but also less pay (But still can offer an income > 90th%ile of jobs). Not unexpected, it’s a trade off.

No disagreement there

In any market, however, there's a spread, which also applies to Telehealth hourly rates.

I was just wondering if anybody out there stumbled upon some goldmine, either by some dedicated sniping or by falling @$$ backward into it by being in the right place at the right time.

Maybe there IS some ER doc out there making $290 an hour for 2 hours a day for some niche SNF-type role.

Maybe there IS some ER doc out there that bootstrapped a solo telehealth operation only in their state for testosterone (or whatever high-volume cash problem) and can pull $200/hr

Maybe there IS some ER doc out there who was able to find enough PAs or NPs to work with them on some niche teleclinic role, and now operates a medium-rate-of-churn midlevel-driven practice for which they now skim margin and take on medical director and owner risk.

I'm looking for stories, examples, and proven pathways people have taken and want to be inspired.

I can't keep doing bedside EM, 5 more years of this and it's going to be life or death for me.

 

[carbonizedeyesockets]

No disagreement there

In any market, however, there's a spread, which also applies to Telehealth hourly rates.

I was just wondering if anybody out there stumbled upon some goldmine, either by some dedicated sniping or by falling @$$ backward into it by being in the right place at the right time.

Maybe there IS some ER doc out there making $290 an hour for 2 hours a day for some niche SNF-type role.

Maybe there IS some ER doc out there that bootstrapped a solo telehealth operation only in their state for testosterone (or whatever high-volume cash problem) and can pull $200/hr

Maybe there IS some ER doc out there who was able to find enough PAs or NPs to work with them on some niche teleclinic role, and now operates a medium-rate-of-churn midlevel-driven practice for which they now skim margin and take on medical director and owner risk.

I'm looking for stories, examples, and proven pathways people have taken and want to be inspired.

I can't keep doing bedside EM, 5 more years of this and it's going to be life or death for

It has been done for sure. I worked with a couple of guys who had started a Healthcare company providing care to nursing homes directly and via telemedicine. They expanded to outpatient care - also direct and telemedicine. They employed other docs and also PAs, NPs, and nurses. Were they making 300/hr? I have no idea, but I highly doubt the docs employed by them were.

For a number of years, they were working full-time EM hours while doing the business on the side. They have since transitioned to doing it full-time the last I heard. So, yes, it can be done. But it is not something you can just slide into. Even if they're raking it in now, they're an exception and it didnt happen overnight.

 

[The Knife & Gun Club]

I would imagine there’s ways to do it but would require some serious risk tolerance and hustle on the EM docs part.

At least I know one doc that does telemedicine for addiction medicine and does well enough for himself that he was able to scale back his EM time significantly.

Since Covid it’s been legal to do suboxone/buperenorphine via telemedicine was never allowed pre-2020. Now he has a network of referrals (mostly rural EDs) that refer to him for tele-addictions. He does the intake and writes for the initial bupe and then NPs do the long term follow up. He’ll occasionally treat other things that go along with opiate use disorder like writing for sleep meds and anxiety meds (mostly non-narcotic stuff like trazadone or atarax). He’s got a counselor who will help with home detox and can write home detox meds for new patients.

I think there’s a not insignificant amount of medio-legal risk involved but not more than practicing clinical EM since most of his care is protocols he’s written even if it’s an NPP placing the orders.

He doesn’t have a fellowship, just did some decent CME, learned on the job, and hustled for the first few years.

 

[EctopicFetus]

It’s doable a friend of mine started his own DPC which has morphed into virtual care along with it. He has moved into OUD / suboxone as well. In my opinion it can be done.. you have to sell your soul just a touch but im not sure its any worse than the moral injury we deal with working in understaffed EDs seeing patients in hallways and lacking the resources one would expect in a first world country.

My 2 cents if i had the desire. I would start up a telehealth company, pitch some DPC stuff to low wage paying organizations and offer some care there. On the side I would do medical weight loss with MOunjaro/ ozempic and do it where i can monitor labs/ side effects etc. Get them on a nutrition plan etc. Frankly those resources can be found online and you can customize this to your patients. Similarly customize a workout plan that fits into their needs and voila you are probably clearing 25-50k a month in recurring revenue working very little. I would work with a compounding pharmacy to get the meds for my patients and make some profit there as well.

There is the formula. Personally, I would avoid testosterone replacement stuff since it is a controlled substance and the risk of getting in trouble isnt low. I think you can morph yourself then into other avenues of lifestyle stuff. Botox and other injections and perhaps make a deal with a plastic surgeon and they can kick back some dough for referrals. It’s not illegal if you aren’t involving medicare/medicaid.

This is the formula as i see it and it could be very successful. You have to be agile as they next big thing will come on the market and you have to be ready to do it.

Use terms like precision medicine, functional medicine, lifestyle medicine and make all the plans unique for the individual and honestly I think you could make a total killing in the right market.

Note there are 2 plans i would run i outlined here and i would do them side by side. I think this model is 500k+ a year in income for the head doc. You are welcome. Thanks for attending my TEDtalk.

 

[gutonc]

It has been done for sure. I worked with a couple of guys who had started a Healthcare company providing care to nursing homes directly and via telemedicine. They expanded to outpatient care - also direct and telemedicine. They employed other docs and also PAs, NPs, and nurses. Were they making 300/hr? I have no idea, but I highly doubt the docs employed by them were.

For a number of years, they were working full-time EM hours while doing the business on the side. They have since transitioned to doing it full-time the last I heard. So, yes, it can be done. But it is not something you can just slide into. Even if they're raking it in now, they're an exception and it didnt happen overnight.

I'm pretty sure I know at least one of the people you're talking about (and if not, I have a med school classmate with a remarkably similar story) and that guy has been hustling hard for 25 years so definitely didn't slide into it as a "retirement" gig.

 

[Brigade4Radiant]

Yes I do telehealth I do it part time I make like 75-100k a year Amwell and various other platforms paying 35 a call for 5 min. Hims pays like 150 an hour but you need to do 12-15 calls in that time

Now trying to do glp compounded trleheslth after getting obesity certified and doing a subscription model after vetting some compound pharmacies

Liability is low as telehealth is usually all recorded

You won’t find good telehealth options through physician community forums on Facebook as they have to pay out to post on them so you get low paying ones for 8 bucks a call

 

[WhatJobDoIPick]

As with most ventures, ownership is key.

 

[cyanide12345678]

Yes I do telehealth I do it part time I make like 75-100k a year Amwell and various other platforms paying 35 a call for 5 min. Hims pays like 150 an hour but you need to do 12-15 calls in that time

Now trying to do glp compounded trleheslth after getting obesity certified and doing a subscription model after vetting some compound pharmacies

Liability is low as telehealth is usually all recorded

You won’t find good telehealth options through physician community forums on Facebook as they have to pay out to post on them so you get low paying ones for 8 bucks a call

You starting your own glp telemedicine gig?

Want to buy my website lol?