Tele companies experience?

[dramw]

I am looking into possible teleneuro opportunities. I have contacted 1 company so far ( specialist telemed ). Would like to know if you have any experiences with any companies and if you may tell me what it’s like and if you have any recommendations. I am interested in tele-stroke or acute tele neurology positions.

For example, with the above company, they have 12 hr shifts acute inpatient and I get put into a “pod” system. Am I going to be stuck infront of a screen the whole 12 hours? What if I need an hour break for something personal? What do you usually make per shift? How many patients do you see per shift? Etc.

Thank you.

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[ProReduction]

All of the TeleNeurology companies are a hypercorporate race to the bottom. Logistics differ slightly in whether 1 hr vs 4 hr vs 12 hr shifts, base pay vs pure eat-what-you-kill, volume per hour, back-up, etc. However, all of the companies have the same modus operandi. They serve some of the worst hospitals with the worst physicians in the US and they will do anything to placate their "clients" (this is what they call the hospitals they serve . . . not "patients"). They all promise the same "less than 3 minutes to callback, less than 5 minutes to Neurologist on video 24/7/365", which has turned into every rural ER and inpatient unit in the country abusing TeleNeuro for STAT evaluation of what would usually be routine see-in-a-month outpatient issues. Physician churn is extremely high and pay is relatively stagnant. There has been a massive flood of new (mostly DO) grads entering Tele within the last 2 years which has kept salaries much lower than they otherwise would have been. Many seasoned MDs that have been doing this over the last decade are retiring in the low 40s. I have lost count of the Neurohospitalists that I know that went from burned-out in-person Neurohospitalist work to TeleNeurolgy to retired/non-clinical within only 3-4 years of going from in-person to Tele.

Just know what you are getting into before signing.

 

[Postictal Raiden]

All of the TeleNeurology companies are a hypercorporate race to the bottom. Logistics differ slightly in whether 1 hr vs 4 hr vs 12 hr shifts, base pay vs pure eat-what-you-kill, volume per hour, back-up, etc. However, all of the companies have the same modus operandi. They serve some of the worst hospitals with the worst physicians in the US and they will do anything to placate their "clients" (this is what they call the hospitals they serve . . . not "patients"). They all promise the same "less than 3 minutes to callback, less than 5 minutes to Neurologist on video 24/7/365", which has turned into every rural ER and inpatient unit in the country abusing TeleNeuro for STAT evaluation of what would usually be routine see-in-a-month outpatient issues. Physician churn is extremely high and pay is relatively stagnant. There has been a massive flood of new (mostly DO) grads entering Tele within the last 2 years which has kept salaries much lower than they otherwise would have been. Many seasoned MDs that have been doing this over the last decade are retiring in the low 40s. I have lost count of the Neurohospitalists that I know that went from burned-out in-person Neurohospitalist work to TeleNeurolgy to retired/non-clinical within only 3-4 years of going from in-person to Tele.

Just know what you are getting into before signing.

My understanding that the concept of tele-neuro (or tele-medicine for that matter) came into existence to address severe shortage in many areas of the country. However, with the proliferation of residency programs and tjr increasing # of newly-minted neurologists (many of which are interested in the neurohospitalist model), do you anticipate tele-neuro job market will saturate?

I do share your sentiment regarding how this concept has damaged our field, at least in the inpatient setting. It has turned us into a commodity for hospitals to improve their bed turnover rate and ER discharges. Consulting neurology and expecting a speedy response has never been more convenient. This is not only for stroke, but also for the most mundane inpatient consults “ie evaluate for Parkinson’s”.

 

[JumpingLumberjacksofMaine]

Here's my understanding of tele.

1) National companies that have tons of overhead from broad credentialling and thus need to have people see a ton of volume to break even (which angers hospitalists/hospitals because of the template-based stroke workup for everyone model). Sometimes there's a perverse incentive to order a ton of tests if you're paid on productivity.

2) Regional/hub-based usually academic centers doing outreach; the game here is that the transfer business is most valuable, so they're less inclined to offer follow-up rounding or non-acute services. Also may depend on using poorly paid academicians/fellows.

Neither is an indictment of the technology--it works fine for the original application (enabling the 80% of hospitals that can't have full time neuro coverage to treat strokes). It also works relatively well for most inpatient stuff, routine follow-ups etc. A few more tests get ordered, a few more transfers.

The problem is how it is organized and practiced. There's not many barriers to entry and it's tough to compare quality directly, so it's a classic commodity market--low cost wins. Which, if you're the doc, means that they have to squeeze you for productivity and keep salaries down, which is easy enough to do, since anyone with a pulse anywhere in the country can be a tele-neurologist.

 

[Hockeyfan23]

For someone who is actually working for a big telemed company currently, I do have some opinions of my own.

1) while there are of course obvious limitations to the field as there is any, I do not feel this has in any way damaged the field of neurology. I feel much gratitude servicing the “worst doctors and hospitals” (which is also not true) across the country. Most people get much benefit and joy out of my visits and level of care. The “abuse” from the ED, hospitalists is true no matter what style of practice. Whether you are in clinic or in person inpatient setting this was happening long before teleneurology. Unfortunately we live in a “anything goes” legal system in this country and every specialty will always be bombarded with things they don’t wanna see. While there are a lot of cookie cutter models, just this past week I’ve seen/diagnosed Syphilltic myelitis and NMO (granted I’m a hybrid where I do both stroke and rounding shifts). You have no shortage of fun and interesting cases and every day is different.

2) just like most businesses outside of medicine, it is very production based. There is no pressure to see any more patients than you are comfortable with. I like a higher volume personally and it makes my day go faster. I typically see 11-13 patients on stroke shift and around 30 rounding shifts. I’ll be on par to make around $500k this year. I also get full benefits, 401k, etc. Oh yea….all while working half the year. My days off I get to be with my wife and 2 yo son which is priceless. I have no obligations and don’t ever have to call headache patients back or get an insurance auth for mri etc. when I’m off I’m completely off. There is ample opportunity for bonus shifts or patients while off duty but there is no pressure from anyone to take this.

Just my $0.02. Haters gonna hate.

 

[dramw]

For someone who is actually working for a big telemed company currently, I do have some opinions of my own.

1) while there are of course obvious limitations to the field as there is any, I do not feel this has in any way damaged the field of neurology. I feel much gratitude servicing the “worst doctors and hospitals” (which is also not true) across the country. Most people get much benefit and joy out of my visits and level of care. The “abuse” from the ED, hospitalists is true no matter what style of practice. Whether you are in clinic or in person inpatient setting this was happening long before teleneurology. Unfortunately we live in a “anything goes” legal system in this country and every specialty will always be bombarded with things they don’t wanna see. While there are a lot of cookie cutter models, just this past week I’ve seen/diagnosed Syphilltic myelitis and NMO (granted I’m a hybrid where I do both stroke and rounding shifts). You have no shortage of fun and interesting cases and every day is different.

2) just like most businesses outside of medicine, it is very production based. There is no pressure to see any more patients than you are comfortable with. I like a higher volume personally and it makes my day go faster. I typically see 11-13 patients on stroke shift and around 30 rounding shifts. I’ll be on par to make around $500k this year. I also get full benefits, 401k, etc. Oh yea….all while working half the year. My days off I get to be with my wife and 2 yo son which is priceless. I have no obligations and don’t ever have to call headache patients back or get an insurance auth for mri etc. when I’m off I’m completely off. There is ample opportunity for bonus shifts or patients while off duty but there is no pressure from anyone to take this.

Just my $0.02. Haters gonna hate.

Thank you for the reply. During your shift, are you infront of your computer screen the whole 12hr shift or can you take a break, eat food, etc? If you don’t mind me asking, what is your company called and do they pay per patient?

 

[Neurogeneral]

Gotta say am not a fan of teleneurology work so far. Have been doing teleneurohospitalist part time where i do rounding consults.

My company, unlike other teleneurology companies, serves several hospitals in a very desirable region. I don’t know why this region would even need teleneurologists as there are plenty of on the ground neurologists there but I am guessing that they mostly just want to do monday to friday clinic.

Anyways, its high volume work and the patient encounters are not any quicker than my previous in-person rounding job. Very long conversations with difficult family members can still occur. My shifts are 8-9 hours long and am pretty much glued to my screen for the entirety of my shift. You got to keep shifting through EMRs cause you obviously get paged from other hospitals while rounding at others. Some hospitals expect all notes to be done very quickly. And i feel limited clinically sometimes cause i cant do a proper neuromuscular exam.

I see about 18-20 patients for an 8-9 hr shift at about $175 per hour rate.

 

[JumpingLumberjacksofMaine]

While I appreciate your comments/viewpoint, there's a difference between just throwing hater-ade out of envy and offering nuanced, constructive criticisms.

This is a new field and a new way of practicing. There are systemic issues when you roll out any innovation. Unfortunately, the systems in which we practice medicine are much more a process of evolution versus intelligent design. So there is no surprise that tele-neuro, gen 1.0 has some kinks to work out. Disruptive technologies and systems/processes that use them have to evolve together.

Most of these kinks are a result of adapting the original technology/use--acute stroke--and spreading beyond that. With acute stroke, time/reliability are the most important criteria.

The faults that we're seeing now are a result of adapting this original use to covering other things--routine new patient consults, follow-ups--situations where different criteria are important--quality, thoroughness, cost (both direct and indirect--e.g. all those tests that get ordered). The system that was created to use telemedicine emphasized speed--broad credentialling (thus high overhead) and making sure folks got off camera quickly (thus template notes) so there would never be difficulty getting someone on camera for the next acute.

But this is the same system design has caused the flaws that are VERY commonly noted with tele-neurology. And I can tell you, these are complaints that are very broadly expressed by hospitalists, administrators and even thought leaders in telemedicine.

Ultimately there will be a teleneuro 2.0 that is structured differently. It may be the same companies. I would guess not--it's very hard for companies built with one cost-structure to pivot to another (e.g., why Kodak invented digital photography but couldn't make a go of it--it's not because they were dumb or didn't realize it's potential). There's a lot of academic thinking on this topic (Clayton Christensen's The Innovator's Dilemma).

So anyways, I think the technology is good, glad teleneuro is taking off, but there is a lot of criticism about how it is being adapted, and at least some of that is based on genuine criticisms of how it is being employed vs generic brand hater-ade.