Telepsych, Why Has No One asked this yet?

[NeuroendoHolism]

In the forums surrounding telepsychiatry on here I have seen many of the older posts mention that "you must be licensed in the state the pt is located in, IF you are to work abroad and do telepsych sans medicare. Since generally most ppl in telepsych are working for a telepsych corp and not pp then lets say that i want to graduate and only do telepsych, which state should i get licensed in? Which telepsych company has the most power and what state is it located in?

---

Members don't see this ad.

 

[sighchiatry]

Contact all the big telepsych companies you're interested in 6 months before graduation. Get their job offers. Leverage the offers against each other. Sign with the company you like the best. They will pay for and obtain all the state licenses you need. Everything will be ready to go by the time you graduate.

 

[NeuroendoHolism]

Thank you for responding. I think how the forum goes I should post additional questions I have on the same post...
Why is telepsychiatry a 1099? I understand I'd be much more heavily taxed is this true?
Is there a site dedicated to summarizing the telepsych laws in each state?

 

[splik]

Thank you for responding. I think how the forum goes I should post additional questions I have on the same post...
Why is telepsychiatry a 1099? I understand I'd be much more heavily taxed is this true?
Is there a site dedicated to summarizing the telepsych laws in each state?

1. It isn't. There are employed jobs (W2) and there are independent contractor work (1099). Most telepsych work is IC but there are definitely employed positions as well. It depends on the work and the company/organization. While you have to pay self-employment taxes, the SS part is only for the first 128k or so of your income, and you can write off many expenses on your taxes and there are various other benefits to doing 1099 work. For many people a combination of employed (W2) and self-employed (1099) work gives you the best of both worlds in terms of benefits and tax deductions. with the new trump tax bill, even though physicians don't qualify for the benefits as many other businesses, they have deliberately incentivized self-employment over employment so it will generally work out better to be self-employed. Also if you are 1099, your compensation should reflect this as your hourly rate will be greater take take into account that they aren't paying those taxes for you.
2. the american telemedicine association Home - ATA

 

[TexasPhysician]

There are dozens of telepsych companies operating in virtually every state. They pick up contracts at various intervals, so it isn’t easy planning ahead. That said many of them will pay and help with adding state licenses.

I prefer to be an IC or owner due to added tax deductions. I find the deductions more than compensate for small additional taxes.

 

[NeuroendoHolism]

I'm very naive to all this so thank you for your input and information. With that said, (1)is telepsych work that is termed IC another way of saying you started and run this online telepsych business yourself? (2) How in god's name do you compete with the larger corps that have patient pooling and advertising for the whole country?

 

[Stagg737]

I'm very naive to all this so thank you for your input and information. With that said, (1)is telepsych work that is termed IC another way of saying you started and run this online telepsych business yourself? (2) How in god's name do you compete with the larger corps that have patient pooling and advertising for the whole country?

I'll leave #2 to the better informed, but being IC in telepsych if you work for a company does not mean you started/run it yourself. It can mean that if you're working for yourself, obtaining your own patients, etc. which I'd imagine is very difficult to do unless you have a solid patient pool and then move yourself. Most positions will be more like the idea of locums where you didn't start the company but got hired on to fill an opening as a specialist in your field. Obviously the positions aren't necessarily temporary like with locums, but it essentially means you're working a job for the company but not truly part of the company itself.

 

[mm45]

With reference to tax deductions, are people using accountants or a tax software?

 

[downwithDTB]

(2) How in god's name do you compete with the larger corps that have patient pooling and advertising for the whole country?

I imagine that you do exactly the same thing that you do when starting a private brick and mortar practice: hustle.

To get patients brick and mortar, you cold call every PCP in the area, you send flyers and you act like a human, not a big business. You offer service and quality that keeps their patients coming back to them after they refer to you. I would think that for telepsych, you would target PCPs in underserved areas and let them know that they are getting a high quality psychiatist who will return their calls and collaborate with them. You give them your cellphone number. You'll never compete with marketing to consumers, but you can compete to get referrals from desperate doctors who hate having to collaborate with big box medicine.

 

[BiscoDisco]

Anyone ever heard of overnight ER telepwych shifts? I'm a bit of a night owl and would love to do a couple of these a week if the opportunity is available.

 

[WisNeuro]

I imagine that you do exactly the same thing that you do when starting a private brick and mortar practice: hustle.

To get patients brick and mortar, you cold call every PCP in the area, you send flyers and you act like a human, not a big business. You offer service and quality that keeps their patients coming back to them after they refer to you. I would think that for telepsych, you would target PCPs in underserved areas and let them know that they are getting a high quality psychiatist who will return their calls and collaborate with them. You give them your cellphone number. You'll never compete with marketing to consumers, but you can compete to get referrals from desperate doctors who hate having to collaborate with big box medicine.

If you are in my area, and take insurance, you simply have to say that you can see a patient for an initial consultation in a timeframe <6 months and you'll probably have your panel filled in no time.

 

[jbomba]

If you are in my area, and take insurance, you simply have to say that you can see a patient for an initial consultation in a timeframe <6 months and you'll probably have your panel filled in no time.

I know this is very geographic dependent, but in your area any idea what kind of hourly rate insurance can generate seeing 2.5pts hr?

 

[WisNeuro]

I know this is very geographic dependent, but in your area any idea what kind of hourly rate insurance can generate seeing 2.5pts hr?

Not sure about the reimbursements from panels for you guys, I'm just buried in the cognitive testing codes these days. I just know that wait lists at most places are 9 months out for institutions and not much better outside of them.

 

[NeuroendoHolism]

Forgive the run on sentences, I started this post, I'm on a psych forum, I feel safe on this thread, I matter as well share with everyone why a pre-med is asking about telepsych...

I'm turning 28 before I take the MCAT this spring. Graduated with Psych and Phil 2014 and for me personally, after I decided neuroscience wasn't right, behavioral medicine wasn't right, and naturopathy DEFINITELY wasn't right I settled on medicine because I could take it anywhere in the world and really my goal IS to see as much as the world as I can before I die and frankly I LOVE the idea of making 150-250/ hr by internet while traveling the world. And I don't mean for the rest of my life but definitely when I get out of being most likely STUCK in VA for four years ie VCOM because I'm from Maryland and have a 3.3 I'm definitely going to NEED to travel. Tell me what's wrong with this, is my hobby being romanticized and my career in medicine being underutilized. Because for me 150-250 is more than I'd get anywhere in any of the countries I speak another language in plus australia and the UK. AND doing telemedicine as a PA or a NP doesn't come close to 150-250/ hr. So to me this still makes the most sense to me.

 

[FlowRate]

I'm turning 28 before I take the MCAT this spring.

Now I remember...

 

[splik]

Forgive the run on sentences, I started this post, I'm on a psych forum, I feel safe on this thread, I matter as well share with everyone why a pre-med is asking about telepsych...

I'm turning 28 before I take the MCAT this spring. Graduated with Psych and Phil 2014 and for me personally, after I decided neuroscience wasn't right, behavioral medicine wasn't right, and naturopathy DEFINITELY wasn't right I settled on medicine because I could take it anywhere in the world and really my goal IS to see as much as the world as I can before I die and frankly I LOVE the idea of making 150-250/ hr by internet while traveling the world. And I don't mean for the rest of my life but definitely when I get out of being most likely STUCK in VA for four years ie VCOM because I'm from Maryland and have a 3.3 I'm definitely going to NEED to travel. Tell me what's wrong with this, is my hobby being romanticized and my career in medicine being underutilized. Because for me 150-250 is more than I'd get anywhere in any of the countries I speak another language in plus australia and the UK. AND doing telemedicine as a PA or a NP doesn't come close to 150-250/ hr. So to me this still makes the most sense to me.

I'm not sure where you get the idea you can do telemedicine traveling the world and making 250/hr comes from. Telemedicine usually pays a lot less than in person work for obvious reasons, and there are significant limitations on work that you can provide by telemedicine to outside the country (as medicare and medicaid require that you be in the US while providing these services). There are some platforms where people pay cash to see physicians via telemedicine but the work may be sparse (i.e. most people find this difficult to get enough work unless they are multiple platforms and obtain multiple state licenses and even then its a struggle) and time differences etc will make traveling internationally and providing such services much more challenging.

Some insurance companies are starting to offer telemedicine services to patients via certain platforms because it is cheaper, i.e. that kind of reimburses much less, and they may also place restrictions on where you can be located. you may have to located/reside in a state participating in the IMLC (Interstate Medical Licensure Compact) to do this. You also have to have a good connection which may also be precluded by international travel

There are some telemedicine jobs that allow one to live abroad, but living abroad and traveling widely are quite distinct

 

[reca]

Forgive the run on sentences, I started this post, I'm on a psych forum, I feel safe on this thread, I matter as well share with everyone why a pre-med is asking about telepsych...

I'm turning 28 before I take the MCAT this spring. Graduated with Psych and Phil 2014 and for me personally, after I decided neuroscience wasn't right, behavioral medicine wasn't right, and naturopathy DEFINITELY wasn't right I settled on medicine because I could take it anywhere in the world and really my goal IS to see as much as the world as I can before I die and frankly I LOVE the idea of making 150-250/ hr by internet while traveling the world. And I don't mean for the rest of my life but definitely when I get out of being most likely STUCK in VA for four years ie VCOM because I'm from Maryland and have a 3.3 I'm definitely going to NEED to travel. Tell me what's wrong with this, is my hobby being romanticized and my career in medicine being underutilized. Because for me 150-250 is more than I'd get anywhere in any of the countries I speak another language in plus australia and the UK. AND doing telemedicine as a PA or a NP doesn't come close to 150-250/ hr. So to me this still makes the most sense to me.

It’ easy to travel as a doctor. Work locums 6 months of the year and then use that money to travel the other six months.

Put aside the logistics of making telepsych work from Costa Rica or the Maldives (licensing, internet connection, weather problems, time zone differences, prescribing). Do you really want to spend your time in a beautiful resort town in front of a computer talking to people about their psych issues?

 

[TheTravelingShrink]

Telepsychiatry from abroad is definitely possible. Here's a recent post from a community of US doctors who want to practice abroad as to how to set up a telepsychiatry private practice -

10 Tips For A Telepsychiatry Private Practice While Abroad | Hippocratic Adventures

Here are ten tips to help you build a TelePsychiatry Private Practice and live abroad

www.hippocraticadventures.com

And also, their job board has at least one telepsych company that you can work with while abroad, last time I checked.