Across my career, including as CMIO of Kaiser Permanente’s Colorado medical group, I’ve had a front-row seat to how remote care and technology are reshaping clinical practice. I’ve also watched many colleagues make the shift to telehealth positions seeking flexibility and an escape from hospital and clinic burnout. These siloed jobs often lead to a different kind of burnout because they can be isolating, rote, and disconnected from actual systems of care. The difference matters.
The telehealth trap nobody talks about
The promise sounds appealing: Work flexibly, set your own hours, practice medicine on your terms. The problem is that these roles are about operating a specialized retail service, not practicing medicine. They’re only prescribing erectile dysfunction medications. Or only managing GLP-1s for weight loss. Or only treating hair loss. All day, every day.
These aren’t health care jobs. They’re regulatory requirements for what are essentially e-commerce businesses that happen to need a medical license to operate.
One former colleague described it as, “I was just clicking buttons and following protocols as fast as I could… which did not really feel right, or why I went into medicine in the first place.”
Services vs. systems: Know the difference
The telehealth landscape has two fundamentally different models, and your career satisfaction depends on understanding which one you’re joining.
Single-service platforms offer narrow scope and predetermined protocols. You’re not building relationships with patients or addressing their actual health complexity. You’re executing an algorithm that doesn’t require your years of training.
Modern health systems are using telehealth as infrastructure for comprehensive care delivery. They recognize that patients don’t have single-issue health concerns and are built to treat the patient as a whole person, with a constellation of needs and concerns. These systems intrinsically attract clinicians who can address multiple problems, coordinate across conditions, and exercise real clinical judgment.
There’s a true quality of life difference between these two. Single-service roles lead to burnout fast (maybe even faster than traditional settings) because at least hospital or clinic-based medicine felt like real doctoring. System-based roles let you practice actual medicine that happens to use video and messaging as tools, not constraints.
Three non-negotiables for fulfilling telehealth roles
1. Scope of practice that respects your training
Can you practice the full breadth of your training, or are you boxed into narrow service lines?
The best roles let you see a patient for acute sinusitis, then notice their poorly controlled diabetes and actually address it. You can say “Let’s also talk about that concerning mole you mentioned” rather than “That’s outside my scope, book a different appointment.”
If the job description is essentially “prescribe a specific set of medications to patients who meet protocol criteria,” that’s not clinical practice. That’s a regulatory checkbox.
Look for platforms where you’re handling problems that genuinely require physician-level thinking, not spending your day on questions a patient education tool could answer.
2. Respect for your expertise
Does the platform trust your clinical judgment, or treat you as an interchangeable widget?
Real health systems understand that frontline clinicians need to be directly involved in the decisions that affect their work. They view doctors as partners who shape how care gets delivered, not just labor resources executing someone else’s playbook.
Look for genuine autonomy in care decisions, where your clinical insights influence how the platform evolves, and where you’re supported by rather than surveilled.
3. Technology that actually helps
The best platforms are using AI in really creative ways to handle grunt work. Agents are gathering histories, organizing records, and surfacing relevant information, so you can focus on clinical thinking that uses your training and intuition.
If you’re spending shifts chart diving, hunting through fragmented records, asking the same intake questions repeatedly, the platform isn’t using available technology well. AI should eliminate that burden.
I now work with a platform where AI gathers and organizes complete health histories before I see a patient, and even lets the patient review a summary and add context. It allows me as a provider to have a rich relationship with everyone who comes to my virtual clinic. I’m practicing at the top of my license the vast majority of my day and focused entirely on clinical decision-making. This AI infrastructure investment separates health systems from telehealth services.
Questions to ask before you sign
Get clear answers before accepting any telehealth role:
- What’s the scope of conditions I’ll be treating? (Single category = red flag)
- Am I joining a platform building a health system or operating a specialized service?
- How much autonomy do I have beyond protocol?
- What technology handles administrative burden?
- How does the platform incorporate clinician feedback?
- What does a typical shift actually look like?
Hold out for better
Telehealth, when built as part of a genuine health system rather than a narrow service line, improves access and delivers excellent care. But the industry needs to evolve beyond viewing physicians as expensive commodities to be managed and constrained.
The platforms that will succeed long-term recognize that clinicians aren’t just cogs. We’re skilled professionals who deserve roles that respect our expertise, support our judgment, and use technology to enhance rather than constrain our practice.
If you’re considering telehealth, hold out for a platform building something real: a system, not a service. Your career satisfaction depends on it.
Adam Carewe is a physician and informaticist.
