We were on a call recently with a physician who told us, almost in passing, that she’d been seeing patients on a telemedicine platform for four years. She said it the way you’d mention a hobby. Then she added, before we could say anything, that of course it was just a side gig.

She’d been doing it for four years. It was her practice.

We’ve had some version of that conversation hundreds of times now. The details change. The apology doesn’t. There’s a tone physicians use when they describe work they do outside a hospital or clinic, a tone that asks, in advance, not to be taken too seriously.

What we want to talk about is the language. Side gig. Moonlighting. Supplemental income. The hustle. Those words are inherited. They come from a version of medicine where the hospital or the practice was the center of your working life, and everything else was a way to earn a little extra during residency or plug a gap between jobs. That version still exists, and there’s nothing wrong with it. It’s just not the only version, and hasn’t been for a long time.

Here’s a number we keep coming back to. Medicare telehealth visits went from about 840,000 in 2019 to 52.7 million in 2020, according to HHS. Sixty-three times more in a single year, and that’s just Medicare. It doesn’t count commercial insurance or cash pay. Yes, the pandemic kicked it off. But it’s been five years, and the volume hasn’t gone back to where it started. Patients tried this. They kept it. They aren’t going back. The infrastructure caught up. The reimbursement codes caught up. The language hasn’t.

When a physician calls her telemedicine practice a side gig, she’s not just describing a schedule. She’s putting the work, and herself, on a ladder. Real medicine is the top rung. Whatever she does on her laptop after the kids are in bed sits somewhere lower, and she’s reminding her colleagues, and herself, that she knows the difference.

The language is sticky for a reason. The hierarchy it preserves is tied to identity. A lot of us were trained inside one picture of what a physician is, the doctor who is fully inside the institution, whose place is legible to everyone. Stepping out of that picture, even partway, can feel like stepping out of the role itself. The apology in the conversation isn’t really about the work. It’s about staying inside the picture.

The cost of staying inside that picture is higher than physicians realize, and physicians aren’t the only ones paying it.

Here’s what we’ve watched. A physician decides, quietly, that she wants more remote work. She picks up some shifts. She tells herself it’s a side thing. Because it’s a side thing, she doesn’t get licensed in states she could easily be licensed in. She doesn’t learn how platforms negotiate or how contracts read. She doesn’t treat it the way she’d treat a career, because she hasn’t given herself permission to call it one. Three years later she’s still describing it apologetically, still under-licensed, still under-leveraged. Side gig framing produces side gig outcomes. The work isn’t small. The frame around it is.

The part that matters most to us, honestly, isn’t about the physician. Tens of millions of patients see a doctor on a screen every year now. The quality of that care depends, in part, on whether the physicians on the other end have decided it’s worth being good at. A physician who treats remote work as a side gig isn’t building the multi-state licensing that protects continuity, or the platform fluency that cuts down on errors, or the operational habits that make handoffs and follow-up cleaner. We believe committed physicians produce better outcomes. We don’t think that stops being true on a screen.

And here’s the part nobody is saying out loud. Like it or not, digital health is its own specialty now. It requires a whole new skillset, one that isn’t taught in medical school, residency, or fellowship. The physicians doing it well are learning it on their own time, on the job, often without anyone telling them they should be.

That’s hard to do alone. The hierarchy we’ve been talking about is enforced socially more than structurally. The hospital isn’t stopping anyone. What stops physicians is the quiet sense that the people they trained with don’t take this work seriously. Other professions figured this out long ago and built networks around the career and the life, not just the craft. Lawyers have firms and bar associations. Founders and executives have rooms like EO and YPO. Physicians have specialty societies for the medicine and not much for everything around it. When physicians treat the work as legitimate together, the language shifts faster than it does alone.

We’re not arguing that everyone should leave clinical practice. We’re not arguing that remote work is somehow better than in-person work. The argument is narrower. Physicians deserve language that lets them treat the full range of their work as legitimate from the start. And patients deserve physicians who made that decision before they showed up on the screen.

If you’ve been describing part of your work as a side gig, you don’t owe anyone a different word for it. But it’s worth asking, just once, whether the word you’re using is yours, or one you picked up from a profession that wasn’t built with your life in mind. The answer is yours. So is the language.

Suneer Chander, MD, and Takashi Nakamura, MD, are cofounders of AIR Physician Academy and board-certified emergency physicians who have built telemedicine careers of their own. Together, they have guided more than 250 physicians through the transition from traditional clinical practice to flexible, sustainable careers in virtual care, supporting physicians with multi-state licensing strategy, contract negotiation, and long-term career design.

Dr. Chander is a graduate of Boston University School of Medicine with 20 years of experience in emergency medicine. Dr. Nakamura trained at Virginia Commonwealth University and the University of Connecticut and practiced at two Level 1 trauma centers during his 12-year career. Both have practiced telemedicine since 2019 and are committed to helping physicians practice medicine on their own terms, without sacrificing the clinical work they trained for.

AIR Physician Academy is a physician-led telemedicine training program for doctors who love medicine but want more control over how they practice it. Through a structured curriculum, peer community, and expert guidance, AIR helps physicians design telemedicine careers that fit their lives. Its graduates build financially rewarding clinical practices and telehealth businesses, negotiate competitive contracts, and reclaim time and autonomy. AIR Physician Academy shares updates on LinkedIn, Instagram, and Facebook.