Why telemedicine should be a career, not a side gig [PODCAST]

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When his shifts were cut during the pandemic, he took a telemedicine job to pay the bills and ended up loving it. Suneer Chander is an emergency physician who co-wrote the article “Telemedicine as a career, not a side gig,” published on KevinMD. He makes the case that telemedicine is the most impactful public health advance to come out of the pandemic, yet most doctors treat it as weekend income instead of the career patients actually need it to be. You will hear why so few physicians work in it full time, what a day of asynchronous care in sexual health, obesity medicine, and psychiatry really looks like, and the red flags that signal a company using your license rather than respecting it. Chander argues the field needs committed clinical leaders, not moonlighters. You will hear which doctors are the best fit, the red flags to watch for, and how Chander says to weigh an offer beyond the paycheck.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. Today we welcome back Suneer Chander. He’s an emergency physician. He co-wrote the KevinMD article “Telemedicine as a career, not a side gig.” Suneer, welcome to the show.

Suneer Chander: Thank you, Kevin. Thank you for having me.

Kevin Pho: All right, so let’s start by briefly sharing your story and then jump into why you decided to share this particular article on KevinMD.

Suneer Chander: All right. So my name is Suneer Chander. I’m an emergency medicine physician and I have been practicing in the Boston area since 2003. Back in the pandemic, when the pandemic started, I got into telemedicine not because I thought I was going to love it, but more out of a sense of hustle. My emergency department had cut my shifts by 40 percent. I have kids going into college. I needed to do something in order to preserve income during that time.

What I found was that I loved it. It fit really nicely for me and solved some problems that I was having in my extended emergency medicine career. I love the fact that there is this intersection between technology, innovation of care models, and entrepreneurship, and I was so much more able to be creative in what I was doing.

I grew my state licensure from one to 51, so I am licensed across the country and in DC, and that provided me with a lot of opportunities. I was able to get jobs on multiple clinical platforms. I’ve worked as an advisor for multiple companies, and I had access to multiple leadership opportunities.

In 2023, I started the AIR Physician Academy, which stands for the All In Remote Physician Academy. It’s a career training program and a peer network of physicians who are trying to do the same thing I’m trying to do. I also help run the Network of Virtual Physicians, which is a third-party staffing solution for digital health companies.

Now, to answer your question about why I wrote that article. I’ve had an epiphany recently. I actually think that telemedicine is the most impactful public health advancement to come out of the pandemic. But to really make the most of the opportunity for patients, we really do need physicians who are committed to this space and ready to lead the work that drives quality care for patients. That won’t happen, it really won’t happen, if the doctors who enter the space are just trying to get extra income on the weekends or when they have time off. Really, what our patients deserve is people who care about the field as much as they care about the patients.

Kevin Pho: Now, from your background as an emergency medicine physician, just give us a day in the life. What type of cases and what type of patients would you see on virtual platforms?

Suneer Chander: OK, so it’s really interesting. In the beginning when I first started, what I had access to was what I think most people would understand you have access to: virtual urgent care. Treating, just trying to prevent people from long delays to go see their primary care doctor or having to go to the emergency department.

But then I was able to get involved with asynchronous types of care, where you really have no visual or audio interaction with a patient. You’re basically chatting with a patient, either in real time or back and forth with a few delays. Surprisingly, you can get a lot of information from a patient through that modality. You’re able to ask deeper questions. They’re able to answer them more quickly. And you remove this level of bias that we have, and also this level of skepticism or shame people may have about talking about private things.

So there’s a lot in sexual health. There’s a lot in obesity medicine, a lot of opportunity there. There’s a lot in psychiatry, honestly, because there’s just not enough access to care for people with mental health issues. Then there’s also really not a lot of doctors in this space, so there’s really an opportunity for us to step in and become leaders: giving telehealth companies advice, our domain expertise on how they should take care of patients, how they should think about the care that they’re delivering from a medical ethics standpoint.

That’s a muscle that a lot of these telehealth leaders who are not doctors just don’t have. It’s not that they’re not ethical, but medical ethics is something that, I don’t know, we get almost indoctrinated into during med school and residency. It’s really hard to build that muscle without going through med school and residency.

Kevin Pho: Just give us some context. You said that not many physicians do telemedicine and remote care as a full-time job, and one of the messages I read from your article was that a lot of them treat it as a side gig, and you’re trying to evolve that commitment. What are some of the numbers? What’s some of the context in terms of how many physicians, in general, do telemedicine full time, and what proportion roughly of physicians do telemedicine as a side gig? What’s some context there?

Suneer Chander: I may not have those numbers, but I think I might have some adjacent numbers, and I can give you my gestalt here. So what I do know is that there are one million physicians in the country, of which only 8 percent are licensed in three or more states. And really, in order to do telemedicine, you need to be multi-state licensed.

There are about 2,000 physicians in this country that are licensed in 20 or more states, and maybe 500 of those are licensed in 51. So just judging by those numbers, you’re looking at a very small minority of physicians that are actually engaging in telemedicine full time or part time.

The other thing that I find interesting is that two years ago, I went to a conference at HLTH. It is probably the biggest digital health conference. 12,000 people attended. Only 400 were doctors. That is telehealth. That is what I see in telehealth on a day-to-day basis. It really is an opportunity, an ocean of opportunity, for physicians to step in and really provide their expertise to these companies.

Kevin Pho: All right, so tell us about some of the barriers that are preventing physicians from doing telemedicine full time. You mentioned that one of the reasons you went into it was for that security, and as we both know, physicians generally like the security of what we call a traditional, quote-unquote, medical job, right? What are some of the barriers preventing physicians from going full time to a remote or telemedicine job? Why aren’t more physicians doing this?

Suneer Chander: I think there are three or four real reasons why people are averse to doing it. Two are definitely misconceptions. One is that you can’t make any money in it. Second is that it’s going to be boring, that I’m not going to be fulfilled. I think that’s patently false. Multiple people make plenty of money in it. Multiple people are really, really happy with their job. I personally am happier than I’ve ever been.

The other reasons are that, honestly, doctors are a little risk-averse. We’ve been prescribed a path forward and we have to stick in that box, and if we don’t, our colleagues are confused, and our parents are confused, and our friends are confused. And you do have to take a risk, and you have to trust yourself that you can get through it. But I think that’s a major barrier, that we’re kind of programmed a little bit, and I don’t mean that at all to put people down. I was like that. I was really hesitant to go into it.

And the last reason I can think of is that it is a solitary field. People want to go to work and they want to see their friends at work, they want to see their colleagues. I think the vision of a telemedicine doctor is a lonely person in their basement without any lights who is taking care of patients. It doesn’t have to be like that. In fact, I dedicate a large portion of my work to networking, to talking to other doctors in the field, developing relationships with other people.

Kevin Pho: So what kind of options are available for physicians who are interested in telemedicine work, and whereabouts would they go about finding these opportunities?

Suneer Chander: Yeah, there are plenty of options. There are different types of companies that provide different types of work. For example, there are companies that are direct-to-consumer cash-pay models. I think you’ve seen these on Super Bowl ads. You’ve seen the Ros or the Hims and Hers of the world. That’s one way to work with companies.

Another is that there are these business-to-business employer-based contracts. For instance, if there’s a company that has a large employee base that wants to provide fertility care to their employees, they may partner up with a company like Carrot Fertility. There’s that type of model.

There’s another type of model too. There’s a lot of virtual urgent care, both in that business-to-business model and in direct-to-consumer models. And then there’s insurance-based type care, whether it involves thyroid care, obesity care, HIV PrEP, pre-exposure prophylaxis. There are plenty of opportunities. I’m starting to work with a company soon that will be doing precision medicine using genetic testing to really guide what medical treatment would be the most optimal for them.

So there are plenty of options. Where do you find these options? A few ways. I think you have to dedicate some time to networking. You should go to conferences. You should put yourself out there. You should go and meet people. There are definitely opportunities on LinkedIn, and Indeed and ZipRecruiter. You should build up a knowledge base of how to understand which companies are good to work with and which companies may not know what they’re doing. That is a skill set that you’re going to need to build. But totally doable.

Kevin Pho: Are you finding that companies sometimes are shying away from physicians and hiring non-physician clinicians and advanced practice practitioners instead as a cost-savings measure? What do you see as the future for physicians in the telemedicine industry?

Suneer Chander: That’s a great question, Kevin. Yeah, there are definitely companies that will use advanced practice practitioners. I don’t think it’s the only model. I do think there are challenges in staffing a company completely with mid-level providers. There are licensure and compliance issues that are challenging there. There is supervision that needs to happen that also can be challenging. And even when a company does hire NPs or PAs, they still need physicians to supervise them.

I’d say that it’s probably a 50/50 split among telemedicine companies in how they do it. I do believe that the companies that really use APPs are having a lot of turnover. And it is a harder system for them to manage.

Kevin Pho: Now, if a physician’s listening to you now and evaluating a telemedicine option, just tell us some red flags that they should be aware of. I’m sure we’ve all heard stories about physicians’ licenses being used. I’ve heard of ADHD medicine companies just kind of using that physician license to liberally prescribe controlled substances, or physician licenses used for medical spas. What are some questions physicians need to ask to make sure that that option isn’t a red flag?

Suneer Chander: Yeah, great, Kevin, amazing. So really, first things first, I think if you’re going to step into this world, part of the reason why I wrote this article is that you need to develop some literacy around it. You need to understand the business of telemedicine, and you need to understand what the red flags are. That’s the only way you’re going to be able to stick up for yourself and stick up for your patients, really.

So, red flags that I tell people who come through our community in our career development. There are some clear ones. One, if there is some non-doctor telling you what you should or should not prescribe. If you ask them what the regulations are and how you treat patients in each state and they don’t know, they don’t care. If they have no clinical leadership on their team. There are a lot of telemedicine companies that are run by these tech bros that see the opportunity but view this as e-commerce. It is not e-commerce. It’s just a different way to practice medicine. I think that you have to be able to suss that out a little bit.

Kevin Pho: So in terms of training, and I know that you have a training program, is it necessary for physicians to go through some type of, like you said, literacy? How long does it take to become literate with the space? Is it something that they could do tomorrow? Just tell us about that transition period.

Suneer Chander: So I could tell you why we started our program. It was about two years in when I realized it. My co-founder and I had a discussion, realizing what we had been doing over the last two years and how we had worked with the wrong companies, how we trusted without verifying. And we came up with what we thought were the clear things that doctors should know, and developed a six-month program around it.

If I had all of that information upfront, it would’ve been really a lot of help. I do think you can go get this information on your own by trial and error. But we just made it so much simpler for people, and we could fast-track that information to you. It’s not hard, but it’s important.

Kevin Pho: Now, again, for those physicians interested in hearing or transitioning to a telemedicine practice model, give us a common success story that you’ve heard. What exactly would that look like? Let’s say a physician is burned out by whatever practice they’re in and considering alternative models. What’s a common success story that you see?

Suneer Chander: All right, I could tell you an example of someone who’s a psychiatrist who’s been through our program. He started off, got nationally licensed, and was able to acquire multiple clinical roles. While he’s working for those clinical roles, he offered up his domain expertise for free, got leadership positions at those companies because of that, and has now been able to be a fractional medical director, fractional CMO, and owns about five medical practices. He has doubled his income and is happier than he has ever been before professionally, not just because of his income.

Kevin Pho: And are there physicians where telemedicine maybe is not the right fit for them? I know you inferred earlier in terms of what it entails, but talk to us about some of the characteristics physicians have where telemedicine may not be the right choice for them.

Suneer Chander: Yeah, so I think there’s a path forward for everyone. But the people who get a path to success quicker, I think, generally would fit into that generalist bucket: the internal medicine, family medicine, emergency medicine doctor. Outside of that, we definitely have had specialists who go through our program. We’ve even had a cardiothoracic surgeon who’s come through our program, right?

But that cardiothoracic surgeon is also double-boarded in functional health. A lot of the specialists or proceduralists in our program are willing to learn other types of medicine. Some of them have gotten obesity medicine certified. Some of them are really interested in the longevity space, which I do believe will be the next hot thing in telemedicine. And some of them do integrative health. So there are options for people. It really depends on what interests you and what you’re willing to learn. It’s not for everybody, but it really is for people who are curious about learning new things.

Kevin Pho: We’re talking to Suneer Chander. He’s an emergency physician. Today’s KevinMD article is “Telemedicine as a career, not a side gig.” Suneer, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Suneer Chander: All right. So I’d say you should really focus on developing the skill set when you’re transitioning into a new career. I don’t think anyone should evaluate any opportunity based on income alone. There are three things in my view that compound: relationships, education, and money. And if you take all three of those into consideration, then you will be able to evaluate the opportunity better. I would say the most impactful jobs I’ve had paid me the least, but put me in front of smart people who were able to teach me a new skill set.

Kevin Pho: Suneer, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Suneer Chander: Thank you, Kevin.

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