HomeFeaturesPros and Cons of Working in Telemedicine: An NP’s Perspective

Pros and Cons of Working in Telemedicine: An NP’s Perspective

Over the last several years, telemedicine has changed the healthcare landscape. It is estimated that there are at least 158 million telemedicine visits annually. Telemedicine is a popular benefit because it allows patients to communicate with health professionals without visiting the office. The appointments are convenient because the patient can talk to the provider by phone or video from the convenience of their home. It is also affordable for patients without health insurance who need simple treatment.

Many nurse practitioners have transitioned from working in healthcare settings to working remotely via telemedicine. Telemedicine can sound appealing to most providers, but it has many advantages and disadvantages. It can be convenient and flexible, but on the other hand, it can be frustrating to practice with limitations and specific guidelines to follow.

Pros of Working in Telemedicine

Flexible Hours

The number one appeal of working in telemedicine is the flexibility it offers. The NP can typically create their schedule and choose their work hours. If they are a full-time telemedicine provider, they need to complete 40 hours of work per week. They can do this by working four ten-hour shifts; five eight-hour shifts; or three twelve-hour shifts. This is very convenient for parents who want to be more available to their children.

For example, a telemedicine NP can be accessible early in the day when their children are awake, and then work in the evening when their children are in bed. Or if a parent works in the morning but wants to be off in the afternoon to pick up their children from school, they can do that too. Or, an NP can choose just to work weekends.

Many telemedicine platforms do not have a required minimum of hours to work. This is amazing because the NP can jump onto the platform when available, and do not have to schedule shifts ahead of time. Flexible hours are ideal for an NP with multiple jobs.

Work from Home

NPs are drawn to remote work. It is very convenient to work from home. The NP can sit at home and enjoy their morning coffee while starting to work. There is no need for long commutes and getting stuck in traffic. The NP saves a lot of wasted time driving to work and money on gas and tolls. Since the NP is home, they can easily prepare a healthy meal for lunch, instead of relying on takeout at the nearest restaurant.

If the NP has some home repairs or deliveries they need, they can be available to the workers while they are home. Working from home is also a bonus to pet owners. Their pets no longer have to spend the entire day alone.

Since the NP is location independent, they can even work while visiting family or friends out of town. I like the opportunity to work in telemedicine while I am traveling. If I have some free time, I can work a few hours and earn some “fun” money.

Not Overwhelming

Working in telemedicine offers a better work-life balance. The majority of telemedicine work is urgent care like visits or focused visits. Patients need quick, accessible care to address their acute issues. This can range from needing antibiotics for urinary tract infections, treatment for erectile dysfunction, birth control prescriptions, or even hair loss treatment. These visits tend to be quick and easy, so the NP does not feel overwhelmed addressing multiple problems per patient.

Some telemedicine platforms offer primary care services, but the patients are scheduled at 1-hour intervals as a new patient and 30-minute follow-up intervals. This is fair compared to 30-minute new patient and 15-minute follow-up appointments in some in-person practice settings. As a telemedicine provider, NPs feel free to take their time during a patient consultation.

Can Be a Side Hustle

Another benefit of working in telemedicine is that the NP does not have to work in telemedicine full-time. If they already have a full-time position but want to earn extra income, they can pick up a few telemedicine shifts in the evening or over the weekend. If the NP does not want to commit to a schedule, they can merely log in to the telemedicine portal and see some patients for as long as they want.

Since working in telemedicine is not overwhelming, as stated above, it can be an excellent option for NPs looking for a side hustle. The best part is the upfront costs are low. The NP would just need at least five state licenses to make themselves marketable. If an NP has an hour to spare before their next commitment, they can sign onto the telemedicine platform, see a few patients, and make some extra money.

As a full-time nurse practitioner, I still work telemedicine on the side. Some weeks I work no hours, while others I may work 20 hours—it varies.

Access to Convenient Care to Patients

Telemedicine is a benefit to patients because it provides easy access and care. NPs love filling the gaps in healthcare and offering convenient care to patients. Patients are very appreciative when seen on telemedicine because it takes a few minutes to get what they need.

As an NP, I enjoy working in telemedicine because the patients are grateful. They are grateful for being able to get a temporary medication refill. At the same time, their primary care provider is booked out or getting treatment for something as simple as a vaginal yeast infection. It is rewarding to help patients in such a simple way.

Additionally, there is an increase in patient satisfaction using telemedicine. Research has shown that overall patient satisfaction levels are among 98 percent. Patients view a provider’s competency and interpersonal skills through telemedicine, similar to traditional face-to-face encounters. Patients love the ease of telemedicine, over office visits that require wait times and delayed care.

Documentation is Limited

One of the main causes of burnout in NPs is documentation. Documenting every detail of a patient’s visit in the electronic health record (EHR) and all of their medical history and screenings can be burdensome to providers.

The nice thing about telemedicine is that the documentation is limited. Most telemedicine companies offer certain snippets that can be used with each type of telemedicine visit significantly decreasing the amount of time spent documenting. Since most patient visits are focused, the documentation is also focused and straightforward.

Cons of Working in Telemedicine

Working With Multiple Companies in One Platform

In telemedicine, each platform typically works with multiple companies in that one platform. So, NPs would need to be trained to work with each company. This includes the different types of medical problems being treated and the various EHR software each company utilizes. For example, the telemedicine company may support clients from a women’s health program, a weight loss program, and an urgent care program.

Each client will have different requirements, guidelines, and EHR systems. This can be overwhelming in the beginning. The NP would have to learn each system and figure out which guidelines apply to which company.

Follow Strict Practice Guidelines

One main con of working in telemedicine is that the NP has to follow strict practice guidelines. Each telemedicine practice has explicit guidelines for each company they support. So, one company may only offer a 30-day refill of medication while another company may offer a 90-day medication refill. The NP would have to know which company offers what and ensure they adhere to those guidelines.

The guidelines specify when the patient can be treated via telemedicine or must be referred to in-person evaluation. The guidelines also dictate what are first-line treatments for certain illnesses. Thus, the NP must start with the recommended medication even if the patient has a specific preference. Normally, clinicians can decide how to proceed with an in-person visit.

Unfortunately, guidelines can be restrictive. Even though I have been an NP for more than ten years, I always have to refer to the guidelines while practicing telemedicine to ensure I adhere to the requirements.

Diagnostic Limitations

Working in telemedicine has its challenges. The physical exam is limited since patients are not seen in person. Skin changes and mood can be seen on a video encounter. However, internal ear exams and lung auscultation can only be done in person. When a patient starts a telemedicine visit for a cough, the differential diagnosis for this is endless. It would be beneficial to be able to do a lung exam to see what treatment is necessary. It can be difficult to treat a patient without a full workup.

Even visual assessments can be constrained in a virtual encounter. The NP must be confident in their assessment to make an educated decision. Also, NPs cannot take blood or urine samples during the visit. This can prolong the time a diagnosis is made or encourage prescribing unnecessary antibiotics.

Per-patient Pay Structure

Telemedicine typically pays a bit lower than an in-person practice setting. Some telemedicine companies offer a pay structure where the NP is paid per patient seen. This differs from the common pay structure of a clinical setting, where NPs are paid a salary or hourly. Being paid per patient has limitations because if a telemedicine platform is not busy, the NP may only see one or two patients per hour. As a result, the total hourly rate would be low.

Synchronous (video) visits pay more than asynchronous (messaging) visits. Depending on the company, an NP can be paid $5 to $12 per asynchronous visit and $20 to $30 per synchronous visit. Sometimes an NP may only see asynchronous visits during their shift which would limit their hourly income. I prefer a guaranteed hourly pay structure because you cannot control how many patients you can see per hour via telemedicine.

Working Solo

Although some NPs may enjoy working alone, others may miss the clinical setting. First of all, no other providers are present to bounce off clinical questions with. Second of all, there are no other employees present with whom you can socialize.

Some NPs miss the outpatient or inpatient setting where they are in contact with their peers. This may be a con for full-time telemedicine NPs. After the thrill of working remotely wears off, some NPs may feel lonely working by themselves.

Subject to Audits

Most telemedicine companies audit patient charts monthly or quarterly. This is done randomly, but it is to ensure that the NP follows practice guidelines as explained above. This is a bit irritating because as an NP, I want to have the autonomy to practice how I would like. I do not like knowing that someone else will oversee my charts to ensure things are done correctly. In the beginning, expect that feedback will be given and the NP may need to change the patient’s chart or treatment plan. Once the NP has practiced with that telemedicine company, they will pass their audits with flying colors.

Sophia Khawly, MSN

Writer

Sophia Khawly is a traveling nurse practitioner from Miami, Florida. She has been a nurse for 14 years and has worked in nine different states. She likes to travel in her spare time and has visited over 40 countries.

Being a traveling nurse practitioner allows her to combine her love of learning, travel, and serving others. Learn more about Sophia at www.travelingNP.com.