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.

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.