Changing the face of healthcare, telemedicine has been instrumental in helping to bridge the gaps in the provider shortage. Not only has it been revolutionary in breaking down geographic barriers to healthcare access for patients, but the industry is opening up unique opportunities for NPs in a variety of specialties from primary care, to psychiatry and dermatology. Working in telehealth certainly comes with some appealing benefits but as with any job, it has its disadvantages. If you’re considering applying for NP positions in telehealth, here are some factors to consider first.
If you’re looking for a career change but can’t or don’t want to leave your current place of residence for whatever reason, most telehealth positions offer you the flexibility to work from anywhere within the state you’re licensed in so long as you have a computer, webcam and microphone, and a stable internet connection.
However, you may find that your job opportunities in telehealth are limited as laws require you to be actively licensed in the states where you treat patients. Although some employers will help you obtain additional state licenses, cross licensing can be time consuming. Not only can legal issues arise due to the differing practice laws but the requirements for licensing vary from state to state. Fortunately, many boards of nursing are moving towards compact licensing for APRNs which will make it easier for providers to work in telehealth. In addition, most national telemedicine companies understand cross licensing barriers and thus avoid the issue altogether by only assigning patients to providers who are in the same state.
The hours for telehealth positions vary depending upon the employer. While some positions do require you to work part or full time and adhere to a set schedule each day (such as 8 am to 5 pm) others offer its providers to have more flexibility by allowing them to set their own clinic hours so long as the provider meets a certain number of hours per week. There are also telehealth companies that allow NPs to have an even more flexible schedule by paying on a per consultation basis. This is the most flexible option as it allows you the freedom to work as little or as much as you want. In these types of positions, you can work in telehealth while also practicing full time in order to earn supplemental income or to continue practicing as an NP will you pursue other ventures.
While you will still have responsibilities and expectations to meet as a telehealth provider, not being tied to a traditional workplace opens up the opportunity for you to work from within the comforts of your own home, which is a great way to have more of a work-life balance. There’s also something to be said for not having to deal with office drama and gossip; you’ll have some much-needed personal privacy and the opportunity to be solely focused on your practice.
By the same token, working from home does pose its own set of challenges. A chatty coworker may no longer be an issue at home but other distractions like the television, the dog or the kids can deter you. As luxurious as working from home may seem, it takes a tremendous amount of self-motivation to stay on task and not become sidetracked by your other responsibilities at home. And if you’re the type who thrives upon daily social interactions with coworkers, it can be difficult to adjust to the solidarity of working remotely.
Telehealth has a tremendous impact on wellness in that it’s convenient and accessible for patients; allowing them to see providers whom they may not otherwise have the ability to due to geographic restrictions and other barriers. Because of the convenience, you may find that patients are more engaged and have better outcomes with the treatment options and advice you give. They’re more likely to show up for their virtual follow up appointments as well as check in with you when questions arise about medications or new symptoms they’re experiencing since it’s much easier for them to do so. As a telemedicine provider, you may finally feel you’re able to practice in a way that’s more impactful and rewarding, especially when it comes to reaching underserved patient populations.
Patient Diagnosis and Treatment
Telemedicine can be very effective when diagnosing and treating minor conditions but no matter how advanced the technology becomes, at times a virtual appointment may not be enough to diagnose certain patients. Unless a patient is in an environment such as a nursing home or a telemetry unit of a hospital where you can track data like vital signs, physical examinations are limited to video conferencing. You also cannot physically touch a patient nor perform diagnostic tests to rule out certain illnesses; meaning that you will often have to use your clinical judgement to evaluate a patient’s symptoms. You must be extremely confident in your clinical judgement abilities, otherwise you may find practicing in telehealth very challenging.
Treatment plans are another obstacle in telemedicine. While there are continuous advancements being made in the technology, it will be years of quality control and testing before administering certain medications and performing procedures in telehealth is ever possible. NPs with prescribing authority can still write prescriptions for patients, however some states do have imposed restrictions on the types that can be written in telemedicine and the rules for prescribing Schedule II drugs in telehealth can be pretty complex in some states.
While you might think that telemedicine would come with a high risk for malpractice, typical visits consist of routine checkups and prescription writing, not high-risk and complex cases, so the liability is actually pretty low. Additionally, recent developments in telemedicine technology include secure video chat platforms that allow providers to take notes during their consultations. This means that telehealth providers often have better documentation, which ultimately results in less liability if something does go amiss. Though there are some malpractice insurance providers that have been slow to include coverage for telemedicine, most insurance companies do provide such.
Although liability is low for NPs, there are other regulatory barriers to telehealth; a main concern being security and privacy. Regulations vary from state to state but most require that patients be informed of the risks for potential privacy violations. In order to make telemedicine more accessible, the laws are rapidly evolving and becoming more favorable. Presumably, telehealth employers should be well aware of the of the laws at the state and federal levels, but it doesn’t hurt for you to be informed of the regulations too in order to protect yourself as well.
Equipment and Technology
Regardless of how well your patients can (or can’t) use technology, glitches during virtual appointments can happen for both patients and providers in telemedicine. This can create a plethora of problems like communication issues between you and your patient, and your job performance if the problems are recurrent. Not to mention, it can be downright frustrating. Fortunately though, many telehealth companies do have an IT department that can help you troubleshoot glitches and technical problems virtually. Most companies also promise to provide adequate training for new employees.
Working in telemedicine can be very rewarding for NPs. Not only are the compensation and benefits comparable to practicing in a traditional setting but because telemedicine providers often have follow up and consultative roles, NPs who want to work in chronic disease management, remote monitoring or health coaching have an opportunity to find real happiness in their practice while also having more work-life balance.
If you’re considering a position in telehealth, it’s important that you do your research on the companies for which your applying with. Ensure that they are a reputable organization that values its providers and stays up to date on all of the latest rules and regulations for telemedicine best practices.