Restarting Telemedicine

In January 2022, I started working telemedicine on the side to prepare for my 3-month sabbatical. I ended up barely working telemedicine during my sabbatical because I was pretty busy. I then quit telemedicine in October 2022, because the pay structure changed from hourly to per patient. The platform wasn’t busy enough to see several patients per hour. So instead, you were technically “on call” and someone from the telemedicine company would text you if there was a patient waiting. This didn’t match with my standard of living so I ended up resigning. 

In 2023, when I took another 3 month sabbatical, I had more free time and sort of wished I had some per diem telemedicine work available. Since I was planning on taking November and December off for the holidays, I decided to apply for telemedicine work. I liked having the option to work a few hours a week if I wanted. Plus I wanted the option to work remotely in case I decided to live abroad while waiting for my boyfriend to get his US visa.

While in Colorado, I ended up finding a good telemedicine company to work for. I did the training on the weekends and picked up a few shifts to get familiar with the platforms. This company offered a mixture of synchronous and asynchronous visits, which I liked. Sync visits are video or phone visits. Async are messaging visits. The messaging visits are when the patient completes a questionnaire regarding a certain medical topic and you review their answers, message them for any clarifications, and then prescribe the medication. 

I was trained to work with 3 different companies on the platform. Initially I was a bit annoyed because each platform has their own guidelines to follow so it was time consuming to refer to the guidelines. For example, one company wants you to give a 90 day supply of medication without further refills while another company wants you to give a 30 day supply with 1 refill. Each company also has certain snippets you have to use during the visit, so you have to make sure you send the required snippets before, during, and after the visits. Eventually you get used to it and it doesn’t take too long. 

At first I was disappointed to learn how little they pay for the async visits. Depending on the company it can range from $6-10/async visit. The video sync visits pay pretty well at $20-27/visit. Eventually, you get used to doing the async visits that it literally can take 1 minute, so $6 per 1 minute of work is not bad. 

The nice part is you can just jump online and complete async visits whenever you want. In order to complete sync visits though, you have to schedule yourself ahead of time. I usually only schedule myself when there are incentives. For instance, on the weekends during busy hours the telemedicine company offers an extra $25-50/hour to sign up for shifts. So, I would get paid that hourly rate in addition to the per visit. Often this ends up being $100/hour.

Not bad to make $100/hour while in the comfort of your home. I am usually multi-tasking by reading, watching my show, or doing housework too. And I am happy to help patients get simple treatment for basic things like a UTI, yeast infection, or acne. The patients are very grateful and nice so it can be pretty rewarding. The video visits tend to be basic cold symptoms or rash. The async visits are usually chronic medication refills, ED, UTI, birth control, or herpes. 

So far it has been nice to make an extra few thousand dollars per month working telemedicine. I have been trying to use this income as “fun money”. Treating myself to things or others I normally wouldn’t. In 2024, I plan on spending a few months in Europe with my boyfriend again, so I will be glad to have the option to work telemedicine. This is great for when I want to be productive or keep up with my skills and make some extra cash to splurge. 

Sometimes I wonder why don’t I give up in person care and just do telemedicine because it is so easy…. I think if I ever come to the point that I do not want to travel for work anymore I would just transition to telemedicine part time. 

Meeting Up with Prior Coworkers

I had worked in Bradenton, Florida on and off for 2.5 years. During that time, I became close to several of my coworkers. Clearwater, FL is a one-hour drive from Bradenton, FL. So, while I am on my current assignment, I planned a get together with some of my prior co-workers. Some of them still work at the same clinic, while others do not.

It was actually so much fun and I am glad I was able to get us together. I was impressed that 95% of the people I invited made it. There is something special about people you work/worked with. Only they can understand the good and bad times at work. We laughed the entire time, reminiscent of the past but also catching each other up with the current.

We had such a good time that everyone agreed to do it again soon. This time I may invite a few extra people. Even as a traveling nurse practitioner, I am still able to form strong connections in the workplace. Although I cant see or talk to them on a regular basis, it is still worth catching up time to time. 

Working in a New Geriatric Clinic 

I am working for a brand-new clinic in Clearwater, Florida. They just opened one month prior to me starting. They are a Medicare advantage plan clinic, seeing geriatric patients only. My orientation and training was one week long which was nice. I had a full day of EHR training which was needed. I had used this EHR before but 7 years ago. Part of the reason I decided to move forward with this assignment instead of postponing it when I was tired from my travels, was because I knew the first week I wouldn’t be seeing patients. 

I shadowed the other providers and completed HIPPA and OSHA training for the millionth time. There is only one physician at my clinic but he is really nice. I am covering a nurse practitioner that is on maternity leave. Everyone is really friendly and welcoming. The clinic itself is big, but the staff size is small. I am used to working in a similar geriatric clinic with 50 employees in one clinic vs 8 employees here. The company has multiple new clinics in the Tampa area. The company has been around for a couple of years and have other clinics throughout the USA, but they are still learning/growing. 

It has been very interesting working at a brand new clinic vs the geriatric clinic I normally work at that has been around for 30+ years. The MAs are very helpful here during the new patient visits in gathering the intake. They do half of my job by asking about the patients screenings, fall risk, ADLs, dementia screening, social/family/medical history, and medications etc. It takes them an hour to gather all of this information. This may be an issue once the clinic is busier seeing several new patients per day. So far I only see 2 new patients per day and maybe 1 or 2 follow ups. I believe in January it will be a bit busier, but no where as busy as what I am accustomed to. 

In the other geriatric clinic, I would often see 4-5 new patients per day and 8-10 follow ups. This clinic provides 1 hour visits for new patients and 30 minutes for follow ups which is nice. Since it hasn’t been that busy, it has given the staff time to figure things out. I am not a big fan of the EHR for this model. We are using e-clinical works here. For a patient that has 35 diagnoses and 15 medications, the EHR makes it difficult to multitask within the chart. So, if I am typing in my assessment and plan I cannot simply refer back to the labs. I would have to exit that area and click into the labs separately. This makes the documentation pretty time consuming. 

I prefer the other geriatric clinic’s EHR because it is an internal one they created, so it is very PCP friendly. Also, we have to send our consult notes to billing to review before we can sign off on them which is weird. Especially for managed care since we do not bill per encounter.

My current clinic is less strict about referrals which is nice. They do not have to be approved by management (for now). We don’t have a nurse to oversee the MAs or a social worker/case manager yet. I believe they will hire for this when the clinics get more busy. In fact, the MAs even have to process referrals since we do not have a referrals coordinator yet.

The patients have been very pleasant and not as complex as I am used to. Probably because the Clearwater, FL area has a higher socioeconomic community than other areas I have practiced (in regards to the geriatric population). 

It’s nice not being super busy, and being able to spend as much time as I want with complex patients. I think about how the other geriatric clinic has PCPs seeing 18-20 patients per day, which is crazy. I think the maximum patients per day seen with this company is 10-12. I do appreciate how well organized the other geriatric clinics are, but they’ve had decades to figure things out. Working for a newer company/clinic definitely has its challenges. 

For example, we do not have all the typical in house medications we would need yet such as Kenalog for joint injections or even lidocaine. The MAs are not IV therapy trained so if a patient needs IV fluids either the physician or I would have to start an IV, even though it has been years since either of us have done one. We don’t have an xray tech or an ECHO tech. We are just practicing at a limited capacity. 

I am enjoying my time so far, but I will see how things go to see if I would want to help them at other clinics in the future. 

My Luxurious Car Rental

As I have mentioned in the past, I always get a work rental through National. If you do not drive your own car to an assignment, the agency will provide you with a rental car for free. Even if the agency uses their own preferred rental car company, I always request that they book my rental car through National.

I love using National because you can choose from a multitude of cars off the lot, instead of just taking whatever the car company gives you. Additionally, once you rent with them for a certain amount of time, you easily become an Elite member and get free upgrades (meaning you can choose even nicer cars from the elite section). 

For my Clearwater, FL assignment I was happy to get an Audi Q3 as my rental car. My agency booked a standard rental car through National, and when I went to pick up my car, they had an Audi Q3 available in the elite section. So, I was able to upgrade to this car for free. I have always been a car person and used to have an Audi personally, before I gave it up after being a full-time locums nurse practitioner. 

I forgot how smooth yet sporty, Audis can be. It definitely makes my commutes more enjoyable and I find them to be more fun. I am grateful to be driving a car I normally would purchase on my own, but at no cost to me. Being a traveling nurse practitioner not only allows you to save on the cost of having your own car, but you can even drive luxurious cars for free! The best part is that I am not responsible for any maintenance but can drive a car of my choosing. As I have recommended many times in the past, travel NPs – use National!

Transferring DEA to Another State

Public service announcement: If you have not renewed your DEA certification since 2023, there is a new requirement that you have to complete 8 hours of controlled substance training prior to renewal. 

Something to keep in mind about being a travel NP is that you can only use your DEA certification one state/location at a time. So, after practicing in Colorado, I needed to transfer my DEA to Florida. Normally the agency I work with does this for me. However, I did it myself this time since I am working with a new agency. 

You just have to go on the DEA website and change the address of practice on file. I forgot it can take a few weeks for it to become effective. Pretty much, I had to wait for the FL DEA office to approve the transfer. 

I had already started my assignment before my DEA was active in FL. Luckily, I hadn’t needed to prescribe any controlled substances yet. It took 3 weeks for my DEA to become active in FL. 

I know a locums nurse practitioner that has two separate DEA certifications so that she can keep one in each state she practices. She usually goes back and forth between two states to work without much notice so this works for her. This requires two separate registrations with the DEA.

This is something to keep in mind if you are not taking any time off between assignments and plan to work in a different state right after your current assignment. 

House in Clearwater, FL

It can be a bit tricky finding short-term housing in South Florida or the Gulf Coast during winter months because a lot of snow birds book them up. Fortunately, I was able to find a 2-bedroom furnished house on furnishedfinder.com. The best part is that it is only 5 minutes from my job!

Living in a hotel for 4 months during my assignment in Colorado, I really wanted to live in an apartment or house for this assignment. The inside of the house is really pretty. It is modern and up to date. The backyard is right off a preserve. I don’t think I will spend much time there though since I spotted a black snake in my backyard the day I moved in. 

The location is great. It is close to plenty of shops, restaurants, and ten minutes from the beach. I even have a second bedroom for guests. It makes a big difference when your living space is comfortable during an assignment. It ended up costing the company about $4000/month. It is high for Florida but like I mentioned before, it is high season for mid-term rentals. 

See below for some pictures:

The Best Time to Negotiate Pay

As a traveling NP, when searching for an assignment, some agencies list the jobs and pay on their website. Keep in mind that this pay rate is not concrete. The same thing goes when a recruiter emails you a potential job and it says what the hourly pay is. Remember, everything in locum tenens is negotiable.

I usually have an hourly rate I have in mind that I will communicate to my recruiter. Then depending on how well the interview goes or how eager the site seems; I may ask for a higher rate. So, the best time to negotiate a higher pay rate is after an interview with a site, once the site makes an offer to move forward.

This is the best time because the site has made it clear that they want to move forward with you. The recruiter will do everything in their power to make sure you say “yes”. As a seasoned travel NP, you may also have multiple job offers at the same time. You can play these offers against each other to have your preferred choice match the other offer from another agency/job.

It is a disservice to yourself if you only work with one agency and are only interviewing for one job at a time. This will decrease your hourly rate potential.

I also like to keep in mind if the area is rural, then they will have a harder time finding a locum. In this case, I would ask for more per hour than is offered. On the other hand, if I interviewed with a site that I know interviewed multiple candidates in an ideal location for me, I am less likely to ask for a higher rate since I know there is a lot of competition and they may go with a provider asking for less.

Don’t forget to negotiate, negotiate, negotiate.