Join hosts Dr. Leo Damasco and Phoebe Gutierrez as they break down the realities of serving as a virtual medical director in telemedicine. They explore the critical differences between PC owner, medical director, and collaborating physician roles, why many doctors unknowingly become “ghost medical directors,” and practical strategies to protect your license while building sustainable oversight systems.
What if taking on a medical director role in telemedicine didn’t have to risk your license, but instead gave you clarity, proper compensation, and real impact on patient safety?
In this practical and eye-opening episode of Telemedicine Talks, Dr. Leo Damasco and Phoebe Gutierrez dive deep into one of the most requested, yet misunderstood roles in digital health: the virtual medical director. Drawing from real-world examples, enforcement cases, and Phoebe’s extensive compliance experience, they explain why many physicians are being sold “passive” roles that are anything but, and how the lack of proper structure leads to board actions and lost licenses.
They discuss:
Phoebe also shares insights from her recent blog on medical directorships and highlights current enforcement trends that every telemedicine physician needs to know.
This episode is essential listening for any physician considering or already serving in a medical director, PC owner, or collaborative role in telemedicine or digital health.
Three Actionable Takeaways:
About the Show:
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
About the Hosts:
speaker 1: [00:00:00] Hey everybody. Welcome back to telemedicine Talks. It's awesome being back. thank y'all for listening. As always, we have our host, Bibi Gutierrez, and myself, Leo de Masco. So today we wanted to talk about. One of the roles, and not necessarily, a directly clinical role, but one of the roles that a lot of the telemedicine doctors are finding and really being asked for, and it's a medical director role.
Okay. And, the brick and mortar side, you know your medical directors, they're the one that kind of runs your clinic, so forth and so on. But, a lot of these telemedicine companies are looking for medical directors. I personally think it's a great role to be in, but there's some caveats that you need to know and you need to be aware of, and some nuances, especially in the telemedicine side.
And actually, Phoebe, you put out a recent blog about this in your kind of consulting website. And I thought it was super interesting and actually Not inclusive, but complete. let's talk about [00:01:00] that. where could they find this blog, by the way?
speaker 2: Oh, yeah.
Camino strategy group.com resources . But one of the things that is bubbling up and I always like to try to. Really make people understand what it means to be a virtual medical director. Because, you know, Leo, to your point, there's a lot of doctors who will take on these roles and not quite understand what it entails, and they're kind of told like, oh, it's a passive role.
Don't worry about it. I don't need you to shut in . And really what, I spent a lot of time on was kind of going. Through like different states that are actually like sanctioning physicians taking licenses away, really kind of coming down hard on these, what they're calling like ghost medical directors.
And so to me, I always find it funny because everybody always, goes back to like, well, the regulations say I have to do this. And I'm like common sense says that you should probably do it this way as well as, meeting those requirements. But it's been a really [00:02:00] interesting kind of dynamic to understand that you have all these physicians so worried about compliance, jumping into these roles and then not actually realizing what they're doing.
speaker 1: No, and it's super interesting. you know, early on in this telemedicine journey, mine right There has been a lot of us, myself included, that have been , approached by startups, by companies, right? That saying, Hey we are looking for medical director, shoot, you go on LinkedIn, right?
And you type in medical director, telehealth, and there's a whole bunch of opportunities out there. But after having conversations with these companies and these CEOs and these founders of these companies. They don't necessarily really fully understand what a medical director is, or when they tell you, hey, what they expect from it, it really doesn't fit the bill and that could get you in trouble.
Again, a lot of them just selling it as, Hey, it doesn't take much time. this is what we do and really it's not gonna take much of your time. And that's not true. So what is the [00:03:00] role of medical director and how is that different from a PC owner?
speaker 2: Yeah, that great questions. Great question. So I think the way that I like to make people think about it is that just because you're doing things virtually, so just imagine like as a telemedicine physician, you have to meet standard of care and all of those things state by state.
Being a virtual medical director is the same thing. When you have a brick and mortar medical director, you're on site, you're making sure that there's protocols, you're making sure that care is being delivered the right way. You're checking in with staff. if something were, let's say, there was an emergency, you're on site being able to document and do some of those things to make sure the practice is running.
So ultimately, as a medical director, you're kind of directing the clinical side of this practice. And making sure that it's running smoothly. sometimes a PC owner is also a medical director in, most instances when you're talking private practice, usually they're one and the same.
But for larger companies, right. For, [00:04:00] some of the larger platforms, I would build, systems where there were like maybe a regional medical director. So you would be covering, these three states and really trying to make sure one, that the medical director's not biting too much, off.
'cause it is hard to kind of oversee a lot of operations. But, ultimately really just making sure that there's checks and balances and oversight in place. So the PC owner is responsible to make sure that there's oversight in place. Right. The medical directors are responsible to do that oversight.
speaker 1: Yeah, no, that's a good distinction. And it's an important distinction to understand. And like you said, especially with startups, a lot of these startups will ask for a PC owner slash medical director, but just be aware, it technically is two different roles. and this is important in terms of delineation, especially if.
You're focusing on PC directorship, as your main role. As this business grows and as operation grows. 'cause the medical director, like you said, is in charge of ops, right? Bottom line is [00:05:00] in charge of clinical ops. And as it grows, you may not be able to cover both of those jobs at the same time, especially as it scales.
So also in terms of compensation, a lot of the startups will expect you to accept a compensation package where you get paid all in one for this PC slash medical director. But I think it behooves you to consider kind of a separate compensation package for one, right.
PC medical director or PC owner and medical director separately. So as kind of the role of the medical director escalates or it's larger, it gets clear that you could separate it out and hire a separate medical director if that's the case. and I ran into this a lot, and when talking about compensation, yeah.
there's a separate, market rate for PC owners and a separate market rate for medical directors. And sometimes there's similar rates. If you're gonna hold both titles, you can, argue that yeah. You get paid for two separate titles [00:06:00] versus just the one.
speaker 2: it's the same of thinking about being a supervising position also.
speaker 1: Yeah. Correct.
speaker 2: To me, what's so interesting is like when I was a good old government employee. In the way that we were structured was, you had your rank and file staff, then you had a manager, one, manager one could only oversee five people, and then you would have a manager two, and the manager two would oversee two manager ones, maximum of 15 people.
And they had all these interesting rules, mainly because. Managing 50 people is really hard, right? Yeah. A manager two does something very different than what a manager one does. So to me it's instilled in my brain of like the delegated model. When you think about like a PC and a medical director.
And I think it's a little problematic when you think like, okay, I'm one person. I'm signing one contract. But ultimately, all those roles are very different. They have different expectations , they have different workflows, they have different things that you're kind of committing [00:07:00] to. And I've seen this time and time again where The PC owners, really supposed to make sure that the business entity is accurate and that there's a really solid, kind of like compliance framework. they delegate that stuff down to the medical director and the medical director is responsible to, make sure that their supervision.
Of staff and if there's not supervision, they have to do it. They have to make sure that, there's a chart review process, not review the charts, but that there's a chart review process. Yeah, there's a documentation process, so it's a little bit more operational. And then you have your collaborative physicians that are meeting with the providers and reviewing those charts.
And really kind of following all the different checks and balances to make sure that they're really comfortable and confident in the care that's being delegated and provided. So what tends to happen is you have a person who will take all of these roles for, $400, be told that it's a extremely [00:08:00] passive thing and then a year later get a board action because somebody got injured, at an aesthetics clinic. And when, the board went to investigate, they saw that the business wasn't structured correctly. Oh. And the medical director hasn't confirmed that the collaborating physician has done anything because the collaborating physician hasn't done.
Anything, and it's been that this provider has been able to kind of, run independently with really no oversight. So to me, the way I really think about it is there's all these different levers that they're trying to, you know, again, checks and balances. I even tell like if you're a physician practice and you're the only physician that is, practicing medicine, it's also really good protection for you to get.
A separate medical director and go, look, I have my checks and balances. 'cause I also have another physician who looks over my shoulder. To me it ultimately goes back to are you actually doing, patient safety? [00:09:00] Of course, but like, do you have all of those boxes covered?
speaker 1: Yeah. And that's a good example with a private practice too. And it's a little hard, going into the telemedicine space to get your kind of idea around it. Because a lot of times you're not there, right? Like you have meetings, so forth and so on. But these are kind of just entities that exist, but they aren't really necessarily physical for you, right?
So you have to keep that in consideration, and talking about the different roles, ideally too, the way you set it up is, let's say you are, going into a startup and they need. A PC owner, medical director, and a collaborator. Right. That ideally you're gonna get different contracts for each
Right. always have a separate contract. Yeah. Because again , Each contract, interestingly enough, a lot of these companies will use templates.
Yeah.
speaker 2: So they inadvertently leave certain pieces out. A medical director agreement. Does look different than a collaborative practice agreement.
Yeah. Very similar. You can absolutely do them together, but if you're using [00:10:00] templates, it's not gonna be the same you know, owning a PC and coming up with the arrangement between, a professional corporation, the medical side and the management side. they're littered with.
Your expectations. Yeah. it's so funny because, you know, my background really all started in like contract compliance. Yeah. So whenever I hear people go like, I don't know what I'm supposed to do, it's like, just go read the freaking contract. It literally spells it out.
I mean, it's not, the most layman's terms, but now that everybody is, Pretending to understand all this stuff, throw it into cha GPT, tell it to tell you what your job description is, and just make sure you build those things into a solid workflow for yourself.
speaker 1: Yeah. Yeah. And no, I'm like beating this idea of this dead horse, but they're not the same thing. and a lot of companies think they're the same thing and will try to compensate you like they're the same thing, but they're not. And I've definitely walked away from a lot of potential opportunities because, you [00:11:00] know, they just didn't respect that idea.
they're like, Hey, you're the PC owner. You should do what the medical director does know. As a PC owner, you get paid to incur that risk and to, oversee the compliance, but you are not getting paid to actually, operationalize that. That's a whole different role altogether. And same with the collaboration role As a medical director, yes, you operationalize it, but are you the frontline people actually doing it?
Maybe, maybe not, but if you are, then you're gonna get paid for that role as well, or as you should. So don't sell yourself short. I see this a lot and I've talked to a lot of people and there's a lot of confusion, but, I just wanted to make that distinction.
speaker 2: I think it's an important distinction because I do think, again, like.
The amount of physicians that are so freaked out about compliance and regulation and not losing their licenses, but that have agreed to take on a clinic in a state and have never spoken to that clinic and have no [00:12:00] process, it just boggles my mind. How can you be so risk adverse and then do something that's so risky?
to me, I can't wrap my brain around it right now. Again, I'm not at all saying don't do this. Yeah. I'm saying, there is this inherent of like, I wanna be a medical director. I want it, I want it, I want it. And it's like, have you been a collaborating physician first?
or I wanna be a PC owner, but I don't know what a PC owner does. I don't understand what that is. But I want it. And so to me that's the big, kinda like just, crawling before you, run is like, you really just wanna make sure, yes, there's a huge distinction between them.
Do you understand what the heck you're supposed to do? Are you willing to do those things? And again, you're basically saying that this is, your practice or your kind of like, vetting and to your point, Leo. You are taking on all the risks saying you agree.
for the people that are like just signing these deals left and right, because it's, $250 or $500 or [00:13:00] $700, it just kind of compounds if you don't have a solid system to make sure you're doing it the right way.
speaker 1: Yeah. And now what further complicates this is the P-C-M-S-O structure.
in brick and mortar a lot, that structure doesn't necessarily exist, right? The owners are usually the providers and, you know , if you become a medical director for, these practices that, don't have the P-C-M-S-O structure you don't know the nuances of how operations should go.
Right? I think one of the big pitfalls is not understanding, again, that role as a medical director and how to ensure to keep that distinction between clinical and the business side, between the MSO side, which is the business side and the clinical side, because, in your examples I know you have a lot of examples, especially in the blog I was reading it where the medical director ignored or just didn't know about this distinction and got in trouble for it, right?
speaker 2: Well, you have to [00:14:00] understand too, interestingly enough, so one of the big things that I see happen a lot for being a virtual medical director is you get dinged, or not even dinged, you'll lose a license, you'll get in a lot of trouble is if you're doing anything brick and mortar.
A lot of like medical boards will come and do site visits, the first thing is if you're a medical director, there's supposed to be something in the clinic that says you're the medical director. There's supposed to be something on these companies websites that say that you are the medical director.
I've actually had pushback from physicians telling me in the past of like, I don't want this company to list me and blah, and I'm like.
but you took on the role and you have to, so interestingly enough, I saw a case where they went into a site visit.
They saw that there was no medical director, you know. Plaque or flag.
speaker 1: Yeah.
speaker 2: that led to diving into deeper questions, which led to them getting audited, which led to them realizing there was no agreement. So there was like, where's the medical director agreement? [00:15:00] Where's the collaborative practice?
There was none. So it was this whole thing that kind of bubbled because they didn't have this plaque on the wall. now again, I mean it's all those nuances that come into play when you think about some of these things. Another big one is just kind of like making sure that.
The aspects of how these companies are marketing is being marketed correctly. Yeah. So those are typically the first things that would potentially get you into trouble. And then again, especially if you're not doing the mandatory things kind of behind the scenes that you're supposed to do month over month, and if the practice isn't overseeing some of those, it ultimately is, just bad news.
speaker 1: Yeah. now going back to the whole, what about the PC medical director thing? So the PC owner is ultimately. In charge of that. Right? But we'll delegate that to the medical director.
speaker 2: So compliance is a delegated model. Yeah. I think I need, I need to put that on my gravestone. I say it so much.
So everybody is incentivized to [00:16:00] delegate risk, right? I hire a lawyer, I pay this lawyer a lot of money. I am delegating my decision making to my lawyer, right? Because if I go make this thing and the lawyer was wrong. Well, I guess I could sue that person, or I could, do whatever. So in any day we are constantly delegating our risk down.
So the PC owner, again, you can absolutely be the PC owner and the medical director and the collaborating physician. But then you are taking on all that risk. If you hire a medical director and you delegate it down and the medical director screws up, then it's on the medical director. The medical director delegates it down to a collaborating physician and they screw up.
It's on the collaborating physician. So it's this very interesting kind of like model where. As long as there's those checks and balances and you are doing the piece that you are supposed to do in theory it's supposed to mitigate a lot of those risks and, you know, ultimately protect you. So a good example to think about it is if the PC owner is responsible to make sure that the [00:17:00] medical director has a chart review process, and that there are certain kind of like operational things kind of set into stone.
There's a monthly, medical director meeting and there's all these things. They're responsible to set that stuff up and kind of make sure it's documented. Okay, so then you have the medical director, Two of those medical directors don't show up to the monthly mandatory meeting, it is in the best interest of the PC owner to document that.
So at the end of the day, if those medical directors are doing crazy stuff and doing whatever, the PC owner at least did their piece to go. I tried, we're mitigating this.
speaker 1: Yeah.
speaker 2: My world is called a corrective action plan documentation. But that's basically the flow that these bigger hospital systems, these bigger organizations, they all have this because they have a full blown compliance team that does it.
Like what I used to do for many years. So it's that piece where it is, everybody likes to say, am I in compliance? Am I out of compliance? It's this really operational thing that you just have to get in the cadence.
[00:18:00] and you have to like really. say Tructure and stay organized and really just get into that groove of that operational workflow, which again, where this gets bad is when you have the blind leading the blind.
somebody who doesn't know how to be a PC owner working with a startup who also has never done this before, and they're, not able to support each other because they don't know what they don't know.
speaker 1: Well, and, in this day and age too, with a lot of tech starting up, these practices, right?
Or not necessarily these practices, but these services, and they're asking for that or soliciting for that. Yeah. it's just like you said, they don't know what they don't know, and they don't know what to ask for. and a lot of them have. Kind of an incorrect idea of how it should happen.
Yeah, definitely don't jump in fully without, knowing exactly what it is and knowing what to ask for. you know, when you respond [00:19:00] to those ads or whatnot Know what to look for. So what are good questions, right? So let's say, hey, this company goes in and, you're responding to this job ad saying, Hey, we need a medical director.
It's a telehealth thing, and this is practice. it's a few states. There's a PC owner. What questions should you have and kind of what red flags, do you need to be looking out for?
speaker 2: Yeah, so I mean, I think that there's certain things that I always say are probably, you would wanna understand, at least the competency and the level of the company that you wanna work with, right?
So, I think the first one is what services they're providing and if it's something that you feel comfortable, competent overseeing. This happens a lot in my opinion, like in the mental health space where you have, lots of, mental health nurses wanting to start, you know, mental health.
Mm-hmm. Kind. And you have like emergency medicine doctors or neurologists or really, I don't wanna say random, kind of physician designations, but [00:20:00] also not a psychiatrist or somebody who's comfortable in the mental health space taking these on. And these are like all schedule two narcotics being prescribed .
Yeah. So for me it's like risky on risky. So I'm always like, don't think about regulation, think about your comfort level. If somebody comes to you and they're suicidal and they need this and they need that, can you actually answer these questions for this clinic? And if the answer is no, then it's probably like, okay, well.
Yeah. That might not be the best fit. I think the second question I always ask is, internally, like operationally, how are you structuring your oversight process? Who is helping you run these operations? Is it somebody who has healthcare background? Is it somebody who is comfortable with compliance?
for me, those are really big questions because I would wanna work with somebody who at least has. A baseline understanding of compliance. Sometimes that's working with like another NP or pa because other clinicians understand compliance. Sometimes the business folks are a [00:21:00] little bit harder because They don't . Right. And they're not as adverse to risk as I would say, like me and you and the providers in the space are. the other thing I think that's always kind of like. A big ticket is making sure that they're comfortable letting you review charts. So in so many instances, I hear this from both sides, doctors, providers, clinics, well, the state says there's no chart review process, so I don't need to do it.
speaker 1: Oh, big red flag.
speaker 2: And I'm always like. you're getting to know this person. wouldn't you want to have that? Like, I wish somebody would wanna review some of my stuff. Or, certain things, sometimes it's like, it's good to have kind of like the checks and balances and so it's a little bit of like that piece.
And then of course, like who makes all their hiring decisions? So I find it really weird when you have companies hiring clinicians that don't know how to vet clinicians. [00:22:00] I can't hire a clinician. I don't know the right questions to ask. So to me, the other key question is, how am I gonna get incorporated into your hiring process?
Because as the medical director, I actually wanna make sure that I get to vet review, verify the people that you're hiring.
speaker 1: Yeah.
speaker 1: I think that's a red flag for me too. You know, like if you are taken out of the direct hiring process without any input. These are the people that you're supervising.
These are the people that you know you're on the hook for. So yeah, that's a big one.
speaker 2: Yeah. And then of course, like the other thing is always around if they're doing anything in kind of like the payer space. Billing, especially if it's like Medicare, really understanding like, what are you billing for?
Yeah. Give me the codes. Again, not that any physician's gonna know exactly what those codes are and what translates, but you'll be able to at least take that back to your chat GPT and ask it and go, are there any red flags with this?
[00:23:00] there's nothing wrong with how they're billing. So I always typically like to ask, you know, what are your codes? who's your billing partner? Do you mind if I meet with your billing vendor? Can I get an intro? Because you see all these audits, right?
Somebody is billing. So there is a certain point where like sometimes even the billing companies are doing things in a way that's not necessarily correct. So you always kind of wanna do your own vetting of like, who are your partners? Who are you working with? So for me, those, I mean. Leo, you've been on many calls where I'm always like vetting people asking all these questions.
I always tend to like, ask a little bit more. you're entering into a relationship with somebody,I'm not a transactional person to begin with, but try to really go like, is this a business you wanna support? Yeah. Is this a business partner you wanna work with? Is this something you can get behind?
And then from there you kind of get to, make the final decision. A lot of times you can go back and go, Hey, I'm not comfortable with that, or I'm not comfortable with this. And then kind of get their feedback on how they're, planning to [00:24:00] approach it. Sometimes it's just a flat out, like this is not a good opportunity.
Yeah. You and I have had those conversations where I'm like, Leo, I just don't think it's worth it. Money sounds great. I wouldn't take it on, Yeah. Versus ones where it's like okay. Okay. I get it. Makes sense. All right. we have to make sure that we build it into the workflow and that it, verify a few things, but, to me it's good to have the conversation so you know what you're getting yourself into .
speaker 1: And here's another thing that I think is important for the medical director job, is clinical pathways, right? And how are the clinical pathways set up? Are they clinical pathways based on, strict clinical criteria? Or is there kind of a lack of distinction between what's clinical and what's business meaning?
The clinical pathway should be driven by clinical decision making only, right? Run by the medical director, right? A lot of companies, especially in this [00:25:00] P-C-M-S-O model, the M SSO side likes to dictate how clinical practice is run, right? Based on underlying, operational factors, money factors, marketing factors, so forth and so on.
As a medical director, it's your job to ensure that distinction remains as distinction it's your job to keep the MSO side at the MSO side and the clinical side. Now there's a business nuance to this, right? we're all running a business, right?
But still, it, ultimately is your responsibility to keep the clinical distinction there. That's why the P-C-M-S-O model exists, and that's your job
speaker 2: yeah. Yeah. Well, and I think too, like traditionally, it makes a lot more sense, right? So people always get confused when it's like pc, MSO, like people don't really understand it and it's like, well, it historically when everything was so insurance based.
That was your checks and balance. Your MSO was your checks and balance. You had to go through credentialing, you had to have a billing partner, you had to do licensing. Like that's traditionally what an MSO would do. Now it's [00:26:00] slightly adjusted to where it's like, the MSO does marketing and tech and operations.
Yeah. And legal, which no startup has in-house, legal it's kind of like rife for. Mistakes and like rife for error because it's now being led by sales, marketing money versus before where it was you had to do all these things before you could even submit a claim.
speaker 1: Yeah.
speaker 2: Right. Yeah. So there's no blocker on each side. I say this all the time. hospital systems, every other institution in healthcare is an uphill battle to get accredited, to be able to be live. Telemedicine is the only thing. That doesn't have some of those hoops, in the cash pay, private practice, you know, telemedicine, digital health space where you can literally just build it and launch.
And if people buy, they buy, and the only time that there's really like roadblocks that come in as, it's like if you're trying [00:27:00] to do marketing, you have to do things the right way. You could get flagged by like Facebook, it's a really interesting thing to me. Again, like it's so important that these PC owners and this medical director at in my opinion, this like virtual checks and balances needs to understand this because they're kind of the only thing that is really making sure that it's running, you know, the right way.
speaker 1: That is a great point. That is such a great point. 'cause you're right anybody could build a website, find a source of whatever, find a doctor that's willing to prescribe. But you're right not set up the needed compliance, not set it up the needed structure to do so. and ah, yeah.
What an interesting point because there is no checks and balances . Huh. We've seen that too, actually. And I've actually been approached by a couple startups that are like, oh yeah, we could just do this. we don't need the structure. You know, we don't need a PC owner, like I could own this and I could run this business as a non-clinician in the A CP OM state.
That's fine. [00:28:00]
speaker 2: Yeah. Well, the interesting thing is it's just so nuanced, right? Like, I argue with people every day about CP om and compliance, and my lawyer said this and it's different and blah, and I'm like. You ask 10 lawyers about CP, om, you're gonna get 10 different responses.
Yeah. You ask 10 different operational people how to operationalize it. You're gonna get 10 different responses. it's a very nuanced space. And so a lot of times it's people talking to the wrong people or, ultimately, like, not really understanding what some of these things mean, and again, like nothing precludes you from starting, so you go. I don't think it's a real rule. Then, I always joke my speed limit, you know, like Nothing stops me from driving a hundred miles an hour besides a police officer coming, right? It's the same thing here. It's like nothing's gonna stop you from starting your business until you're up and running and then you have an auditor knocking, or you get a medical board complaint, or [00:29:00] somebody goes, why don't you have your medical director sign up on the door and you get, dinged somehow.
There's all those things that kind of come from the reciprocal end, and I really just want people to understand like how to avoid it on the front end. Yeah. Yeah. No important thing to remember. especially in this day and age, right? It's just out there. It's out there. And a lot of docs not knowing are willing to take it.
speaker 1: They just really are.
speaker 2: I think it's hard. I mean, there's a lot of companies out there that really market towards doctors and really are trying to, I think it's great, right? I love private practice. We did not have doctors doing this, willing to take the chance, take on the work, take on the risk.
Like all my private practice clients would have no private practices. So am I sitting here saying that this is a horrible thing? No. Yeah, definitely not. It's
speaker 1: a
speaker 2: beautiful thing that we need more of. But with that said, you do have a lot of companies that really, you know, will [00:30:00] tell doctors you don't need to do anything.
it's passive. It's this, it's that. And I think that's where just changes how doctors think about it. And because there's not really like a course or a training on exactly how to do this. You kind of learn from trial and error from, the
doctor.
speaker 1: it's funny you say that because just recently that happened to me and they're like, oh yeah, this is gonna be passive, this is gonna be passive.
You know, we're gonna pay you this much and you're not gonna have to do much of anything. You're like, maybe check a couple and, collaborate a little and, check our protocols a little, really delve deep into what they really want. yes, there's some passivity to this and yes, it's an admin job where you're not necessarily having to work a daily clinical, you know, nine to five.
But this is an active role, right? you should consider this an active role where. There has to be regular check-ins. You know, there has to be, regular discussions, regular clinical oversight, so forth and so on. [00:31:00] So yeah. Yeah,
speaker 2: It was interesting. I spoke with somebody the other day it was a physician, nationally licensed, had their own company.
Had their own clinic was doing telemedicine in about 10 states. And had a business entity in one state and was like so confused that like they couldn't do it. They were like, no, I comply with CPOM. I'm a doctor. And I'm like, no, you still don't comply with CP Om, you're still outta compliance. that's what I'm saying.
this whole thing is really, really confusing and kind of convoluted. And so to me it's just interesting because It's very important to healthcare. It's very important to telemedicine and digital health. But it's also probably one of the most confusing things I've ever had to work on to try to, understand in my whole career.
speaker 1: Yeah. 'cause really, you're right in the brick and mortar space, especially in large hospitals, there's a system already set up. And you're walking into it, you have defined roles, you know, there's probably a precedent as [00:32:00] well, you know, and people know what they're doing ,
speaker 2: yeah.
speaker 1: So,
speaker 2: this is why, like, it was so funny. So the physician clients that I have, I basically set them up with like, here's all the rules in all the states, and here's how you have to think about it for your own licenses and, kind of all of this stuff. And it's so funny how even with the rules in the face, they're still kind of making mistakes and accidentally doing, the wrong thing on accident.
But that's the thing. it sounds great to do things, Multiple places and oversee multiple clinics and all of that. But it really, really, really requires you to use a different side of your brain than, the clinical one.
speaker 1: Yeah, absolutely. And there really is no training in medical school for that.
speaker 2: Yeah,
speaker 1: there's a lot of clinical stuff, but nobody trains us to have these roles. Ask around, ask the network of people that have already done it. Ask Phoebe,
speaker 2: Only if you wanna listen though, because I get, like, I'll tell them and they're like. That sounds [00:33:00] really,
speaker 1: nah, that's not a good idea.
I don't agree with you. I disagree. I've seen that too. Like there's times where I'm like, well, you know, that doesn't sound right. Here's the actual rules, you know, and you pull up and they're like. okay.
speaker 2: I love the one where like, I heard different from my accountant,
speaker 1: right? Alright, this is what they're doing.
Or hey, you know, and God, I be believe this point, but the compensation point is like you're not gonna be doing much work anyways.
speaker 2: I think everybody correlates it to time.
speaker 1: It's not, and
speaker 2: it really isn't. No. So I will say, I think that people need to understand everything you do in the beginning is hard, so you are always gonna spend a little bit more time.
A little bit more energy getting up to speed 'cause it's new and it's just a little bit different, right? Yeah. So if you're doing this and you're trying to charge something as it translates to your time, it's never gonna shake [00:34:00] out.
speaker 1: Yeah.
speaker 2: And so it's like you also have to be willing to invest a little bit of like time and energy into streamlining.
Leo, how many hours do you and I spend. not compensated, trying to figure certain operational things out for different private practices. Oh, right.
speaker 1: tons. We're sitting there and it's always the same cell, right? Oh, it is gonna be passive.
it's not much to do. even in the medical director jobs that I've taken and that I'm in right now. It's like, oh, yeah, yeah, yeah. this is all that needed. No, no it's a lot of hours, a lot of thinking. Plus, if you're actually in that role, it's risk too. How much are your licenses worth to you?
It's not time-based. gosh, it's one of my pet peeves that, the company's approach us and they're like, oh yeah, this is only how much I'm willing to pay you for these roles because this is how much time, it's gonna take you to work. No, You've worked your butt off to get those licenses, how much time, money, sweat, how much loans you still have out [00:35:00] there.
they're paying you for your licenses, for your expertise. For all that, and, you know, it kind of irks me when they come back and say, Hey, you're only gonna work of jobs or we're only gonna pay you this much because you're only working these amount of hours.
So,
speaker 2: yeah. I agree. Eventually it does shake out. You know, like, I do think it is like something very lucrative, but again, you really have to have a system. We have a person who's gonna come on, in a couple weeks and his wife manages everything for him.
So it's like she is managing all of his, medical directorships and collaborations and making sure that people are doing what they're saying. She has a foldering system. It's so organized, right. They have like a mini setup and system in place. again, you can absolutely do this and learn something like flex leadership skills, help private practices.
You just need to make sure you know what you're signing up for and that you have like system in place so that it's organized. You know, some tips I've always said is like, Leo, kind of like very [00:36:00] similar to the system, we built for you, which is a really solid onboarding process for providers.
So you're able to all those files up front and make sure you have everything you need, including their malpractice and all the stuff that's listed in your contract that you're supposed to have. making sure you have a system to save all those contracts, track compensation, invoice people you know, document, like your communication logs.
You just wanna make sure that you have a good, solid system down. And then plus, you know, you wanna make sure that you have, whether or not those, it says that you're supposed to communicate with a provider quarterly or monthly. If you were brick and mortar, you'd be talking to them every
speaker 1: day.
Yeah.
speaker 2: So to me the idea is like a simple check-in, a simple text, a Hey, how's it going? Happy first week, blah, blah, blah, blah. That goes a long way when you're building a new relationship and trying to get comfortable with a person.
speaker 1: Yeah. And second on the organizational unit . Phoebe, I know you're my organizational unit, so thank you so much .
I [00:37:00] dunno what I would do
It'll snowball and you just don't know it, initially you're like, okay, it's just one or two. But, as you get opportunities, even just with, you know, companies if you're involved in one company with multiple providers, so forth and so on, it's just gonna snowball.
So having a good organizational unit to keep you sane is key . Especially if you're not that organized like me . But, yeah. Yeah. Huge. Shoot this is a great talk. I think, looking forward, we should do the same thing about collaborating decisions about, the PC ownership kind of roles and stuff too.
And, kind of just provide education in the generation of those roles. We get those a lot. Right. Those is one of the most common questions we have. So, this is awesome. Well, cool.
speaker 2: Yeah. and like I said, I wrote a pretty lengthy blog on my website about medical directorships.
speaker 1: Yeah.
speaker 2: don't do lots of blogs guys. to me, when it's like, it's such a important topic, I really kind of like put a bunch of time and effort into it and so, I would say, [00:38:00] check it out because it really kind explains like really big mistakes that people are making. There's tons and tons of resources in there so if you are doing these things, you're able to kind of like vet and make sure you're not making some of the mistakes, especially in the section that talks about current enforcement that's happening.
speaker 1: Yeah. Hey there. I love the part where you give example of the cases, so forth and so on, you definitely define the roles.
this is a very kind of a useful tool. We should also, connect it to the. Telemedicine talks website and just shuttle people to your blogs way as well. But hopefully this is, you know, the first of many. I'm volunteering you to do more. What is turning out to be,
speaker 2: I guess I will start.
speaker 1: You're not busy enough at all.
speaker 2: Yeah, I know. No, you don't keep me busy, Leo.
speaker 1: Oh, not at all. I'm super organized. we've already established that.
speaker 2: Well, I think that. The biggest thing for everyone to understand is if something sounds too good to be true. it usually is. If [00:39:00] a company is lacking in certain transparency, especially as it relates to kind of like charting and documentation and billing.
you just really have to understand that there's a bunch of opportunities out there. Make sure you're taking the right ones. And not selling yourself short, just hoping for, some extra revenue.
speaker 1: don't be afraid to walk away. Don't be, a lot of times we've been in this conversations, right, and it just feels like the doctors that are.
Thinking about walking away from a really bad deal, they feel defeated, right? you shouldn't, you're doing the right thing, you're walking away and it's the right thing to do. A lot of times, as doctors we're so used to winning and you so used to, getting things that are just like, when you know these deals don't pan out it's almost a failure.
But no, it's actually a positive that you're walking away from a bad deal that you know, can eventually get you in trouble.
speaker 2: Yeah. Agreed. [00:40:00] Agreed.
speaker 1: Well, cool. Well, this was an awesome talk. thank you for that. Check out the blog camino strategy group.com if it were up to me, there's gonna be more my Phoebe, but, we'll see.
I'm gonna help. I'm gonna help. I just don't write as good. My English is not as good. So, but no. Hey, thank you everybody for joining in. Check us out if you have any topics you want us to talk about. delving deeper into. Even better yet, if you just wanna show up and, we could talk things through on a live blog, give us a holler info@telemedicinetalks.com, bebe@telemedicinetalks.com or leo telemedicine talks.com.
Cool. Yeah, I think ne next topic we'll be covering too is, I kind of alluded a little bit to it, but what it actually means for a physician to own a telemedicine company. why you are not exempt from corporate practice of medicine. So as physician, you should definitely do that. Licensure does not equate to having your business structure correct.
speaker 2: [00:41:00] So, we'll be diving into that one on a future episode. So if you're building a physician owned practice, you're gonna definitely wanna pay attention to that one
speaker 1: shoots. Yep. And we'll see you again next time. Thank you everybody for listening.