Dr. Leo Damasco and Phoebe Gutierrez sit down with Dr. Steven McDade, as he shares his journey toward greater freedom, building a diverse telemedicine portfolio, the mindset shift from acute care to preventive/wellness medicine, and how telemedicine revived his passion for practicing medicine.
In this episode of Telemedicine Talks, Dr. Steven McDade joins Leo Damasco and Phoebe Gutierrez to discuss his transition from full-time emergency medicine to a flexible, primarily telemedicine-based career. After 13 years in the ER, Dr. McDade sought more time at his mountain home in Colorado and discovered telemedicine as the solution.
He opens up about overcoming skepticism and imposter syndrome, the massive reach and positive impact of virtual care, building a diverse portfolio that includes medical directorships, hormone replacement therapy (HRT), weight loss medications, men’s/women’s health, and unique collaborations (including with a boutique gym and a breastfeeding NP).
Dr. McDade highlights the lifestyle benefits, no commute, working from anywhere (including Portugal), schedule flexibility, reduced burnout, and renewed excitement for medicine, while still practicing some ER shifts. The conversation also covers the expanding opportunities in telehealth, AI’s role, and advice for physicians considering the transition.
Top 3 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 Guest:
Dr. Steven McDade is a board-certified Emergency Medicine physician with over 13 years of experience. After practicing in Colorado, he transitioned to primarily telemedicine (80/20 split) to gain flexibility and spend more time in the mountains. He serves as a medical director for a telehealth company handling 911 diversions, works in men’s/women’s health, HRT, weight loss, and various clinical collaborations.
Connect with Dr. Steven McDade:
You can reach out to Dr. Steven McDade via the Telemedicine Talks team at info@telemedicinetalks.com
About the Hosts:
speaker 1: [00:00:00] Hey, welcome back everybody to Telemedicine Talks. This is your host, Leo Damasco. I'm here with a good buddy of mine Dr. Steven McDade. he is a ER doctor, been practicing for 13 years, but has transitioned to primarily telemedicine. I can say that, right?
speaker 2: Yeah, I still do some emergency medicine, but I'm probably 80% telemedicine and 20% emergency medicine.
speaker 1: No, that's amazing. That's amazing 'cause, I met you in the start of our, telemedicine journey. I think I started and... same time that you started.
speaker 1: And, I think you're a cool person, awesome to talk to. So, you know, I wanted you to come on the show just to hear your story and see what you're up to and just shoot welcome.
speaker 2: Yeah, thank you for having me.
speaker 2: I've been in emergency medicine, like you said, 13, 14 years. I work in private practice emergency medicine in a great town in Colorado. I live in Colorado. I trained on the East Coast and, about six, seven [00:01:00] years ago, I built a house in the mountains that I was like, "I'm gonna spend a lot of time here," and, like,
speaker 2: There's the Front Range, Denver, Colorado- Yeah. Okay ... and, like, the city , and, like, it's where majority of the population of Colorado lives and, you know, that I wanted to spend more time in this mountain town that was four and a half hours away, and I just couldn't figure out how to spend more time there and be an ER doctor, because, you know, in order to be an ER doctor and make money, you have to work ER shifts, apparently.
speaker 2: Something like that. Yeah. it was like, I'd work these clusters of shifts and then go to the mountains and then, you'd have to deal with, wintertime driving conditions and snow and, like, getting back. Sometimes I'd leave a day early to get back to my shift because you don't want to miss a shift, et cetera.
speaker 2: So long story short, I was like, "How can I do this better and spend more time in the mountains and lead to more freedom and more flexibility and, not be chained to a hospital as a board-certified- residency trained ER doc, right?
speaker 3: [00:02:00] Yeah.
speaker 2: Yeah. and
speaker 2: as an emergency medicine physician, like, there's other jobs out there and, like, you don't have to be an ER doc, but that's what I was trained to do, and like, you know, that's where the value was. So I was like, "That's what I thought you needed to do." And after doing it for, 13 years, I was like
speaker 2: How can I do something that can get me more freedom, more flexibility, more time to either be in my mountain house or be somewhere else," right?
speaker 1: Yeah. Yeah.
speaker 1: Then one day I was talking to somebody through, he was like a think tank group or some kind of- Yeah, yeah
speaker 2: It was, like, some kind of, an investor group for physicians or what, but anyway, somebody mentioned that there's a training course for telemedicine, and I was like, "Oh, I should look into that." And then I looked into that. That's how I met you. and then kind of proceeded down the telemedicine avenue and getting multi-state licensed, and then very skeptical.
speaker 2: Yeah, I remember
speaker 1: that. I
speaker 2: remember that. Very skeptical it's hard to, you know, like, [00:03:00] you went through ER residency, you went through residency medical school, and, like, this is all you know, and sometimes you feel like a one-trick pony
speaker 2: as an ER doc, and, like, you don't realize that you can, do other things. So that's how I ended up pushing towards more telemedicine and getting more multi-state licensed and then, figuring out jobs, and that was a whole process, you know?
speaker 1: Yeah. Yeah. And it's interesting that you say that especially with the transition, right?
speaker 1: And, I train like you. we're trained to be clinicians, to be in the front lines, right? And to be in the ER, and then you go and do this telemedicine thing, right? And which is a different beast altogether. And for a lot of people, it's hard to reconcile that. It's like, hey, are you stepping down?
speaker 1: Are you almost turning your back on medicine, so forth and so on. how do you reconcile that to yourself and say, "Hey, this is actually something I wanna do"? and you said you were practicing for, like, 13 years now, right? I always think of, the ER lifespan in the ER of an ER doctor's like 10 years .
speaker 1: And then after that we start kind of [00:04:00] getting old. We're crusty from the very beginning, right? That's what residency does to us. But we start getting old and beat up, and we're looking for things, right? And we want- Yeah ... different things. So how did you reconcile that with yourself saying, "Hey, you know- No, I'm not.
speaker 1: this is actually something down my alley and something I wanna do.
speaker 2: Yeah, I think a lot of people, there's imposter syndrome, right? Hi, Phoebe. I think a lot of people worry about are you giving up the trade and skill that you trained for and then going into, telemedicine, and, is telemedicine, colds and coughs and urgent care and z- Z-Paks and, I was a little worried about that, but then I realized, like, emergency medicine, at least for me, and I still practice emergency medicine. I'm a single coverage nighttime ER doc. I see, like, on average 30 patients a shift. And I'm not burned out. I still like what I do, but, it's a grind.
speaker 2: And, like, patients are not that thrilled about being in the
speaker 1: ER, right? Absolutely not.
speaker 2: [00:05:00] Telemedicine, you start seeing people that, like, wanna see you that you can help and not necessarily, like, deal with problems that, You know, people who go to the emergency room have a problem you have to deal with.
speaker 2: The issue is already there, right? Whereas in telemedicine, like, you get to help people live better lives, as opposed to trying to fix a problem that occurred in the emergency room. So I felt that people are happier in telemedicine. You can help them live better lives quality lives that keep their health in check and healthy as opposed to fixing problems all the time in the ER, trying to fix problems that a lot of times you can't fix.
speaker 2: So cleaning up after the fact. So eventually I kinda thought of it that way, and then started getting more and more in the telehealth space, and, like, the space is so huge that you have a much bigger reach. I was just talking to people about this the other day. Like, emergency medicine, in a year in emergency medicine if you work an average shift load, you may see [00:06:00] 2,000 to 5,000 patients in a year, 5,000 being a busier, you work a little bit more and- Yeah
speaker 2: you have a higher patient volume. In telemedicine you may see 5,000 in a month. Yeah. or 5,000 encounters in a month. So your reach is just bigger. once I learned that, I was like, this is also good medicine,"
speaker 1: right? Yeah. No, absolutely. and it's one of the draws too, and that's, one of the ways I reconcile with myself as well.
speaker 1: It's like, "Hey, I'm reaching a bigger population. I'm touching more lives," right? And a lot of times in the ER too, I agree with you, how many lives am I actually changing, right? Not that many - Hard ... to be honest. Yep ...
speaker 1: So no, that's amazing. And now, a lot of times too, in addition to reaching more people, what people find when they switch over to telemedicine is that now they're doing things that they weren't necessarily doing clinically, right?
speaker 1: They're doing, like, administrative jobs. They're reaching into interests that they didn't know that they had, or skills that they didn't know they had, or just [00:07:00] expanding. what are you up to? Yeah. What's going on with you?
speaker 2: Yeah, I've been at this for two years, so not that long, but
speaker 2: when you talk about telemedicine jobs, like, you get taught to kind of build a portfolio of what you're doing, right? Yeah. And it takes a little bit of time to, like, build that portfolio up, and it takes a little bit of time to, figure out what interests you, right?
speaker 2: Like, emergency medicine, you go through med school, and then you're like, "I'm gonna do emergency medicine." Then you get trained in emergency medicine, right? And you go through residency, and then you get a ER job, and that's really, what you like to do and what you think you like to do and what you practice.
speaker 2: And then you get into this world of telemedicine, there's all these options, right, of things you can do. Medical directorships- Yeah, yeah ... PC owners administrative task. Or, synchronized visits where face-to-face contact, just like we're talking on a video, right? the list goes on and on, right?
speaker 2: So you know, you have to, like, figure out, and it takes a little bit of time to figure out, what you wanna do and where you wanna pour your time and effort. And I'm still tweaking that, [00:08:00] figuring that out. But I would say my base, I'm a medical director of a telehealth company.
speaker 2: It's a really cool company because talking about the reach and, keeping people out of the ER, like one of the jobs that I do is we field 911 EMS calls that they wanna divert from sending an ambulance to the person or prevent them from going to the ER because they don't need to go to the ER.
speaker 2: Yeah. And they get, diverted to us and then we talk to them as a physician virtually and discuss, like, do they still need to go to the ER, which we can obviously still do. We can still dispatch an ambulance or we can save them an ambulance trip, an ER trip cost, money, bills and take care of them at their house.
speaker 2: And so I still do a lot of that kind of virtual care in-person, synchronized care, that's kind of my base. And then, I do weight loss medications, I do hormone replacement. I got big into men's health and doing HRT. So I [00:09:00] work for a virtual company that does a lot of HRT, which is fascinating, and this is not a field of medicine that,
speaker 2: I mean, I knew existed, right? But like- Yeah ... was definitely not practicing that in the emergency room, right? So there's a whole field of, like, peptides and hormones and weight loss medication and ED meds and men's health and women's health, and I do hormones for women's.
speaker 2: I have a whole segment, I do collaborations, and one of my collaborations with a husband and wife nurse practitioner couple is They run a gym, a boutique gym. But They also do have a GLP peptide and TRT hormone clinic in their gym.
speaker 3: So cool.
speaker 2: Really? So I'm the collaborating physician for them.
speaker 2: So, like, all these people are like, gym rats and love the gym, but they're also getting their cholesterol and hemoglobin A1C and hormones optimized and testosterone and, these people are, really healthy. ... I would say way more healthier than the general population.
speaker 2: [00:10:00] And it's just a unique situation. Like, I would never be in that situation collaborating with these two husband and wife NPs that are doing this, and taking care of this, elite gym population. The biohackers.
Yeah. You got some biohackers over there.
speaker 2: they're a little bit biohackers.
speaker 2: Sure ... but yeah, to answer your question, I would say in general, I still like synchronized care and delivering care, whether I have strep throat or I have a UTI or I have pneumonia or I don't feel good and I'm dizzy, and, like, people still make virtual visits, on whatever platform with me.
speaker 2: So that's still rewarding. And again, you get to take care of people. So many times over, 15 years in the ER, people are like- they don't wanna be there, a lot of times it's something bad happening ... and I'm a nighttime doc, so like bad, you know,
speaker 2: who's in the ER in the middle of the night, right? Not typically good things. Yeah. And so if you can prevent people from going to the ER and deliver good care virtually, and you're talking about like, there's communities in rural Georgia that I take care of every day, right?
speaker 2: [00:11:00] That have no access to care. There's Syracuse, New York, like I see patients almost every day from Syracuse, New York. Rural upstate New York, like they're hours from a hospital. The hospital wait in Syracuse is like through the roof. they call and they're like, I can't go to the hospital.
speaker 2: I can't sit there in the waiting room for eight hours." And, maybe they don't need to be in the hospital you know- for eight hours, right? Yeah. So that's rewarding still, and then, there's all these telehealth like I said, weight loss medications, men's health, women's health.
speaker 2: All these things can benefit people's, lives in a positive way that I was not doing. It's such a brain shift, right? Like, I'm like activating the cath lab for a STEMI, at 2:00 in the morning and like The guy's going into respiratory failure and having a cardiac arrest and I'm trying to save his life and intubate him and get him to the cath lab and keep him stable.
speaker 2: But that damage is done, right? That's like a complete blockage of the coronary and years of plaque buildup and, when you can practice medicine and [00:12:00] hopefully prevent that, I mean, obviously it's still gonna happen, but- Yeah ... it's just a different brain shift
speaker 1: compared to what I was doing every day.
speaker 1: and what I noticed when you were talking about this too was like your excitement about it, right? years and years of ER will wear on you, right? And you become salty. You become almost negative, like- Yeah ... oh, medicine's a negative thing almost. And sounds like it activated something where it got you excited again.
speaker 1: like you're almost like a bright-eyed, bushy-tailed med student again going, "Oh, yeah, this is great." Yeah. There's so much opportunity happening, and you're in it, it's activating your entrepreneur side. It's activating your interest side. You feel like working out,
speaker 1: The gym rats that you take care of, it's like, oh- Yeah ... this is my population,
speaker 2: I think also, that's just talking about the like positive side of medicine and liking medicine again, right? If you're burned out and I wasn't burned out, I just was like how can I lead to better flexibility and freedom, right?
speaker 2: But really it's kind of- I work less ER shifts. I'm, not in such a negative environment. You know, you're in a better vibe. People say thank you to you. They're happy for their care, right? [00:13:00] And so, that leads, to better care. That leads to better job satisfaction.
speaker 2: And so besides, liking medicine and delivering good care, there's a whole nother aspect to telemedicine of like what does it do to your life and, what doors does it open in terms of flexibility, right? I like going to the gym.
speaker 2: Yeah ... I go to the gym at 1:00 PM every day, right? And I block that on my calendar and, like, if I wanna spend two hours at the gym, I can. If I wanna spend 30 minutes- right ... I can. If I need to go do something else, I can, right? So it does lead to flexibility and the whole concept of, me trying to spend more time not tied to a hospital whether I'm staying in the mountains or staying in Denver you now can do that because you can work -
speaker 3: Yeah
speaker 2: I remember two instances. I started telehealth. I was still working the ER. I took a vacation in Portugal, and I was doing telehealth from beach in Portugal. and it, clicked I was like, "Oh, I can do this?" And like, I remember doing [00:14:00] telehealth that week, and it, pretty much paid for my Portuguese vacation .
speaker 2: Right, right. And I was like, "Oh, this is the answer." I'm like, I'm not... And there's all this, micro time you save that I don't think people think about, right? Yeah. I drive 35, 40 minutes to the hospital, 35 minutes typically, at night, and then sometimes it takes me an hour to get home, right?
speaker 2: Yeah. That's an hour and 45 minutes of my day I'm in my car driving to and from a hospital, when I do telehealth, there's no commute time. Yeah. Remember when, you're in the ER and, like, you got behind on 10 charts, 15 charts, whatever?
speaker 2: I mean, this happened to me a week and a half ago where, like, I had a cardiac arrest at 6:30 AM, and I'm done at 7:00 AM. Well, guess who was there till 9:00 AM?
speaker 1: Yeah, yeah. And then you have to document it away, and you're working for free, right? You're working- for free.
speaker 1: Yeah.
speaker 2: You're documenting. You're there till 9:00 AM, and then you have to commute in rush hour traffic at 9:00 AM, and you get home at 10:00 AM, and then you're in bed by, like, 11:00 AM. Well, there's none of that.
speaker 3: Yeah.
speaker 2: and so the freedom and flexibility [00:15:00] It gets you is really nice.
speaker 2: There's some negatives about telehealth too, but in general I would say, way more positive.
speaker 3: Yeah. I think too, Steve, you embraced it from, I think, day one. Yeah. Whereas a lot of people are like, "Oh, I'm gonna ease my..." You were like, "Nope, screw that.
speaker 3: I'm jumping all in. I'm gonna go figure out what I like, what I don't." you're like me with consulting, which is- Yeah ... we're crazy. Yeah. but to me- Mm-hmm ... I mean, that's the whole thing is, like, I think part of what I love about telemedicine and some of the physicians that I have gotten to work with is if you are really interested in learning other ways of medicine, especially as an emergency medicine doctor, you can truly learn just about anything- Yeah, yeah
speaker 3: you want, right? if you actually look at some of these collaborations as like a two-way street, sometimes like the NPs will teach you a little something- Oh, absolutely ... that you didn't know before. And you're like, "Oh, okay, I'm really into maybe ketamine therapy," or, "I'm really into peptides," or, yeah, "Maybe I'm really into, you know, wound care," or I don't know.
speaker 3: But what I'm saying is, I think you really [00:16:00] embraced it. and I think that also is one of the reasons why it helps you enjoy medicine again, 'cause you're getting to learn something, practice something, innovate a little bit. And yes, of course, we're always worried about compliance, but
speaker 3: you're kind of getting to dabble without having to do the traditional route of like, "Oh, I gotta go get a real job," and like-
speaker 3: Yeah. I mean, it's
speaker 3: a real job. Sorry, I didn't mean like- It is a real job. What
speaker 3: are you talking about? You know what I meant. Like a W-2 . Well,
speaker 2: yeah, no, I think... obviously, patient safety is very important, and compliance is very important, and, the, the medicine world when you're trained, right? Like, when you go to med school, residency, especially like allopathic, US trained, it's very finite road, right?
speaker 2: you're a dermatologist- Right ... you're an OBGYN, you're an ER. But when you're in telemedicine, like, there's tons and tons of telemedicine jobs, and, opportunities, and startups, and AI companies, and tech companies, and,
speaker 2: there's all kinds of stuff out there, right? And so you just have to figure out what you're interested in. And sometimes, you don't know, [00:17:00] and, you start doing jobs and figure it out. and then you meet people, and they're doing this, and they're like, "What do you think about this?" And like, "I don't know.
speaker 2: I've never done that." and I'll give you an example. Like, I have a collaboration with an NP that needs a physician that collaborates for infant breastfeeding. And so- I don't know anything about breastfeeding, right? Lies.
speaker 3: you're the expert But- I
speaker 2: get that. But she needed a collaborating physician, and I'm like, "Listen, I'm an ER doc.
speaker 2: Like, I don't know how to do that. that's outside my realm. you probably need a pediatrician. you need a neonatologist. And she's like, "No, you can't find them. There's nobody that does this. I need it, like,
speaker 2: They have all these certifications." She's like, "We'll work together." And so, I've been for the past year working with her, collaborating with her She is the breastfeeding expert in New York. Basically they get referred to her on, babies that aren't latching appropriately and breastfeeding appropriately, and, have all these problems, and I'm the collaborating physician.
speaker 2: And I'm learning
speaker 1: Yeah. That's awesome And You're a breastfeeding specialist now [00:18:00] too.
speaker 2: Yeah. I'm not practicing unsafe medicine. I'm just using it as an example
speaker 3: yeah ...
speaker 2: of again, the opportunities and niches out there are really
speaker 2: And this isn't even talking about, like, tech companies and AI companies- Yeah ... and, like, peptides and the peptide world, and, the AI telemedicine world is gonna explode. and it's just gonna get big. And I can use an example. I actually saw one of the platforms I work on for is now doing yearly refills of these medications, and it's an all automated message.
speaker 2: And basically it's just if you're a patient that's been with them for a year and is refilling your meds for the next year, you don't have to respond to the message. It's just as automated, and you have the opportunity to respond and say, like, "I wanna refill the med," or, "I don't," or, "I've had a change or my medicine," or, like, "There's a change," or, "I don't wanna proceed with this."
speaker 2: But if the company doesn't hear from them, then they start the renewal of the medication And it's all AI driven. Now, how compliant that [00:19:00] is and how safe and, I don't know. I mean, we could talk about that, but,
speaker 2: in general, you can see that happening, right? it's AI driven and, like, minimal patient interaction, good or bad. But it's out there. So yeah, And to, speak on, like, how fast I was and, like, how pushy I was, you know, very skeptical, but I was, like, starting to get multi license, and multi license are expensive, and I was like, "I gotta figure out how to not be tied to the hospital.
speaker 2: Like, I've gotta figure this out." Yeah. Yeah. And, how are other people doing this? and I knew people were doing this, right? And I was like, "I'm gonna push hard to see if this works." And then, there's learning curves, and there's days of frustration, I talk about the early days of working nights in the ER, applying for telehealth jobs, training for telehealth, onboarding of new companies, interviewing, setting up interviews, working platforms, right? And eventually it gets to this peak where like you're working ER, you got an interview at 1:00 PM, you gotta get up early.
speaker 2: you got all these cases to do on this platform that are time-sensitive that you need to get done, and then you're [00:20:00] back in the ER that night. And like I don't know if it was worse for me because I was a nighttime doc, but at one point I was like, This is a lot.
speaker 2: But eventually you start putting your effort into, you know, where it matters and you like cut back on your ER shifts. Yeah, I know. And like I was giving away night shifts now. And hard to give away, but I was like, "Please, somebody take these." Like, "I don't wanna work these three this month," and so eventually you just kind of figure it out.
speaker 2: And then I'm in that phase now, I'm about two years into this, and like I'm in that phase now where I've got my core jobs and I'm happy and everything's running, But I'm always trying to fine-tune that stack and that portfolio. And, that's the phase I'm in. And then, you always look for opportunities- Yeah, yeah ... and like I don't wanna say better jobs, but you look for things that interest you or may fit better with your schedule and you know, do you get to surf two hours today, or do you get to surf four hours today?
speaker 1: Right. No. Yeah. I surfed two yesterday. No, but- To your point, right? maybe you are looking for better jobs, right? And as [00:21:00] you grow, within the space, your experience grows, your needs grows. Plus, now you could say, "Hey, I've been doing this for this long.
speaker 1: Now I can do this for you," right? And as you like work within the system and work within the environment, then now you're becoming the expert, right? And now you can present yourself, "Hey, I'm the expert now. I know how to run this for you. I know how to do this for you." Yeah. So I think it's just exponentially increasing, and I think you're at a good point where, you know,
speaker 1: You're always looking, and when something comes up you're like, it's the little penguins on icebergs, right? which one could I throw off after that?
speaker 2: Yep.
speaker 1: Right, so- I think,
speaker 2: One of the best jobs I have right now is being a medical director of a telehealth company and not because I'm the medical director of the company, More so because I go to all the meetings, right?
speaker 2: you don't wanna be meeting to death, but, you go to all the meetings and, you get to see the behind the scene decisions- Yeah ... and all the, like, nuts and bolts and, what contracts are we getting here and how do we get this contract and, what's a SOC 2 certification?
speaker 2: there's just, like, [00:22:00] all this stuff that as an ER doctor- Yeah ... didn't even know exist. I mean, I knew people were like, there's meetings and business meetings and people making financial decisions and, et cetera, but, now I'm involved in it and, like, get a say in it and, like- Yeah
speaker 2: behind the scene. And however long I stay with that company or you move on to another company as a medical director and you have all that experience from one company, right?
speaker 3: Yeah. So I
speaker 2: think that's invaluable. And I'm so glad and fortunate that, I'm 42 years old and, I've done emergency medicine.
speaker 2: I'll still do emergency medicine but I think if I'm gonna do medicine for another 10, 15, 20... How many physicians are, like, burned out and, I mean, I met a ER doctor, she was three years out of residency, she's like, "I can't do it anymore."
speaker 1: Oh, yeah. Like- the new guys get burned so easy.
speaker 2: Yeah. Right? She's like, I can't do it. " and I'm like, "Well, I've done it for 15," and I'm not saying I'm better than you or anything like that, but I'm like, I'm so glad that I found this pathway now- Yeah ... because I'm [00:23:00] like now my career can be another 15 years, 20 years, whatever, until whenever I'm ready to be done or move on to the next thing.
speaker 2: Yeah, easy. And I always think medicine is so strange in the setting that you go to undergrad, med school, residency, fellowship, job, and, what if one day you can't practice medicine? Like, you just can't practice it. What do you do? What do you do for income?
speaker 2: How do you pay your mortgage? How do you pay your bills? How do you pay for your kids' stuff, right? like, you're an accountant, right? you stop doing an accounting job at one company, you just get another accounting job at another company. Or you pivot and do something else in finance, right?
speaker 2: But medicine's weird and doesn't really work like that. You're so trained that, like, if somebody says, You had a stroke and you really lost function of your right arm and you can't intubate anymore. You can't be an ER doctor anymore."
speaker 3: Yeah, yeah.
speaker 3: Right?
speaker 2: Yeah. And I mean, how do you pivot or what do you do? And so I think- [00:24:00] That's a whole nother thing of, telemedicine. you have a lot of opportunity to do a lot of different things and there's some safety in there. Now, somebody has a stroke and loses function in their right arm and can't independent ER doc, maybe they go on disability insurance and
speaker 2: live their best life, if their disability insurance pays them well. But I think for most docs that have something disastrous happen, They're an interventional cardiologist and they get a bad tremor and they can't function, and these things really happen.
speaker 1: Yeah. It's all or nothing, right?
speaker 1: It's all or nothing. Right? You can't go back and train another six, seven years, right? Right.
speaker 3: Well, I think the one thing that's really interesting about just the telemedicine and digital health, the whole thing is you kind of said it, Steve, best is, like, you kind of get to be behind the scenes.
speaker 3: So you get to see, like, how startups work how some of these, very intelligent, well-funded companies are making decisions. And so for me, it's actually really interesting because you, get, like, a 101 on a bunch of different things- Yeah ... that you could actually potentially do.
speaker 3: Because it's so funny, like, most people at startups are, either... [00:25:00] sometimes they're dropouts, they just had, a really good idea, got really, you know, kind of self-taught. So I don't know, I love the startup environment because of that. Everybody's really scrappy at the beginning, but it does also give you a sense of hope that you can also, teach yourself.
speaker 3: we're gonna have somebody here in a couple weeks on our show who was a physician and ended up building an EHRlike an open loop competitor I guess you'd say. Mm-hmm. and, yeah, doctor, did the whole thing and then was like, "Nope, I'm gonna go into product."
speaker 3: Like, "I wanna do product stuff." And I was like, "Okay." And, Yes, he's still a doctor, but it's really interesting 'cause it... Again, if you actually are open to it, even outside of, medicine, you can still do so much in medicine and not have to actually provide care.
speaker 3: with medical directorships, you really are, kind of crafting how should this stuff work, right? Yeah. Like, how should we onboard providers? How can we, expand? Should we offer this service? Should we you know, offer this? And again, I keep going back and it'll be on my gravestone, but, we need more physicians in places like that to drive some of these [00:26:00] conversations, to make those decisions.
speaker 3: Because these companies Truly 90% of them wanna do the right thing, but they just, don't know what they don't know.
speaker 2: Yeah. I think... I work for a startup now and, I see all these mistakes they make and, I point them out to them, and they're grateful, but I only point them out to them because I know what other telehealth companies are doing right, right?
speaker 2: Because I've worked for- Right ... multiple telehealth companies. But then I see this startup like, yo, I'm like, "You shouldn't do that," and they're like, "Why?" And I'm like, "Well, this is why." And they're like, "Oh." And I can give you examples, but in general, I'm like, "Hey, this telehealth company that's like a multi-billion dollar telehealth company does it this way.
speaker 2: You probably should look at doing it this way. Their compliance is right. They follow state regulations. They know they don't prescribe this medication in this state. you're prescribing this medication in this state, you probably shouldn't be doing that. I'm warning you." And I'm just trying to help them, and they're like, "Oh, really?"
speaker 2: I'm like, "Yeah, spend a little money and talk to your lawyers and see what they say." Yeah ... so startups are funny in the sense, especially that, are [00:27:00] really new and, have an idea and, are in the healthcare space and You need experienced physicians in the telemedicine space to help them.
speaker 2: Yeah. You know, it's really a good thing.
speaker 1: we say it a lot, right? A lot of these companies, again, they mean well, but sometimes they don't know what they don't know, right? Yeah. So, and, they're, you know, full bore going, "Oh, we're gonna do this. It's a great idea." and I think that's where, you and your experience becomes invaluable.
speaker 1: Like, "No, I've done this here. I've seen the mistakes here. this is what they do on these telemedicine companies." And they love it. they eat it all up. Yeah. and that's what makes you indispensable for them, right? Yeah. So cool. We are wrapping up. One question I always like to ask at the very end too.
speaker 1: So think about intern you right after graduating med school. If you go back and talk to this person, what is the one piece of advice you'd give them?
speaker 2: one piece of advice in terms of life or as in terms of medicine?
speaker 1: Whatever. Open book.
speaker 2: I think one piece of advice, being in emergency medicine for 15 [00:28:00] years, is I wish I was better diversified starting out.
speaker 2: Not a one-trick pony, right? you're only an ER doc. You can't cath people. Yeah. You can't read a CT even though, I read CTs all night long in the emergency room at night, right? you can't do that. You're licensed and board-certified and specialized and there's a reason for that.
speaker 2: But I think diversifying early on, right? And also, maybe you don't need to be an ER doc 40 hours a week. Maybe you can be an entrepreneur, maybe you can be a real estate investor. Maybe you wanna own a cleaning company that has 20 employees. Maybe you wanna make custom surfboards.
speaker 2: I have ER doc friends that own bars. one owns Yeah ... a fried chicken restaurant. Like- ... you don't need to be just an ER doc, and I think... I wish I knew that earlier, right? [00:29:00] I've always had this entrepreneur grit in me a little bit.
speaker 2: Like, I've always wanted to start my own company, be a business owner, but I spent many, many years, like, working for an ER group as an employee and I still do. I still like my job. But I think again, one piece of advice going back is like, you can do a lot more than just grind every day in an ER.
speaker 2: And I think about how many ER physicians are out there, and we need them. Don't get me wrong, we need ER physicians, and we need people, grinding away, right? But you don't have to do that. Yeah ... but that's really hard to recognize, right? Like, undergrad, med school, residency, fellowship, residency training,
speaker 2: Emergency medicine residencies are not gonna, like, all of a sudden give you lectures and train you and tell you to go take a three-month course on, entrepreneurship, right? Yep ... that's not what they're there for.
speaker 1: No, you're trained to be one thing and one thing only, right?
speaker 1: You've lost your 20s, your early 30s to do one thing. Yeah. And that's it.
speaker 2: I sometimes think to myself, I'm like, "Where would I [00:30:00] be if I, like, started this telehealth thing or got involved in these companies 10 years ago?" Yeah ... or it's not that I'm, like, regretting anything or looking back, but I'm like, I'm only two years into this, and I'm, like, really happy with where I am
speaker 2: But it gives you, I think diversification, I think that's really important, being able to diversify yourself and again, what happens to you if something happens and you can't practice emergency medicine, right? And you have four kids in college and two homes and, you know, it's good to, be diversified and have...
speaker 2: job satisfaction and life happiness-and flexibility. that's important,
speaker 1: yeah, and it shows life expectancy increases, right? Yeah. We could live beyond 58 years old. Yeah.
speaker 2: So... Which is what, the average for ER doctors. Right, so- 58 or something like that. Yeah.
speaker 1: No, this is amazing.
speaker 1: Steve, thank you for your time. Appreciate having you here. and yeah, looking forward to updates later on. Love to have you on a little bit later to see what you're getting into maybe, you know, months from now. Yeah. But, Phoebe, any [00:31:00] closing thoughts?
speaker 3: No. I wish more doctors were like Steve and so easy to work with, and so- Oh, yeah
speaker 3: like hungry and ambitious. And also just, like, open to the constant discomfort that it's going to take.
speaker 3: Yeah.
speaker 3: Just like how you felt back on, your first day of med school or your first day of residency. Like, it's uncomfortable. And I've heard, A lot of doctors have jumped in and, like, quit because they're, "Oh, I can't deal with the onboarding," or, "I can't deal with this," or, "I can't deal with that."
speaker 3: Yeah. All the time. You do get to a peak, and there is a point almost probably, like, the day after, you probably were thinking of quitting that you're all of a sudden like, "Oh, I'm in Portugal."
speaker 1: Yeah.
speaker 1: Yeah. The moment that realization- The moment- ... hits- Yeah ... and you're like, "Wait, this is really working."
speaker 1: I get it now. Yeah.
speaker 2: It was real, and I was like, "Can I make this happen?" Like, this is a task, And you can. Yeah ... and, gonna have bad days and good days. I mean- Yeah ... definitely. I still have bad and good days, and days that I'm like, Did I do that right?"
speaker 2: Or, like, you know. And there's growth [00:32:00] and learning and... I would say There's a lot of self push, you know?
speaker 2: you gotta
speaker 1: push. Yeah ... Well, amazing. Thank you for your time. Those that wanna reach out and wanna be on the show, drop us a line, info@telemedicinetalks.com.
speaker 1: Steve, thank you again. until next time Yeah. Have a great one.