Phoebe Gutierrez and Dr. Leo Damasco recap the biggest legal, regulatory, compliance, and business developments in telemedicine over the summer. They discuss the DEA’s progress toward final rules for controlled-substance prescribing, the FTC’s action against Hims & Hers, Eli Lilly’s lawsuits surrounding Retatrutide, corporate practice of medicine enforcement, and the rapid growth of white-label telemedicine companies.
It was the summer telemedicine stopped getting a pass.
In this episode of Telemedicine Talks, Phoebe Gutierrez and Dr. Leo Damasco recap major telemedicine developments from the summer, focusing on increasing regulatory and enforcement activity. They discuss the DEA’s progress toward final controlled-substance prescribing rules and what greater federal oversight could mean for telemedicine companies operating in this rapidly evolving space.
They both examine FTC action against Hims & Hers, including subscription practices and cancellation requirements, while questioning whether traditional healthcare regulations adequately fit cash-pay telemedicine. They also discuss Eli Lilly’s lawsuits involving Retatrutide, emphasizing the potential risks physicians face when prescribing non-FDA-approved treatments and the growing attention from state medical boards.
Finally, they explore corporate practice of medicine enforcement, including Carbon Health’s settlement and evolving PC/MSO requirements, before turning to the growth of white-label telemedicine companies. The episode highlights why physicians must understand their responsibilities, review their agreements, stay informed about regulations, build specialized expertise, and find ways to distinguish themselves in an increasingly competitive telemedicine market.
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[00:00:00]
Hey everyone. Welcome back to Telemedicine Talks. So every week we break down how telemedicine really works, the legal side, the business side, and all the parts in between that keep founders and physicians up at night Welcome back to another episode with us, your hosts, Phoebe Gutierrez and Dr.
Leo Damasco.
Hey. Welcome back, everybody. Thanks for hanging out with us. school's back in town, thank God, right? You know, those of us- Hallelujah ... with kids. thank... I love 'em, I really do, and it's fun to hang out with them, but yes. Thank God. yeah, other people are raising my kids now.
perfect. But that leads us into what we're gonna talk about today, not dropping your kids off at school and forgetting about them all day. But, you know, summer's over, and, for a lot of us, we're getting back into the swing of things and getting back into it. And, we thought it was a good idea today to just basically [00:01:00] recap what's been going on over the summer, if you've been, out of office, unplugged, just kind of get back in the swing of things.
So, yeah, Phoebe, what's been going on this summer?
Man, we have had a lot of some really interesting things happen this summer, what I would say are really relevant to everybody in digital health and telemedicine. In kind of just, like, general regulatory news, of course, we are continuously seeing the extension of, prescribing flexibilities from the DEA.
Most recently, actually, last week, the DEA sent the final rule, so that means, like, the final package of the regulations that they're gonna propose to codify into law, they sent that forward to the final approving board last week. So the hope is that by the end of this year, we're gonna actually understand and know exactly what is going to be happening when it comes to controlled substance [00:02:00] prescribing.
Yeah. So is that gonna mean we're not gonna, like, fall into kind of what we did last year? You know, everybody was expecting it, in what? September? December? I forget. Timeframe. We talked about it a lot. I think it was, like, December 29th. Right.
Like,
it's pretty close to when it was expiring. And the government was shut down, then the date came and went, and people were like, "Oh, yeah, it's gonna happen," but it never really did. And that really shook a lot of people's business models, right? People shut down certain lines because they didn't know what was going on.
So, no, this is a good thing. You know, maybe we'll have a little bit more clarity this time around, and being proactive this time around. So it's good to hear.
And so typically what happens, 'cause I've been part of many final rule drops, is like what we used to call them on the regulator side, which is the government will release this, and they'll go, these are our final decisions on all the rules.
You as states now need to go take this information and implement monitoring and auditing and enforcement measures to comply with these [00:03:00] things and make sure you're overseeing it appropriately." And so my hypothesis is and I can't even remember, was it like a year ago, a year and a half ago, where they came out with their proposal as it related to some of these, changes as it related to controlled substance prescribing in the virtual capacity, one of those being that telemedicine companies were gonna have to register for kind of like a federal, you know- Yeah
you're gonna have to basically say you are doing this prescribing, and my guess is that is gonna stick. and we're gonna talk about this throughout the rest of the episode, so it'll make a lot more sense, but currently there is no monitoring and enforcement of telemedicine organizations today.
And so this is going to be the federal government's way of going, "Look, we understand who all the players are in the game," because there's so many now.
we understand who the players are, and we are gonna now have visibility into that, and we're gonna be able to go back and do checks and balances to [00:04:00] audit them.
So once they release the final rule, typically what happens is states will have about 12 months, usually like six to 12 months, to come into compliance with enforcing those rules. So I'm really interested to see what actually drops and what sticks with what was previously recommended. In some instances, I've actually seen the federal government make no changes to those final rule recommendations.
Oh. So a lot of the stuff that we heard, Leo, you know, from colleagues of ours that like- Yeah ... "Oh, that final rule package is garbage, and you know- Yeah. Yeah ... this isn't gonna stick, and this isn't gonna..." The government does not care. So they are going to put forth what they are recommending as the final set as it governs this controlled substance prescribing, and we'll go from there.
So, Q1 2027 is gonna be fun for any telemedicine company that is playing in the controlled substance space.
Yeah. No, and it makes sense, [00:05:00] right? And we've been living in the Wild Wild West and, I've always often asked, "Hey, who's watching?" and how people are held accountable, so forth and so on.
and we've seen the cases, but this is gonna be interesting to see.
Yeah. it's actually really, really interesting because- in cash pay telemedicine, there's honestly like really little oversight-
Yeah ...
outside of, you know, I guess that kind of segues us into some of the next topics of like the FTC is which I would consider probably the biggest enforcer when it comes to digital health and telemedicine because the big difference behind or between let's say like payer, traditional kind of like insurance programs and CashPay is CashPay has the money to market, and they are incentivized to market, and that's actually what gets companies in trouble.
it's funny that it's the FTC. You'd figure, in my mind, the commonsensical answer would be, hey, it'd be the, you know, the [00:06:00] state boards, so forth and so on. But you're right, you know, especially these direct-to-consumer CashPay folks, there's no leverage on the medical side, right?
especially to the businesses, right? Yeah. Yeah. The leverage for the docs and practicing, you know, comes from the medical boards and there's some accountability there. But really, we've talked about this before, nothing's really stopping the businesses, other than some of what we've seen.
But then what we also have seen is those businesses come down, shut down, rebrand, rename, and then open up, and you got the same problem all over again. So what's been going on with FTC?
Last month the FTC sued Hims and Hers, which, you know, to me, like my ears perked, my eyes were like- Yeah
"Oh, oh great."
that's a big player.
And interestingly enough, Hims and Hers is like, "We're fighting you back. Like we're gonna go head-to-head because we actually think that what you guys are trying to [00:07:00] enforce is impossible." And I'm stuck in the middle between the two, to be perfectly honest.
So, just to kind of get into it, towards the tail end of July, Utah, the state of California, and the FTC, kind of like the federal branch made some pretty serious allegations against Hims and Hers as it relates to just how they're doing kind of like their memberships.
So the first big allegation is that the company, you would enroll people into these like recurring prescriptions- ... subscriptions without really sharing what the terms were. So people were thinking they were signing up for free unless they got a prescription, and then inadvertently found out like, no, they're just enrolled in this $100 per month- Yeah, yeah
thing, but they're not really getting anything from it. And they also made it really difficult for you to cancel. [00:08:00] So federally, federal guidelines actually say that if you have kind of membership type subscriptions, you have to have what's considered one-click cancellation, and Hims and Hers did not have that.
So in order to cancel, you'd have to reach out to this person and that person and confirm multiple times. And so it made it really difficult for people that were stuck into this loop to kind of like get made whole
So what is Hims and Hers, saying about that? What's their fight back?
So Hims and Hers' fight back, which I think is pretty... Like, if I were them, I'd probably do the same thing, is, like, go look at every other telemedicine company-
Yeah ...
and tell us what we're doing different because every other company, operates that way.
So after this dropped, I started to look into cancellation workflows for some of these companies, and nobody, like nobody, has one-click cancellations. I was looking at some of the large, like, sexual [00:09:00] health companies, some large women's health companies, and it was really interesting because they have the same kind of workflow where you enroll in a program, they're not guaranteeing a prescription, and you continuously pay, and then you kinda can't get out.
Yeah.
So their argument here is that we're not the ones that are outdated with our operations. You as the federal government are outdated in your regulatory thinking because that is not how telemedicine operates.
That's an interesting kind of comeback, And I'm thinking about, the subscriptions I have, not just medical subscriptions, but, the commercial or, just different types of subscriptions that I have, right?
and they just show up on my bill, right? 'Cause yeah, they just kinda, one, I didn't know I subscribed, and this is again not necessarily telemedicine, but just, commercial items altogether. So I wonder, if, yes, that's probably the rule, but how well they're enforcing that across the board across different [00:10:00] business lines as well.
Or are they just trying to make an example because, you know, this is the only thing that, they could tag somebody on? It's like- Well- ... tax evasion, right? You know? A little bit ... you can't get them for murder- A little bit ... so you get them for tax- there's
always, in all of this, and this is why I track, like, litigation so closely, is there's always case law references because that's, like, when you're getting- Yeah
sued or when you're in one of these investigations, that's what they reference. There's a precedent here because this judge once said this person screwed up, and because of, ... blah, blah. Yeah. What the interesting part here is, like, Hims and Hers is like, "No, but you guys are wrong."
And I think it honestly, and I gotta say it, one of my big things is you cannot compare the insurance industry, Medicare, Medicaid, with cash pay. You can't layer the same rules and regulations- No. No, you can't ... and requirements on that industry into cash pay. And so even as we talk about, like, Stark Law and referrals and this and that, Does all of that stuff [00:11:00] really apply in the cash industry, or are there a different set of rules that we really need to start thinking about to set some guardrails for telemedicine companies to be able to operate compliantly?
'Cause, I will argue tooth and nail that the way that telemedicine companies pay physicians today is an immediate violation of Stark. I'm the first one to say, you only get paid if you prescribe a prescription versus the time that it takes to assess and analyze and look at their data.
I mean, you as a physician are incentivized to prescribe, and you are rewarded by a fee, which is also, quote-unquote, a referral. To me, I think there's a whole new world for regulators to wrap their heads around what we need to do in digital health to make it safe and compliant and good care.
And I'm sure a lot of the telemedicine [00:12:00] doctors are gonna, not like some of the opinions that I would have, but I think that is kind of like the basis of Hims and Hers is trying to say here is that, like, "Stop putting these outdated rules on us. It doesn't work for us."
It makes sense, right? 'Cause yeah, when you talk about traditional brick-and-mortar medicine, right, how many- direct-to-consumer cash pay practices are there really, right? It's just wasn't you got your concierge practices maybe, but really it was the exception versus the norm.
And especially years back, direct-to-consumer telemedicine was the norm, right? Mm-hmm. So no, it's all good points. Yeah, interesting to see how this comes out of it, and looking at it too, a couple states jumped on the suit as well, so, you know, California, Utah, jumping on the bandwagon with the suit.
So yeah, that's huge 'cause if the precedent's set, it could definitely change, knowing kind of the workflow and working for different companies this is how it's done, right? That's- what kind of I wouldn't call it standard of care, but kind of standard of practice in terms on the [00:13:00] patient-facing side.
Yeah. And, like, interestingly enough, so right after this happened, I'd say maybe a week later, Visa then released
like, a notification stating that they are also now investigating Hims and Hers, and they put Hims and Hers on notice because they're getting so many complaints and disputes-
Really?
from people saying their card was, you know, incorrectly charged for some of these services. So what used to happen when I was a regulator is a lot of times we would either get, like, LA Times would report on something, or the FTC would report on something, and then it would tip us off as a regulatory agency.
Yeah.
And then we would dive in, and in my opinion, that's what is happening now in Hims and Hers. You have the payment processors, you know, really kind of intervening because through LegitScript certification and some of the other requirements that a lot of these large companies have to comply with if a federal agency is [00:14:00] investigating you, they also don't want to be on the hook for allowing improper behavior.
Yeah.
So they have to protect their brand, to protect their terms of service, have to also start investigating as well. So it's this interesting ripple effect that you have to go against.
Yeah, and it's funny, now just this is a precursory look into what's going on with Visa and Hims, but yeah, it seems like, yeah, I guess it makes sense.
Visa and probably all the credit cards monitor, kind of the complaints, right? And each dispute. And it seems that, yeah, Hims and Hers is exceeded the kind of the 1.5% threshold of all transactions. And yeah, they actually charge $8 to the company for every dispute, and, it says that, hey, they're charging at least $75,000, for the prior month, the month of July.
So you do the math. That's a lot of complaints, and yeah, no, that's, interesting. I wonder, if this again goes down, it definitely puts every, every [00:15:00] single telemedicine, platform on notice saying, "Hey, watch out for this."
Yeah. and my big thing is like, Hims is the first one, but I'm very bullish when I come to, my thought that very soon, there is going to be different departments in various regulatory agencies that are looking at telemedicine, and they are going to start crafting some really, good oversight tools.
Yeah.
Shout out state agencies, happy to
consult for you. It's probably happening right now, right? Um, lots of ideas. I've done this many times. But to me, I think that's kind of what is gonna need to be put in place to mitigate some of these things. Now, Hims and Hers are so big, they're like, "Well, you're coming to us after a certain point."
Yeah.
like it's, we'll see kind of how this goes and progresses. But again, this is kind of like what I would consider the example, but which is also a really good segue into another good example [00:16:00] case that we saw this summer with the drug Retatrutide. So to kind of catch everybody up peptides are booming in telemedicine, and, as we all know, Retatrutide, which is such a hard word
to say. Retta has really kind of emerged to this, quote, unquote, like what I will say is kind of like a miracle drug. Eli Lilly is the company that is funding all the clinical trials to really validate what, they're seeing in some of this data, and also to be able to turn it into something that is FDA approved, legally able to sell.
And so you see a lot of, what I would consider black market or gray market-
Mm-hmm ...
selling of Retatrutide because there is no brand to it yet, right? Like that- Right ... is the name of the peptide. Now, when Eli Lilly, continues and gets the approval, I'm sure they're gonna brand it to something really [00:17:00] cool but for right now, you have all these other companies that I would say are kind of like hanging onto the coattails of what Eli Lilly is pushing. Because of that, Eli Lilly is suing six different companies, and that was another big kind of like bombshell that dropped this summer Interestingly enough, I had told a lot of clients, 'cause clients would come to me and ask, you know, like, what do you think about Retetrutide?" And this pharmacy offers it or that pharmacy. And it was always like I don't know. I'm not a clinician, but I can tell you that I would not want to mess with Eli Lilly. Like that was always- ... my thought. Like I don't wanna mess with Eli Lilly.
Like point blank, period. Whether or not it is a miracle drug or not, it is still not FDA approved, therefore I personally wouldn't feel comfortable wanting to prescribe that thing. There's a lot of companies that as we can see in some of the lawsuits, that had no qualms about [00:18:00] doing it. And one of the companies named in their lawsuit, which I thought was really interesting, was a very small four, location med spa here in northern California, my hometown that was marketing Retta, but just like, the other 10,000 med spas that are marketing it still on the internet.
that's kind of an interesting turn, right? 'Cause yeah, you've seen the ads, Unless you're living under a rock, You know that people are saying, "Hey, we have access to it. Research only," right? But why waste your time on a small four location med spa, right?
unless, yeah, they're trying to make a statement, right? Hey, you're not under the radar. Nobody's under the radar for this, And where that plays into the telemedicine doctors is, hey, you know, you're gonna get approached by small companies, whatever pharmacy saying, "Hey, are you willing to prescribe this?"
is this something that you could do?" And, I think, you know, take [00:19:00] a little caution into doing that, right? 'Cause, you're putting yourself up on spotlight as well.
100%. So, when you dig into kind of the complaint that was brought by Eli Lilly, you really start to pay attention to what they're trying to do.
They identified over 14,000 locations that are, illegally marketing Retetrutide. They, of course have lawsuits against many of the Retta manufacturers as well as pharmacies. And the interesting thing is they've also provided all of this information over to the medical boards.
They're telling the medical boards to go and pay attention to the physicians and the prescribers that are- Yeah ... doing this, and that to me is the scary part, right? you have Eli Lilly pushing, telling regulators, "I need you to look into this. I need you to pay attention."
If they do, how many physicians, you know, potentially could have some implications as it relates to their licensure because [00:20:00] they inadvertently or accidentally prescribed something that they didn't realize was violating federal law?
And that actually brings up kind of an email that I got kind of along the same lines.
states are paying attention, right? I think it was South Carolina that just came out. You know- Yep ... I know a bunch of us noticed in our emails that have a license. And don't quote me, it's one of the Carolinas. east of the Mississippi- It's South. It's South Carolina Is it South?
Okay.
I confirmed it 'cause you told me. They came out with a statement saying, "Hey, yeah, we are not allowing any non-FDA approved peptides in our state. Regardless of where you're prescribing it, where it's coming from, that's just a no-go, and you are subject to board investigation and board, you know, reprimand or even further actions if you are engaged in those practices."
So yeah States are paying attention. you called it earlier this year, when we had that episode of, "Hey, what's coming along?" Yeah, it's only a matter of time [00:21:00] until, the regulations and these regulators are catching up to the practices
Yeah.
I mean, I think the big thing is because telemedicine lacks so much regulation when it comes to business owners or really, like, non-clinician owners, and I think we learned this when we did our episode on the owner who owned Cerebral and then, you know, went to- Yeah ... that other company. I'm drawing a blank right now.
the Cerebral issue was a massive criminal investigation. Yeah. Lots of people got into trouble, and he was able, as the CEO, to step down and then go start a company and do the exact same thing where he was illegally prescribing. Now, I'm not saying that other telemedicine companies do that.
What I'm saying is it's really easy for a person who doesn't have a license to be able to get a fresh start. right now, the onus and the risk is always delegated down, and I hear that day to day. And in some of the companies I work [00:22:00] with, I even say that. Our technology does not need to be perfect because at the end of the day, if the physician is prescribing something- Oh, yeah
and it's incorrect and our system is wrong or broken, that falls on the physician or the prescriber. I mean, I even have to go, like, "Look, we all gotta have our own risk," but there are certain things that I think physicians need to stay informed and updated on to make sure that they're, doing this the right way.
Yeah. That's just a great point overall, right? As doctors practicing in this space, we are the ultimate, end stop, right? the buck stops with us. And your head has to be on a swivel, but you have to always keep on the lookout, yeah, businesses will promise, "Hey, we have, workflows and pathways that are protecting you," but really, things could fall through the crack.
Bottom line is, hey, just watch out. look out for your back. Ask questions and make sure that people are actually doing the right thing. Because ultimately, it'll come down to you, and when you step up to the [00:23:00] board, it's gonna be a hard conversation or hard argument saying, "Well, you know, I left it up to them," and, I don't think that's gonna stand up very strongly- Yeah ... on your side.
Yep. Well, and I think that's also, like, a good segue into a lot of what I would consider this summer... We saw some really interesting, corporate practice of medicine cases- Yeah ... which was new. Shout-out California for always, trying to lead the way.
Leading the way. Always. But, Carbon Health had a pretty massive, $4.5 million settlement with the state of California over corporate practice of medicine violations. And really, again, it goes back to Carbon Health was not able to demonstrate that the physician owned the clinical side of the business, and that the PC was really independently operating on the clinical side.
And this was, like, the first time the attorney general was, really kind of, like, digging their teeth into [00:24:00] the rules and the regulations, and then looking at it from an operational capacity. So like, Leo, how many times do we get approached for, PC types of opportunities, and at the end of the day, if they're not willing to comply with how it needs to be operationalized, like, we have to walk away from those.
Absolutely. And a lot of these companies, they don't realize, or they've gotten bad information that this could happen. You know, We've had these conversations before or after these meetings with these certain companies. I'm like, "What the heck just happened?" I wanna rent your EI, you know, your TIN," or, "I wanna rent your NPI number."
Remember that one? Yeah.
And we both looked at each other like- We just need your NPI number. I was like, "What?"
you want 50% stake in my NPI number? What are you talking about? Right? Like, no. No. A lot of these companies come in and they're like, "Yeah," but they just don't understand- Oh
CPM laws, And that obviously was a blatant one. We both looked at each other and we're like, [00:25:00] "Oh, hell no." we're out. but right? It goes to show. Yeah. And-
I forgot about that. I buried that one deep into my We were like, "Right, it was in their PowerPoint," like- Oh, yeah ... you know- I was like, "No, this is not happening."
Oh. But, even the kind of the subtle stuff too, like, I know California, people are reworking their MSO PC contracts in California.
Yep. Well, we just redid one with you- Yeah ... in one of your
Yeah ... large things because California has outlawed the restricted transfer agreement.
That's- Correct ... like SB-351, and you still have so many companies that are like, "No, no, no," like, "At the end of the day," like, "we don't like this doctor, we get to choose a different one that's gonna come in and replace it." And it's like, but that's illegal in California. Yep. So, like, by all means you can fight tooth and nail to put that into a contract, but it's illegal.
They have made it- ... specifically, explicitly illegal, right? Yeah. So PC owners, if you do have a PC [00:26:00] MSO contract in a company out of California, definitely recommend looking back, talk to your legal and saying, "Hey," and talk to the MSO's legal and say, "Hey, we need to make this right."
This is where the, quote, "friendly model" really has to be friendly. And I think, you're gonna find a lot of people, talking to their PC owners again, right? Like, a lot of times the PC owners are just kind of ghost figures, right? But a lot of people don't know. They're just there.
And so yeah, real relationships have to be created, right?
You have to have the documentation. And, like, at the very least, and this is what I say to everybody, is like, "Go back, read your contract." Grab your contracts, actually.
Don't read them. Throw them into ChatGPT and be like what should I be doing as the physician?" Yeah. And if you are not doing those things, like, by all means, especially if you are in California, if you are in Texas, if you are in Oregon, if you are in New York, if you are in New Jersey, or the Carolinas, you've got to make sure that you are [00:27:00] complying with those things because, again, my hypothesis three years ago, and Leo can quote me, was that in three years we're gonna start to see a lot of corporate practice of medicine- Yeah
enforcement, and the states are just catching up because this is new. I mean, California's setting the precedents, and I will not be surprised if we don't start to see some more in Texas and- Yeah ... New York and some of the other states that are a little bit more stringent on this stuff.
That list just grows, every time we talk about it. You know, we're just adding more and more states to that list. But yeah, you definitely called it. Check out one of our earlier episodes. that was kind of, "Hey, what's looking ahead?" Shameless plug though, if you don't wanna do that yourself Phoebe does that for you.
the funny thing is Leo like, I joke, I do Leo's auditing for him, and when he is not doing the stuff that he's supposed to do and When I say that, I literally mean like, "Leo, did you just log your notes? I know you met with these four people." Yeah.
Okay. "Did you log your notes? [00:28:00] Can we just get all of our documentation..." I can't sleep at night. So I was like, "Leo," you know, like I'm like texting you- Right ... "Come on, man. Like, I just need to get some sleep. Just tell me we got all of our stuff locked in."
And honestly,
that's the type of person you want. You know what I mean? these are my licenses is the way I look at it. And then, sometimes things are just happening at 1,000 miles per hour, so it's nice to have somebody being like, "Well, you really need to do this."
I just want you guys to slow down a little bit and be really thoughtful with what you're doing.
I don't have a medical license. I did not have to go through all the schooling and the sleepless nights and all the people throwing poop at me. Like, I don't have to go through that. And for me especially in like digital health and telemedicine, I just wanna make sure physicians are informed and everybody is understanding, 'cause it's very different than the hospital- Yeah
and it's very different than what you've, done in the past. Yeah. Yeah. But yeah, so there's a lot more kind of enforcement that's [00:29:00] related to, a lot of the, peptides , compounding, corporate practice of medicine. Those are all things that are kind of like right now.
And then I think the other, just the kind of like last remark is I think this summer was kind of also the boom of what we saw as this like white label telemedicine industry. And like what I mean by that is you have large companies now that basically are supporting other types of organizations- Yeah
starting national telemedicine companies. Me, myself, I'm in California, I don't have a clinical thing. If I have 50,000 followers on Instagram, I could contract with one of these companies, launch a landing page, and tomorrow be quote unquote compliantly prescribing. and I think that has also been really interesting.
and we've seen this boom, right? And there's a multitude of [00:30:00] companies coming out, and, new companies are coming out and this is a great solution for them. these white label companies are offering, your physician services, your marketing services, so forth and so on.
And it's, kind of the new, how to open up your business template is to, hire these white label companies. And you're seeing this a lot, If you've noticed, right, especially in the very, very beginning of, the telemedicine boom, you had the same doctors prescribing for a bunch of different companies.
And that's because, well yeah, it was just really one company providing service to a bunch of different companies because of this white label service. But now you're seeing a lot of them. So how does that play in the bigger scheme of things? What should we be looking out for
because of this?
I think there's two things. I think one of the things that I thought was interesting, and this might be an unpopular opinion, but if you listen to this podcast you know I'm not gonna just like not talk, of course. one of the interesting things that [00:31:00] I thought is I almost feel like physicians are diluting themselves a little bit.
So because it's so competitive and we're seeing more and more nationally licensed doctors, or even not even nationally licensed, but anybody who has 10 or more licenses is now really trying to kind of get into the telemedicine world.
Yeah.
And because of that, it's like a supply and demand kind of issue.
So you have physicians that are literally, negotiating against each other and at the end of the day, the companies don't care. It's always kind of like a race to the bottom. So it's very similar to how people are looking at pharmacy pricing or some of the other pricing. you know, I told you, Leo, I had a physician, 'cause I will randomly just ask like, "Would you do this thing for this much money?"
I had a physician agree to do like asynchronous reads for $7 an encounter, and I'm like that, can't be that great care. Like what? Like $7? Like, oh my goodness.
You know, it depends on the workflow, right? If this async care is gonna happen, it's only [00:32:00] gonna take you 30 seconds to a minute, then $7 is a good number.
But I'm assuming, this is the typical async care where it takes you a little bit more, right? But it's a statement of what I'm seeing overall and just kind of on the doctor side in the market and just our reimbursements, right? when I first started a few years back now, the rate was a lot higher and, you know, we were in the driver's seat 'cause, there weren't many of us playing in the telemedicine space, especially in the 51 licensed telemedicine space.
Now, I think there still isn't as many, but relatively the numbers have grown and, companies are finding that, yeah, people are willing to work for less and offering less. And I'm actually seeing that in my wallet too, Companies that I've been working for years have been adjusting their pay scale and paying less.
And I don't wanna say they're getting away with it. it's a business model, right? They're running a business as well, I get it. But yeah [00:33:00] they're getting away with it.
Well, my real, opinion about it is that I think it ultimately depends.
I think you will. You'll have some physicians that have no problem getting into the space and- Yeah ... you know, kind of hopping on various different platforms and prescribing. But one of the other things that I think has been really interesting about this is a lot of these companies actually need really strong medical directors and really strong experts in various fields, right?
Like men's health- Yeah, yeah ... or women's health or really specific like cardiovascular. Leo, we had a client reach out who like wants to talk to you about lab data and pediatrics, which I think is like really interesting and like completely up your alley. Yeah. So it's this interesting thing where it's like you need kind of the generalist physicians for the daily work, but as they're crafting their overall strategy and like how to actually, expand and do things, they do need these like niched down providers and physicians [00:34:00] to be able to kind of lead some of that conversation.
You know, my thing is like I think it's interesting. Do I like it? I don't know. I'm still on the fence. I love the access to care. Yeah. Do I think it's the best care? I don't know. I don't wanna necessarily speak on it too much, but it is something that I'm seeing almost, like literally just talking to your phone, 'cause you know, like we all know our phones are listening to us, like talk into your phone, say like, "White label telemedicine," and like I swear your algorithms, you'll see all these companies that are doing it, and it kind of is eye-opening because it's not so much now just your big players of SteadyMD and- Right
and some of the kind of like OGs in the space, but you have these new up and coming that are like, "We're willing to do peptides," or, "We're willing to do this. We're willing to kind of push boundaries," and they're thinking about it more from a telemedicine perspective- Yeah ... of like, "We can build your website.
We can do your Google ads. We can do your this, we can do your that." Where, to me, if I'm looking for [00:35:00] passive income, for me as a- Yeah ... non-clinician, partnering with a completely, 50-state PC makes sense.
Yeah. it's almost, you know, you can think about it as almost like your mom and pop shops now, right?
yeah, you have your big players, but yeah, these moms and pops are opening up and now I think the success of that is directly correlated too to the accessibility now of a lot more doctors playing or working in the telehealth space. So I think, to talk to them three years back, I don't think, that it would've been possible because, the doctors playing in that space were, you know, attached to the bigger guys, right?
But now, there's a influx and, you know, I get it, rightly so. it's a great place to work in. But yeah, the market is getting, I wouldn't say flooded, but there's a big increase in the number of doctors looking for jobs and I think it creates that environment where these white label companies, these smaller moms and pops can survive.
Yeah. Well, and I will say I think this is also just like- the [00:36:00] people skills, right? Yeah. So to me it's like being able to network. You get to meet a lot of really cool companies being on different platforms and working with different organizations. And so to me it's like none of this of what I'm saying, should hinder or stop a person from jumping into telemedicine.
I think I'm actually saying the opposite. I'm saying get in, get your feet wet, get through kind of your first phase, and then it, there are so many other opportunities- Yeah ... where you can partner with these other companies to, again, craft different verticals or change different things.
But, ultimately there's a lot more that they can use from a physician's perspective, even just outside of being a direct prescriber.
And I think, you know, going back to our talk last week or our guest last week when we had Mike Wu-Ming here, No, it was on his podcast.
Hey, check out us on his podcast
Bootstrap MD.
Yeah. Check it out. we were talking about this exact subject, you know, how to distinguish yourself. how to be, more successful [00:37:00] in the telemedicine game now.
First starting, you know, a few years ago all you needed to do was just be in the game, right? But now, yeah, you have to have a different qualifier to separate yourself from the pack if you wanna move along in the telemedicine environment, right? now if you just like, you know, clicking and just, doing clinical stuff and, doing that all day every day, then great, you could just jump in and people are willing to hire you. But if you're looking for the jobs that, free up your time, and maximize your efficiency, you're gonna need a way to separate yourself, and how do you do that, you know, what's your distinguishing mark?
Yeah.
Anywho.
Well, I know this was a little bit of a longer episode. There was just so much from the legal, regulatory, compliance, business perspective that kind of happened this summer, and I really wanted to just spend some time, you know, with my boring stuff, not the fun stuff. But we just wanna say, we really appreciate everybody listening to Telemedicine Talks.
we are [00:38:00] your resident telemedicine experts, whether you asked for it or not. You got me and Leo here at Telemedicine Talks- Talk to that ... supporting you every step of the way as you jump into your telemedicine journey. So thank you so much for joining us on this episode, and we'll see you next week.