We sat down with well-respected emergency and sports medicine physician (and newly minted telemedicine provider) Dr. James to hear his thoughts on the future of telemedicine, what makes for a good telemedicine provider, and why he sees patients return to telemedicine again and again.
Distinguished MD Dr. James has had an enviable career. From solo practice and the rural ER to international travel and the Olympic games, he’s - quite literally - been around the block and seen it twice. Still practicing after 35 years, we wanted to know why he decided to add telemedicine physician to his impressive CV, get his take on the future of healthcare delivery, and hear his advice for providers considering a transition to telemedicine practice.
From the Rural ED to Urgent Care Telemedicine Physician
What’s your background? What did you do before practicing telemedicine?
I graduated in 1979 and have had over 35 years in emergency medicine and sports medicine as a team physician. I started at Marshall University - known as the “rural healthcare center of excellence.”
As a sports medicine physician, I worked with international elite athletes, staffed the Atlanta 1996 Olympic Games, traveled with the US Soccer team, and worked with university teams. I also practiced in full-time ER roles, directing two or three emergency departments with a focus on small-town USA.
What are your telemedicine patients like?
I practice telemedicine with a group headquartered in Atlanta, Georgia. For this group, calls come in from Florida and neighboring states, most of them are from Georgia though. And in Georgia, it’s either (urban) Atlanta or (rural) everything else.
The typical metro call will be from a 35-year-old with a great job who is sick at work all day and getting ready to go home. They will initiate the telemedicine consult while they are on the road headed to the pharmacy - they are efficient! While the average rural patient has gone to work, gotten home, and taken his/her temperature before calling.
Many of the calls are from repeat users - at least 40% - and some have had 5-7 consults in the past few years. These are very well-informed patients and a completely different population: they do a little homework, they are working, they are more technologically savvy.
Folks love telemedicine, and if you can’t treat them, there isn’tpushback.
Why did you want to start practicing telemedicine?
The smartphone has changed the world over the last ten years. It’s easy to see that the next big thing in healthcare is for people to access good medical information over their phone.
Early in my career, I had a concierge program as part of my solo general practice that allowed patients to get access to me 24/7. It was very successful and our patients received excellent timely care, but the economics of the program never really made sense. For one thing, the Mayo Clinic in Jacksonville opened up nearby. But the concierge piece was the beginning of a telemedicine-type service.
Now, I work as a part-time telemedicine physician with a group out of Atlanta. For me, telemedicine could be a transition to early retirement or it could be a way to jump in and get involved in a new approach to a concierge program. I’m also very interested in telemedicine and sports concussion care.
Tell us about your telemedicine consults?
Phone consults typically last anywhere from 10 minutes to 30 minutes. Upper respiratory, sinusitis, and sore throat are the most common ailments.
It can be hard to practice good medicine without being in person, without putting a stethoscope on the heart, but these patients have made an informed decision to take my medical advice and see if they get better because they prefer the efficiency and convenience of telemedicine over having to wait around in an ER waiting room.
What do you miss most about practicing in person?
Taking vital signs - like blood pressure and heart rate - can be one of the missing pieces of the puzzle. If I can get a temperature and a pulse from the patient I’m pretty happy. I make a lot of patients take their own pulse and count it out for them.
How do you balance traditional medicine with telemedicine for supplemental income? (schedule, etc.)
In addition to telemedicine, I do emergency medical service leadership and act as a regional medical director. And I’m still a team physician for a division two team. For telemedicine, I block out the same reproducible schedule of a few hours every day. There is variation in call volume from one day to the next.
What are the differences in practicing telemedicine vs. traditional? Anything you miss?
With telemedicine, you miss the basic human to human interaction: the chance to take someone’s hand, hear their story, and interact with family members. You also miss the education element. It’s great when you have time to do some teaching at the bedside about the illness and how to best manage it.
What was the most difficult thing about getting started practicing telemedicine? Was there a learning curve?
The calls took a little longer in the beginning. It had been ten years since I practiced in Florida or in a small ER in Georgia, and I found it took a moment to remember the personality and terminology of those patients - even though I was already familiar with them. People’s perceptions of pain and the ways people describe their ailments are different. It could be difficult for someone who doesn’t know the culture.
What’s the best advice you can give to someone thinking about getting started in telemedicine? What do you wish you knew?
You have to have a little bit of the old GP-type philosophy. You need to be able to relate to people and be their next-door neighbor—as opposed to being the academic, stiff, white coat guy. You have to have a healing ministry attitude.
It helps to get the patients to open up a little more when theyrealize the doctor is their friend.
How much experience do you think someone should have before starting in telemedicine?
Having experience helps provide the “sixth sense” about what patients are experiencing. Experience helps “confirm” your clinical impression of the patient’s presentation. It’s very important.
Do you foresee yourself returning to traditional medicine full time? What does your future hold?
I probably won’t return to full-time emergency medicine, at age 66 those 12-hour shifts are too long.
Telemedicine is something you can do way past retirement age if you are good at it. It’s a way of keeping your hands in it until you are well into your 70’s. Medicine is a healing ministry, it’s hard to hang it up.
What’s next for telemedicine and for you?
With telemedicine, we are in the first chapter of a ten chapter bookin this thing, it’s going to explode.
I want to write the chapter on the overlap of emergency medicine and sports medicine. As I get better in telemedicine, I want to explore things like sport concussions: how do you address common sports injuries with telemedicine? I think you can guide a good self-examination of athletes with telemedicine.
Thanks, Dr. James! You’ve inspired us all.
If you’re a physician considering a telemedicine career, explore our current telemedicine jobs.
And learn more about provider experiences in our previous spotlight interviews with an urgent care telemedicine nurse practitioner balancing career and family and a fourth-year resident embarking on her first job after residency.