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In today's newsletter:
Congress extends Medicare telehealth
Telemedicine pros and cons
Practical Win: Deduct where you can
Locums Corner: Find your routine
What I’m Reading
The funding package Congress passed in February, the Consolidated Appropriations Act of 2026, extended the pandemic-era Medicare telehealth flexibilities through the end of 2027.
For anyone weighing telemedicine as a side income stream, that matters, because it takes two years of guesswork out of whether the visits you build a schedule around will still be covered. The major physician groups are still pushing to make the rules permanent too.
Hospitals are taking on more uninsured patients, and rural ones are the most exposed.
The enhanced ACA subsidies that propped up marketplace coverage since 2021 expired at the end of last year, and the fallout is showing up on hospital balance sheets. About 1.5 million fewer people enrolled this year, premiums more than doubled for the average enrollee, and uninsured admissions are climbing.
HCA tied a roughly $150 million quarterly hit to the coverage drop, and it's one of the better-positioned chains there is. Rural hospitals have no such cushion, and hundreds were already at risk of closing before any of this.
Telemedicine: Worth Your Time?
A hospitalist I know told me he had been picking up more telemedicine shifts recently. He'd been picking up virtual urgent care visits from his kitchen table and was happy he didn’t have to physically be at work. He was making decent money but he still couldn't quite bring himself to call it real work.
I’ve been thinking about that conversation a lot, because telemedicine sits in a strange place for most of us. We treat it as the thing we do when we're too tired for a real shift, or too cautious to commit to one. That sells it short, and it also lets a lot of doctors walk into bad deals without looking closely. So this week I want to lay it out the way I'd want a friend to lay it out for me, the good parts and the ugly ones.
Why it's tempting
You can work from anywhere with a decent connection. The better platforms handle scheduling, billing, and the technical headaches, so your startup cost is close to nothing. As a 1099 contractor you pick up tax advantages a W2 job never hands you. For example, for family medicine, emergency medicine, or internal medicine, virtual urgent care is a natural fit since broad diagnostic reasoning is exactly what virtual urgent care runs on. And the demand clusters in the evenings and weekends, which is when most of us actually have hours to spare.
There's a quieter benefit that matters more than any of that. A steady telemedicine login is a cushion. If you lose a contract, move across the country, or want to take a slow month, that work keeps a baseline of money coming in while you sort things out. Autonomy is mostly about never being trapped by a single paycheck, and this is one of the cleaner ways to build that buffer.
It’s Not Always Glamorous
The pay range is enormous, and the bottom of it is insulting. Some direct-to-consumer platforms pay fifteen to twenty-five dollars for a quick visit, and plenty of physicians take those rates because they never stop to benchmark against anything. If you don't know what your time is worth, someone will happily tell you it's worth very little. Run the math per hour, not per visit, before you sign.
Liability is the one most people underestimate. On a platform you're the physician of record, which means the exposure is yours. If the startup you signed with folds, and plenty of them do, you can be left holding the malpractice risk and scrambling for your own tail coverage. Read the indemnification language, and ask who carries the policy and what happens to it when the company disappears. If you are asked to supervise NPs or PAs doing the physical work, you need to make sure you double check all the work they do since your name will be listed as the attending on file.
Skill drift is the one issue in particular. If you spend a few years doing nothing but low-acuity virtual visits you will lose procedural (and surgical) skills. I wouldn't want to explain a five-year gap in hands-on work to a medical director, and neither would you. Keep your skills up on a regular basis with some in-person shifts.
The ground keeps shifting, too. Reimbursement rules and licensure requirements move with the political weather, and you have to be licensed where the patient is physically located, not where you are.
My Thoughts
Telemedicine can be a great gig but it still takes active work. It's a tool, and a good one when you bring fair rates, a clean contract, and skills you've kept sharp. Bring none of those and it turns into a low-paid grind. Whether it's worth your time really comes down to you. For what it's worth, I think it can be lucrative, but only if you treat it like real work. It’s here to stay until at least the end of 2027, so this could be a side gig to look into for some extra income.
🚀 The Practical Win: Use Your LLC
I would recommend running your telemedicine work through an LLC (assuming you’ll be paid as a 1099 contractor). Your equipment, part of your home office, licensing fees, malpractice, and CME all count as deductions as well so track everything and ask your accountant about the specifics.
The Locums Corner
On longer locums assignments, it can be a mental grind. I find it helpful to find a routine, even with a hospital schedule. Find a local gym (sometimes hospitals have their own gyms too) to go to before or after work. Make your own food if you are able to (extended stay hotels have kitchenettes). The more you can stick to your routine, you can make those assignments feel manageable.
That’s it for this week. Have a great week and thanks for reading!
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