Telehealth and Underserved, Vulnerable Populations: Prisons, Schools, Military, Seniors
Learn the tremendous impact telemedicine is having on access to healthcare in correctional facilities, in schools...June 12, 2019
We sat down with telemedicine provider Michelle Everhart to learn about why she started in telemedicine, why she may never go back to “brick and mortar”, and why telemedicine makes her a better care provider.
Nurse practitioner Michelle Everhart loved her career, but when she got pregnant she struggled with the decision of whether to leave the job she loved to spend more time with her son. A common dilemma faced by moms in medicine, find out how she decided to embark on a telemedicine career, what she’s learned along the way, and her advice for other nurse practitioners considering a telemedicine role.
I’ve been a nurse since 2007. I started at a community health center in San Diego - taking care of families from the grandparents to young kids - and I also worked in private practice for a weight loss clinic. I loved both of these jobs because I got to really focus on helping people improve their health. And then… I got pregnant.
Nothing is more important than family. Getting pregnant with my son and wanting to spend more time with him was my tipping point. Doing a clinic job was going to take away from that as it’s not just a 40-hour job. Now there are more requirements to spend on documentation, reviewing labs, calling patients, etc. and it’s outside of that 40 hours and cuts-in to the times that you would have free. That’s when I arrived at the decision that I should probably look for a job that would allow me to work from home and have that flexibility.
Before I got started, I was really interested in telemedicine - imagining how you could be an efficient provider without the cost of a brick and mortar clinic, how it enhances efficiency, and how it saves time for both the provider and the patient.
At first, I was surprised this platform actually existed for nurse practitioners - I thought only RNs could practice telemedicine! I wanted to work from home and didn’t realize there was an opportunity for home-based NP work, so I started selling lipstick from home… that didn’t really work out!
First, I started working with a primary care concierge medicine clinic supporting their telemedicine platform. Then, I saw an Enzyme Health ad for an urgent care telemedicine nurse practitioner so I applied. I wanted to continue to be a full-time nurse practitioner but work from home for flexibility.
Technically, I have two full-time roles, but with the urgent care platform I’m on-call for about 36 hours/week and there can be a lot of downtime. It’s not like I’m talking to patients the entire 36 hours. Sometimes there are no patients and sometimes there are many.
With on-call shifts, I put in my availability for a four-hour block of time. Then, I get a notification sent by the website or by text message saying I have a patient waiting. You need to be available to take the call within ten minutes.
I consider myself high-tech and I wanted to be able to use technology in my job. In a traditional clinic, you may hardly have any technology beyond a simple EHR. With telemedicine, there are a lot of technology tools we can use to make our practice better. For example, we can communicate with our patients via email instead of calling them, we can send online prescriptions instead of calling them in, we can provide immediate video care instead of making patients schedule and wait for an appointment. That’s why I really love telemedicine because we can incorporate technology and use that to an advantage.
I definitely miss having coworkers. I didn’t think I would miss the drama and conflict, but now I miss the people. And I also miss my patients and establishing relationships with them through follow-up care.
And I miss wearing good clothes. :)
There are still more advantages of staying at home though.
What I don’t miss is driving and traffic because I used to drive an hour to and from work. Now I’m always on-time because my job is at home - I can’t be late!
I found it hard to let go of in-person clinical practice. I felt like I was losing my skills and for a while, I wondered if I was making a wrong decision. Then I realized, “you’re not really losing your skills, you’re actually gaining more knowledge,” because I’ve been studying more than before. Sometimes when I see a new patient I read about the complaints and skim through resources for five minutes before seeing them. It’s a benefit to working in telemedicine because you have time to research the patient’s condition beforehand.
Telemedicine makes me a better healthcare provider. Instead of just giving patients an educated guess, I’ve already researched and read about their symptoms and am confident in the care plan.
You have to appreciate technology and actually love telemedicine in order to like working in this space. Because in the beginning, if you are already technologically challenged, you may not love it. There is a little learning curve.
My best advice is to know your strengths and limits. If technology is something that is challenging than you might not like it. But if you are technologically challenged and eager to learn, then you should go for it. Because someday you’ll be a pro.
There is definitely a difference. When you talk to patients on the phone you can’t see facial expressions and it’s a little harder to empathize. The key is to ask more questions and really learn to listen carefully. You can hear it in their voice - if they are sad or scared. Then you can offer guidance and reassurance.
With video visits, the hardest part was knowing what to do since you can’t really listen to the lungs, etc. - but there are many clues that you can get by looking at the patient over video. For example, you can tell that they are having shortness of breath.
I feel like I’ve developed a specialized set of empathy skills just by practicing medicine in this way.
We had a sunroom that we never used and I decided to use that as my office. For telemedicine, you don’t really need to buy anything. I already had all the equipment I needed, but I wanted to buy things to make it feel like a real job and workspace. So, I bought a really nice desk, a room divider to use as a backdrop for video calls, wireless headphones to cancel noise, and a new phone for higher video quality.
My life has changed a lot.
The best part is getting to be with family, and to me, that is the most important thing. I never thought this was possible while being a nurse practitioner.
The downside is that I can feel like I’m isolated. There are times I feel really bored because when you are in the clinic you can chat with your coworkers in between patient visits.
No. Sometimes I’ll see clinic jobs and consider applying and then ask myself, why? Right now I don’t see myself going back because of the flexibility telemedicine allows and ability to put family first.
My goal right now is to be really good at being an urgent care nurse practitioner.
If you’re a nurse practitioner considering a telemedicine career, explore our current NP telemedicine jobs. And stay tuned for our next provider spotlight interview with a sports medicine and emergency MD turned urgent care telemedicine physician.