Is it possible for a psychiatrist to work from home? Cut commute costs and time down to zero? And still be able to serve patients' needs?

Telepsychiatry is fast becoming an established way for people to receive mental health care. In fact, American Psychiatric Association's JobCentral lists hundreds of jobs involving telepsychiatry – and even including a dedicated "Telepsychiatry" filter. Over 50 companies are listed as providing psychiatry services on the California Telehealth Resource Center.

There is, in fact, a large need and role for telepsychiatry. For psychiatrists, telepsychiatry is a way for them to reach underserved populations, areas with no psychiatrists, and inmates in correctional facilities. It's also a way for them to reach persons with severe anxiety, and those who are unable to leave their home.

And telepsychiatry can provide many benefits to the psychiatrist. All of the patient visits, charting, and communication is done through a webcam-equipped computer. Thus, the psychiatrist doesn't need to spend long hours commuting. There's a lower risk of assault to the psychiatrist when seeing patients in emergency departments, jails and prisons. And much of the chart review and note-writing can be done during clinical encounters.

However, like any clinical position, not all telepsychiatry jobs are alike.

Evaluating a telepsychiatry company

Before joining a telepsychiatry company, ask yourself key questions about the company:

Who works at the company? Ask the company if you can contact their other psychiatrists, and ask about their work culture. Is the company run by an experienced psychiatrist with a track record in business administration? Does a high turnover indicate employee dissatisfaction, or numerous changes in the company's strategy?

What is the work culture like? How do people communicate successes and failures? If much of the communication is done by e-mail or instant messaging, some nuances in communication may be lost. Look for standing, scheduled video meetings, along with adequate phone and video support in case you need to troubleshoot bad video connections at midnight, and clinical consultation for difficult encounters.

Finally, ask if the company supports licensure and malpractice for the areas you wish to operate. Many companies help their new psychiatrists obtain medical licenses for states, and can provide support to learn about the different legal practices for each state.

Evaluating a telepsychiatry job

Then, look at the job itself. Just like any other clinical job, ensure that you are happy with the work hours, the number of clinical encounters, the patient population and staffing support. Telepsychiatry's success is very dependent on clinical and operational processes, because you rely on nurses, medical assistants and staff on the other end to operate the computer and handle patient emergencies.

Some jobs even require psychiatrists to cover multiple hospitals at once, which may mean that the hospitals have different staff, different intranets, different procedures and even different electronic health record (EHR) systems. In such cases, the psychiatrist should feel comfortable understanding the local nuances, culture and emergency procedures.

Finally, think about time and money. Ask such questions like:

• Scheduling: Do you get to choose your own hours? Is it fixed? Are you on call all the time? How long does it take to get contracts going?
• Payment: Do you get paid when a certain number of patients is reached?
• Requirements: Do they pay for licensure? Credentialing fees? And malpractice?
• Contracting: Are you a 1099 contractor or a W-2 employee? This has an effect on your taxation. For instance, 1099 contractors are considered "self-employed," allowing the psychiatrist to deduct equipment, utilities, education and rent from their personal taxes.

Evaluating the technology

Once you're satisfied with the clinical duties and the company, look at the technology used for the video visits. Understanding what would become your virtual office is analogous to touring a real-world work environment on a job interview.

Does the company provide adequate support for their video visits, EHR, e-prescriptions and picture archiving and communication system (PACS) imaging displays? Most hospitals include dedicated EHR specialists during work hours. Ensuring there is a hotline for troubleshooting technology will let you recover from crashes and faults.

What video platform does the company use? Does it work with your existing equipment? If your existing computer does not meet their requirements, will the company provide a laptop or other dedicated video equipment?

What EHR platform does the clinic or hospital use? If you're not familiar with the EHR, you may need to schedule multiple days to learn how to use that EHR. Even if you have used the EHR before, EHR's are typically customized for each institution, and you will still need to spend time to learn nuances and customize the EHR's shortcuts and templates to your liking.

What communication systems do providers and staff use? Some companies have staff that use only one industry-standard instant messaging program, making it easy to reach out to people. Other companies' staff may use a confusing mix of instant messaging, pagers, personal cell phones and clinical hotlines, making it difficult to know how to reach people. Understanding not only the technology available, but also the work culture, can help you understand whether the company is right for you.

Like any job, there is no one perfect telepsychiatry position. But gathering as much data—including collateral data—about companies and their positions can help you make choices that suit you. Good luck on your search!

Want to learn more? Visit APA's Telepsychiatry Toolkit.

About the Author

Steven Chan, M.D., M.B.A.
APA's Committee on Telepsychiatry