#221 How an ER Doctor Found Freedom Through Telemedicine and Digital Health

Hey everyone.

Hope you're having another great week. How many of you are interested in practicing medicine on your own terms, meaning whenever you want, wherever you want in the world? Well, do you know that's available to you right now? Through the growing field of telemedicine, many of you may not know much about it or actually the different options when it comes to practicing telemedicine. This week I'm talking to Dr. Takashi Nakamura. I think he's a physician who's figured it out. He's going to share his story, actionable tips how he built an amazing practice of telemedicine and enjoys the life that he's always wanted in medicine. I know you're going to enjoy this, so stay tuned. Welcome to the Passive Income MD Podcast where we talk about creating your ideal life through multiple streams of income. If you enjoy hearing about this stuff, make sure to hit subscribe. Now, let's get on with the show. He's a board certified ER physician. He transitioned to digital health and found geographic, time and financial flexibility. All great things. Motivated to help other colleagues transition fully into telemedicine, he co founded a company called all in remote Physician Coaching Academy. He also owns five physician groups and is a co founder CMO of a company called Mind your own Rx. It's a digital health travel company and continues to serve as a clinician, advisor, medical director and MP collaborator for telemedicine startups. He's got a fantastic story. I'm excited to have him here. Tekashi, how are you doing?

Good, good. Thanks for having me Peter. Super excited. Thanks so much.

Yeah, I just been, it's been really cool to watch your entire journey. I know that I've been able to see all the amazing things you've done and so this might be new to some people in terms of finding it out, find finding out about you and what you're doing in terms of the telemedicine space. Do you mind just telling people right off the bat what is all in remote Physician Academy?

Yeah, of course, of course. So all in remote Physician Academy or Air Academy is really for doctors who want to get into virtual health. Right. Safely and also be very successful at it. So I have a team, a team of coaches, we help them leverage their multiple state licenses to get multiple streams of income in a variety of ways. Right. So not just like clinical telemedicine. Right. The consultations, but also in ways like advanced practitioner oversight, medical directorships and also entrepreneurship if they want to start their own business or if they want to do like remote physician groups, they want to run remote physician groups and things like that. So we also source exclusive off market jobs and deals using our network for our members and we provide a community of like minded doctors so they can all just lean on one another pretty much for the rest of their telehealth career.

I mean, it's so cool, I mean what you've built and grown. Obviously telemedicine has been all in use, especially with everything happened with lockdowns. Telemedicine became even more of a thing out there. Let's talk about it. How did you get started in it? You're an ER physician. When did this all start for you?

Yeah, yeah. So I got lucky, right? I really do think that I got lucky with telemedicine because I got started right when Covid happened and I really just wanted a side gig. I wasn't trying to go like full on into telemedicine or anything like that. I was quite happy in my, you know, in the emergency department, working full time there. But it was a W2 job, right. So I was just looking for something else to do and I was like, okay, well you know, let me just try do a little bit of telemedicine. It's pretty easy for me because I just want to do some urgent care or something, right. So I got licensed up in a handful of states and I found a couple of jobs, urgent care jobs, workman's comp type of jobs. And I was doing it on my free time. I was seeing like maybe three to five patients, like whenever I had free time, open up my laptop, I was doing that. And in about a month you make between 1,000 to like $4,000, right. And that was extra, extra money for me so I could do whatever I want with that money. I could travel or you know, the other cool thing is they were 1099. So I was able to now expense my Internet bill and do some kind of interesting things that I couldn't do with the W2, purchase some scrubs, buy a cell phone, right. For business, for my consultations. So that's how it really started is just true side gig.

And then, and then at what point did that become like, all right, it was a side thing and you've got your ER thing. I mean now with hearing all your story, you've gone so far from that. Like when did that start to transition and become more substantial part of your, your clinical time?

Yeah, so I, I found a job and because I live in Hawaii, right, they wanted me to work the night shift. To take on consults overnight. And that was easy for me because I was, you know, it's, it's evening time for me in Hawaii. So they offered to license me up nationally, 50 states plus D.C. and on their dime. So I was like, yeah, sure, okay, I'll do that. And what happened was it really opened up the doors for me. I got to meet other people who are multi licensed and they had a different way of thinking about working, about doing telemedicine, being a doctor in this space. And so when I got licensed up, there were like 50 of us. From what I was told like back three years ago, there were just, there weren't many of us. They called us unicorns. And so I got these interesting jobs that wouldn't go to anybody else. So I got offered like jobs to partner with startup companies to help them, things like that, and be their physician group owner with companies that wanted to go nationally. So that's pretty much that got me getting other types of contracts. And so eight months in I was onboarding with other startups and I was helping other friends and friends of friends with telemedicine. And I was looking at my finances and I realized I was projected to make over $50,000 the next month. Right. And jobs weren't going to go away anytime soon. I was getting more and more of these. I was giving away some offers and jobs to other friends at the time. I was like, huh, I'm making twice as much as my ER, brick and mortar. Maybe I don't need to, I maybe don't need to work anymore. And so it really got me thinking. And the next month I put in my six month resignation. And I was saying, yeah, you know, I'm still gonna probably do like one or two shifts. So I, you know, I, I opted to try to go per diem, but I never went back and I never looked back. And so I've been doing telemedicine since then. It's been over two years I've been out of the er and I love it, love it.

It's such a crazy story. I know that a lot of people would love to have followed that path. I have a couple questions about what you said. Number one, you said that people started giving you these opportunities like in different startups and things like that. How are these opportunities coming to you or how are you finding them?

You know, they're off market. The kind of stuff you see like on the national advertisement, you know, job advertisement boards and things like that, they're there for like everybody else, right? I Think because I got myself into these communities of like minded doctors who are looking for good jobs, they're all just kind of falling onto my lap. I was getting calls from like recruiters, coordinators, health care attorneys who had like, who are working with startups. And so they're all word of mouth, all warm introductions via email.

That's crazy. I mean, and then at some point you said you made that mathematical decision or calculation and you're like, wait a minute, it makes more sense for me to do this. But how did that feel? Because we're all used to being in clinical medicine. You're used to showing up as doctor and then now leaving that and moving to telemedicine world. Was that, was there any fear behind that? Some hesitation? And what did it take to really cross that line?

Yeah, 100%. 100%. A lot of I was very worried, right. Because I didn't want to have to go back or if I'm going to quit, like I want to make sure there's still a channel to get back in. So I did all that research and made sure, especially in the emergency department, learn how to intubate again. Like what am I going to do? Do just go back to the urgent care first. So there was a lot of thinking on that, on that part. Yeah. But I think the way telemedicine is going. Well, I know the way telemedicine is going, there's going to, it's just going to continue to grow and grow and grow and I think we position ourselves in a good place. So as long as you're on top of it, you know the market, it's just going to get bigger.

I mean, tell me about the lifestyle at that time. I'm just curious, like what did it look like from your time perspective? Like how much time are you spending on it at what time of day? You mentioned before that you were in the evenings doing it, but is that what you were doing or were you choosing your own times?

Well, in the beginning I was taking what they gave me. Right. But I realized that, well, as I leveraged myself because I could leverage myself with a lot of licenses, I could. It's more of a partnership that I had with some companies. Right. It wasn't like a employer employee relationship. I was helping them start up so I could do a lot of things on my own time. Now I just, I really do everything on my own time. I make sure that I prioritize other things first. Right. So my day to day, I wake up in the morning, I exercise, I take My kids to school, I make that a non negotiable. So every single day I take my kids to school, I sing with them in the car, I come home and then I open up my laptop and then, and then I'll do telemedicine. And if I have meetings or whatever, then I just don't do telemedicine. Then I have lunch with my wife every single day. Right. And in the afternoon, well, if I want to do telemedesine, I just open up my laptop and I just look at different cues because I have so many contracts and this is how I think a lot of my colleagues do it who are very successful in telemedicine. They have multiple contracts with different companies. So you're never gonna run out of, you know, patients in a queue. So if you look at one queue and if it's empty, you can move on to another queue. So really the moment I open up my laptop, it's very efficient. I'm just seeing patients, I'm chatting with patients, I'm texting them, calling them and like that.

I mean, is this anything? Is there a particular specialty? I mean you're er. So I think it lends itself to doing a lot of this other stuff. But what other type of physicians have you noticed that are doing this and what kind of specialties and are they in?

I think the fm, im, Emergency medicine, I think those are most common because you can pretty much do anything. But really if you're in a non surgical specialty, it's, it's really easy to get into telemedicine. I really think so. It's still kind of the wild west. If you have an interest in a field, if you do enough cme, if you attend the conferences, if you, if you learn enough about it and then you start prescribing and you work on their mentors or advisors, I think you can be an expert at that. So for me personally, I'm an emergency medicine doc, right. But I do men's health, women's health, I do menopause, I do lifestyle care, chronic care. Really anything I'm interested in, I just delve right into it and, and, and I just start.

That's so cool. So at what point did you decide to help other people in this? Because I think that's the next evolution of this. And the fascinating part of the story for me is that you not only did it for yourself, but you started helping other physicians and doctors get into this through the all in remote company. Can you tell a little bit about how that came to Be, yeah, sure, sure.

I was doing it anyway, right. So, you know, we all have friends who are burned out or burning out or who want to do less of the clinical job or to see what I'm doing. Like, oh, I want to take away a few of my shifts. I want to do a little bit of telemedicine. So I started helping friends out and then it just got bigger. I'm now helping friends of friends and then I have strangers cold calling me and just like, hey, I need help. Can you help me, you know, do telemedicine the way you do it? And so I was doing that for a little bit and, and of course I enjoyed it. Enjoyed it a lot. And then I got to hanging out with other entrepreneur doctors, right? Saying, hey, you should just start coaching. And that for the first time got me thinking, like, ah, I should just formally coach these people to do it. It's taken a lot of my time anyway. And so myself and a couple other of my friends, my other colleagues, we just came together and said, hey, we're all successful. We're doing telemedicine differently from everybody else. And we're, you know, we're making a good living. We're making multiple X our brick and mortar income. Let's just, let's just start teaching that we have a system that works. All of our friends who've done it the way we've done it have been successful and the majority of them actually left their brick and mortar. So we thought, hey, let's, let's do this. And so we put it together. We had a lot of help, we had some coaching ourselves. So we did join a mastermind, which you're a part of, and we got a lot of assistance there because we're not business people, right? We just want to help. Like, I'm a doctor and I'm a. I just want to make sure people are happy, people are doing what they want to do. They get to live the kind of life I get to live pretty much on my own terms, right. I have all the time freedom and I get to travel every month. So that's what I want to do. I wanted, I want to help them, but we got to make a business out of it. We got to make sure we're structured correctly. So we had some, some of you folks, some, some coaches, some people who are already doing this type of things help us.

I mean, what have been some of the big challenges for you around building a business like this? That's what I want to ask you. And the other part of it. Again, I'm going to ask you some challenges around telemedicine in general, but let's start with the first one. What are some challenges that you've run into, at least from this company, that you've built to help other physicians? I know that a lot of people have expertise, want to go and help and serve other people, but what have you had to overcome, at least so far?

Yeah, it's pretty hard, right? I think people already have this. I don't know, they have some, some negative thoughts around telemedicine. I don't know why. I think it just has this negative light. Like when I tell people, hey, I'm doing telemedicine, I'm having fun, right? They kind of look at you like, huh, you're probably making like half your brick and mortar income. Like, you're probably burned out. You're probably not in a good place. You're probably like close to retirement. Or, you know, like they have these, like, weird, I think, just different thoughts and, and to get people to think differently, like, you know, you can actually do telemedics on the side. You can actually, you know, you can make, you can have a good, decent side gig doing telemedicine, or you can go all in. And there's a way to make more than your brick and mortar income. It's hard to convince people that. I think that's been the biggest challenge. I think people are pretty skeptical, you know, you know, physicians, right? Like, it's hard to get them out of their golden handcuffs and to teach them, to tell them that, you know, telemedicine or virtual health isn't just about still having your golden handcuffs, but in boxer shorts, right? Minus the trip to and from your brick and mortar. It's more than that. You can do asynchronous care, you can do other types of things. You can fit yourself as a physician in all parts of virtual health. And so. So to get them to open their eyes just to see that has been kind of challenging.

How about for you personally doing the telemedicine? Is there any part of the clinical part that you, you miss? Is there anything you've had to give up there? Or maybe there's some downside that you love to share with people just to give them a full picture of what it's like?

Yeah, yeah. So I think for me it's been okay. I really do enjoy it. But if you're going to stick with your own field, for example, what I do find a little bit tiring is like, say if I'm only doing urgent care, right? Then it's like, well, I might as well just go to an urgent care clinic and be a doctor there. Then I can touch and I'll have the socialization. I get to talk with the nurses, the staff. And it's a little different there. But if you are interested in other things and you want to get that out, if you have a little bit of an entrepreneur mindset and say you, you have some creams that, you know that work some compounds like that, if you want to start something, right, I think that's what makes it interesting and that's what's going to make it fun for you to just maybe start doing some skincare, right? Learn about it and be an expert at it. And if you're in primary care, it's pretty easy to just start working for a company like that and just learn and have fun doing that.

I mean, how quickly can somebody get up, you know, get up and running when it comes to telemedicine? Even if they just want to do it on the side to supplement their income, like, what's the possibilities there?

All right, so from a business standpoint, you can, you can start a telemedicine company in 48 hours. I, I know some companies out there where you can just stand up and just right away start, start selling some things. Of course, you got to market it and things like that. From, from our standpoint as clinicians, it's. I think what you want to do is you want to, you want to think about how much time you want to spend doing it and how much money you want to make. I think just kind of have that, that thinking first. And then, then you got to determine how many license, how many state licenses you want to get. I would recommend getting at least 10 licenses because you want it to be on your own time, right? You don't want to be opening up queues and there's nobody to be seen, right? So you want to at least have 10 state licenses at minimum to start. If you live in a state that is, we call it an imlc, state Interstate Medical Licensure Compact. So if you're in a state that is participating in this compact, you can get licenses at a discount and they come in fairly quickly, like within the month. So you can get started right away. I think you just get your licenses and then you start applying for jobs. And I'll start by looking@ Indeed.com, zipRecruiter, Doximity, LinkedIn, and find a job that you think you're going to enjoy, you know, make sure there's no like non compete and make sure it's pretty flexible. Like if you don't want to work weekends, don't find a job that you know, makes you work like one weekend or something like that a week, right? So find a flexible job. And I recommend trying to work for more than one company if you can. So I tell my members, people who want to go all in on telemedicine, I say have at least seven different contracts. So you work just on your own time, right? And then I think the last thing is just either get yourself in a community or build a community around you. If you have friends that are doing telemedicine, great. In telemedicine I think it's pretty easy to be a loner, right, because you're just literally at home or whatever, just opening up your laptop or just looking at your phone and answering patient questions and making money like that. So it's pretty easy to just kind of be shunned from the rest of the world. But if you have a community then you can always help each other out. And you know, the best jobs out there are the ones that are being referred to you by friends. So if you can have a community like that of like minded colleagues, friends and then you can really, you can, you can do telemedicine for a long.

Time now that you're on this side of it and you built these companies, you have this physician academy all in remote, you, you're also start worked with these startups, you're consulting, you're doing all of these things like how do you feel about your life and career as it is today with all the other stuff you're balancing, you know, take a, tell us how like the, at least this point, your journey, what's going on in your head and how do you feel about it all?

I love it, I love it. Like I never thought and I'm a pretty happy guy, right? In general, like I like in medical school I got mad once and all my friends still tell me about it. At the time my food didn't come and I love food, right? And I was waiting for my food and asking about it and I got mad and like that's the one time Tekashi got mad, right? So I'm a really positive person, optimistic. But I've never been happier in my life. When I was working the error, I had this like goal like I want to at least have the option to retire in 10 years, right. So I was trying to, I was trying to work towards that goal. And I got the talent mess. I'm like, hey, okay, so I'm, you know, making this much more than my, my brick and mortar. I'm going to try to retire in five years, but now I don't want, I don't ever want to retire. I want to do this for the rest of my life. Because like I said, I'm doing everything on my own time. I get to travel, I get to be in my family. When my, when, you know, my kids are going to baseball or lessons, my wife, my daughter does singing lessons, I can go every single time. Like, I don't have to answer to anybody. I have no bosses, right? So I couldn't be happier, to be honest with you.

It's so cool to see you on this side of it. I mean, what do you think the potential is? Again, I mentioned this, but I really want to hit this home. Like, what's the potential for physicians that are watching this to be able to just get started in this and then what do you think the future is for telemedicine? I think we all have some ideas, but now that you're in it, what do you think it is in terms of the market and where it's going from here?

Yeah. So to me, if you're in a non surgical specialty, it's a no brainer. Like just do telemedicine. Just do a little bit of it, right? Because you're gonna have to do it. It's because the future, to answer your second question too, the future is so bright in telemedicine. Right. It's only gonna get bigger and bigger. So you might as well get started now and make, make some change. So if you have a W2 income, right. Which most primary care doctors do, right. And it doesn't, regardless of how many patients you see, you're going to make the same amount. It's really easy to fit telemedicine in there to make a little bit more. Or if you have a, if you're in a clinic, if you have a clinic and you're maxed out on patients or you want more patients but you can't get them, right, just do some telemedicine, just get 10 extra licenses and just do extra telemedicine on the side, you'll make an extra few thousand dollars. Even, even just making a little bit more. I mean, it's just, it's so easy to do. I think everyone should do it.

So cool. I know that people are going to hear this story, they're going to Want to connect with you, find out more about your academy, something you said, it's going to resonate with them. Where's a great place for people to find out more about what you're doing?

Yeah. Yeah. So if anyone wants to get into telemedicine at any level, right, Whether you really want to go all in and you want to transition out of your brick and mortar or if you just are thinking about it and thinking, oh, maybe it's for me, just get on the website allinremote.com and just fill in your information there and we will get back to you and we'll see what we can do to help you out.

That's so awesome. Thanks so much. I know you've helped so many people in our community transition, find their ideal kind of balance between life, career, finding all these things, still be able to be a physician and do these cool things. What kind of advice do you have for someone who might want to follow in your footsteps, whether that's even in the telemedicine route? Maybe somebody wants to start a business or create something and go into a new direction.

Yeah, I think the most important thing is to surround yourself with like minded people. So if you want to do something in that specialty or intelligence or just surround yourself with people doing that, if you want to get into a business, start a business, surround yourself with people that are business minded, right. And get all that advice because really that's where you're going to get more your ideas and that's going to really propel you forward things that you can, you'll probably get done within a year or two, you can probably get done within months if you have the right community around you.

All right, well, congrats. It's a great story. Congrats on your success. And again, the cool thing you're doing is that you're helping other people get into this as well too. I know some people can be really interested in it. Really appreciate your time. Thank you so much. And let's talk again soon.

All right, thanks Peter. Thanks for having me. Have a good one.

All right, bye. Enjoy the show. Let me know by dropping a review in the podcast app you're listening to us in and if you haven't already, make sure to hit subscribe. Join the thousands of physicians who are also on this journey to creating their ideal lives through multiple streams of income. Learn more at our website passiveincomemd.com thanks again for allowing me to be a part of your journey. See you next time.