#142: Thinking About Telemedicine? Here’s What Veterinarians Need to Know. With Dr Shadi Ireifej

Telemedicine.

What’s your gut reaction when you hear that term?Maybe you think it was just a clever COVID workaround, or second-rate substitute for a “real” vet visit.

Or maybe you’re a bit curious about what it’s like to work in telemedicine— but you’re worried it’ll be boring. Or worse: that you’ll spend your days diagnosing lizards over Zoom.

Whatever you think— chances are, you’re wrong. But don’t worry. This episode will change that. We go deep on the real-world pros and cons of telemedicine , from two key angles:

For curious vets:

• What’s it really like to work in telemedicine?
• Is it fulfilling?
• How will I cope with all the tricky questions (and species?!)
• Is the pay good?
• Can you get into trouble for giving remote advice?

For clinic owners:

• How do you integrate telemedicine into your practice?
• What are the practical hurdles?
• What’s worked (and what hasn’t) from someone who’s built a global platform from scratch?

Our guest is Dr. Shadi Ireifej , a board-certified surgeon, tech entrepreneur, and co-founder of VetTriage, a global teletriage platform.

This one made me rethink what “good vet work” really means. I think it’ll do the same for you.

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Topics and Time Stamps

01:43 So you think you want to work in telemedicine?

04:20 Common concerns about telehealth work

06:11 Will I get sued for giving the wrong advice?

10:37  Vets on Tour: Upcoming Events

15:55  Income and Work Hours in Telemedicine

18:35 Will I have to give advice for all sorts of weird animals?21:29 Unexpected Joys of Telehealth

23:44  Future of Telehealth and Technology

29:21  Challenges and Lessons in Telehealth for Practice Owners

36:33 What about the technology?

What It’s Really Like to Work in Veterinary Telemedicine

• The Nature of the Work:
  • As a "tele vet," you engage in veterinary consultations remotely, often via video calls.
  • The cases are typically routine general practice situations, such as skin issues or diarrhea.
  • The primary goal is often triage: determining if an animal has an emergency and providing advice or direction until they can see their family veterinarian. This might include palliative care instructions or what clinical signs to look out for.
  • You might deal with a wide variety of animal types, from dogs and cats (which make up over 90% of cases) to a wide variety of more unusual animals.
  • While you don't perform physical exams or diagnostics like palpation, radiography, or lab tests, you rely on basic principles and your experience.
• Common Concerns and Challenges:
  • Fear of giving wrong advice and legal liability: This is a common and understandable concern among veterinarians considering this work. There is a worry that advising a client that a situation is not an emergency could lead to a negative outcome for the animal. However, the risk of liability in telehealth appears significantly lower than in brick-and-mortar practice, statistically speaking. Platforms like Vet Triage implement multiple layers of protection, including website information, disclaimers clients must sign, the doctor reiterating limitations, written records with legal language, and providing clients with tools to monitor the patient and recontact the service.
  • Dealing with unfamiliar animal types: Veterinarians may worry about having to give advice for species they have no clinical experience with. While this can happen, the approach is often based on basic triage principles, and you are not expected to have all the answers immediately. You can research information or consult with colleagues and call the client back.
  • Boredom or feeling unfulfilled: Some veterinarians transitioning from clinical practice worry they might be bored or unfulfilled due to the lack of hands-on procedures or critical cases like CPR or surgery.
• Unexpected Joys and Rewards:
  • Giving clients peace of mind: A significant source of enjoyment for tele vets is seeing the relief and stress reduction in clients when they are told their animal's situation is not an emergency. This is highlighted as a primary reason why vets enjoy the work.
  • Helping in difficult situations: Even when a situation is severe, providing advice and perspective can help owners and potentially keep an animal alive until they can reach a veterinarian, which vets find rewarding.
  • It can feel addictive: Some seasoned tele vets describe the work as having an "addictive" quality, viewing it akin to a "veterinary video game".
  • Flexibility in work arrangements: Telemedicine work can be done full-time (40-60 hours a week) or on the side in addition to a brick-and-mortar job. This flexibility can contribute to a happier veterinary career by offering a change of pace or environment.
• Suitability and Experience:
  • Experience is crucial: Most platforms require a minimum level of real-life experience, with Vet Triage typically hiring veterinarians who have been out of school for at least five years. Newer graduates may struggle with feeling comfortable giving advice over video without sufficient practical experience.
  • Personality matters: You must enjoy talking to people. If you prefer getting your hands dirty with surgery or procedures and dislike client contact, this job is likely not for you.
  • Comfort with spontaneity: You need to be okay with not knowing what type of animal or case will appear on the video call without warning.
  • Collaboration: There is often a collaborative environment where veterinarians can talk to each other and share ideas and experiences with different species and situations.
• Income and Work Hours:
  • Compensation models vary by company. At Vet Triage, veterinarians are paid per call or video consultation seen. Calls average 10-12 minutes, allowing vets to handle 4-6 cases per hour.
  • Income depends on the volume of cases seen, which can be inconsistent.
  • There can often be a mal-distribution of cases, with the busiest times often being evenings and weekends/holidays (in the US time zone). This means veterinarians need to be available during these hours to make the most money. The middle of the night is typically quieter.
• Technology and Operations:
  • Telemedicine requires a stable and secure platform. While practices could use off-the-shelf tools like Zoom or WhatsApp, they may face challenges with technology issues on the client's end (bad internet, older devices, lack of tech savvy).
  • Developing a robust, custom platform that is web-based, device-agnostic, secure, and allows for evolution as rules change (like requiring electronic medical records) is an significant undertaking.
  • Maintaining tight and thorough medical records is crucial, perhaps even more so than in brick-and-mortar, due to the limitations of virtual interaction. Consistency in record-keeping among multiple doctors can be a challenge.
• The Future:
  • Telemedicine is expected to continue evolving, incorporating technologies like telerobotics, telediagnostics, telementorship, and telemonitoring. Telediagnostics, such as devices using thermal imagery to monitor parameters like temperature and heart rate remotely without physical contact, are already emerging. Augmented and virtual reality may also play a role in the coming years.

The Pros and Cons of Integrating Telemedicine into a Practice

• Working with Existing Clients: Practices can incorporate telemedicine for their own clients, where an established Veterinary-Client-Patient Relationship (VCPR) already exists.
• Staff Recruitment and Retention: Using a tele-triage service, like Vet Triage, to handle after-hours calls can significantly reduce the burden of on-call duties for practice veterinarians. This is highlighted as a particularly attractive feature for new graduates who often wish to avoid being on call. Reducing or outsourcing on-call duties can help entice vets to join a practice and can help with turnover.
• Improved Work-Life Balance and Flexibility: Integrating telemedicine can allow staff to work from home for certain appointments, offering a change of pace or environment. This can enable vets who cannot be physically present in the clinic (e.g., due to pregnancy) to continue working.
• Increased Capacity/Productivity: If many appointments become virtual, a practice could potentially quadruple its appointment capacity.
• Future Technological Advancements: The integration of future technologies like telediagnostics (e.g., devices using thermal imagery to monitor patient parameters remotely without physical contact) could offer new ways to manage patient care within a practice setting.

• Resistance from Veterinary Culture: It has been difficult to convince the broader veterinary culture that telehealth is a viable method of practice. Vets can be skeptical, resistant to change, worried about ethics, providing "bad medicine," and potential impacts on income. This resistance is particularly strong among large animal and equine vets who are traditionally used to being on call 24/7 and having clients contact them directly.
• Low Adoption of Integration Models: Despite the potential benefits, models involving leasing telehealth platforms for use within brick-and-mortar practices or using off-the-shelf tools (like Zoom or WhatsApp) for client consults haven't widely taken off as expected. It quickly ran out of steam.
• Perceived Lack of Value: Some employers in brick-and-mortar settings may not see the value in paying a veterinarian a six-figure salary to work from home via video calls.
• Technological Hurdles: Clients often present challenges with technology, such as bad internet connections, older devices, lack of tech savviness, or devices dying. This makes setting up and conducting virtual consultations reliably challenging and often requires dedicated technical support teams.
• Maintaining Consistent Medical Records: Just like in traditional practice, ensuring all doctors maintain tight and thorough medical records can be difficult, but it is especially crucial in telemedicine due to the limitations of virtual interaction.
• Veterinarians' Preference for Hands-On Work: Vets working in a hospital setting may prefer to perform physical exams and diagnostics. They might feel inefficient or wonder "what am I doing here?" if they are stuck on a video call when they could have the client come in for a hands-on appointment.
• Platform Development Costs and Complexity: Building a custom, secure, and evolving platform suitable for telemedicine is a significant undertaking requiring substantial investment and development resources. While off-the-shelf tools exist, they may lack necessary features like robust security or the ability to adapt to changing regulations.

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