Four lanes, four ways of being paid
| Lane | What you do | Usual unit of pay |
|---|---|---|
| Live visit panel | Scheduled or on-demand video consultations | Per consultation, or per hour of availability |
| Nurse triage line | Symptom assessment against protocols, disposition advice | Per hour, sometimes per call |
| Asynchronous review | Message-based care, chart abstraction, utilization review | Per chart, per case, or per hour |
| Teleprecepting | Supervising a student across your virtual visits | Per student hour logged |
The unit matters more than the headline figure. Pay per consultation rewards speed and punishes a complicated patient. Pay per hour of availability sounds safer until you learn that some contracts pay a reduced rate for hours where no patient appears. Ask what happens to an hour that stays empty, and ask before you sign.
Volume promises are the other thing to test. A platform that pays per case owes you nothing if the cases do not arrive, and a quiet month is entirely their risk to create and yours to absorb.
Licensure follows the patient
Care is treated as happening where the patient is, so you need to be licensed in that state at the time of the visit. A nurse in one state serving patients in six needs standing in all six, and a platform that recruits nationally is often really recruiting for the states where it is short.
For registered nurses the Nurse Licensure Compact makes this easier. A multistate licence issued by your compact home state lets you work in fellow compact states without repeating the application process each time. Not every state is a member, and a single-state licence gives you no such reach.
For nurse practitioners the picture is less tidy. The APRN Compact exists on paper but has not come into force in the same manner, so nurse practitioners generally apply to each state separately. Practice authority varies too: what you may do independently in a full practice state may require a collaborative arrangement elsewhere, and a telehealth contract that ignores this is a contract to read twice.
What you actually need at home
Less than the job adverts imply, but the parts that matter are not negotiable. A wired connection rather than shared wifi, because a video call that stutters through a medication review costs more time than it saves. A room with a door you can close, since a household audible in the background is a privacy problem rather than an inconvenience.
A headset with a microphone, a camera at eye height rather than pointing up at the ceiling, and a lamp in front of you instead of a window behind. Two screens if you can, because reading a chart on the same screen as the patient's face means one of them is always hidden.
Then the boring items: a locked drawer or an encrypted machine for anything downloaded, a password manager, and a phone number the platform can reach you on when the video fails. Most contracts make the equipment your responsibility, which also makes it your deduction at tax time.
Questions to ask before you join a panel
Ask who carries liability cover for the visits, and get the answer in writing rather than in a recruiter's summary. Ask which states you will be assigned patients in, and whether you are expected to add licences at your own cost.
Ask how the schedule is set and how far ahead. Ask what notice cancels a block, and whether cancellation is paid. Ask what the platform does when a patient needs an in-person examination, because a service with no referral pathway pushes that problem onto you in the middle of a consultation.
Ask about the record: who owns the note, how you get a copy, and how long you can retrieve it if a complaint arrives two years later. The contracts guide covers those clauses in more detail.
Teleprecepting, and how it differs
Teaching a student across your virtual visits is the one telehealth lane where the work comes to you rather than the other way round. There is no panel to join and no client to find. A coordinator matches you to a student whose program permits video hours, and you are paid for each hour they log, at a rate you choose between $12 and $20.
How many of a rotation's hours can be virtual is fixed by the student's school and written into the agreement with your practice. Psychiatric care and settled primary care follow-ups are the categories most often allowed. Anything needing hands on a patient generally is not, which is why a purely virtual placement is common in psychiatry and rare elsewhere.
Run the consent openly at the top of every visit. Name the student, say what they will be doing, make clear that saying no changes nothing about the appointment, and record the answer in the note. Patients accept far more often than clinicians expect, and the ones who decline usually have a specific reason worth knowing.
Making a video rotation work in practice
Use a platform with a private breakout channel. You need somewhere to hear a presentation and correct it without the patient listening, and a second device on mute is a poor substitute for a proper side room in the software.
Agree the hand signals before the first patient. One for step in now, one for wrap up, one for I disagree and will explain later. On video you cannot catch a student's eye across a room, so the signals have to be explicit and rehearsed.
Build in five minutes between appointments. Face to face you teach in the corridor, which costs nothing. On camera that corridor does not exist, so the teaching either goes into the visit and slows it, or into a gap you deliberately left. Preceptors who skip the gap end a virtual day exhausted and behind. There is more on the psychiatric version of this in the PMHNP guide.
Questions
Do I need a licence in every state my telehealth patients live in?
Generally yes, because care counts as being delivered in the state where the patient physically is. Registered nurses with a multistate licence under the Nurse Licensure Compact can practise across member states without separate applications. Nurse practitioners usually apply state by state, since the APRN Compact is not yet operating in the same way. Confirm the current position with each board involved.
Which telehealth lane pays most reliably?
Reliability and rate are different questions. Hourly triage work pays modestly but predictably. Per-consultation panel work can pay better per hour worked and disappears when volume drops. Teleprecepting sits between them: the rate is set before you start and the total is known in advance, because the hours are agreed at the outset rather than depending on demand.
Can a whole NP rotation be taught over video?
Sometimes, in psychiatry particularly, and it is the student's program that decides. How large that allowance is gets recorded in the paperwork between the school and your practice, so ask a coordinator for the figure before you commit a term to it. Programs that allow a fully virtual placement in psychiatry will usually still require in-person hours in other populations.
Do I need my own insurance for telehealth work?
Assume yes and verify. An employer policy covers work for that employer, not a panel you joined separately, and some individual policies exclude telehealth or limit it to named states. Tell your carrier which states you will be covering and get confirmation in writing before the first visit rather than after a claim arrives.
Sources: Nurse Licensure Compact · APRN Compact · AANP state practice environment · Teleprecepting in nurse practitioner education