Start a Teledermatology Practice

1. 1

   Confirm who can do this

   This is a licensed medical practice: board-certified dermatologists own the full scope, and NPs and PAs with dermatology experience practice under their state's supervision and scope rules. You must be licensed in every state where a patient sits during care; the Interstate Medical Licensure Compact accelerates multi-state licensure for physicians. Non-clinicians can participate only on the operations side of a properly structured practice, with healthcare counsel on corporate practice of medicine rules.

2. 2

   Choose your visit architecture

   Synchronous video visits work for consultations and follow-ups; store-and-forward (patients or referring clinicians submit photos and history, you respond within a defined window) is where teledermatology economics shine, letting one clinician review dozens of cases daily. Most practices run both: async for triage and routine management, video for complex discussions. Invest in photo-quality instructions for patients; image quality is your physical exam.

3. 3

   Set the payer strategy

   Cash-pay async visits commonly price between $50 and $150, attractive against long in-person waits; commercial insurance and Medicare now cover much telehealth (rules keep evolving, so verify current telehealth billing policy annually); and B2B lanes add volume: primary care groups buying e-consult coverage, employers, and correctional and rural health systems desperate for dermatology access. Medical dermatology delivered this way is the core; keep cosmetic consults a separate cash lane.

4. 4

   Build the escalation pathway

   Teledermatology's clinical honesty is knowing what it cannot do: suspicious lesions need biopsy, and some conditions need in-person care. Build a referral network of in-person dermatology and Mohs practices by region, document escalation criteria, and track that referred patients actually land. Practices that handle the handoff well earn referring physicians' trust; practices that hold everything virtual earn lawsuits.

5. 5

   Systematize the high-volume conditions

   Acne (including isotretinoin management under the federal monitoring program where your setup supports it), eczema, psoriasis, rosacea, and rash triage are the volume engine; protocols, patient education sequences, and structured follow-up intervals per condition turn quality into repeatable operations. Chronic disease follow-up subscriptions (a yearly fee covering scheduled check-ins and message access) fit dermatology beautifully.

6. 6

   Scale with clinicians and research

   Growth means adding licensed clinicians state by state, contracting as the dermatology layer for telehealth platforms and health systems, and, for practices with physician depth, becoming a dermatology clinical research site (industry trials in psoriasis, atopic dermatitis, and new biologics pay sites well and fit alongside virtual practice with a modest physical footprint); fellowship-trained dermatologic surgeons sometimes complete the model with an in-person Mohs surgery suite, the high-volume, high-margin surgical end of the specialty. The bottleneck is always licensed hours; build systems that spend them only where judgment is required.

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Best for: Dermatologists and dermatology-experienced NPs and PAs who want geographic freedom

Not for: Anyone without dermatology credentials, and anyone unwilling to do the deliberate multi-state licensing work. This rewards dermatologists and dermatology-experienced NPs and PAs who want geographic freedom.