Blake McKinney is a doctor with medical licenses in 49 states and a 50th likely on the way. That would put him into a small but growing group of physicians who see a big future online.
Telemedicine, which involves medical consults via the web and smartphone apps, requires that doctors have licenses to treat patients wherever they are, not just in a single location. With licenses across the country, McKinney can be at home in Denver, but treat a patient in Rhode Island or Delaware or anywhere else in the U.S.
The telemedicine market has been around for more than a decade, but it's tipping into the mainstream as regulations increasingly shift to favor its adoption. The market is expected to hit $130 billion by 2025, according to a recent report, as more insurance plans start covering the cost of virtual visits.
Venture-backed start-ups are now prescribing everything online, whether it's flu medication, hair loss treatments or birth control. The companies all either employ doctors, contract with a physician network or do a bit of both.
Telemedicine start-ups can either hire a lot of doctors with one or two licenses or retain a smaller team of people who can work across many states. McKinney's company CirrusMD, a chat-first virtual primary care provider, chose the latter approach, as did virtual care start-up Lemonaid, which is based in San Francisco and has three doctors on staff, each with 50 licenses.
"Licensing physicians in multiple states is incredibly beneficial for patients," said Zachariah Reitano, the CEO of Ro, an online pharmacy and telemedicine company that prescribes erectile dysfunction medication and hair loss treatments. "It enables a physician to treat patients in care deserts and increases access to care where there aren't enough providers available."
It's still rare for doctors to have that many licenses. Research from the Federation of State Medical Boards shows there were just 14 doctors licensed everywhere, including Washington, D.C., according to the 2018 census. That's a jump from six in 2016. The group publishes research every two years.
The number with all 50 licenses is likely higher now, telemedicine executives say, because of technology.
"It's still uncommon, but we see more of it," said Nathaniel Lacktman, a partner at law firm Foley & Lardner, who works with many clients in the telemedicine sector. "I can't think of really any good reason why doctors would need so many licenses prior to telemedicine."
There are some shortcuts to getting to about two-dozen licenses, such as the Interstate Medical Licensure Compact, but it's not available to everyone and there are lots of exceptions. To speed up the process, a cottage industry has emerged of companies and consultants that specialize in helping doctors with licensing and credentialing.
"The need is there," said Jon Larson, CEO of MedSpoke, a physician licensing company. "There's a big shortage of physicians, and technology offers us a better way to solve this problem."
Larson said the average cost is about $90,000. The licenses also need to be maintained.
There's also a due diligence process that can take a while. Typically, the state medical boards will call up every other state board where the physician has a license as a form of background check.
Sajad Zalzala is one of the few doctors with 50 licenses, a process that started three years ago. While he's seen demand from telemedicine companies and has worked for a handful of them, not everyone in his profession is sold on the new model.
"Some doctors don't view telemedicine as real medicine," said Zalzala, who previously ran a physical clinic and now is experimenting with a new online clinic dedicated to anti-aging therapies. "When I started this journey a little over three years ago, the reaction I got was less than positive from some of my physician colleagues."
But he expects the market to head in his direction.
"With brick-and-mortar only, you can only help a few patients," he said. "With telemedicine, you have access to so many more people."