Episode 56 - How to Launch a Telehealth Direct Primary Care Practice While Still Working in the ER: What Dr. Christina Long Learned in Year One
Dr. Christina Long is an emergency medicine physician in Utah who left an online pill mill telehealth gig to open her own concierge practice, The Bougie Bee. She breaks down what state licensing really costs, why Meta and Google banned her ads, and how she prices her memberships.
What does it actually cost to start a telehealth practice? Dr. Christina Long, an emergency medicine physician in Utah, found out one surprise at a time. She finished her emergency medicine residency in 2010, spent 12 years in academic medicine at Loyola University in Chicago, then moved her family to Utah in 2023 and started over as a pre-partner with all the nights and weekends. A med school friend recruited her for his telemedicine company, and for a while the asynchronous work was an easy extra income she could do from her phone on a camping trip.
From the emergency department to telehealth
The telemedicine work came with no training, even though she had to learn compounded medication concentrations and dosing math on her own. Over time the reimbursement dropped to $5 or $6 per patient while the workload climbed, and none of the patient messages she answered were paid at all. She was spending half her time corresponding with patients to make sure they got good care, inside a system that did not support it.
"It's just kind of like an online pill mill where I felt like my license is being abused big time."
So she kept the flexibility and dropped the model. She sat for the obesity medicine board exam in October, and once she passed she decided it was time. In about two and a half months she stood up her own practice, The Bougie Bee, and opened January 1 offering weight loss, menopause care, sexual health, some dermatology, and urgent care. By spring she was at 30 patients, which was her goal for the entire first year.
What state licensing really costs
She is licensed in 25 states, and she is blunt that she did not need most of them. The Interstate Medical Licensure Compact costs around $800 and only expedites applications rather than granting access, about eight states do not participate, and the hard ones are genuinely hard. Texas required a jurisprudence exam she failed the first time by guessing, and California ran about $1,800. Florida turned out to be the easiest because it offers a telehealth-only license that it does not advertise. Renewal schedules and fees vary state by state, and as a 1099 physician she pays for all of it herself. Her advice now is that three to five licenses is plenty: your own state, a neighboring state, where you trained, and wherever your referrals come from.
Ad bans and Legit Script certification
Paid advertising is where she hit a wall. Meta banned her for a month because a neighborhood business post used the word tirzepatide. Google banned her from its own ads because she used the word telemedicine. What she learned is that advertising a telehealth practice or discussing medications online requires Legit Script certification, which cost $3,300 plus an annual fee of around $2,000 and required answers for every state she is licensed in. She almost asked for a refund, then learned practices can be shut down without it, so she went ahead. The certification also audits her website, EHR, payment processor, and pharmacy partners, which means dropping a convenient partner that is not certified.
"How come they can advertise it, but me as the licensed physician cannot?"
Pricing, profit, and asking to be paid
Online competitors advertise medications for $100 a month, and she does not try to beat them. She charges one annual fee up front that covers her physician fees for the year and passes medications through at close to cost. What she sells instead is 24/7 access to a physician who actually knows the area. She started with heavy discounts for her first patients and admits she still feels guilty naming her price, even though patients tell her it sounds reasonable, and she is open that the practice is not profitable yet.
"Don't expect to make a profit the first year. It's just ongoing expenses and eventually I'll get there."
How to start your own telehealth practice
Her advice for physicians starting out is to be patient and give yourself at least six months to research the models, payment structures, scheduling, and pricing before committing. Then pick a business name, buy every domain variation so no one else takes it, set up the LLC and register with your state, find a website designer, and interview EHR companies until one fits. She learned the domain lesson the hard way when another physician trademarked a name nearly identical to her old blog. She is also clear that she is not gatekeeping any of this.
"I'm not gatekeeping any of this information. I'm happy to share all of it."
About Dr. Christina Long
Dr. Christina Long is an emergency medicine physician in Utah and the founder of The Bougie Bee, a concierge telehealth practice she opened in January.
Website: https://www.thebougiebeemd.com/
Instagram: @thebougiebeemd
Facebook: https://www.facebook.com/TheBougieBeeMD/
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