Designing a 50-State Telemedicine Career on Your Own Terms with Dr. Takashi Nakamura

In this episode of Startup Physicians, Dr. Alison Curfman interviews Dr. Takashi Nakamura, an emergency physician whose search for a simple telemedicine side gig evolved into a fully remote, 50-state clinical career and a leadership role in digital health.

Takashi shares how wanting to be more present for his young family in Hawaii led him to explore telemedicine, ultimately becoming licensed in all 50 states plus DC. That national licensure opened unexpected opportunities: medical group ownership, corporate practice of medicine (PC) leadership, compliance roles, and executive positions within rapidly scaling digital health startups.

The conversation explores:

• How telemedicine side work grew into a high-leverage, location-independent physician career
• What PC ownership and corporate practice of medicine mean for early-stage startups
• The path from clinician to executive without an MBA or formal business training
• Why an abundance mindset is essential in the physician innovation community
• The lifestyle transformation that telemedicine can offer—holidays off, nights at home, flexibility, and autonomy
• How Takashi’s program, All In Remote / ER Physician Academy, helps physicians obtain multi-state licensure and uncover both clinical and non-clinical roles in digital health
• How physicians can transition into advisory roles, administrative positions, executive leadership, or even launch their own companies

The episode highlights the vast—and often unseen—career landscape available to physicians beyond traditional brick-and-mortar practice, and how telemedicine can serve as both a bridge and a springboard to greater freedom, fulfillment, and impact.

Listeners who are contemplating career redesign, craving flexibility, or seeking meaningful work beyond conventional practice will find a roadmap filled with possibility.

00:01 – Welcome & Introduction to Dr. Takashi Nakamura
00:45 – From ER Shifts to Telemedicine as a Side Gig
02:20 – Getting Licensed in All 50 States and DC
03:56 – PC Ownership, Corporate Practice of Medicine, and Compliance
08:13 – Executive Roles, Medical Groups, and Learning on the Job
14:42 – Creating All In Remote and ER Physician Academy
17:40 – Helping Physicians Replace Income and Expand Opportunities
22:04 – From Virtual Clinical Work to Executive and Founder Paths
23:52 – Redesigning Career, Holidays, and Lifestyle Around Your Values
26:14 – The Upside of 1099 Work and Working on Your Own Terms
27:51 – Final Advice: Find Like-Minded Physicians and Positive Community

website: airphysicianacademy.com

Transcript

Alison Curfman (00:01.099)
Hi everyone, welcome back to Startup Physicians. This is your host, Dr. Alison Curfman, and I'm excited to be joined today by Dr. Takashi Nakamura. Hi Takashi, thanks for joining me.

Takashi (00:11.692)
Hey Allison, thanks for having me.

Alison Curfman (00:14.581)
Well, I know that your story and the resources that you provide for physicians are gonna be very interesting to the people listening. So Takashi is an emergency physician and has started an incredible company called All In Remote. It's a physician focused business that he can tell us all about. But before we get into that, I know you have some other experience in startups. So Takashi, do you mind just taking us back to...

your training and your clinical training and how you got into startups in the first space.

Takashi (00:45.614)
Yeah, for sure, for sure. So yeah, like you said, I'm an emergency physician by specialty and I got into telemedicine really almost, I would say by accident a little bit because I just really wanted it as a side gig, but I was working at Level One Trauma Center pretty much full-time. And when my older daughter turned five, she started doing some activities.

at school, like hula, mean, Hawaii. So hula is a big thing, right? So she started doing hula and all these other types of practices and got into sports, got into golf. And I wanted to be more available for my daughter. And so in the ER, the only way I could kind of manipulate my schedule was to start working night shifts. So I started working night shifts so could be more available during the days. And then I wanted to work a little bit less in the ER so I could be more present for my daughter, my son, who's younger, and my wife. So

I started looking into telemedicine as another form of income, I'd say. And so I started looking at telemedicine. This was in 2020. This was in 2020, just before the pandemic, actually. I started getting licensed up a little bit to see if I can do some urgent care type of consults. I knew urgent care was kind of big in telemedicine at that time. So as a side gig, really, I got licensed in five states, and I started doing some telemedicine consultations on the side.

Alison Curfman (01:46.943)
What year do you think that was?

Alison Curfman (01:51.495)
Okay, okay.

Takashi (02:09.3)
And that allowed me to give away like one to three shifts a month so could be more present in my family. So that's how I started in telemedicine really. And from there, that's when I kind of, you know, looked into a little bit more, looked into things outside of urgent care and primary care medicine in the digital health space. And being in Hawaii, one company offered to pay for a lot of my licenses. In fact, all the licenses. So.

they paid for 50 states and DC. So I was licensed nationally at this time. And this is when the pandemic did hit.

Alison Curfman (02:43.241)
And were you working full time for that company at that time or?

Takashi (02:46.658)
I was working just part-time per diem because I still had my ER brick and mortar full-time gig and I was still working there, you know, eight to 12 shifts a month at that time.

Alison Curfman (02:56.609)
That's incredible that they paid for all those licenses.

Takashi (02:59.554)
They did. Well, the reason for that was I was doing their night shift. So in the evening in Hawaii, it's overnights in the mainland. So they needed just a doctor to stay on or a few doctors to stay on throughout the night to take care of the country doing primary care and urgent care. And so they paid for all my licenses then. Yeah.

Alison Curfman (03:15.965)
Interesting. That's interesting. Yeah, very cool.

Takashi (03:20.342)
So yeah, so then I got licensed in 50 states in DC. And it turns out that I was like one in 50-ish doctors in the country that had all these licenses. And with that came other opportunities, not just clinical ones, but administrative roles and executive roles. And I was asked to help run the medical groups for some companies that were going national. Because in order to, know, to...

comply with corporate practice of medicine rules for these companies, they need a physician who's licensed in the states that they're going to treat. So they asked me for help. Yeah.

Alison Curfman (03:56.031)
Yeah. And that's for people listening, that is what is referred to as PC ownership. And it does have to do with compliance and corporate practice of medicine. My experience with that was when we started, imagine we didn't know what state we were going to launch in because we were talking to payers in a lot of states. So we actually needed to start a medical group in a lot of different states.

and enroll that medical group in Medicaid, which is a multi-month process. So you need to get the ball rolling, even though it's just kind of like a shell entity, there's not any care being delivered. And so we set up medical groups in all sorts of states and some of them have requirements that medical groups have to be owned by a physician. And so the legal entity would be that I own

the medical group and had a relationship with a management company, which is how ultimately the funds would flow. But for compliance reasons and to get it started, we had to start medical groups in a lot of different states. So I was the owner of all these non-functioning medical groups. But I say that because as a fledgling startup that's hoping to get their first contract, doesn't know what state it's going to be in, you've got to be prepared.

from all directions because you never know from your business development side of things what opportunity is going to really start firing up pretty quickly. And we wanted to be able to say, have a medical group and we're ready to go in your state when we're trying to sell to payers. So I can imagine that all of a sudden for all these companies that are trying to do multi-state expansion, having a relationship with a doctor like you who could help.

oversee that and, and allow them to stay compliant and, and also to, get kind of the, the groundwork laid for some of their expansion projects. I wanted to just describe that for a minute because some people might not be familiar with it.

Takashi (06:00.43)
Yeah, and I think most people are not familiar with it. And so it was a really interesting experience for me. as you know, there's no playbook on how to be a good medical group owner or PC owner or CEO or chief medical officer. Like, we don't know those things. I was just an average ER doctor doing clinical work. And so to be thrust into these roles, to have to learn the nuances, the legal...

Alison Curfman (06:16.319)
Yeah.

Takashi (06:29.762)
and the compliance factors with every single state, right? And the first company that I was offered this ownership and role on was a company that got this huge employer contract and they were gonna expand state by state by state. having to like, you know, incorporate, we actually incorporated in every single state and we didn't know how to form qualify our business into different states at that time.

So it was a hot mess, but it was such a, it was a big learning experience. And to be able to learn how to have an executive role, really, I think that did a lot. And so to be, know, nice as nationally now, and then being a PC owner and executive physician, learning how to run startups really helped, you know, me with not just this company, but with other companies and helping other companies grow and being like a clinician, even.

within those companies being a clinician and a backup clinician because I'm licensed everywhere.

Alison Curfman (07:28.777)
Yeah, yeah, yeah. How did you find these opportunities or did they find you? Because you were licensed everywhere, but were you like marketing that? you saying to companies like, or did they just find you somehow?

Takashi (07:41.218)
Yeah, not at all. think it's because there were only so few of us that were licensed nationally and there weren't many companies that wanted to go national right away at a time. You most companies would take it few states at a time, if anything, right? So there were only some big companies that were looking for national kind of just movements, right? So because there were only a few of us, the attorneys all knew us by name and I got to know a lot of people in the field.

and that really helped. So a lot of jobs came my way. So was very fortunate.

Alison Curfman (08:13.909)
Yeah, that's amazing. And I think the other thing that it really illustrates is that you started with your clinical skills, right? You were able to get licensed and provide clinical care with these telemedicine companies because you're a physician with this background. But the first time you had one of these other opportunities, you probably didn't know the best way to do it. weren't really like super well. It's not like you completed a degree in this. you weren't super well prepared to

be an administrative person at a startup, but you learned. That's what I like to focus on for people is that as doctors, we like to have trained in something for 20 years before we start doing it, but we are actually really good at learning things. I think that that's so much of the startup mentality is that you know what you know and you know what you do. That's an ER thing too, right? You know what you know, you know what you don't know and what you need to call a consult for.

I think that as you learned, it then probably opened up just like hundreds of other opportunities because now you have this layered experience on top of your clinical skills.

Takashi (09:24.302)
That's totally right. I like how you said that. We know what we know, we don't know what we don't know, but the fact that we go out there and learn, all of this is on the job training for us because there's no playbook out there, like we're saying. And there's no website that teaches you how to be a physician executive. Well, maybe there is now, but five years ago there wasn't. There's no YouTube that's gonna teach you these things. There's no instructional videos. So I really had to just kind of pick everything apart. had to go to a community that created a community of PC owners and executives.

people who are chief medical officers and fractional medical directors in the digital health world and really pick their brains and kind of build a community of people who are licensed in 40 states or more. And really that got me through a lot.

Alison Curfman (10:08.489)
Yeah. And for me, I remember I would spend time with the other CMOs of my firm's other portfolio companies. You got to be looking for other people that might be dealing with some of the same things as you. I spent a lot of time talking to the lawyers at the firm to make sure that I really deeply... They want us to be compliant. So they very much want to spend all the time they need to help train me and talk to me about...

the things that I need to know. So I think that the information and the growth is there for people who want to take it.

Takashi (10:44.962)
Yeah, and you know there's so many startups that are still growing and still starting up every week, or there are multiple startups that are starting and growing every week, and they all need physician leadership. They need, I mean, not just clinicians, but backup clinicians and advisors and people on a panel, they need physicians to help with compliance. There's so much opportunity, but if you're not looking for it, you're not gonna find it, right?

Alison Curfman (11:08.949)
Yeah, I think a lot of people are a little bit heads down in the traditional model that they're working for and maybe tied up with some organizational politics and their schedule and all the things that go along with traditional practice. And sometimes it can be hard to see opportunities outside of the world that we know best.

As soon as you kind of pop your head out of all of that and meet people like you and me and the other people that are in both of our communities, you realize that not only are there so many opportunities, but there's so much support and so many other people that you can go along for the ride with.

Takashi (11:52.814)
That's right. I remember when I saw you for the first time, you're presenting at Bonniku's conference. And I was like, oh my gosh, Allison is me. I am Allison. And we're in the same community. didn't know, right? Because we were doing a lot of the same things. So that was a surprise. was just so, I was really excited. I was watching all of your presentation and I was in the back corner. It was a ladies only conference, right? So like being a guy, I couldn't go any further closer to you, but you know, we had a booth there. So in the back room.

Alison Curfman (12:02.133)
Yes!

Alison Curfman (12:20.534)
Yeah.

Takashi (12:22.07)
I was listening to you and thinking, my goodness, she gets it. Like, you know, there aren't many doctors like us.

Alison Curfman (12:26.099)
Yeah. Yeah. And I mean, I think the other thing that I've heard from you and your partner that I love, this is a core value of mine too, is an abundance mindset. So I have definitely had people be like, isn't such and such community or this organization or something else already doing the thing that you're trying to do? I'm like, great. Let's both do it.

no shortage of opportunities. There's no shortage of people. I felt the same way when we first launched and we had no competitors on the market. My goal was really that I wanted to build this business so that it could prove the model would work and that we would draw other competitors into the market. I was like, the more people taking care of complex kids, the more options complex kids will have.

It's kind of a little backwards to be like, yeah, no, want more, you know, more competition, but I don't ever see anything as like competition. And I think that you and your partner are very much the same way. otherwise, if you had a scarcity mentality, you'd be like, well I'm one of 50 people licensed in all the States. I want to keep my market share and my opportunities because I, wouldn't want to get a bunch of other people licensed in 50 States because then they'll be my competition, but it's definitely not how you think.

Takashi (13:53.998)
Yeah, not at all, not at all. I'm totally right. And I think that it comes with just being in a good community of like-minded people with that abundance mindset, being with good people first. And I think for the most part, us physicians, we want to be good, good people, right? So I think just being in this kind of community is great. And you're right. It's like real estate. There's so many physicians in real estate and other types of side gigs and other jobs similarly, or even more so in this space. think there's just an

There's so much out there. You can't get rid of them quick enough, you know? And so that's why we, you you have your course, I have my course. And I think that many more people, there's going to be more of these, I think, in the future, just because there's just so much out there. And when people start really looking at these opportunities, there's going to be more interests.

Alison Curfman (14:42.825)
Yeah, for sure. And I think, yeah, what you and I do is we have similar backgrounds, but different approaches. So my vision is to try to help doctors position themselves as advisors for startups and for venture firms and really understanding how their skills can be translated, which may have some of the same flavors of what you guys do. But I know you have a whole program where you take people through the whole process of

getting 50 state licenses and understanding what sort of opportunities beyond just like being a PC owner. But yeah, like you said, even practicing clinically in these companies that's it and you can do it from anywhere, right? Like, I mean, I guess you have to be in the U S if you're practicing clinically, but it just provides so much flexibility. And what sorts of things are you seeing from people that go through this route as far as their

Takashi (15:38.701)
Yeah.

Alison Curfman (15:39.861)
career design and happiness and all of that.

Takashi (15:42.754)
Yeah, so that's exactly why we started the course because when I met Suneer, know, he's my best friend, brother and partner in the business. But we were doing clinical and non-clinical work doing telemedicine. I convinced him to get licensed up even more than he was. I think he was in like the teens or maybe 20 licenses or something. And so he eventually got licensed at 50 states in D.C. And with him to all these opportunities showed up. And so we did know that

the secret that we felt that nobody else knew as physicians that there's so much opportunity in telemedicine. So that's why we started the course. And what we did was when we had our beta, we just attracted a lot of folks who wanted to fully leave their brick and mortar. So I feel like more than half of the people, even now, are those who are either on the brink of burnout, they are burned out, or they have other priorities, or they have different identities now. They want to be a mother, a father.

know, a husband, a better husband or wife, and they enjoyed other things and they don't want to just identify themselves as being a physician. And so we attracted those people. so in order for them to have a good career within medicine or telemedicine, you want them to just be as leveraged as possible. Right. So more license equals more leverage, equals more opportunity. And we teach them with going kind of in that route. Right. So get a lot of licenses and then see all the opportunities out there and just go after them.

And a lot of folks initially want to make their income back or in the digital, in telemedicine, they want to make whatever income they're making in the living world. Right. So, so I think really our course has been kind of more designed towards getting people to have that opportunities, the opportunities, but also the option of making as much or more in doing telemedicine. And a lot of times it starts clinically. So they do a lot of clinical work. And then we also show them all these opportunities out there, all the non-clinical things.

Alison Curfman (17:18.665)
Yeah, they want to replace what they were making.

Takashi (17:40.342)
not just the clinical synchronous and asynchronous work, but the administrative stuff. If they want to do a nurse practitioner or advanced practitioner education, like supervision and collaborations, we teach them a little bit of that. We teach them a little bit of corporate practice of medicine, PC ownership, administrative and executive roles, and entrepreneurial things too. So it's this very comprehensive course, but really that path from the beginning to end, it's really teaching them how to leverage their opportunities and do clinical work and enough to make

as much or more compared to the brick and mortar income first.

Alison Curfman (18:14.825)
Yeah. And I've definitely seen evidence of people that went through your program. Then they're like, wait, there's all these companies starting healthcare ventures. what? I have an idea. I've got 50 licenses. Why don't I just start one? And so I see you guys sprouting out some physician founders as well.

Takashi (18:33.858)
Yeah, yeah, and every physician member is different, I think, because they all have their own goals, their own values, they kind of see themselves doing different things. So we just try to support them as much as we can to do whatever they're dreaming of doing.

Alison Curfman (18:48.449)
That's great. what sort of work do you feel like other than the corporate practice of medicine stuff, when you talk about other like executive and administrative roles, you see opportunities for doctors to do more strategic and sort of design work and how have you seen that?

Takashi (19:09.474)
Yes, totally. So we have members who are really into AI, marketing, just tech in general. I'm not a techie guy. And I think the big misconception is that people who want to get into telemedicine, have to have some sort of tech knowledge or something. I am not that guy. I have one laptop. I try to do the multiple.

screen thing, it didn't work for me. I have like an old iPhone, I'm not gonna get a new iPhone until it breaks, right? I'm so not that guy, but you don't have to know tech to get into this field. And you don't have to be interested in, but I think it does attract people who are interested in tech or interested in just some specific part of the digital health landscape space. know, whatever they're interested in, think we just, I mean,

As a coach now, I have to be a little interested and now I want to learn a little bit more about it. We bring experts from all over to help teach and things. We also have some coaches who are experts and have some network or something like that and we kind of help guide them. So yeah, so whatever people want to do, we really try our best to get them going down that path.

Alison Curfman (20:18.933)
Yeah, that's great. think that it's a nice like stepwise approach that most doctors could probably easily see themselves delivering care virtually. Like it's like, okay, that's actually not that hard for me to envision. Like maybe you're in a GYN and you work for a women's health telehealth company that does a lot of

counseling and menopause treatment and things like that. Like it's like, okay. Well, could I see how like maybe I have my own practice and I do some telehealth now. Like, could I see myself doing that sort of clinical work for a company? Yeah, that sort of makes sense. Okay. And then as they actually get themselves into the position to be able to find these jobs, perform these jobs, then they start to kind of realize like what the next steps could be.

Takashi (21:13.644)
Yeah. And it's like, well, I can, maybe I can do that. Maybe I want to do that, you know, and maybe I want to run a business and learn how to get, you know, investments or start, you know, learn, learn how to do a startup. And so I think initially people are clinicians and you're right, like as they see all these other things, other positions that, you know, their colleagues have like, huh, maybe I want to do that, or maybe I can do that. And that's how it starts. And then they just kind of go these different paths. But I think that

every six months when I speak with an alumni from our course, it's like they're like doing something completely different, have a whole other set of like interests, you know, and doing so it's really interesting because I think this field is moving so quickly. Like whatever you're interested in, you can really just delve right in and get to get to work and get a few contracts doing kind of similar things.

Alison Curfman (22:04.897)
Yeah, I think a lot of times what holds us back is fear of like the unknown and not having the security of a full-time W-2 job. think, you you and I as emergency medicine have probably had a little bit better opportunity to kind of ease out of it. Because like, okay, even if you're full-time W-2, if you're 15 shifts a month, you still have like a number of days per month that you could.

tip your toe in and try something else. But I think it's hard for people to think of cutting back something that's very stable. I've certainly had at least two times in my career where I was making a really good salary. The money came every two weeks. It was very stable, but it wasn't my passion or what I wanted to be spending my time doing. And it took...

a little bit of a leap of faith to say I'm gonna go in a different direction.

Takashi (23:05.998)
Yeah, totally. I think, yeah, for us, ER doctors is pretty easy. You can just try to give away shifts and you can really hedge. For some others, you know, it's really all or nothing. It's like you get your insurance and your pension or you don't. And I think it is a leap of faith for some people. you know, at the end of the day, it's if you

Alison Curfman (23:22.453)
Yeah.

Takashi (23:31.18)
If there's something on the other side that you really, really want, I think there's going to be regret in not doing it. So, you know, it's all part of the mindset and coaching too, right? If that's what they really, really want, like, I want to help you get there. So let's make it happen in the safest way possible. So you don't like, you know, don't mess up and you're not stuck without insurance or something like that.

Alison Curfman (23:52.757)
Yeah, you don't want to take unnecessary risks. But I think that a lot of what spurs people is exactly what you started with, was I wanted a better lifestyle for my family and my parenting. I remember very clearly thinking that we will have reached the pinnacle of our careers someday when we both have Christmas off.

That was like a big dream of mine. And the other one was that I will at some point in my life be able to sleep every night, like go to bed every night. Like that was like, wow, that'll be amazing. I'll probably be 65 by the time that happens, but like that'll be so cool when I get to sleep every night. And as time went on, I realized like, well, I could...

design a different career. We haven't worked holidays in years. I do locums work and PRN work, but I don't work nights. I sleep every night. It's great. I feel like I'm rubbing it in because somebody out there is probably working night shifts right now. there's options to design your career and design your life the way you want to. And some of the things that were my big dreams a long time ago, some very low bar.

Takashi (25:02.03)
Okay.

Takashi (25:16.622)
It's the best, know, like even now, like Thanksgiving and Christmas and major holidays, we have some of our members or alums saying, this is the first Thanksgiving I have had off in X amount of years and things like that. And it's crazy, like if you have that as goals as a physician, it's just, wow, we weren't really reaching too high, but those are real goals. I know, I know I'm there.

Alison Curfman (25:39.157)
I think we're accustomed and like it's kind of ingrained in us that like, you you sacrifice everything for your job first and like patients come first, which it's true. We all went into this with a very service mindset and I still take care of patients. still very important to me to take care of patients and use my clinical skills, but there are ways to do it on your own terms and to do things, to practice medicine on your own terms without

leaving medicine. Like it doesn't mean you have to go quit being a doctor. There's other ways to be a doctor.

Takashi (26:14.338)
Yeah, totally, totally. And that's what we get people to see too is like in with telemedicine, a lot of it is 1099 and independent contract work. So yes, there are risks with that, but there are so many, so many benefits of being able to do it that way. You can work when you want, how you want, where you want for the most part, and on your own terms, really. And you're not stuck with like swiping in for us in the ER, right? Swiping in, swiping out, having, you know, set shifts, having to work.

three out of the five major holidays every single year. I think that that was our rule. We had to work three out of the five, we get to take two off, but we'd have to like, know, almost like a raffle, you know, like vote for it or something.

Alison Curfman (26:51.891)
Yep. Yep. Well, I think this has been such a great conversation and I'm sure it has been inspiring to people who are listening and recognizing even more of the opportunities that might be available to them. For anyone that is interested in connecting with Tekashi, he is on LinkedIn. So we'll put that in the show notes. And then your website is, it's allinremote.com, right?

Takashi (27:18.914)
Yep, now you can go there or airphysicianacademy.com. It'll lead you to the same place. And we do intro sessions to explain more about how our elite course is. And it's a six month course. It is very, very comprehensive, but there's a lot of guidance and several coaches that help you really gain the type of freedoms that we have, but also to just help explore things in telemedicine and.

Whatever you want to do in it, we help you get there.

Alison Curfman (27:51.595)
That's very cool. Well, do you have any last pieces of advice for people that might be considering a career change?

Takashi (27:58.446)
just hang out with like-minded people. Be close to people that are doing what you want to do. Just be in positive space. And I think that it's just going to take you places.

Alison Curfman (28:14.689)
That's amazing. Well, thank you again for your time and thank you all for listening.