Most DTC telehealth companies — including some of the largest and most marketed names in the space — primarily use nurse practitioners (NPs) or physician assistants (PAs) as their prescribing clinicians. These are skilled healthcare professionals. But their training is fundamentally different from a physician's, and that difference matters most when cases are complicated.
What Internal Medicine Training Actually Is
Internal medicine physicians complete: four years of medical school + three years of internal medicine residency (11,000+ clinical hours) + ABIM board certification exam. The residency is deliberately broad — cardiology, pulmonology, nephrology, gastroenterology, endocrinology, rheumatology, infectious disease, hematology, neurology, and critical care, among others. The purpose is to train a physician who can manage complex, multi-system disease, recognize when conditions are interacting, and know when to refer versus manage.
By comparison, a nurse practitioner graduate program typically involves 500–750 clinical hours. NPs are excellent for protocol-fitting presentations. The scope of diagnostic training is different.
What the Difference Looks Like in Practice
The practical difference shows up when a patient's case doesn't fit the protocol or when conditions interact in ways the protocol wasn't designed to handle:
- A GLP-1 patient with a history of medullary thyroid cancer: an NP following a GLP-1 protocol may not recognize semaglutide's MTC boxed warning or know how to evaluate whether the specific cancer history constitutes an absolute contraindication. A trained internist does.
- An ED patient on sildenafil who develops a new headache pattern: renewal protocol renews the prescription. An internist recognizes new-onset headaches in a middle-aged man on a vasodilator warrant brief vascular screening before renewal.
- A hypertension patient controlled on three medications who still needs BP management: an NP adjusts the existing regimen. An internist recognizes this meets ACC/AHA criteria for resistant hypertension and initiates a workup for secondary causes including renal artery stenosis and primary aldosteronism.
None of these are hypothetical. They are everyday adult medicine.
What YourMD's Physician-Led Model Means
Every YourMD encounter is reviewed by Dr. Teja V. Surapaneni, MD, MS — ABIM board-certified internal medicine, 10,000+ telehealth consultations. This means:
- We sometimes say no. An approval rate of 100% is a sign that clinical judgment isn't being exercised. When the medication you're requesting isn't appropriate for your specific situation, we tell you why and what is appropriate.
- We order labs that matter. Prescribing an ACE inhibitor without checking kidney function first is how patients get hurt. We require the evidence-indicated labs before initiating medication.
- We refer when referral is right. New heart failure doesn't get a prescription for carvedilol and furosemide via portal — it gets referred to cardiology. Resistant hypertension on three medications gets a secondary cause workup.
- We treat interactions. A patient starting sermorelin who has prediabetes needs monitoring for GH-induced insulin resistance. A patient starting GLP-1 who's on metformin needs their metformin adjusted as A1C improves. A longevity patient starting rapamycin who takes clarithromycin needs to know their rapamycin levels may increase 5–10-fold from that interaction.
Conditions We Manage Via Telehealth
- Metabolic/weight: GLP-1 therapy (semaglutide, tirzepatide, orforglipron), metabolic optimization, insulin resistance, pre-diabetes
- Cardiovascular risk factors: Hypertension (2025 ACC/AHA guidelines), dyslipidemia (cholesterol management), ASCVD risk reduction
- Longevity medicine: Rapamycin, metformin, NAD+, evidence-based longevity protocols
- Peptide therapy: Sermorelin, PT-141/bremelanotide, wellness injectables
- Men's health: ED (tadalafil vs sildenafil), male pattern hair loss
- Women's health: Female pattern hair loss, HSDD (PT-141/Addyi/Vyleesi)
- Dermatology: Tretinoin, custom compounded topicals
What Telehealth Cannot Do — Honest Scope
No controlled substances. No physical examination, imaging, or procedures. Emergency presentations go to the ER, not our platform. When your situation exceeds telehealth scope, we tell you and refer you appropriately. That is the most useful thing a physician can do in cases where prescribing is not the right answer.
Available in Nevada, Washington, Oregon, and Wisconsin. Video ($50) · Audio ($40) · Chat ($20).