To describe the use of videoconference telemedicine for providing outpatient pulmonary consultation to a remote, underserved clinic site. Analysis of data from the Milwaukee Veteran Affairs Medical Center (VAMC) pulmonary telemedicine clinic. Pulmonary physicians at the Milwaukee VAMC provide outpatient consultations with the use of videoconference technology to patients located at the Iron Mountain VAMC in Iron Mountain, MI (346 km or 215 miles from Milwaukee). Data on demographics, referral patterns, access to care, consultation process, and outcomes are presented. A total of 314 patients (684 visits) received telemedicine consultations between January 1, 1998 and December 31, 2004. Common reasons for referral were abnormal radiology (38%), chronic obstructive pulmonary disease (COPD) (26%), and dyspnea (13%). Physical exam was performed by the telemedicine registered nurse or respiratory therapists in 90% of visits. Common diagnoses were COPD (29%), benign pulmonary nodule (11%), bronchial asthma (6%), and lung cancer (6%). Telemedicine consultation resulted in a change in management for 41% of patients. Only 8% of patients required an in-person clinic visit at Milwaukee VAMC following a telemedicine visit. Telemedicine saved patients 473,340 km or 294,120 miles of travel over the study period. The provision of subspecialty services using telemedicine to a remote underserved rural population provides improved patient access to subspecialty care. Physicians are able to rely on medical history and radiology to manage patients across a broad spectrum of complex pulmonary conditions with the assistance of a non-physician health care provider at the remote site.