Introduction If you're looking for extra income, you have several options other than expanding your practice. You can look beyond your practice and find a variety of interesting part-time jobs that utilize your clinical skills. Outside jobs are a welcome change for many physicians, says Michael McLaughlin, MD, founder of Physician Renaissance Network, a consultancy in Pennington, New Jersey, which helps physicians with their careers. "Doctors looking for extra money may not want to expand their practice and work longer hours doing the same thing," he says. “There are a wide variety of jobs to choose from. Some outside jobs pay quite well -- for example, supervising midlevel practitioners or working for attorneys -- whereas other jobs are more fun than lucrative, such as serving as a cruise physician or staffing a medical tent at an outdoor event. Making money is important, but Dr. McLaughlin says it may not be the chief reason that physicians are looking for an outside job. "They may be feeling burned out or in need of more varied intellectual challenges," he says. "Having another job can restore enthusiasm for your career." What an Extra-Income Job Can Do for You Some physicians take on quite a few outside jobs. In addition to his internal medicine practice in Highland Park, Illinois, Jordan Grumet, MD, works in a nursing home and a hospice, serves as an expert witness in legal cases, and writes a blog for an online physician community. "Having other jobs is a great way to balance your worklife," he says. In a typical week, he spends 20 hours seeing patients in his office, 15-20 hours visiting the nursing home, 5 hours visiting the hospice, and 3-5 hours working on his blog or writing articles. And he occasionally takes on work as an expert witness. Dr. Grumet says these jobs provide new insights into clinical medicine, making him a better physician, and can also make him more efficient. When appointments slow down at his practice, he has other work to turn to. Even though Dr. Grumet's blog-writing brings in only a few thousand dollars a year, he wouldn't give it up for the world. "Writing, in particular, helps you avoid burnout," he says. The blog he writes for, Freelance MD, focuses on physicians looking for extra kinds of work. "In your practice, you can get to a point where you want to try new things," he says. "You need to find something new and refreshing." To find the jobs he wanted, Dr. Grumet developed a wide network of potential employers and constantly reached out to the community. "I see myself as a serial entrepreneur," he says. "I'm always looking for new opportunities." This means "getting outside of your comfort zone," he says. Physicians who can't do this on their own and need help looking for outside jobs can turn to consultants for help. Before you jump at a part-time job opportunity, however, Dr. McLaughlin suggests taking some time to consider what sort of work would fit your needs. "People have very different wants," he says. "Some think that sitting at a desk, reviewing charts, is the last thing they want to do. Others say, 'I've been seeing 80 patients a day, and I want some peace and quiet.'" On the basis of your own search, you may come up with your own choices, but here are 10 part-time clinical jobs to consider. Read Also: For Doctors: How to make money online How to make extra income as a doctor 9 Non medical careers for doctors Paid surveys the underrated revenue stream for doctors Activities in Your Realm 1. Supervise Midlevel Providers Midlevel providers -- nurse practitioners (NPs) and physician assistants (PAs)-- are entering independent practice or working in retail clinics that have no doctors on-site. Midlevel providers are often required to designate a supervising physician and work with him or her. They pay the supervising physician as much as $15,000 a year for basically several hours of work each month. "This is very viable work for busy physicians, because it can be done in their discretionary time," says Philippa Kennealy, MD, owner of The Entrepreneurial MD, a career-coaching consultancy for physicians, based in Los Angeles, California. Physician assistants require supervision in all 50 states, and nurse practitioners need it in most states. AARP reports that as of 2009, supervision was required for NPs in 25 states (including California, Texas, New York, and Florida), and 7 more states (including Indiana, Michigan, and New Jersey) required supervision only if the NP prescribes.[1] Most of the states that don't require physician supervision for NPs are in the West (eg, Oregon and Washington). Physician supervision of independent midlevel providers involves several basic tasks. First, the doctor sits down with the midlevel to create supervision protocols. Then, he or she regularly reviews a sampling of the midlevel's charts, meets with the midlevel provider to discuss the findings, and is available for phone calls and emails from the midlevel on an ongoing basis. The number of calls can range from virtually none to 10-15 per month, according to Fitzgerald Health Education Associates, a provider of test review courses for nurse practitioners, based in North Andover, Massachusetts. Fitzgerald estimates the work takes up 30-35 hours a year for a payment of $10,000-$15,000 to the doctor. The payment is usually a flat fee, but it can also be based on the number of charts reviewed or a percentage of the midlevel's revenue. Because supervising physicians are accountable for the midlevel provider's actions, they can be subject to disciplinary action by the state medical board and could be sued for malpractice for the midlevel's actions. Malpractice lawsuits against PAs are still relatively rare, but the number of these suits has been rising, according to a study by Jeffrey Nicholson, PhD, a PA in Milwaukee, Wisconsin.[2] In some cases, supervision of midlevel providers may raise your malpractice premium, according to Monte Shields, manager of agency marketing at the Keane Insurance Group, a medical malpractice insurance broker in St. Louis, Missouri. To make sure you are covered, Shields advises checking with your carrier. The carrier may require doctors to put the midlevel on their policy as an additional named insured. How do physicians find midlevels to supervise? NPs looking for physician-supervisors sometimes advertise on Craigslist, or you might be able to connect with them on LinkedIn, Twitter, or Facebook, according to the Nurse Practitioner Business Owner Website. This site also offers discussion groups. Pros: Payments are generous, and oversight activities can be performed in your downtime. Cons: Supervising physicians assume some malpractice liability for their midlevels, and their premium costs may rise. However, lawsuits for such situations are relatively rare. Consider This Growing Field 2. Provide Telehealth Consults Sitting at your own home office, you can provide telehealth consults to distant patients. This work -- done by phone or over the Internet -- generally uses part-time physicians. You can arrange to take the calls in your off hours. Telehealth doctors, who advise patients whom they will never meet in person, deal with a variety of simple complaints. Because procedures are not involved, the work is a good fit for primary care physicians. They can even write short-term prescriptions. If the telehealth physician decides that the complaint cannot be handled over the phone, the patient is directed to a local doctor or the emergency department. On its Website, San Francisco-based Ringadoc says that physicians are paid $20 per telehealth encounter. Each encounter takes 8-12 minutes, but the physician also needs to review the patient's medical history, write a brief summary of the encounter, and provide patient instructions. Dr. Kennealy says that rate could be worthwhile if you could see a lot of patients quickly. Some states, such as Texas, prohibit telehealth consults, on the grounds that physicians need to have a face-to-face encounter to understand a complaint. But resistance has been eroding. Telehealth consults are legal in at least 21 states, including California, Illinois, New York, Ohio, and Pennsylvania. Many patients pay out-of-pocket for telehealth consults. Medicare won't cover this kind of telehealth service, but some major private insurers -- such as United Healthcare, Aetna, and Cigna -- have begun to cover the charges. At least a dozen states had passed laws requiring private insurers to pay for telehealth. Providing telehealth services across state borders, however, raises issues of state licensure. Twenty states have licensure laws specifically addressing telehealth, usually requiring licensure for physicians who practice telehealth frequently with patients in that state, according to a state-by-state review in Telemedicine Today.Ringadoc, you can check out American Well, Teledoc, and iSelectMD. Another company, NowClinic, hires physicians to provide telehealth consults for United Healthcare members in 22 states. And Soliant Health, an online recruiting organization, has been looking for doctors to make telehealth consults for hospitals. Pros: You can work in your home and set your own hours. It's a growing field, and there are many outlets to choose from. Cons: Payments seem somewhat low, and you may be barred from doing this work in your state. 3. Work as an Expert Witness Serving as an expert witness for attorneys is almost always part-time rather than full-time work. Full-time expert witnesses would be viewed by jurors as "hired guns" who have lost touch with clinical practice. Physicians' clinical experience is the value they bring to legal cases. Karen Josephson, MD, a solo geriatrician in Long Beach, California, has been moonlighting as a geriatrics expert at law firms for many years. "I really enjoy the work," she says. "It makes me a better doctor because I have a chance to see what other physicians have done and think about how I could have done it better." Also, "the payment will always be better than in my medical practice," she says. She makes an average of $2000-$5000 per case. To avoid the "hired gun" accusation, lawyers prefer that physicians restrict their legal work to no more than 3%-5% of their overall income, according to American Medical Forensic Specialists (AMFS), a recruitment firm for medical expert witnesses based in Emeryville, California. Expert witnesses can work directly for law firms or work for services that supply expert witnesses; these include AMFS or the TASA Group. SEAK Inc., an expert witness training company in Falmouth, Massachusetts, offers seminars and other resources for physicians interested in this line of work. Steve Babitsky, President of SEAK, advises fledgling expert witnesses to start a Webpage and establish their expertise. "Develop a niche -- a small area of expertise where you can dominate your market," he advises. Dr. Kennealy, the career coach, warns that medical experts who go to court have to be prepared for tough cross-examinations. "You have to have the stomach for this kind of work," she says. If not, you can always review cases out of court, which she says pays $200-$300 an hour or more. You can evaluate claims to determine whether they have merit or write reports that are used to settle or adjust cases. Pros: This work is geared toward part-timers, and payments are quite generous. Cons: If you go to court, you may face rough treatment by opposing attorneys. Tapping Your Existing Expertise 4. Perform Claim Reviews Reviewing insurance claims is another part-time job that can be done at home, or just about anywhere. Your work will be delivered to your computer, via the Internet, by an independent review organization (IRO). IROs are unbiased outside companies that health insurance companies engage to address concerns that they might be improperly denying claims, says Heather Fork, MD, owner of Doctors Crossing, a career consulting firm for physicians. The National Association of Independent Review Organizations, which represents these groups, provides a list of IROs on its Website. "All of this work can be done online," says Barry Korn, MD, national medical director of one of the IROs, Concentra Physician Review, based in Addison, Texas. Dr. Korn says a few hundred physicians work for Concentra as part-time reviewers. These doctors determine the medical necessity of coverage requests that have been flagged by Concentra's nurse-reviewers. These doctors also perform more extensive reviews that involve looking back over the treatment for a particular patient for an extended period, he says. Dr. Fork says IROs usually pay $85-$200 or more per hour. Dr. Korn says Concentra's payments range from $100 to $150 an hour or more, on the basis of the physician's qualifications and specialty. "Physicians who do this work need to be prompt, accurate, and reliable," Dr. Fork says. "These companies often want a 24-hour turnaround." They have to meet deadlines they have made with the insurance companies. "Many IROs also require some degree of continued clinical practice," she adds. "If there is insufficient information in the clinical record, the reviewer calls the physician to have a peer-to-peer conversation," Dr. Korn says. "The call has basically two purposes: to obtain information and to educate the physician on current evidence-based guidelines." To obtain this work, Dr. Korn says physicians need to fill out applications, which go through a rigorous credentialing process that takes a month or two. If accepted, the physician starts with online training at home. Pros: You can do this work at home and make decent money. Cons: You may need to meet tight deadlines. 5. Perform Independent Medical Examinations for Insurer Organizations Physicians can perform independent medical examinations (IMEs) part-time, but be forewarned: You'll be performing a history and physical examination that is very different from what you do with your own patients. Don't expect a warm and cozy relationship with the person you're examining. You will be trying to establish whether this person merits a payout for worker's compensation, auto insurance, health insurance, or Social Security. In some cases, patients may be hiding some aspect of their physical condition so that they can qualify for a payout, says David P. Kalin, MD, a family physician and independent medical examiner in Oldsmar, Florida. If that is the case, the physician doing the IME will try to uncover it. "You don't just do a simple history and physical [examination]," Dr. Kalin says. "You have to be pretty thorough about it." "I've being doing independent medical exam[ination]s for quite a long time, and it's a good business," he says. His fees range from as little as $100 an hour for a Social Security examination to $500 an hour for private payers. The IME work involves about one quarter of his professional time. He says some cases can take him an hour or 2 of work, whereas others take a full day. "The way you write your report has to be geared to the way a lawyer thinks," Dr. Kalin says. For example, if the doctor reports that the patient's medical condition was "exacerbated" by a car accident, the patient will probably get very little compensation. But if he reports that it was "aggravated" by the accident, "there is money around that," Dr. Kalin says. Learning this new medical language and understanding the goals that physicians doing IMEs are supposed to meet requires training. Dr. Kalin advises taking some courses approved by the American Board of Independent Medical Examiners (ABIME) and then getting ABIME certification. Physicians seeking IME work can contact worker's compensation, auto insurers, and other companies and agencies. Many state worker's compensation programs, such as those in in Washington and New Mexico, require IME physicians to be approved by the state. SEAK, the expert witness training company, also works with IME physicians and provides a national directory of IME physicians on its Website. Some companies, such as Scope Medical in Stoneham, Massachusetts, engage physicians for IME work. Scope Medical says that physicians typically examine 6-10 patients at a time at a Scope facility, following a specified format. Pros: Payments can be generous, and you can create your own schedule. Cons: The people you examine may feel antagonistic toward you. Surprising Opportunities With Pharma 6. Work With Pharmaceutical Companies "The list of part-time jobs for doctors in the pharmaceutical industry is endless," says Dr. McLaughlin, career consultant. "There are so many different aspects of the work. You could speak for them or serve as an advisor. If you don't want to be a speaker, you can write up a report in your home. You could help the company present data to the FDA (US Food and Drug Administration). Or you could make your practice a site that participates in clinical trials." For many of these functions, he says, you'll need to have good presentation or writing skills. You'll also need to get training on the drug company's product line, FDA-approved product labeling, and other regulatory requirements. The payment for a half-hour speech can range from $500 to $2500 and the opportunity is available to many physicians. Pfizer, the second-largest drug manufacturer, paid 4500 doctors to work as "thought leaders" in the second half of 2009 alone.MD at Home in Chicago, Illinois, says the company pays physicians $50-$70 per visit, in addition to covering their malpractice insurance and reimbursing them for the driving. He says his part-time physicians are expected to work 1 or 2 days a week. In the home visit, the physician examines the patient, provides some basic care with mobile equipment, and writes up a plan of care. Pavelchik says this work appeals to 3 kinds of doctors: those just coming out of residency, those frustrated with the red tape of running a practice, and semiretired physicians who are rolling back their practices. Physicians who do house calls should have strong empathy and have to put up with a fair amount of driving. Often, they travel with a medical assistant. Rather than the black bag of yesteryear, their chief tool is a laptop computer, used to call up the patient's electronic medical record and other information. Chicago-based Mobile Doctors also provides its physicians with equipment for mobile radiography, echocardiography, carotid Doppler imaging, ultrasonography, and phlebotomy. The companies have varying business models. Some are local physician practices entirely dedicated to house calls, such as Doctors Making Housecalls; others are national companies, such as Inn House Doctor, which operates in 8 major cities, and WhiteGlove House Call Health, with offices in 3 states. Whereas many companies focus on Medicare patients, some are boutique operations that depend on cash payments from traveling business people; others contract with businesses to cover their employees. Insurers have also gotten into the house call business. United Healthcare has been running ads in many parts of the country, looking for doctors to make house calls. Pros: You won't have an overhead or insurance paperwork. Some house call companies provide a great deal of technology. Cons: The pay is low, and a great deal of driving is required. Options in Nursing Homes and at Special Events 8. Work at a Nursing Home There is a reason why physicians caring for nursing home patients usually do it part-time, says Reuben Tovar, MD, a hospitalist who serves as medical director at 2 nursing homes in Austin, Texas. "If you're working full-time, going to many different facilities," he says, "you lose your focus, and the quality of care suffers." Dr. Tovar says that the best way to work in a nursing home is to serve as medical director and see patients there as well, which is what he does. The medical directorship is necessary, he says, because Medicare and Medicaid do not pay well for patient visits. But nursing homes prefer their medical directors to be engaged in patient care because they are more engaged with operations, he says. A medical director job requires at least 20 hours of work per month, usually in regular meetings with staff and to comply with deadlines for regulations, Dr. Tovar says. The medical director would spend another 10 hours a month seeing patients in the facility, which can be done in a single afternoon, he says. Nursing home medical directors can earn $70,000-$80,000 a year, according to the Website Simply Hired. In addition, reimbursements for treating individual patients can bring in $75-$150 an hour if coded correctly, according to a 2010 report published by the Kaiser Family Foundation.American Medical Directors Association (AMDA), which represents nursing home medical directors, and obtain AMDA certification, he says. Dr. Tovar did not take that route, though. He began by visiting a nursing home when one of his patients was admitted, which led to the administration asking him to be medical director. Nursing homes are frequently sued for malpractice or elder abuse, but only one fifth of these lawsuits name a physician, according to a 2003 study published in Health Affairs.[7] Dr. Tovar says that's because these cases often involve problems that occur when the physician is not in the facility, such as patient falls. Certain physicians thrive in a nursing home, said Robert Milligan, MD, a family physician in Buffalo, Minnesota, and AMDA member, who spoke in an AMDA sound clip.[8] "They have to love people and be extremely compassionate, and you have to like a good puzzle," he said. "The average individual we care for in a nursing home has 7 medications and 10 diagnoses." Nursing home physicians also have to deal with numerous phone calls from staff and demands from family members. "The main talent you need to have is patience," Dr. Tovar says. "The conversations are slower for these patients, and the family needs to be involved." Pros: Work in nursing homes is usually part-time, and it can pay well if you combine it with a medical directorship. Cons: Physicians may be overwhelmed with calls from staff and families' demands. Facilities face numerous lawsuits for malpractice and elder abuse, but doctors are usually not named in them. 9. Staffing Special Events or Screenings Physicians can get short-term locum tenens jobs to staff special events, such as walks and runs, music festivals, and health screenings. The work, also called "nontraditional locum tenens," may provide a novel way for doctors to travel and practice medicine outside of just taking extra hospital shifts. While "the vast majority" of locum tenens assignments are longer term, there are some opportunities for work that lasts just a day or 2, says Jason Daeffler, marketing director at Barton Associates, a locum tenens staffing company in Peabody, Massachusetts. "Recently, we've seen some demand from music festivals and other festivals." In May, for example, Barton Associates was looking for locum tenens dermatologists to perform free cancer screenings for a few days at an event. The dermatologists performed an 8- to 10-minute scan of each person, and if they found any lesions, they were instructed to ask patients to see a local dermatologist. Daeffler would not reveal payments for these short-term engagements, but he said, "It's a very competitive hourly rate. Providers can definitely earn more than they would at a permanent position." Dr. Kennealy, the career coach, believes these short-term offerings are rare. "Being paid for special events is very limited," she said. Some marathons have an all-volunteer staff working their medical tent. However, physicians may inadvertently run into opportunities. Dr. Kennealy remembers once being paid to serve as physician to an opera singer from abroad while she was performing in town. Because the singer lived in Europe and did not have US coverage, she paid out of pocket. Professional sports is another matter. Doctors often pay for the distinction of being the official team physician, in the hope that the publicity will enhance their practice. Orthopedic surgery and other practices reportedly pay professional teams as much as $1.5 million annually to be listed as team physicians.[9] Pros: Working at special events or screenings takes up just a few days of a physician's time. Cons: Don't count on many of these opportunities. Enjoy the High Seas? 10. Work on a Cruise Ship For many years, Charles Pexa, MD, a Minneapolis-area emergency physician, has been taking free cruises. In return, he puts in a few hours each day as the ship's doctor, and gets paid for it. "It's an adventure," Dr. Pexa says. "I can travel really inexpensively, and it's usually pleasant work. People on cruises are very easygoing." He serves as a cruise physician several times a year. The cruise physician works with nurses in a sick bay that is fitted out with state-of the-art equipment, such as radiography equipment, an ECG, and laboratory testing devices. In addition to running 1-hour clinics in the morning and afternoon, the cruise physician is usually on call the rest of the time. Most times that the ship is in port, Dr. Pexa says he has to stay on board. "This is not a money-making proposition," Dr. Pexa cautions. The pay is about $150 a day, but he and his wife cruise for free. The cruise lasts anywhere from a few days to a month. "Most of the patients just have aches and pains, but you have to be available in case someone gets really sick," Dr. Pexa says. A medical emergency can be a big problem on the high seas. Once, when a passenger had sepsis, the captain had to turn the ship around and go back to port, Dr. Pexa recalls. Every so often, a cruise ship reports an outbreak of bacteria or a virus, but he has not had to deal with that. Dr. Pexa has found work on many different cruise lines, but he concedes that finding a job might be more challenging for a doctor with no experience and in another specialty. Cruise lines favor emergency physicians for this work, but they also hire family physicians and internists who have had experience dealing with serious medical emergencies, Dr. Pexa says. To find out more about becoming a cruise physician, contact the major cruise companies. The Carnival Corporation, the largest cruise line, owns Carnival Cruise Lines, Princess Cruises, Holland America, and Cunard Line. Royal Caribbean International owns Royal Caribbean, Celebrity Cruises, and Azamara Cruises. Another option is Norwegian Cruise Line. Pros: In addition to a modest payment, you and your guest get a free cruise. Patients are friendly and relaxed, and you have a lot of free time. Cons: You can't make much money from this work, and openings are limited. You have to stay on the ship when it is in port. Taking the Next Step Once you know what kind of job you want, you'll need to check out offerings and begin applying. Dr. McLaughlin says this step does not come easy for a lot of doctors. "Physicians don't like asking for help," he says. He suggests asking friends and acquaintances for contacts and getting onto social networking sites, such as LinkedIn. Also check out Freelance MD, the blog on freelance work for physicians, and DocCafe, a physician hiring service that lists job opportunities. If the part-time job you choose turns out to be very fulfilling, you may decide to expand the work or even make it a full-time career. "Part-time work can blossom into something more permanent and change your whole life," Dr. McLaughlin says. Source
