Many physicians are looking for ways to earn extra income without adding space, hiring new staff, or incurring substantial overhead. A way to accomplish this goal is to look beyond your practice to find part-time jobs that involve 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 NPs and PAs or working for attorneys -- whereas other jobs are more fun than high-paying, 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 a new challenge can restore enthusiasm for your career." On the basis of your own search, you may come up with different choices, but here are some options to consider. 1. Teach Students for For-Profit Educators Physicians can choose from a variety of part-time teaching opportunities at for-profit educational companies. For example, they can teach advanced nursing students at the University of Phoenix, or prepare candidates for the Medical College Admission Test (MCAT) and the United States Medical Licensing Examination (USMLE) at Kaplan Test Prep. The University of Phoenix is looking for physicians to teach in its master of science in nursing (MSN) program for nurses who want to become family medicine nurse practitioners. "Physicians help us out a lot," said Mary De Nicola, RN, campus college chair for nursing for the university's Southern California campus. De Nicola said part-time physicians teach students in classrooms and within their own practices. For many years, she said, a physician has been teaching a classroom course on pathophysiology, and physicians can also teach minor surgery in the course's procedures lab. Within their own practices, physicians teach students one-on-one as preceptors, much like they teach medical students in clinical clerkships. De Nicola said the student comes in several times a week for 4-8 hours over the course of 12-30 weeks. She said physicians who are willing to teach regularly have very good chances of finding a paid faculty position at the University of Phoenix, but that payment varies widely, based on such factors as the length of the course and seniority. At Kaplan, part-time positions are more competitive. The MCAT sector hires 1 in 10 applicants, while the USMLE sector hires only a few new instructors each year. Applicants need to be passionate, engaging, and invested in students' improvement, company representatives said. Kent said the MCAT sector generally pays first-time instructors $1500-$2000 per course, and payment can rise, based partly on students' ratings of the instructor. Blumenthal declined to give a pay range, saying it varies widely. Pros: Teaching a new generation of caregivers can be rewarding. The pay is competitive and you'll have a chance to use your clinical skills. Cons: At the University of Phoenix, precepting physicians must be willing to host students several days a week within their practices. At Kaplan, positions are very competitive, and physicians must travel several times a year. 2. Provide Care to Prisoners Physicians can find work 1 to 2 days a week in prisons or jails at a compensation level comparable to private practice, according to Michael Puerini, MD, immediate past president of the Society of Correctional Physicians. Dr. Puerini, a family physician in Salem, Oregon, started his correctional career 22 years ago with part-time work in a juvenile facility. Among the advantages he and others cited were no out-of-pocket payments to collect, generally low malpractice rates, and minimal paperwork. "I don't have to stay late at the end of the day, dealing with paperwork," he said. However, prisoners are "the sickest people in the country," Dr. Puerini added, citing high rates of chronic illnesses like HIV, cancer, emphysema, and hepatitis C. "Physiologically, they are older than their age." Although there are many psychopaths behind bars, Dr. Puerini said physicians have far fewer risks than with patients in a hospital emergency department. "I have never felt unsafe," he said, adding that women do the work without fear, because guards are always nearby. Still, he advised keeping an emotional distance. "I put up boundaries immediately on every patient relationship," he said. Part of the job involves resisting inmates' efforts to manipulate physicians' orders to achieve special status, such as sleeping on a lower bunk or acquiring orthotic shoes. "Outside, you wouldn't think of this as important," Dr. Puerini said. Services are often outsourced to private companies. Miami-based Armor Correctional Health Services, which operates in 5 states, is looking to contract both primary care physicians and specialists in orthopedic surgery, ophthalmology, cardiology, ob-gyn, infectious diseases, and psychiatry, according to John P. May, MD, the chief medical officer. He said casting, obtaining x-rays, minor surgery, and dialysis are generally performed on-site, and nurses staff the facilities around the clock. Work in county jails, he added, is more demanding than in prisons, he said. Because newly arrested felons start in a jail, this is the place where physicians have to stabilize untreated chronic illnesses and fix wounds sustained from eluding capture. When felons are convicted and sent to prison, he said, their health status can be stabilized. Dr. May said many physicians who start part-time end up choosing prison medicine as a full-time career. "Once you've worked inside, you'll find it very rewarding," he said. "It's not so scary and intimidating as you might think." Pros: Payment is competitive, and physicians have very little paperwork and generally lower malpractice risks. Telemedicine allows some services to be off-site. Cons: Prisoners have multiple health problems and many of them are mentally ill, but guards are always nearby and the work is considered safer than service in an emergency department. 3. Become a Supervising Physician for NPs and PAs Nurse practitioners (NPs) and physician assistants (PAs) are entering independent practice or working in retail clinics that have no doctors on site. These professionals 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 what can amount to only 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. PAs require supervision in all 50 states, and NPs 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 NP/PA to create supervision protocols. Then, he or she regularly reviews a sampling of the NP/PA's charts, meets with the NP/ PA to discuss the findings, and is available for phone calls and emails from the NP/PA 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 NPs, based in North Andover, Massachusetts. Fitzgerald estimates that 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 NP/PA's revenue. Because supervising physicians are accountable for the NP/PA's actions, they can be subject to disciplinary action by the state medical board and could be sued for malpractice for those actions. Malpractice lawsuits against PAs are still relatively rare, but the number of such lawsuits has been rising, according to a study by Jeffrey Nicholson, PhD, a PA in Milwaukee, Wisconsin.[2] In some cases, supervision of NPs/PAs 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 NP/PA on their policy as an additional named insured. How do physicians find NPs/PAs 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 those they oversee, and their premium costs may rise. However, lawsuits for such situations are relatively rare. 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 4. Provide Telehealth From Your Own Home Sitting in your own home office, you can provide telehealth consults to distant patients. This work, done by phone or over the Internet, generally attracts 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 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 service, but some major private insurers, such as United Healthcare, Aetna, and Cigna, have begun to cover the charges. At least a dozen states have 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.[3] However, Alabama and Tennessee instituted a special-purpose license based on licensure in another state. Caring for a patient whom you cannot see or touch might seem risky, but so far the work has run into little malpractice activity. To reduce risks, physicians starting telehealth consults have to undergo training in telephone best practices and use protocols, such as those devised by David A. Thompson, MD. In addition to 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. 5. Serve 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 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 will probably face rough treatment by opposing attorneys. 6. Review Health Insurance Claims Reviewing insurance claims is another part-time job that can be done at home or just about anywhere. Your work will be delivered to you electronically 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. 7. Examine Patients for Insurers 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 IME 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 IMEs 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 two 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. 8. Work for 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 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.[4] The sector continues to provide rich opportunities for part-time work by physicians, even as consumer groups argue that accepting dharma money could bias physicians. The Affordable Care Act will require drug manufacturers to release information on payments to individual physicians. Dr. McLaughlin does not believe that this exposure will harm the reputation of physicians who work for drug manufacturers. "Patients would not be upset about this," he says. Drug manufacturers seem to be paying doctors somewhat less than they used to. The business intelligence firm Cutting Edge Information reported that pharmaceutical companies paid individual thought leaders $20,000-$100,000 in 2011, a lower amount than in 2008, when yearly rates were as high as $200,000.[4] Dr. McLaughlin doubts that the payments will shrink any more. "Opportunities to work with dharma won't go away, because this is important work," he says. "Getting the information about a drug out to physician audiences is crucial." Pros: Drug companies make generous payments to physicians who advise them and give speeches about their products. Physicians have a wide variety of work to choose from. Cons: Companies are limiting their payments (although these are still significant). They are also releasing the names of the doctors whom they pay, but it is not clear how this would affect the physicians' reputations. 9. Provide House Calls The revival of house calls provides a new way to make extra money. A variety of fledgling companies offer part-time employment, reviving a tradition that seemed all but dead in the 1990s. Today, about 4000 US doctors make house calls, and the number is still growing, according to the American Academy of Home Care Physicians (AAHCP), which represents these doctors. The AAHCP reports that people aged 85 years or older, a key constituency, is one of the fastest-growing population segments. Chris McAdam, senior vice president for operations at American Physician Housecalls in Dallas, Texas, says that companies such as his are taking over house calls because medical practices aren't providing them. Meanwhile, hospitals and insurers are pushing for more home visits as a way to reduce readmissions. Medicare has improved reimbursements for house calls, and the Affordable Care Act has mandated a large pilot study on them. Lou Pavelchik, practice manager at 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 be able 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. 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 any overhead or insurance paperwork. Some house call companies provide a great deal of technology. Cons: The pay is not high, and a good deal of driving is required. Also, some doctors feel uncomfortable going into neighborhoods or homes they are not familiar with. 10. Treat Nursing Home Patients 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.[5] Nursing homes are looking for medical directors who are empathetic and reliable and have a lot of older patients in their practice who might consider using the facility, Dr. Tovar says. Physicians who want to be medical directors should go to classes endorsed by the 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. 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.[7] "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. 11. Staff Medical Tents at Runs and Other Events Physicians can get short-term locum tenens jobs to staff medical tents at special events, such as walks and runs, music festivals, and health screenings. The work, also called "nontraditional locum tenens," could 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 two, 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." 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 said she was once 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. 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. Source
