Introduction 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." What an Extra-Income Job Can Mean 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 work life," 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 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 and 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 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. 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 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. "We hire some MDs, both part-time and full-time, and some are retired," said Mari Kent, director of faculty recruitment for MCAT. For an MCAT position, Kent said the applicant's score on the exam has to be in the top 10%. She said the demand for MCAT classes is robust, because the test format will change in 2015 and pre-med students are rushing to take the current version. Erika Blumenthal, PhD, executive director of medical programs for Kaplan Medical, which runs the USMLE program, said applicants must have experience teaching medical students or working with the exam. "Before they start, we want them to go through a mentoring program, where they are paired with seasoned faculty," she said. The MCAT program has a similar process, Kent said. New instructors are expected to teach at Kaplan locations across the country, but they may be able to run online classes from their homes later on. Dr. Blumenthal said part-timers in the USMLE program work for a week or two at least 3-4 times a year. She said the busy season is the spring and summer. 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. Good Pay and Very Little Danger 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. Prisoners generally get better care than they had before incarceration. A 1976 US Supreme Court decision established a prisoner's right to healthcare. Prison systems have tried to keep costs in check by introducing telemedicine, which removes the expense of transporting prisoners off-site with armed guards. 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. 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. 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. to be continued...... Source
