Previously we discussed ways to improve your income and get paid extra income as a physician....Part One 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 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. "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 basically has 2 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: There may be some tight deadlines that can put pressure on your schedule. 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. Surprising Opportunities With Drug Companies 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. 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 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. Expanding Your Patient Base 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. 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.[6] 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.[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 Have a Little Fun While You Work 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." 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 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. 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.[8] 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. 12. Earn Your Stay 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. Part One Source
