By Wealthy Doc, Guest Writer
As a physician, you are already in a high-income profession. Sometimes, however, you may need to boost your income. Maybe it’s because you’re wanting to pay off your house or the debt on your office building or your student loans. Perhaps you’re saving up for an early retirement, a sabbatical year, a trip around the world, or your daughter’s college/wedding expenses. Whatever the need, there are quite a few options to boost your revenue. We will explore a few of them here:
#1 See More Patients
Yes, this old-fashioned method still works. Ultimately medicine is a service profession. In the most basic terms, your job is to meet patient needs. You can still do that by seeing a whole lot more patients. Often the highest income individuals are also the busiest. You likely can boost your revenue by getting closer to 100 patients seen per week.
#2 Increase Administrative Work
You may be able to get a stipend as a medical director and do some administrative work for your hospital network. Some providers still have a full clinical schedule and then do their administrative work in the early morning or after work or during lunchtime meetings. This combination allows you to boost your income. Also, depending on your specialty, physician leaders may be compensated more than some clinicians.
#3 Take on a Side Gig
There are a lot of ways to make money. Some of them involve using your clinical knowledge but in a way that is different from your normal practice. This side hustle can involve consulting, disability evaluations, expert testimony, etc. If you have a hobby that could be monetized such as a blog or handyman services then be sure to explore those options as well. Sometimes it can be rejuvenating to do work other than medicine.
#4 Change Your Specialty
Do you regret not choosing a higher income field? It isn’t too late. Plenty of folks have gone back and switched from family practice to radiology, for example. If you are not up to a whole residency, could you do a fellowship? Often you can boost your income tremendously by a 1-2 year fellowship. This is mostly available to general internal medicine doctors who want to specialize (e.g. infectious disease or endocrinology) [Editor's Note: But there are other possibilities as well (Peds EM fellowship for a pediatrician, EM fellowship for an FP etc).] You may find you can have better hours, see fewer patients, and still make much more money.
#5 Learn New Procedures
Although we are slowly getting away from a fee-for-service system, we are not there yet. You can often boost your income by performing more procedures. Are there procedures in your specialty that you are not doing? Could you learn how to do them? Some profitable procedures can be learned in a weekend or a week-long course and then spending some time with a mentor. This investment can pay off huge dividends.
#6 Specialize in a Niche
Some fields have subspecialty needs that are not being met. They are subject to supply and demand. If you learn how to master that subspecialty and market your services you can exploit this need and cash in.
#7 Expand Your Team
Could you boost revenue by expanding your practice? Perhaps you are seeing as many people as you can safely see in a day. Likely you could see more patients as a team if you collaborate with physician assistants and with nurse practitioners. Dentists have learned how to use dental assistants efficiently. Similarly, with lawyers and paralegal services. Physician practices still have a lot to learn.
#8 Renegotiate Your Contract
You don’t get what you deserve, you get what you negotiate. Will your employment contract be up soon? Rather than automatically renewing it at its current terms, consider renegotiating. Incomes for physician specialists have steadily increased over the last six years; has your income kept up? Would you be better off on a fixed salary plus incentive or a 100% productivity-based contract? Have you reviewed recent MGMA data for your specialty compensation to know for sure that yours is competitive? If not, you have some work to do.
#9 Invest
Generate some passive income for yourself. That way your money works for you rather than the other way around. When you have passive income investments you wake up in the morning richer than when you went to sleep. It is the closest thing to getting paid for doing nothing that we can reasonably and legally achieve in this lifetime. Ask around. See who is financially successful in your area. Take them out to lunch. Pick their brain. I make more from investing than I do from working my day job. That did not occur overnight. It took slowly gaining skills, knowledge, and streams of income. Look within your medical profession for buying opportunities but also outside your profession such as small business and real estate.
#10 Move to a Larger Practice
Sometimes you can make a whole lot more money just by being in a larger or a more efficient practice. The highest paid professionals throughout our nation tend to be associated with large groups that can feed them the high-volume of their specialty niche. Are there such opportunities in your town that you have not taken advantage of?
#11 Leave Academic Medicine
I love academic work. There are few things more rewarding in life than writing, research, or teaching. Just know that there is a tremendous financial price that you’re paying for this. It may not be worth it if you need to boost your income. Perhaps you could work for a few years in a private practice and then return to academia later?
#12 Get a Degree
You have proven that you are good at learning and test-taking. Why not take that to the next level? Through online and evening programs there is now a world of choices around advanced training and education. Consider some IT training and add medical informatics to your toolkit. Consider an MBA to learn more about leadership, practice building and investing. Even a law degree can be obtained part-time. You can then be a formidable medical defense attorney.
#13 Establish a Cash Only or Concierge Service
Don’t assume you must treat Medicaid and Medicare patients and work the way everyone else does. Recently primary care doctors around the country have established cash only or concierge services. They often work fewer hours, make more money, and have virtually no paperwork or insurance headaches. It is not for everyone, but is worth considering.
#14 Move to a High Income, Low Cost of Living Area
For many doctors reimbursement is determined by large payers or by the federal government. There is little difference in the total revenue paid for a given CPT code in different regions of the country. Nevertheless, doctors do make more money in some states or towns than in others. There are also tremendous variations in the cost of living such as housing or commuting costs [and taxes-ed]. Consider exploiting this “geographic arbitrage.”
#15 Increase Ancillary Services
Could you add a revenue-generating service to your practice? Could you add a spa suite? Could you offer cosmetic services for cash only? Could you invest in the surgery center, medical office complex, imaging center, physical therapy suite, gym/health club, etc. Physicians and other investors around the country have made small fortunes doing just that.
#16 Get Paid to Take Surveys Online
[Editor's recommendation. Here's some of the best survey companies WCI recommends trying.]
Taking surveys isn't ever going to overtake your clinical practice as your main source of income, but you can make a surprising amount of money doing them as a physician, especially compared to non-physician online survey companies.
It depends on how many surveys you take, how much each survey pays, and how quickly you can take them. No matter how many companies you sign up for, you're not going to get enough surveys that you can spend all day just taking surveys. You have to take them as they come. But it's pretty easy to knock them out during some downtime during the day, while watching TV, while helping with homework in the evening, or while commuting on public transit.
The companies generally send you a check 4-6 weeks after the study or survey is complete. Hourly rates while actually taking the survey range from $60-$300 per hour, although most surveys won't take an hour. If you really make an effort at this, it would not be terribly difficult to make $1,000-$2,000 per month on surveys. That might not be much for a super-efficient and busy plastic surgeon, but it's enough to move the needle for lots of doctors and it is life-changing money for a resident or fellow.
Good luck with finding a way to boost your revenue that fits your lifestyle. I hope this post has opened your mind. Too many of us place ourselves in a little box based on our residency training and assume there’s only one way to make money. Be creative and grow your revenue!
Have you made any of these changes already? Are there others that should be mentioned here? Comment below!
[Founder's Note: This is a guest post from Wealthy Doc, the only physician financial blogger I know of who has been at it longer than I have (started in 2007). This article was submitted and approved according to our Guest Post Policy. We have no financial relationship.]
I’ve heard anecdotal stories of some physicians changing specialties, but it certainly isn’t straightforward. There may also be residency funding limitations if you decide to go back for another specialty: https://forums.studentdoctor.net/threads/what-if-you-change-your-mind-after-completing-your-residency.617573/
Thanks for the forum link, Live Free MD
It certainly isn’t an easy option. I have known a few who have done it successfully. The happiest ones seemed to have gone into “higher income, good lifestyle” specialties like pathology, anesthesia, or radiology. (“the RAP cartel”)
One option that is a little easier than doing a whole residency is doing a fellowship. You have to be choosy though. Going from general internal medicine into cardiology or ID will likely pay off, but doing a geriatrics fellowship won’t add income. I know someone who actually makes less after a geriatric fellowship. That may be fine if it is your life dream or passion, but not great from a financial standpoint.
I find it interesting when people put specialties like anesthesia, radiology, EM, and hospitalist medicine into a “lifestyle specialty” category. Sure, shift work is nice, but the reason those specialties do shift work is because someone has to do them during the evenings, nights, weekends, and holidays. Maybe they should just be the “no-call/less-call specialties”. I think a true lifestyle specialty would be something that nobody ever (or at least rarely) needs after 5 pm on a weekday. Path probably qualifies. Derm. Lots of outpatient clinic stuff. But anesthesia? Ask PoF about his 72 hour weekend shifts. How is that an awesome lifestyle?
Agreed. Anyone who thinks anesthesia or radiology are ‘lifestyle’ specialties is woefully ill informed.
Hmm ok. Point taken. Maybe lifestyle isn’t the best term for it? There are some specialties that tend to have high incomes even at the 25th percentile. The dollar of comp is high and yet they have limited patient involvement or continuity. Other doctors tend to switch into them but rarely switch out of them when changing specialties. I don’t think there is any job in medicine that is truly easy and I am not trying to imply that.
Again, I’m not really disagreeing here but I do have a few friends who do anesthesia pain. They work 3-4 days a week. Outpatient only. No weekends, holidays, or call. They are pulling in $400K – $600K. Not including the surgery center investment returns. I’m betting one of them makes a lot more since he has virtually no overhead and just pays for outsourced billing. One can carve out a great life in many specialties.
Any field including Anesthesia and Pain if under the umbrella of corporate or government medicine are under extreme pressure these days from greater and greater interference from the insurance companies for pre authorization and decreased reimbursement. A pain doc friend of mine in private practice took a 35% salary decrease in the past 12 months and has no vacation. So Be Fair Warned anyone who is wishing to switch specialties into the aforementioned. I know as many Anesthesiologists who are retiring early or reducing hours just trying to get out of the toxic work environment. On a final depressing note, Male Anesthesiologists have the HIGHEST suicide rate than any other specialty.
Ugh. Sorry to hear. That sounds pretty bleak.
Although the insurance denials are getting more aggressive, life around here is still good. Make hay while the sun shines!
That is interesting, I totally see your point. It’s a spectrum of how much you can control your work hours. I think of anesthesia, radiology and EM as lifestyle specialities, but only because I’m across the drape or trauma gurney as a peditric surgeon, and after my 72 hour shift I round, go to clinic and do elective cases. It’s an awesome specialty, but the care can go on indefinitely with these complex kids. I get calls/pages/texts any time including vacation. So there is little control of personal time. OTOH I see how outpatient care can truly be full on lifestyle for say derm or a pain practice. I know a DO with 8-4 4 day a week pain clinic, he does not carry a pager and has no crossover of work with personal life, holidays, nights etc…
I stand by my point that 72 hour shifts are not part of an awesome lifestyle. In fact, I suspect very few people can do them long-term and not burn out.
That said, a lot of docs do this sort of thing to themselves. What keeps a group from breaking those 72 hour shifts up? Why not put two docs on for the weekend and have them each work three 12s? I suspect the answer is “but I want more weekends off.” Well, hire more docs. Not enough docs to go around? Well, maybe they need to be concentrated at fewer centers and that specialty just can’t be in all of the communities it is currently in.
“Take on a side gig.” For Psychiatry, this is easy as we work 35-45 hours a week average as a group. Some local hospitals need weekend and call coverage. I started doing weekend rounding on inpatient units in 2008 fueled by a recession related pay cut for the weekend work at my W2 employed job. They had been paying us $1500 a weekend back then at my W2 job, so NOT getting paid for them any at my longer cost me about $18,000 a year for the monthly weekends I had been doing. In psychiatry, its not unusual to get extra pay for weekends even as a W2 employed doc.
I went out and got $2000 per weekend at another hospital. These weekends are usually 6 hours of work both days plus travel time each day. As time passed, I got used to working two weekends a month. This amount has since increased to $3500 per weekend, and I took an “outpatient no weekend job” in 2011, freeing up an additional twelve weekends. Now I do two a month still, and the second one in any given month pays a $700 premium, so $3500 for the first and $4200 for the second in a month pays a total $7700 a month, almost doubling in nine years and outpacing inflation from 2008-2017.
Adding in covering night call over the phone to screen inpatient admissions at $300 a night on M/T/W of every week since 2/2016 has added and additional $42,000 a year. With the Holiday rate of $2000 a day, weekday rate of $1800, working a Thanksgiving weekend pays a handsome $8000 for roughly 24 hours of work at six hours per day (~$333 per hour).
This income is highly taxed 1099 income, but the hospital provides occurrence malpractice. I deduct my car expenses via the “total expense method” and deduct my CME, medical license fees, etc. Then I put the max contribution into a SEP IRA (last year it was $28,500). The work, weekends, and call ramped up over time so this SEP-IRA has about $100,000 in it now. I used $50,000 of the “Side Gig money” for a down payment on a retirement cabin on 21 acres on top of a mountain (total cost in 2015-16 was $370,000, appraisal is now about $425,000).
I don’t personally know many psychiatrists who work as much as I do, but for 2017 and 2018, I will make about $450,000 a year and will have contributed a max 401K (since age 30) and maxed SEP IRA (since ~age 43) for many years now. The average psychiatrist salary is reported as $240,000 a year for 2016, but Merritt Hawkins (who rated Psych as number two in terms of needed job searches after Family Practice) had these numbers for “Low, Median, High” in psychiatry:
2016 /17 $120,000, $263,000, $450,000
2015/16 $195,000, $250,000, $370,000
2014 /15 $172,000, $226,000, $325,000
2013 /14 $150,000, $217,000, $350,000
So, yes, get a side gig, and put as much as you can into a deferred tax retirement plan. The side gig is really my “early exit” strategy. Arduous now, but I can still do it at my age 53.5. WCI has helped me figure out this exit strategy and prompted me to move my retirement main account back under my control and boot the 1% fee for “Assets under management”. I’m the manager of a 60/40 split batch of index funds now. Thanks again for the inspiration WCI.
A Ellis,
Great insight. I had no idea there was so much opportunity for a side gig or for high income in psych. It goes to show how much personal choice, actions, and behavior influence income. Some say, “oh .. poor me, I’m in a low-paying specialty and don’t have opportunities like you do…..” but there are often options for those who look for them and work at them.
Your info will be helpful, especially for psychiatrists looking for income opportunities or tax info.
Couldn’t agree more – too many docs get comfy and don’t push
There are side jobs out there and they are high paying
As a hospitalist I cut back 25% and then picked up that ‘time off’ moonlighting making 30% more so I worked 1.0 FTE but was paid 30% more for some of my time.
Too many excuses not enough hard work.
Also – check a neighboring state- I live in MA and in NH I can moonlight and make more – getting the license will in NH took 8 weeks – I’ll make a large premium for night and weekend work
Bottom line is people like to complain but wont act to improve their situation
But your FTE and find higher paying work elsewhere!
Then use that money to invest
Side note – pisses me off to read bout ‘Where to invest $10,000 today’
The answer is invest in yourself – go to conferences etc – skill up and leverage those skills to make more money. 10k invested in market etc etc ain’t worth it – its baby money to a doctor.
This would be a great guest post here on WCI!
If you died tomorrow, would you be happy with how you lived your life so far?
If I spent all my free time chasing dollars, I’d not only be miserable, but I’d be filled with regret if I died young. Life’s too short to be wasting it at the office.
You wouldnt be full of regret – you’d be dead!
I’m not dying tomorrow…..But sounds like you’re already dead – you just have to wait a few decades to make it official – you’ve settled for what you have. Its selfish to stop when you have more to give.
My life is for BIG think not living just ‘ok’
$ = freedom, choices
Not chasing – I’m creating, pushing myself, paying the price today so I can pay any price tomorrow.
But hey – go chill on a beach – makes the doctor shortage more real and secures my higher income
JustSayin
You would have plenty of time for regret if you got brain cancer and slowly wasted away over the course of a year. Happened to a local 40 year old dermatologist here not that long ago. I highly doubt he looked at his wife and kids after he got his death sentence and thought, “man, I wish I would have spent more hours working.”
I agree that money = freedom. I’m in my mid-thirties and am already over my halfway point to financial independence due to saving over 2/3 of my net income, yet I still take 2 months off per year and travel anywhere I want to go. I actually like my career, so no plans of quitting anytime soon; but working 32 hours a week and still making bank is awesome and also sustainable into old age.
Terrible story about the local doc – sad to hear it
But its a bit extreme – most people don’t die at that age
And I’d much rather keep foot on the gas now and enjoy along the way – different personality I guess – 2 months off doesn’t interest me – I get rammy after a 3 day weekend.
Your plan is predicated on being able to work, right? I’m going for income generation when I’m not working as a doc. In 20 years I’ll have 20 mil in real estate paid off and spewing cash
Sounds like you’ve done well, but resting doesn’t benefit my family
We enjoy life – just in a different way than you- why so many people equate working with unhappiness is beyond me.
JustSayin
There was someone a few weeks ago who mentioned he was a psychiatrist working 16 hours a day 7 days a week and had a 7 figure income. That was a short-term plan obviously, but it’s a great way to get a solid financial footing underneath you early in your career.
Yes. And that isnt the first time I’ve heard a psych person say that. Kind of wishing I’d went into a field where one could locum and essentially moonlight easily where you were more rewarded for being available like that.
Can only do so much surgery, each one increases amount of headaches you have, etc…
I’m not sure why people think psych has to be low paying. There is huge variability in income depending on practice. Lots of opportunity to earn high income doing interesting work. I work in academic psych, a few years post fellowship. I make between 250 and 300 a year working 9-5ish and 4 weekends a year. No moonlighting here. Correctional Psychiatry is even fewer hours, typically no call and salaries can be much higher. Private practice psych in urban areas can make 500+.
Wow C.
You blew away all my misconceptions about psych income.
I suppose that is the reason why you can’t actually ever talk to a psychiatrist from an ER, much less have one come see a patient. I bet 90% of the psych patients I admit I am unable to talk to a psychiatrist about. I basically have to admit a patient to get a consult and my only interactions are with an NP/PA.
That’s awful WCI! Makes me think ER residents would be well served spending a month in training on inpatient psych to learn more about suicide and violence risk assessment.
A far better idea would be to rotate in a psych ED staffed by a psychiatrist somewhere.
Regarding extra degrees, I am curious how people monetize the additional studies. I considered doing a professional MBA years ago. However, I didn’t want to move into the C-suite of administration.
I knew one other physician who got an MBA. His interest was to expand his practice into multiple locations and start a clinical trial research arm. The latter never materialized. The former seemed like typical medical practice. Heavier not requiring the extra schooling.
Any comments from those who went in for masters degrees and how it helped?
I think WCI had a guest post on this topic awhile back? Maybe he or someone can put in the link.
I got a MBA (finance major) from a top business school. I did it mainly to learn. It has paid off handsomely in dozens of ways though. I can speak “the language of business” to hospital administrators and get projects and capital funding approved. It helped when negotiating our comp plan. It helped with business strategy when starting new practices. My personal investing is in better shape. My network of business professionals boomed. It got me the current job I have for sure. Tomorrow I’m meeting with a VC and another angel investor on some projects that sprung out of the business school. It isn’t for everyone but I have no regrets.
The only thing I didn’t learn well was marketing, as WCI so eloquently pointed out! 🙂
Two
Is an MBA Worth It for an MD?
https://www.whitecoatinvestor.com/is-an-mba-worth-it-for-an-md/
The Path to MD/MBA
https://www.whitecoatinvestor.com/the-path-to-mdmba/
Amazing how important marketing is. It doesn’t matter how awesome your product or information is, if you can’t get it to others you’re not going to help anyone much less make any money. I wish I was better at it.
True.
Not everyone has the same goal though.
When I started my blog I wanted a creative outlet and I wanted a place to direct students and residents to for good unbiased financial information. I was making more than enough income from a dozen different income streams. My website/blog succeeded in meeting those goals even though it is a failure in the eyes of many.
Why would you say your blog is a failure?
Thanks.
I don’t think it is a failure because it has met all of my goals. As WCI points out though I have not helped so many people and I have not made much money.
I agree with hatton1 that no blog is a failure even if some have more reach or earn more. My mom has a blog she’s been writing for years. Very little reach and no money. But it has been a fantastic experience for her and her few readers.
As was frequently emphasized at FinCon, blogging isn’t a business. Some people decide to use their blog as part of a business. In those cases, creating excellent content, promoting it widely, and figuring out a way to monetize it (i.e. attach it to a business) are important steps. But lots of people blog and write excellent content without ever spending much time or effort promoting or monetizing it for whatever reason. I mean, take a look at Mr. Money Mustache. Not much promotion, dramatic under-monetization. Still wildly successful by any measure.
I think all bloggers struggle with this from time to time. As I drifted through conversations at FinCon this year, I realized that by many metrics (traffic, monetization, promotion, web design, seo) my blog is a complete failure. It seemed like everyone I talked to was doing something better than me.
But there were also people who approached me and told me how much they loved reading it, or how it inspired them to start blogging or podcasting or creating something. I occasionally get an email telling me how a certain post really resonated with them and shifted their thinking or lifted them out of a really dark place. I’ve met many incredible people both virtually and in real life through blogging. By these metrics my blog is a wild success.
Found this one in the trash box, I have no idea why. If you keep having comments that don’t show up, shoot me an email and I’ll check the trash box for them again.
If it makes you feel any better, I also feel like a failure at FinCon and I was giving the talk! It’s amazing how much stuff you realize you could be doing better. I figure if I implement 1 out of every 10 ideas I got there it’ll make a dramatic difference.
But content is king. It’s a necessary but not sufficient condition for success. If your content sucks, it doesn’t matter what else you do. I learned that too from a blogger who was doing everything else right. How do you tell someone their content sucks though?
First question is what are your goals? In some cases, like with practice expansion, I don’t think a MBA is necessary or good from a return on investment perspective – you can learn the material without spending 6 figures well enough to allow this to happen. If you’re looking to lead in a hospital system it will probably help open doors, but that doesn’t seem to be your interest. If you’re looking to be an entrepreneur it will help develop a framework and give you connections, but this is dependent on the business school, full time vs not, and the market around that business school.
I agree. The degree is better about teaching you how to fit into a big company and be part of management. Some are more focused on entrepreneurship than others. I did the MBA mostly because I have always been fascinated by business and investing and wanted to learn more. I was also on the faculty at the U. so they paid my tuition. If you have to pay tens of thousands a year that changes the decision for sure.
I expect to get some blowback from this comment. Be careful to make sure your side gig is ethical and something you really were trained to do. The marketing surrounding “hormone pellets” is astounding. They make you feel young again, lose weight, and reinvigorate your sex life. I recognize that lots of docs are making a killing with lab work and pellet injections. I see these patients in my office when they have a complication that someone who went to a weekend course cannot handle.
Great post Wealthy Doc. I just think people need to be careful about some side gigs out there.
I pretty much agree. I think there may be cosmetic demand that is ok to serve (e.g. cosmetic botox). It isn’t what I choose to do, but I don’t think it is unethical. If people want to pay cash to get stuff done that may be ok.
I will not offer my opinion for hire no matter how much they offer. I personally also would never to plaintiff malpractice work.
I am not referring to botox and fillers.
Excellent comment. Not sure why you’d expect blowback from that. Who’s going to disagree?
Anyone who injects hormone pellets to combat weight gain, mood swings, etc without really informing the patients about the risks of the product. I see lots of clinics in my area doing this.
My friend an I are always complaining about this type of scourge. I dont know about pellets but do know that there is a manufactured “low T” epidemic and tons of commercials about it. Lots of bs clinics popping up that are designed to milk insurance companies having people come in for injections when they could use cream instead.
Thats on top of how dangerous is it and non essential. Have an interesting tie in I’d love to explore but not really my field.
The low t epidemic is analogous to the compounding pharmacies basing estrogen replacement based on salivary hormones that are not reliable and you don’t even need a lot of lab work to manage them.
This reminds me of when primary care docs would give Vitamin B12 and HCG injections for weight loss (oh, wait, they still do that??) even though it has been shown to be ineffective. They’d always forget to metion that the 500 calories for daily intake, which was also part of the diet, was the reason for weight loss. In fact, when I rotated through a rural clinic in medical school 8 years ago, they had patients lined up for this stuff.
Placebos are a real phenomenon!
Man, did they make money off of it despite how crazy unethical it was.
Build a portfolio of individual tax free munis Nothing better than monthly tax free income
A rated or better GO bonds over Revernue bonds
VERY VERY SAFE INVESTMENT
Ken,
There are a lot of bond-haters commenting on this blog, but I’m not one of them. I actually just sold a ton of stock and bought bonds. Timing the market isn’t something I recommend, but it was time for me to cash in some chips after a long rise in the stock market. I have municipal bonds in a tax-free bond fund that seems to be performing well. I don’t have individual bonds, but am open to learning more about that option.
Amazing how many people hate bonds 8+ years into a bull market.
I think “cash in chips” implies something you don’t actually mean. There’s kind of a market timing flavor to that phrase. I think what you really mean is you’ve made your asset allocation less aggressive now that you have less need and ability to take market risk. Unless you’re planning on getting more aggressive again later with your portfolio. In which case you’re just timing the market.
Maybe it isn’t the right phrase… not sure… I used to play a lot of poker. When I won a lot more than I ever thought I could I would get nervous and turn some in for cash. That way I could let the rest ride and still come out ahead. I would never end up broke like so many other players I knew. I don’t know what the market will do but I’m farther ahead than I thought I would be or needed to be and valuations are high by most all the measures I look at.
From an online dictionary: “cash in”
“1. To exchange something for something else of equal value. In this usage, a noun or pronoun can be used between “cash” and “in.” I was in desperate need of a vacation, so I cashed in all of my credit card points for a flight to Bermuda. How much money did you make when you cashed your chips in after the poker game?
2. To take advantage of or benefit from an opportune moment or situation. Although the market crash left many people with overpriced mortgages, some savvy homeowners recognized the chance to purchase property at rock-bottom prices and cashed in.
3. To stop participating in a venture or activity. It was no surprise when most of the company’s top investors cashed in as soon news of the CEO’s scandal went public.”
Exactly. “Cash in” implies you’re gambling, not investing.
I live in a very popular tourist area and I worked as a house doc for one of them (that had two hotels). Also moonlighted at an urgent care facility, and a rural health clinic. Not only did they augment my income, they caused me to learn skills and knowledge I didn’t use much in the ER. The hotel job was “off the books” as the patient/guest paid me cash. Incidentally, I even saved a life once in this job. (and this was one case I didn’t charge the patient/guest) One patient/guest even wanted to give me a tip, which I turned down.
Thanks for sharing, BJBANJO,
You are right that we can learn a lot and pick up other skills when working on these side gigs. Sometimes the people we meet become important in our life later too.
Did you just admit committing tax evasion?
I’m sure he kept great records of patient care that the state medical board would approve of, too. Yikes.
You’re making it difficult for me to come up with a #16 to add, Wealthy Doc. Is it fair to stay start a blog? You won’t make minimum wage for awhile, but it can pay off eventually. 🙂
That’s just one of many side gigs that you covered with #2. I don’t have any experience with other options, but there’s expert witness work, insurance reviews, coaching, and similar work that incorporates your medical expertise in non-clinical work. Those can pay hundreds per hour right off the bat.
Cheers!
-PoF
Good point, PoF
I think I read a guest post about that once? Let’s see … oh yes, here it is: https://www.whitecoatinvestor.com/a-side-hustle-to-consider-medicolegal-or-insurance-consulting/
I have recently discovered your website and could not be more grateful! Thank you for all of the wonderful posts and the free advice. It has really changed my outlook on a lot of things.
With regards to the above post, I am the owner of a single provider oral surgery practice pretty much in the middle of nowhere. Because of that, I have been able to negotiate fee schedules with many of the insurance companies in the area. I believe they are mandated to have a provider if they have coverage. So they can’t say that they cover oral surgery procedures without actually have an oral surgeon in their network. Because I am the only oral surgeon in at least an hour radius (more in certain directions), I have been able to negotiate rather well. These fee schedules typically are good for between 24 and 30 months depending on the company. I was even able to negotiate a higher fee schedule with a medicaid managed care company. However, my idea of financial independence is telling the insurance companies to take a hike and going totally fee for service.
The point, though, is that you have to negotiate for yourself. The insurance companies won’t tell you about it. And they won’t tell you when it is time to re-negotiate either. I have a file for all of the contracts and when they expire. I asked for a 7% increase of fees across the board for the last company I renegotiated with. I thought they would give me 3%. They ended up giving me a 6% increase, which is not bad. That brings the rates from this company to about 40% higher than their specialist fee schedule that they originally offered me back in 2012.
Because I am in network for a number of companies, I have people traveling up to 2 hours to get to me. I don’t exactly live in a low cost of living area (it is a major ski,hiking, tourist spot), but I do get to live in a nice place of my choosing where my kids can grow up safe.
OMFS
Agreed. Insurance companies play hardball. They also have information that you don’t have. They exploit that information asymmetry every way they can. It sounds like you understand the game well. Congratulations.
Although it may not be the most financially rewarding “side gig”, I have often thought about doing some sort of manual labor on the weekends/off time. When in high school and college I worked for a restoration company. I got paid $11 bucks an hour (in 1996 that was very good money), and loved the work. We tore stuff down and then built it back up. It felt great to be building something and also it was nice getting some physical exercise with work. Completely different from medicine, which may be why I reminisce about it and at times want to do it again. As the kids grow, maybe I will set this up as a small business for them, and we can work together on the weekends. On this same line of though, if you have a family and your kids are approaching high school age, I think setting up a small business where the kids can be the employees/owners is an outstanding “side gig” on so many levels….whatever business you like.
Go for it, NapoleanDynamite!
I agree there is something rewarding about physical work. Especially if your entire livelihood isn’t dependent on it. I know a physician who owned a home construction site. He used to love to jump in and get to work.
Another physician investor I know owns rental properties. Sometimes he does his own painting and other minor rehab work on the properties. Partly to save money. Partly to get physical. Getting your hands dirty isn’t all bad.
If you do that, your kids will also have earned income that you can invest into a Roth IRA for them.
Roth IRA for teens is definitely a great option to explore.
Great ideas. To add further, I have made some extra ‘shopping money via medical surveys. Many pays between 150-300/hr.
Also, agree with finding the right group – i earn > 500k as an internist (hospital medicine).
Yes, ForeignBornMD, surveys are readily available for physicians. You can do them on your own time in brief time chunks. No liability or stress associated.
The m3 ones are terrible and do that all the time. There are ethical companies like reckner and schlessinger who rarely screen out and the higher paying ones uses webcam and video conference.
I’m curious how you’ve managed to avoid the “screen-out” problem with surveys well enough to make $300 an hour.
Lots and lots of lying…
Actually there is no lying involved as there are good companies who would screen in the majority of the time. The webcam ones normally pay higher, i would get one that works well for my specialty – normally on copd or diabetes about 1-2x per month. I am also the medical director for our hospital pharmacy formulary team, so that helps as well.
Ding ding ding. Great way to monetize a position on the medication and therapeutics committee.
Work with good companies and be reliable when scheduling. The higher paying ones uses video conferencing technology and works like a life interview.
I work per diem for my old employer; when I left there two years ago, they asked me to stay on per diem in order to cover for vacations and other short staffed times. Last year I made an extra 20K working after hours at my old gig. Less this year but that was by choice. I cover at two sites–one is fifteen minutes from my current job and the other is fifteen minutes from my house, so either way I can add an extra two hours to my day without getting home too much later. I have also filled in some Saturdays at other facilities but I tell them it’s got to be a six hour day or it’s not worth me driving an hour to the other sites. The per diem rate is 16% higher than the hourly rate I was making when I was an employee there!
This year we did a cash out refi on our home and used the equity to buy a vacation rental investment property two hours from our house. We decided we would not buy it just to rent it out, it had to make sense for us financially as well, even if it never rented for a single day. But we expect to do very well with it, it is in an area we vacation in every year and the house we used to rent there is making about 15K a year for the owners in vacation rental income. We hope to make 10 to 12 K a year from it, which will cover most of the mortgage and expenses.
Just make sure any ‘side gig’ is ok’d by the employer. Many contracts we see have outside activity policies and conflict-of-interest policies/forms…so just know what you can/cannot do.
often language that can ‘pre-approve’ the activities can be negotiated on the front end of an employment contract.
Yes, great point ContractDiagnostics. I have seen contracts where all revenue generated -even outside speaking- goes to the employer. I negotiated an addendum to my contract before taking this job that exempted royalties, medico-legal work, speaking fees, etc.
Ask for forgiveness not permission
Just perform at day job so well that nobody will care
JustSayin
Personally I think it is better to negotiate the specifics in your contract. I wouldn’t want my employer to find out I had years of income that they legally have a claim to. They are more likely to agree to your terms when they are trying to hire you than later.
Jeez who are you guys working for – legally have claim to my income ????- Highly unlikely they can claim your income – more likely they have right to terminate you… also not a great outcome
Let me throw in some more ways. Most are widely applicable to most physicians, but some are specialty specific. Some opportunities have already passed, but I include them in the list because the same types keep coming up. Here we go: (1) Meaningful Use Government Incentive (44k per doc, too late now), (2) Outreach clinic from your city for a rural and underserved population (same work, but government bonus money for working in an rural area), (3) Telehealth Incentive (bill from your city while seeing patient on facetime in a remote location), (4) Get a bonus from the CMS sponsored Merit Based Incentive Program—MIPS, (5) Get a bonus from the CMS sponsored Alternative Payment Model—APM, (6) For the nephrologists out there, join a End Stage Renal Disease Seamless Care Organization (ESCO), (7) For the oncologists out there, Join a Oncology Care Model, (8) Join a Next Generation ACO to receive a 5 percent increase in your Medicare book of business in 2019, (9) Ask your accountant to put in your profit share and safe harbor money very early, instead of waiting until after your fiscal year, (10) Effectively use PAs and NPs in your medical practice.
How’bout this one….
If you always ski in colorado every year or go to Florida – get licensed there and work while on ‘vacation’
You can then deduct travel and lodging for business…right?
Boom – you paid for vacation
JustSayin
JustSayin
You could. It sound like more work than I’m willing to do (but I’m extremely lazy!). You need to apply and keep up a license and pay and then actually work. Wouldn’t it be easier to just go to a course or something? Like ski in Utah when you happen to visit Park City for a WCI course. Or give a talk. Or interview for a job. Or do some investment research in the area or some other easier tax-deductible reason?
Technically you have to divide up the trip and its expenses by how much of it was for work and how much for vacation. So if you work one day and ski nine, you only get to deduct 10% of the expenses.
I agree sort of – the idea was to generate income & deduct the trip – so going to course only achieves half of the goal. – JustSayin’
I doubt doing another residency would work for many people. As others have noted, changes in the way Medicare pays for residency slots, changes that happened a long time ago, made it difficult to pay someone who has too many years of residency.
Doing a residency in a higher income field also has the challenge of getting in. Those positions are in demand and the training programs would need to have a reason to prefer someone who has been in practice in one field over a candidate right out of medical school. One might hope that the experienced doc knew more, but that knowledge might be of little use in the new field.
It has been ages since we have had someone who had been in practice in another specialty join the residency. Back when it used to happen, they were often pretty poor residents. Part may have been that the same things that made them low enough in their med school classes that they could not get into the residency back then still applied- not good at picking up things quickly so their fund of knowledge was poor. Did not study much, so their fund of knowledge did not increase very rapidly.
Some were tired of working had. They had convinced themselves that the residency and the new field would be easy, so they would tell you that they did not intend to do much work and they did not. None of that experience left me thinking we would be better off with someone who had decided they chose the wrong area of medicine.
The high income specialties have no problem filling their residencies with top medical students. I doubt there are many orthopedics or dermatology residencies that would be particularly excited about an application from someone who had been practicing internal medicine.
The military is one place where second residencies are pretty common and the residents are often the best. As a brand new O-3 attending with 3 years of PGY training I had to supervise a 4th year O-5 EM resident who had previously done an FP residency and practiced for half a decade. That was awkward. What was I supposed to teach him?
But would someone who is in practice and wants a different specialty want to join the military to do a second residency?? That would seem a strange maneuver if the goal was earning more money.
What would you teach a family practitioner about Emergency Medicine? I would hope a lot. That is a different field. Unless the resident had actually been practicing EM using the FP training there would be a lot about the urgent care, crashing patients, resuscitation work that would be very different than office practice.
I agree. It’s a terrible move if your goal is to earn more money.
I could teach a family practitioner a lot about EM. But it’s tough to teach a 4th year EM resident much about emergency medicine to start with, especially when your residency was only 3 years long.
Of all the options listed, renegotiating your contract should be number one.
After all, if even partially successful you are getting paid more just by negotiating. You aren’t seeing a single extra patient or doing new labor of any kind. Get a good market value report, develop a solid negotiation strategy, up your skill set, and see what you can get. Remember to try again the next contract cycle.
Other than negotiating, agree with the side gig. Also, call in a consultant to negotiate with the third party payers and to evaluate your practice for inefficiencies and billing mistakes. They can pay off handsomely.
I agree Dr. Felberg,
I am always getting ready for my next negotiation. I have probably earned more from that than any other activity. You get not what you deserve, but what you negotiate. I’m always amazed at how flexible terms really are, even the “standard contract.”
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Interesting tips. I love reading about ways to make money in other professions. It gives me ideas on how to make money for side hustles. Making money investing always feels the best.
Check out http://entrepreneurialdoc.org. Just fill out the contact form and then a member of the team will be in touch shortly. You recommend products to patients, and then patients purchase these products from the retailer and you get a certain percentage. In other words, you sell high-quality, evidence-based nutritional regimens to patients. It’s the best way I know to add an extra $25,000 to your earnings in a year.
Most of your patients are already buying low-quality supplements from CVS, Whole Foods, etc. So why don’t you sell them high quality supplements?
HI DR.
I AM A FP WITH JUST THREE YEARS EXPERIENCE. NOW THINKING OF CHANGING MY SPECIALTY TO DERM OR PSYCH. BUT I HAVE THE FOLLOWING QUERIES
WHAT IS THE PROCEDURE OF APPLYING TO DERM AS AN ATTENDANT.
I HEARD THAT RESIDENTS THAT HAVE COMPLETED A RESIDENCY BEFORE DONOT GET PAID DURING SECOND RESIDENCY. HOW FAR IS THAT TRUE.
IF I APPLY TO ANY OF THE TWO LISTED SPECIALTIES WILL I HAVE TO COMPLETE AN INTERN YEAR AGAIN OR SHOULD I DIRECTLY APPLY TO PGY2.
IS IT HARD TO MATCH IN DERM EVEN AS AN ATTENDANT(AS AN IMG).
Need to do another residency.
No, Medicare will not fund another residency.
You probably won’t get much credit. Maybe a few months.
Derm is the most competitive specialty to match into. I wouldn’t say impossible as an IMG, but I would say highly unlikely.
Being a Doctor, i can say that we have no time for making money extra, but these ideas are amazing for all doctors. If I get any leave then I will think about your blog. I appreciate your ideas. Thanks for sharing!