[Editor's Note: This is a guest post from Wealthy Doc, a long-time physician financial blogger who prefers to remain anonymous. I often get questions about side gigs or side hustles whereby a physician can increase her income and thought this post did a great job explaining some of the specifics. We don't have any financial relationship.]
A physician friend of mine recently reached out to me for advice on “supplemental income options.” We met for lunch and talked things over. She works part time and her husband is working on his Ph.D. She wants to increase her income, not by adding two more days of clinic time to her schedule, but by doing something different – preferably something more lucrative than her current practice.
She thought my recommendations were valuable. Valuable enough that she bought my lunch! Here is some of my advice, in case
others are looking for this guidance.
I openly admit my bias here. I am a strong believer in the benefits of experience, dedication, education, and certification and I never look for quick fix shortcuts to success. To be excellent you need to really know your stuff and that doesn’t come easily. There is a price to pay. You may spend weeks or months in training. You may spend thousands of dollars in education, training programs, and certification. You may not see an immediate payoff. Hang in there. Keep grinding away and building your knowledge and skills. It will eventually shine through and pay off. It has for me and everyone else I know who went down this route.
You don’t need to reinvent the wheel. There are great resources to help you succeed. A few are listed here:
Disability Insurance Evaluation Work
IAIME
The website of the International Academy of Independent Medical Evaluators can be found at http://www.iaime.org/.
From their website:
“In 1986, the Founding members of the IAIME, formerly known as the American Academy of Disability Evaluating Physicians (AADEP), dreamed of creating a medical organization that would teach the unique skills and techniques required to perform special medical evaluations and assessments on certain types of patients. Today, IAIME is the premier organization that produces educational courses and products on such issues as the proper techniques to perform impairment ratings based on the AMA Guides to the Evaluation of Permanent Impairment, treatment of industrial related conditions, prevention of the disastrous disability cascade, surgical treatment of back pain, the science of bone and soft tissue healing, and the proper methods to perform return to work evaluations that place the injured person in a physical demand Category of work, based on the Dictionary of Occupational Titles (DOT).”
They offer training for and the credential of The Certification in the Evaluation of Disability and Impairment Rating (CEDIR) exam. I achieved that certification and I found the process and result helpful to my career.
ABIME
The website of the American Board of Independent Medical Examiners can be found at http://www.abime.org/.
From their website:
“The foundation of mission of the American Board of Independent Medical Examiners (ABIME) is the belief that certification of independent medical examiners benefits the public good. This belief is based on the tenet that credentialed physicians have demonstrated that they possess the knowledge, skills, experience, and abilities required for the attainment of their certification as a Certified Independent Medical Examiners, (CIME)TM. Credentials, therefore, are reliable indicators of the professional's capacity to perform independent medical and impairment evaluations according to the profession's performance standards. Certification enables the public to make informed decisions regarding the selection and use of independent medical examiners.”
If your wallet has hypoactive sounds, you might try a side hustle
I am certified by ABIME and I found the training and the result extremely helpful to my knowledge and career. Several attorneys and insurers have mentioned that they referred to me specifically because of my Certification in IME – a credential bestowed on me by ABIME. Their directory is actively used by potential referral sources.
Expert Witness Work
SEAK
The SEAK, Inc. website can be found at http://www.seak.com/.
From their website:
“SEAK is a continuing education, publishing and consulting company. We have trained well over 25,000 expert witnesses, physicians, lawyers, nurses, and other professionals. SEAK is the leading provider of Expert Witness Training and texts. We publish professional directories for Expert Witnesses, IME Doctors, and File Review Consultants. SEAK is proud to be the leading provider of Non-Clinical Career and Supplemental Income training for physicians.”
I have found them to be the most helpful for training and education. They publish solid, high-yield books, videos, and live training programs. Their advice is always clear, tested, and practical. I have benefited from more than a dozen of their training courses or associated materials.
Some of their excellent materials include:
Writing and Defending Your IME Report
How to Start, Build, and Run a Successful Physician Consulting Practice DVD Set
Negotiating Skills for Physicians DVD Set
Once you have a fair amount of knowledge and credentials under your belt you can grow your side business quickly. Again, I recommend building that solid foundation first. It will help your credibility at every point on your journey. Sign up on the registries and directories associated with the above-mentioned organizations. Start doing good work and the business will grow.
An experienced trial attorney told me of the three rules he follows:
- Get your money upfront.
- The client goes to jail, not you.
- Get your money upfront.
He suggested I always “get my money upfront.” I have a standard rate sheet the client signs, and I get prepaid for all work. I made a couple of exceptions and I got burned and won’t do that again.
You may choose just a small niche, e.g. non-malpractice pain management IMEs, railroad worker injuries, or file reviews for disabled Anthem employees, etc. If you will be working as an expert, it is advisable to do both plaintiff and defense cases to not lose credibility. There are plenty of insurers and lawyers who truly want a thorough, unbiased, medical opinion. You could become their go-to source.
Once your reputation, referrals, and revenue grow you can be more choosy and/or raise your rates. Although it is tempting to do this full-time, I recommend it be limited to <10% of your practice to maintain your clinical knowledge and your credibility.
There is a lot more to know about running a side business, too much to cover here. You need to make sure your employment contract allows the side income. See if you need to get an additional rider to your malpractice insurance policy to cover “errors and omissions (E&O)” for this line of work. You need to set aside a large portion of the income for taxes since you will have no employer withholding. You need to track your business expenses (including courses, textbooks, mileage, etc.) to deduct on Schedule C from your 1099 income. You may want to set up a SEP-IRA or Solo-401K to reduce your tax burden, etc.
Fortunately, there are great resources on the web now that will guide you on overcoming some of the other challenges of running a side business. Be sure to take advantage of these. For example,
- Side Business Besides Medicine WCI Post
- Non-Clinical Jobs
- Passive Income MD
- Wealthy Doc
- Supplemental Income For Physicians
What do you think? Have you generated income for clinical opportunities not directly related to your employment? Have you found medicolegal work pleasurable, challenging, and lucrative? Have you used any of the resources above? What did you think? Comment below!
‘Expert witness work is great side business!’ **grabs popcorn and a good seat**
Guess we get to find out what hourly rate you’ll take for your soul.
If I understand ZC’s comment right it implies expert witnessing must be unethical and only for the money? I’m sure that goes on out there. It doesn’t need to be that way. A lot of times the medical records or a case is complex to the lay public. A knowledgeable physician can serve as a teacher to the attorney or to the “trier of fact” (jury) who is struggling to understand the science and causation issues. You aren’t compelled to take a case you don’t agree with. If you stick to the medical facts, explain the case well, and bill for your time appropriately it can be a highly paid teaching gig rather than unethical endeavor.
eh, I agree with WD on this one.
most lawyers are looking for your honest opinion and they already have a pretty good idea as to the merits of the case.
there is plenty of work in this space that isn’t unethical or shady.
if you are sued don’t you want a good, competent, reasonable doc reviewing your case?
what a lot of us docs tend to ignore is that there are plenty of med mal cases that have tons of merit where a patient was harmed by a sloppy, lazy, or incompetent doc. is the legal system the best way to deal with this? probably not but it’s what we have. i’ve reviewed some cases that would curl your hair.
Having done a very small amount of “expert witness” work, I agree that it is definitely not unethical to do so. For every expert witness on the plaintiff’s side there is also one on the defense side. In these cases there is usually some grey area on both sides of the case or it wouldn’t make it to a case. Some are cut and dry and often an expert witness can keep a case from ever happening by providing opinion to a lawyer that they have no case.
That being said, most physicians would probably make more money by spending more time on their practice that the side gig. If they do not want or cannot spend the time with their practice, then this side work can be supplemental.
I have experience with this type of outside professional activity. I have been impressed with the professionalism displayed by the attorneys. They do not actually want you to lie or fake anything for them …. they want an expert opinion and that is what you give them. You aren’t acting as the judge or jury …. more so you clarify and provide context to the medical issues. The attorneys may direct you toward certain facts or issues and this may influence your opinion but it is still your opinion and they often have a very good understanding of the medical issues themselves. I sold my soul when I got married and had kids, not by doing some medico-legal work.
Quite the vociferous defense. I’m sure it has nothing to do with the income you derive from such activities, right?
**scrolls down in thread** — “I will get $5000 for a day typically.”
Well, maybe your cynicism has some justification. I know there are people out there who are willing to testify to anything for the right price. I think that is a minority though. I really do. and $5k is really only 2.5K after taxes which for an 8 hour day is about $300 / hour. Really not outrageous at all given supply and demand, training required, lost income, stress involved etc. I make the same or similar for my clinical work and procedures as I do for medico-legal work.
The question of if your primary job allows it is a big one. I’m in the Army and getting even routine clinical side work approved takes paperwork, but things like expert witness work are explicitly forbidden, which no one ever mentions until you want to go do it.
That is a bummer, KFM. Are you allowed to have any outside income? How about non-clinical work? When I took my current job I had them explicitly state in an addendum of my employment contract that I could do medicolegal work and that it would be paid directly to me and not to my employer. I think that helped. Maybe you can do that if you take a civilian job later. This is one of many sacrifices that you have made in order to serve. Thank you for that.
My current practice in a very large medical group also precludes me from doing any work using my medical expertise without approval from the board. Want to consult on a side business that makes medical devices, too bad. Want to be an expert witness. The hassle to get approval is unlikely to be worth it.
I knew this when I signed my contract and it is something everyone should ask before taking a new job. For me, I was ready to give up some of these side gigs. After giving Pharma talks for a year, I was over spending my evenings away from home.
I’m sorry you don’t have the option of doing more of that work if you wanted to. I didn’t realize how restrictive some of these big groups are. Yes, the time to negotiate is upfront when starting if possible. If they want you bad enough they may make an exception.
And yes, there is a cost to this work for sure. With dinner talks there is time away from home and the stress of staying on script and not violating a FDA reg. For medico-legal work there is the time commitment, the deadlines, the stress, and sometimes an assault on your character from opposing counsel.
My understanding is that this sort of l
clause is fairly common for employed physicians. I have one as well that any outside work be pre-approved and the reimbursement routed through my employer before it gets to me. My memory at the time was that it was in order to create a paper trail for Stark compliance on the employer’s part (which a self employed physician does not have to worry about.) Several of my colleagues have side gigs rounding at LTACH’s, giving pharma talks etc so it hasn’t stopped them, but it is a pain.
Time to renegotiate – especially if its vague – if they don’t want pharma connection great state that, but there are so many ways to make money with your degree and license that have absolutely nothing to do with your practice.
Sorry you are in that situation.
– JustSayin
How many years post training do you need before attorneys will seek your services as a consultant?
In my experience it doesn’t take long. Realistically most doctors want to learn all they need to practice well first.
That may take a couple years. You are already qualified as an expert. Some attorneys actually prefer less experienced doctors since they never come off as a slick “hired gun.”
Great post. Why no discussing on hourly wages or compensation?
You are right. That probably should have been in there. Personally I charge $600 an hour. It may vary up or down depending on your specialty, supply, and demand. There are some surveys out there that you can look at. The bottom line is you have to be very comfortable with your fee whatever it may be. If you are deposed and you don’t want to discuss it or if you think you overcharge they will have a field day with you. If you can support your rate based on the market, the value of your time, the lost income you would incur by being way from your practice etc. then you are fine. Remember you are paid for your TIME, not your TESTIMONY. And it is not contingent on the outcome of the case. For most of us $200 an hour is too low and $1200 an hour would be too much. $300-$800 an hour is not unusual at all. Attorneys are used to being paid a high rate for their time, so they are used to this concept. They are actually more comfortable with it than most of us are.
Remember this is pre-tax and with no medicare etc taken out so you will actually net typically less than half after the high tax rate is taken into account.
I charge $750 per hour. You need to have the credentials to back up such rates once you get over $500 per hour.
I will get $5000 for a day typically …. but I can tell them that a day our of surgery is worth at least that so for surgeons its an easy argument to make.
I ask for a retainer of $10,000 upfront to start. I find this works well and the advice of getting money upfront is very important. I found medico-legal to be very comfortable with this arrangement. Consulting for biomedical/device companies is more difficult as they often don’t like such arrangements and always want to get you to work for free. You need to be savvy with these guys … there are ways to make it work but be careful of your time commitments.
I agree. A “retainer” is what the lawyers call the pre-payment. It is important to clarify everything in writing upfront. We return any unused portion. It is easier to return unused funds to the attorney than it is to bill later for services you provided. It is difficult or impossible to collect after the fact, especially if that firm doesn’t plan to use you again. Also, it is important to have a clear cancellation fee. Often a video deposition is scheduled. You have blocked out a lot of time. And then the case settles and they don’t need you. Where does that leave your payment? That is when your cancellation agreement saves you and you essentially get paid for your time and lost income without actually having to testify. That actually can happen quite often since attorneys have pressure to keep things out of the court if possible.
Could you do disability review work with a specialty that doesn’t really match such as Anesthesia? Do they prefer physiatrists, internists etc?
Yes you can. As long as you are a licensed physician, understand the medical issues and can render good service and reports you will have more work than you can handle.
Thanks. By the way, SEAK also does a class for disability review work in addition to the expert witness training. I’ve been considering doing their class in Florida.
I haven’t taken that particular class, but I haven’t had a bad class from them ever and I’ve taken a lot of them. They do an excellent job.
Never did any SEAK classes etc, but why would someone need it? Really DVD’s is 2017 – what’s a DVD. I mean cheese-ball gimick to make money, right?
I work at a large academic med center and have great mentors.
No need to pay for this material. Some of the post seems vague – ‘get your money up front’? really? Who are you working for?
Need to explain the process and how it works so as not to scare docs into feeling they need a ‘program’ to prepare. Reminds me of studying for boards when docs are scared into buying expensive programs.
– JustSayin
update – I actually paid for a SEAK course and my med mal expert business has grown multiples of what I paid for course. Still stand by statement about DVD’s – and about this post
But Steve Babitsky – SEAK Founder – and his conferences are impressive preparation tools and any expert should consider it. Consider me converted!
GREAT! this is what i wanted to hear!
It seems to me that certain specialties lend themselves better to this type of work than others? For example primary care, pain management, physiatry, ortho, and radiology seem to be the main specialties where expert witnessing is a viable option. Is this a correct thought or can any physician do this?
I think that is a fair assessment. Those specialists are more used to assessing function than a lot of others. I have seen a lot of other specialists doing this kind of work though. Also, there is a need for medical malpractice defense work in virtually every field.
That is probably a fair assessment since those doctors are used to dealing with function. On the other hand I have seen doctors of virtually all specialties do this kind of work successfully. There is also always a need for medical malpractice defense work in every specialty.
Great post! I’ve always wondered how legit the seak stuff is since I get their flyers in the mail.
I hear you. Marketing materials make me suspicious too, but they are legit. I have had extensive conversations with the two lawyers that started it and they are high caliber as are the speakers they bring in. The courses run smoothly and are well organized. I also liked some of their more “off topic” courses like negotiation, non-fiction writing, law school for doctors, etc.
Wealthy Doc I generally like your posts and I have been to your blog. I am disappointed in your portrayal of expert witnessing. I am an OB/GYN. I have sat on a committee for my malpractice carrier for 10 years. We look at cases to help decide if it needs to be settled or defended. I have been through a trial as the defendant (I won). A malpractice case is gut wrenching for most people involved. If any of you are considering plaintiff expert witnessing as a “side hustle” you need to realize that you will raked over the coals by a defense attorney. If you could limit it to depose it would be easy money. I think the plaintiff expert in my case was sorry she got off the plane after my attorney made it clear exactly how much money she made from expert witnessing and totally refuted all of her testimony. Medical malpractice in high dollar cases is a blood sport and you better think it through before you do it.
Hatton1 I respect you and your input. I don’t disagree with what you are saying. I definitely am not trying to encourage people to jump into the plaintiff med-mal arena. I personally do almost no med mal and only defense work if I do. From what I have seen med mal is a small slice of the larger pie of medico-legal work. There are a lot of ways where medicine and law/insurance intersect. When there is conflict at the intersection or confusion then physicians can help. Some of it is personal injury or alleged personal injury where there isn’t any. Some is alleged disability – actual or otherwise. Work comp cases can get contested. A sane well-trained physician can shed light on the case. There are all kinds of niches out there involving millions of dollars that have nothing to do with the horrible experiences you referred to. I’m sorry to hear you had to go through that, but I’m glad you were exonerated in the end.
I am glad you clarified your position. When I hear someone is doing expert witnessing I may have a jaundiced eye.
What I think many if not most docs don’t understand is that in medical malpractice there has to be an expert witness to establish what the standard of care is.
While that means there must be an expert for the plaintiff (and often cases are thrown out when the attorney cannot find an expert witness), there must also be an expert for the defense. I strongly believe that if my expert opinion can keep even one physician from losing a lawsuit then it is worth it.
We need qualified physicians to serve as experts. There are clear cut cases of malpractice and negligence. They are rare thankfully. But for the majority of cases where the facts are a bit more squishy, it’s critically important to have a qualified expert witness.
what about for residents? any of this applicable? i’ve been looking for a side gig for some time.
I don’t think attorneys nor insurance companies are interested in the opinion of docs who haven’t completed training. I have seen them hire residents to do insurance exams though. These are mostly just collecting urine and blood and taking vitals though.
Technically a resident is qualified as an expert since you have the knowledge, education and training level above that of the average person. I agree that you would be on shaky ground though since the other side likely has an experienced and board certified expert. Therefore there is little demand.
I did “daylighting” for the bureau of workers comp as a resident. I reviewed charts for medical input to help determine what was reasonable. I think it only paid a dollar a chart or something crazy but it was good experience and a little income. Also I know experts who pay residents cash “on the side” to help organize and summarize the extensive medical records they receive. They pay residents at a rate much lower than their billing rate so that might be an opportunity in your area. Ask around about who is doing a lot of IMEs (independent medical exams) or file reviews. You could also check the SEAK and ABIME directories and reach out to them offering your services. You might get a taker since record review can be painful and cannot all be delegated to non-clinical staff.
I loved this paragraph: “I am a strong believer in the benefits of experience, dedication, education, and certification and I never look for quick fix shortcuts to success. To be excellent you need to really know your stuff and that doesn’t come easily. There is a price to pay. You may spend weeks or months in training. You may spend thousands of dollars in education, training programs, and certification. You may not see an immediate payoff. Hang in there. Keep grinding away and building your knowledge and skills. It will eventually shine through and pay off. It has for me and everyone else I know who went down this route”!
As an ER intern who is rapidly accruing debt while making sure I’m living as frugally as I can, I often get wishful that I will come across a big-money idea. It’s hard to read about maxing out retirement accounts all my friends buying houses (some in residency: tisk tisk) etc… while I am just trying to make sure we stay in the black at home. I sometimes let this get in the way and I lose sight of what this time really is for–for me to become the best physician I can. That’s going to pay greater dividends than nearly anything else I do right now. But…I still wouldn’t mind a little side gig!
John, I am glad you found that helpful. It sounds like you are on the right track. Unfortunately we have to grind away and hope the payoff will come down the road. I don’t mean to imply you must suffer. You actually can enjoy life along the way too. But it is best to keep pushing – especially early in your career. A few quotes come to mind:
Ben Franklin “Dig deep while sluggards sleep…..”
Dave Ramsey “Live like no one else so that later you will be able to live like no one else!”
And my most recent favorite that was brought to my attention by Tim Ferriss:
Jerzy Gregorek “Hard choices, easy life. Easy choices, hard life.”
It may seem slow going now but your residency will fly by and you will be able to meet all of your financial goals soon enough. Congrats on picking a great field too. All of my friends in ER are happy with their choice.
Darn right about that. Just completing residency and learning to be a good doc is a great financial move all on its own!
Curious what people are doing in regards to business expenses for the 1099 income that this kind of work generates. I basically do it in the evenings on my dining room table so I find it hard to come up with expenses to write off against the income. Any ideas?
Well, you may not have any. But any business expense that relates to that work may be deductible. Some examples of expenses I have deducted: mileage from my main office to a satellite location to do an exam or meet for a depo, marketing expenses (website, directory), books such as the AMA Guides, Dragon dictation software, a scanner for records, postage, dues related to this work (e.g. ABIME annual fee), or conferences/courses (e.g. SEAK training course in Cape Cod). Maybe consider a home office or a dedicated computer if applicable for you. This income is taxed at a high rate, so be aware of any business expenses that could apply. Some providers think they are making 20K or more a year but after expenses and taxes it is more like 5K. Note that if you use schedule C deductions to reduce the 1099 income you will have a lower tax bill but you may not be able to make further retirement contributions (e.g. SEP-IRA).
Business expenses are way better deductions than retirement account contributions.
Driving expenses, perhaps a home office deduction (but can’t use that dining room for anything else), a portion of computer, phone, and internet expenses etc.
Hey, my comment disappeared. I had said something like – one of my friends loves doing medico-legal work, and malpractice is just a small part of it. And that there is a learning curve to it. Legal system forms the basis of a civilized society, and this kind of Physician work is part of it. Being cynical is easy- learning a new skill and monetizing it takes a more mature person.
My Comment after Strider_91 disappeared too. I then retyped it as best I could from memory. Now there are two. Strange quirks of computers!
Great post. Question, though: Is expert witness consulting viable in states with tort reform, like Texas?
I don’t specifically know that answer. I hope someone else here can address it. I suspect wherever there are insured lives, disabled, injured workers, or injuries there will be an intersection between medicine and law. Wherever they intersect clarity of the medical issues is valuable.
Of course. There are still lawsuits in Texas, just fewer. But I’m sure there are still plenty.
Thanks for this post. I’ve worked on a few medical malpractice cases for the defense, so I have a little experience in this arena.
With respect to the issue of choosing cases, I have turned down cases I thought were indefensible, and I have declined to work with plaintiffs entirely. While I would never say never – I suppose I might eventually see an incredibly egregious medical error – I don’t like the idea of helping anyone sue doctors. I’m not sure that refusing to work with plaintiffs hurts my credibility, as long as I can also say that I’ve turned down all defense cases that I didn’t believe in.
As for charging, I set my rate at $600/hour for document review, phone meetings, writing letters, and deposition preparation. My rate is $1000/hour for actual depositions and trial, including travel time. The higher rate is necessary to compensate for time out of the office. I have not yet had to be deposed (everything settled early on), but none of the lawyers seemed to blink at these rates, leading me to wonder if I could charge more. When you look at the post-tax income here, charging more seems reasonable to me, but I guess it’s all about how many other options the lawyers have. I work 30 minutes outside a major city, and I’ve been told by multiple lawyers that they’ve had a hard time finding someone in the big city to work with in my specialty.
As for collecting money upfront, this would seem to be good advice; I’m going to change my contract to include this. For two of my cases, it took a couple of months for all of my invoices to be reimbursed, and that was after me emailing the lawyer every two weeks asking for an update on my fee. The lawyers were all great to work with; I got the sense that the billing on their end had to go through multiple steps before a check to me would actually be cut.
Thanks for your comments. When I said it is good to do both plaintiff and defense work I was thinking more of personal injury cases. I don’t think it necessarily applies to med-mal. It is fine (commendable maybe) to do only defense in that arena.
Your fees sound reasonable for this work. I have had attorneys tell me I could charge much more. Again as long as you are comfortable with them, they are fine.
Yes, actually most attorneys are professional and respectful. They normally do pay what they owe. It is just easier and 100% guaranteed if you get the money upfront. If they aren’t willing to pay upfront that is a warning sign since they likely wouldn’t pay later either. They are motivated to pay the fee prior to the service being rendered. They are less interested in paying after. I hear it is the same for even the oldest of professions.
My Passive Income Gripe…in the end the options are few for docs and resources online always mentioned the same ‘ol
-med expert reviews
– real estate
– crowd funding
– marketing blah blah
– blog (mentioned by some as passive, but I’m sure WCi will agree this is quite active and time consuming)
I think WCI has mentioned this before – that for most docs simply doing more of what you know is the best bang for the buck- moonlight, see more patients . So Passive Income sounds all well and good – diversify etc, but really it is by far the exception and not a rule that a doc will make more doing something other than their primary job in hopes of achieving the ‘work less – make more’ passive income dream.
I have done some Med-Expert work and find the above statements to be true – its rewarding but even at a case a month isn’t the type of money that changes my lifestyle.
JustSayin’
No, there are LOTS of options. But you are right that it doesn’t make sense to use many of them when your active income is earned at such a high hourly rate.
Don’t forget real estate rents, bond interest, savings account interest, stock dividends etc. Those are also passive income.
I don’t consider this work a “passive income” stream. It is a way of boosting your income, but it is quite active. There are a lot of available passive income streams but that is a separate topic in my mind.
Again, not to be argumentative, but….its often said ‘there are lots of ways to make passive income.’ I agree with WCI that there are investment vehicles as he listed, but what comes to mind when most people hear ‘passive income’ is some sort of business side hustle that runs with very little direct supervision (generic example – a vending machine). I return to the fact that for a Physician – even those paid on the lower end of pay scale – its challenging to make more than if they simply worked ‘x’ more hours. True passive income businesses are rare ….Thanks for your insights as always….JustSayin’
You are not being too argumentative. I think I actually agree with you. I have a lot of passive income streams. In fact, my passive income more than covers all of my living expenses. That money comes from investments in businesses and real estate that I own but do not run. I do not consider my medicolegal work passive at all. It is very active work. If you like Robert Kiyosaki’s language this work is ‘S’ and most of my passive income comes from the ‘B’ quadrant.
Haven’t formed an LLC for my med expert work – maybe Trump Tax plan changes that – devil will be in the ‘pass through – details.
What expenses do you take?
I sit i read I call and speak to them , maybe a notary fee here and there.
Guess its fingers crossed tax law reduces pass through to 20-25% and then I get SEP-IRA contribution benefit too.
What am I missing?
(I make 15-20k pre tax in case review if that helps)
JustSayin
You could have your business lease space (5yr contract) from yourself instead of home office deduction…
I am not an accountant
Information only not advice
I’m going to have to think about that. I think that might work in my situation.
Keep us posted with what you find. Interesting concept.
Any updates on this WCI?
No. Probably should spend more time thinking about it. What’s the market rate for periodic rental of your dining room table to yourself?
WCI – Heard from many people about renting from themselves – Grant Cardone mentions it all the time. How is this not ‘self dealing’ – the numbers must make it worthwhile. Have you learned anything on this topic….
JustSayin
14 days a year it’s a great deal. A deduction for the business and not taxable income to the individual. The law is pretty clear on it.
I have always been a strong believer that you can make more by being more efficient at what you do.
For me that comes down to cutting down my EMR time and increasing procedures that reimburse at higher at rates.
I think everyone physician should have a scribe. It’s been said that 50% of our time is spent doing computer work, which we do not get paid for. I model my practice after the dentists. I have 3 exam rooms and book 3 patients at the same time every 3 minutes. I have a nurse in each room that does the intake, presents to me, chaperones my exam (I’m an OBGYN), and then finishes the note and orders while I’m walking into the next room.
This system allows you to see more patients (which compensates extra staff), but most importantly, frees you up to use your brain and not your typing skills, which results in less burnout.
As for ancillary procedures, I’m a believer in practicing medicine and not cosmetics. I’m trained in box, laser, fillers, etc, but I find it to be boring and unfulfilling. So I don’t. Something that works well for OBGYNs, PCP, generalists, urologists, GI, and colorectal surgeons is pelvic floor physiotherapy. Reimbursements are great while providing improved patient care with no risks to the patients. I hired a consultant to train me and my staff and it has been my best investment to date. (Rates are comparable to expert testimony).
*every 30 minutes.
really? how much does pelvic PT pay?
Enough to account for 70% of my collections.
Each incontinent patient can have a simple cystogram, simple uroflow, and straight cath post void residual. That’s an extra $250 for 5 min of work. Cost is betadine swab, red rubber Cath, sterile water, 60cc syringe.
I’ve actually thought about franchising or licensing my pelvic therapy center but most docs are non-believers, so I just keep doing what I do.
Do you do the Pelvic Physical Therapy yourself? What CPT codes do you use?
I had a consultant come in that taught me how to do the protocols and how to code.
Each state is different with their LCD, even with Medicare.
I signed an NDA & paid $75,000. That was 7 years ago. I recouped my expenses in 4 months.
If you are in Primary care & just do the simple CMG, uroflow, and PVR you’d make an an extra $1000/day (assuming you see 20 patients per day). After a year it’ll drop because you would have run through your established patients and then you have to figure out how many new patients you use per day. Figure 29% of all your patients are incontinent.
Obviously you should have a treatment strategy if you are going to screen.
Between ABIME and IAIME which one do you recommend? Which is more recognized and has more marketing power? Doing both does not seem necessary or cost effective.
Also what is a typical compensation for disability insurance review? Is it by hour spent or by case?
I think as a neurologist seeing strokes, neuropathies, back pains and headaches daily, this side work will be suitable. Thank you.
It looks like many people had good outcome by being listed on the SEAK directory for chart reviewing. Is this the best one to be involved? I would greatly appreciate if someone could describe how to get started as a part time or per diem chart reviewer. I am a neurohospitalist with 2 weeks free each month and can incorporate this in my schedule easily.
I did a SEAK course about starting a consulting business. Helped me learn a lot about starting this medical practice management firm https://journalsolutionsllc.com/home
Dear Journal Solutions,
How was the SEAK course? I am looking for information on how to start my consulting business and need someone to walk me the through starting an LLC, etc. I do medical expert and UR work.
Thanks!
It taught me a lot. They have various courses. I did the book/audio and visual course. If you contact them they’ll be able to assist you and perhaps see if one of their in-person seminar would work for you.
If I am a VHA physician and my “malpractice” covered via Federal Torts Claims Act (FTCA) what type of medical malpractice insurance would I have to purchase to cover doing medical expert work?
Does anyone have any experience regarding how much it would cost to get liability and errors and omission insurance just to be able to do medical expert work? If so, please provide the name of a recommended insurance company.
Thanks
Do people actually buy that? Looks like they do:
https://www.brunswickcompanies.com/professional-liability-insurance/expert-witness-errors-omissions-insurance/
I bet it doesn’t cost much.