Physician interest in supplementary work outside of the primary practice setting is nothing new. But the industry of medicine is becoming increasingly regulated and constrained. The widely lamented lack of physician autonomy in the patient care setting is mirrored by a lack of physician autonomy when it comes to pursuing work alongside patient care.
It is important that practicing physicians understand restrictions regarding side work to avoid unexpected financial penalties—or even grounds for termination. The process of blending a patient care practice with supplementary work can be successful, but it requires strategic planning.
Physicians who want to pursue side work while maintaining a clinical partnership or remaining employed in clinical practice need to understand that it is important to work on creating an accurate account of the independent side project. Partners and employers may have questions, and providing them with well thought out answers can help facilitate effective communication.
Phil Boucher, MD, is a self-employed pediatrician in Lincoln, Neb., who practices at Lincoln Pediatric Group, a group of 11 physicians. Boucher creates the podcasts Parenting Matters and Private Practice Matters. He also runs a Facebook group for parents called Present and Productive Parents. He discussed his plan with his partners so they would know what he was getting into before he started. “I didn’t want them to be surprised or be caught off guard to see my information online,” Boucher says.
One of the most important strategies for navigating the blend of patient care with side work involves careful consideration of the concerns that physician partners and employers may have. Clinical partners may have apprehensions about the possibility that time and attention could be taken away from shared responsibilities, such as on-call duties and last minute patient needs. As with any skill, knowing the priorities and personalities of colleagues and supervisors can help a physician home in on the specific issues that may present a conflict.
Peter Valenzuela, MD, MBA, is a family physician in Santa Rosa, Calif. and is the chief medical officer for Sutter Medical Group of the Redwoods. Valenzuela runs a side business creating comics about the healthcare industry, which he posts on social media and on his website (www.doc-related.com). Valenzuela says that his practice has restrictions about what physicians can do outside the medical group. “I make comic strips, which do not directly compete with anything our health system provides,” he says.
Physician partners or employers may be hesitant about how side work could impact the values and reputation of the practice. Valenzuela points out that employers may be concerned that a physician’s side work could put the employer at risk. He says that, in his case, the question regarding whether his comics would paint a dark picture of how physicians are treated in the practice was raised. “I was able to successfully argue that my comics target what’s wrong with healthcare across the United States, not just in our neck of the woods,” he says.
Profit income sharing
Financial matters can be complex, and can vary with each practice setting. Nana Korsah, MD, is a primary care physician who own MD Worklife Balance, a financial coaching business for physicians. Korsah, who advises her clients about balancing multiple streams of income, says that some employed physicians have contracts that basically say that the employer or practice group owns anything they (the physician) does for profit.
On the same note, Valenzuela explains that his group requires physicians who have administrative side gigs, such as medical directorships outside of business hours, to pass funds through the medical group to be taxed.
If a doctor is dedicated to pursuing a side project—a discussion, and possibly a new contract—can make the process work out. A negotiation can be more successful if the physician explicitly addresses the concerns of the practice or employer.
Boucher suggests that doctors tackle employer concerns and work towards mutual benefit. “I see hospitals that worry that the physician’s brand will eclipse its own, but this has never actually been the case in practice. If the hospital promotes their own staff, then the outcome helps both the physician and the hospital to have more reach,” Boucher explains.
Before starting any side project, a physician must consider liability issues. Typically, medical malpractice insurance coverage is specific to a defined professional setting and scope of practice. Additional patient care or other work that is not clearly mentioned in a contract may not be covered.
Doctors who take on patient care outside their primary practice setting (through moonlighting or locums for example) must ensure that all patient care is covered by a malpractice insurance policy.
But taking on outside work does not necessarily mean that a physician has to purchase an additional medical malpractice policy. Boucher, who provides information to parents through his podcasts, took steps to ensure that his online presence wouldn’t put him at legal liability for topics discussed. Projects such as writing or editing health content for a professional website or blog may include disclaimers or built-in liability coverage that protects all team members who work for the publication.
Some types of side projects—such as product promotion—may or may not incur a risk of litigation. The manufacturer of the product may be fully responsible for the effects of the product but it is important for a physician to define liability and legal responsibilities rather than make assumptions.
Physicians who have professional interests outside the primary practice setting can usually achieve a balance. And when a compromise can’t be reached, a physician is faced with a difficult career choice—a choice that depends on long term professional goals and priorities.
Issues regarding intellectual property rights may be areas where neither party is willing to compromise. “We actually had a physician leave our group because he wanted to patent a device, but his agreement would not grant him intellectual property rights,” Valenzuela says.
The key to having a successful side project as a practicing physician lies in good planning before getting started. “Go slowly and look at it is a long game that requires patience, time, and financial risk. Don’t do anything that could jeopardize your license, your current gig, or that makes you look sleazy or salesy in the eyes of your colleagues or patients,” Boucher says.