As a physician you have the unique opportunity to expand your career outside of the clinic through opportunities in writing, teaching, consulting and so much more. However, before you look for a "side-gig" make sure you understand all of your employer's potential restrictions on them.
Doctors are often sought out for consulting work within the medical industry, and while these projects can be a nice supplement to clinical practice, hospital systems and universities that employ doctors may have restrictions regarding this type of work.
Even for physicians who are self-employed, some non-clinical endeavors within the medical field can pose true conflicts of interest or may be concerning to patients and/or referring doctors.
If you are a practicing physician, setting yourself up for success when it comes to non-clinical projects involves not only understanding the existing rules but also sometimes taking the lead in establishing the guidelines yourself. Before stumbling into an unpleasant situation with your employer, it is imperative for you to learn what your employer’s policies are regarding outside physician work. Contracts ultimately don’t need to state a reason for a particular policy, just that the policy exists.
Many hospitals and health care organizations put clauses into physician contracts that stake a claim to book royalties, device revenue, and other income from medically related ventures. If you create an income-producing product, your employer may assert the rights to financial profits that you earned.
Another issue that some employed doctors face is that employers may contract to receive payment for non-clinical physician work, such as medical-legal evaluations. Some hospital employers may also institute a model in which they repay a doctor based on relative value unit (RVU) reimbursement conversions, which are used by Medicare to determine payment for medical services. Others may keep the earnings for the department as a whole.
Some employers have even more stringent rules and completely disallow any work outside of the direct work assigned by the employer, meaning taking on an opportunity outside of these parameters can be grounds for termination.
It may seem unfair, but if it is in your contract, you either need to get an exemption in writing, take on the project with the restrictions in place, or potentially pass up on the consulting opportunity if you don’t see a personal benefit for yourself. Even when you are self-employed, or if your employer does not interfere with your non-clinical work, you may need to be cautious about what you tell the companies who ask for your services as a medical expert.
If you work for a number of different companies, for example as a speaker for competing pharmaceutical products, a statement listing your competing projects is typically necessary. Many physicians provide consulting services for rival companies. Doctors who author journal articles or serve on advisory boards may have extensive experience in the industry and can work in multiple facets that seemingly conflict with each other. Nevertheless, your work as a key opinion leader (KOL) may deliver enough value that competing companies may be completely on board with the situation.
When a physician’s industry ties are hidden, however, that can pose problems. The key is then to be transparent so that you will not have to deal with problems down the road that could potentially cost you more than just one “side-gig”.If you share clinical responsibility with other physicians, you may have mixed feelings about outside work. While you might want to take on a few side projects yourself, you could become resentful if the physicians with whom you share clinical duties spend their time on other projects—especially if it seems to cause extra work to fall on you.
If you are a physician who employs other doctors, you might be concerned about whether their side projects could compromise attention and dedication to patient care, and you may even grow concerned about the quality of their clinical care. Furthermore, as an employer, you may feel that you are providing resources and credibility for the doctors who work for you, and if you estimate that your practice support gives them the opportunity to pursue lucrative side work then you may feel that you deserve a share of the proceeds.
Regardless of your role in the equation—whether as an employed physician or as a physician practice owner—creating fair rules regarding independent non-clinical work is the best way to alleviate conflicts and inconsistencies. Legalities and regulations are certainly an important aspect of managing your work as a physician expert. Nevertheless, you can abide by the rules, yet still, get painfully close to crossing a line when it comes to integrity.
You may be providing advice to one company when you know proprietary information about another. You can still maintain honesty in such a situation, but you have to carefully consider your responsibilities, and this may require stepping aside from a project if you aren’t giving each client their fair share of your skills and knowledge.
Even when you are completely honest, the people who rely on your care—your patients and your referring physicians—may begin to wonder about your motives if you are closely allied with products that affect their health. Sometimes misunderstandings can lead to problems with your reputation even if you have not approached your patient care with any conflicts of interest.
Most of the time, doctors can take on consulting work or non-clinical projects without any problems. Once in a while, however, conflicts of interest can be a problem. Planning ahead and being aware of these pitfalls can pre-emptively alleviate small issues before they become big problems allowing you to freely pursue opportunities for your career and professional development outside of the clinic.
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