How physicians can benefit from side jobs without leaving their main practice

There are just so many ways to benefit from working on the side, even as an employed physician! A large percentage of the physicians we work with (as well as my friends and peers) engage in occasional or regular second pursuits in addition to their medical work. We are increasingly seeing side jobs as a bridge toward retirement or, in fact, the only work after retirement from a full-time W-2 practice.

The spectrum of side work is immense and growing. There are various types of telemedicine, and indeed teleradiology is a dominant method now of radiology employment. But there is telecardiology, tele-primary care, and so much more. A variant is having specialists interact remotely with primary care physicians rather than with patients directly. Medical expert witness testimony for both plaintiffs and defendants is also a common side job. Consulting, speaking and teaching for pharmaceutical and medical equipment companies has always been a source of side work for physicians and continues to grow in opportunities. For example, the rise of robotic surgery has prompted a large increase in the need to teach practicing physicians new techniques. There is also a general need for physicians to perform independent medical exams for lawsuits and disability claims. File review for medications and prior authorization work has also always been a steady need in the job market. Becoming a part-time medical administrator or a medical director of a clinical program or facility (nursing home, ACLF) is a common offering as well.

Let's discuss both the upside and downside of these side ventures. First, the risk, which is primarily malpractice for most clinical responsibilities. Forming an LLC will generally not protect you from malpractice risk, as you are still the clinician responsible. If you decide to work in a clinical side job, you might be covered by your own malpractice insurance, but you must ask. I remember when I did some eICU work in the past, my malpractice carrier wanted a significant premium to cover their risk. If you cannot work out something with your own carrier, make sure the side employer is covering you with what's termed an occurrence policy (covers you into the future for the dates you worked, not for when the claim is made). Also check out the malpractice carrier they are using (avoid sketchy and offshore coverage). Other negatives are the time involved, but this will be a different issue for each physician (as noted above, side work may not only be in addition to full-time practice elsewhere). A final caution is to consider whether the side work is, in essence, the same thing you do in full-time practice. For example, taking extra call with your primary employer would probably not qualify as a second job, but doing locums work or doing call with another hospital system probably would.

There are many benefits to side work. It often offers a gradual exit from full-time work, as noted above. It may also serve as a part-time job in part-time retirement itself. During your regular practice years, it augments income and hopefully savings toward retirement. A nice benefit is that your side work is most likely paid as 1099/independent contractor income. You can probably deduct many expenses (travel, conferences, books, subscriptions, some meals, and some entertainment costs for potential referrals) from this income, but not from a W-2 job. Another great benefit is the opportunity to have a second retirement plan. Even if you maximize your salary deferral into the retirement plan at your W-2 job, you can fund profit-sharing contributions in a second plan connected to your side work. Depending on your age and income from the side work, some physicians greatly benefit from an individual cash balance plan. An uncommon but definite benefit to side work (especially locums work geographically separate from your full-time work) is exposure to other places and systems. We have worked with more than one physician who used side work elsewhere to transition to full-time work elsewhere.

So, consider side work if you have not already done so. Talk to your financial planner and your accountant about it to make sure it will be considered "separate" employment for benefits and retirement savings purposes. Think about your reasons for doing a second job and weigh the time loss against your other family and life commitments. If you do begin some side work, talk to your financial planner early about setting up your expense deductions and retirement plan options.

Steven Podnos, M.D., CFP, is the principal of Wealth Care, LLC, in Merritt Island, Florida.