Ways Resident Physicians Earn Extra Money
What are the different ways a resident physician can earn extra money?
Many of you are probably thinking, how the hell am I going to have time to make extra money during training? It is valid because some need extra cash. And so I have a few ways to make extra money if you have time.
Before I get into this, there are some ACGME prohibitions against working for several days in a row or a certain number of hours within a few days. It would be best if you investigated those before you start the first potential possibility, which is moonlighting.
Make Extra Money by Moonlighting
Each state has different levels of licensure. Some states have training permits; others will have a low-level license. And then, as you progress forward in the USMLE and complete your other coursework and training requirements, you can be fully licensed and allowed to see patients on your own. You need to investigate the licensure requirements in the state you’re training in and determine if you can work independently.
It only applies to some specialties, not all specialties. For instance, you’re unlikely to have moonlighting opportunities in pathology, dermatology, and surgical specialty opportunities.
The most plentiful moonlighting opportunities are for ED and hospitalists; that type of inpatient activity, when you’re providing face-to-face clinical care, will be the most excellent way to find jobs. You could also do urgent care. Millions of urgent care clinics are popping up seemingly in every strip mall in the country simultaneously. So, the first one is moonlighting.
Physician Resident as Research Assistant
The next would be being a research assistant. If you’re in an academic training center or affiliated closely with the university, there are always part-time academic research positions where you can comb through data on the weekends. You won’t have to write anything generally. You’re just collecting data for whoever is doing the higher-level research that will pay. And usually, it’s your own time. So, that would allow you an opportunity to make a little bit of money as well.
Tutor Students during Residency
Lastly, tutoring is the easiest and best way for someone to make money.
And this would be tutoring med students or those in undergrad specifically. Many people are on the biology course in their undergrad, or they’re in med school and need a little assistance with specific subjects that will pay a high rate per hour. It would be entirely in your own time, and one can also do it remotely. You could work from home, in your own time, based on your schedule, and get a decent hourly rate for tutoring.
A couple of things you need to think about. One, how to get those positions.
There are plenty of websites you can sign up for, and they’re like a brokerage for students looking for a tutor in a specific area, obviously the person who wants to teach those subjects. The downside is that the brokerage, or whatever you want to call it, will take out a decent percentage of your hourly rate.
If you can directly go to the students by posting on university or med school boards, that would be a better way. It would increase your hourly rate rather than going through one of those middlemen whom you will have to sign up and go through a vetting process. The scheduling for some of those sites could be more precise. Again, they will take a percentage of what you want.
So, beyond doing moonlighting, some of you don’t have the time, are burned out, don’t want to do an entire shift, or may need to be farther along in the process. You may be in your internship or PGY-1. And tutoring is the best and easiest way of making the most money with the least stress.
That’s my thought on how to make money while you’re a physician resident. The main problem with cash is that the average residency pays around $60,000. Now, you will make less at the beginning and then make more as you progress in training, and the fellowship increases slightly. For some of you that are single, that’s enough money. But it would be best if you also considered where you live. And then those with families with multiple kids, sustaining a family on that amount of money is extremely difficult.
I review hundreds and hundreds of contracts yearly for those coming out of training. I can tell you that thinking they’re finally getting a hefty paycheck monthly or biweekly is life-changing for some of them. Getting through those four or five years of training is difficult for some. And so supplementing their income is a massive benefit to them. Those are my thoughts on making a little money while you’re training.
Medical Residents are Employees, Not Students
Is a medical resident considered a student or an employee?
When you come out of med school, you have your first internship year, then you transition into residency, and you will get paid a salary, albeit a small one. Many residents still determine the tax classification once they enter residency and fellowship. So, let’s discuss that today.
There was a Supreme Court case in 2011 called Mayo Foundation versus the United States. And essentially, in that case, the Supreme Court found that medical residents are employees, not students. Therefore, their salary will have taxes deducted, so the FICA includes Social Security and Medicare.
Residents Tax Classification
Now, as most of you are reading this blog are either a resident or a fellow; you understand that you usually work 50 to 80 hours a week. Your base compensation is not commiserated with the time you spend working. So, any amount of money that one can save is significant. It may change anytime, but the employer will take FICA taxes from your salary.
So, let’s talk about the different classifications in employment and why it matters to the physician. You are either an employee or an independent contractor when you are working. And when you get out of training, you’ll have the decision to make as far as if you’re going to pursue a job with one or the other.
Let’s talk about the benefits of both.
Tax Benefits for Resident Employees and Independent Contractors
As an employee, taxes are subtracted from it, but you will benefit from having a lot of ancillary things provided to you. As an employee, you will receive health, vision, dental, disability, and life. They’re going to pay for your underlying premium for your malpractice insurance. They will provide you with potential productivity incentives, moving expenses, and signing bonuses.
When you’re an independent contractor, generally, you won’t get any of those things. There are a few independent contractor jobs where they will pay the underlying premium for your malpractice insurance, but everything else will be on you. So, as an independent contractor, you’ll get paid in amount, and the employer will take no FICA taxes out of it. You will not get any health benefits. They will not pay for your dues and fees, board, DEA, credentialing, and privileging—it will all be on the physician.
Now, why would you do one over the other?
Ideally, the independent contractor relationship allows some more flexibility than being an employee, meaning you can work for multiple organizations as an independent contractor. Whereas, as an employee, almost every employment contract will have exclusivity or prohibited outside activities. The employer will have veto power if you want to work for another organization while employed with them. Most of the time, organizations are okay with moonlighting, and locums work if it doesn’t interfere with your day-to-day activities for that employer.
Employment after Residency Training
If I had to say what is better, anyone coming out of training is unlikely to enter multiple independent contractor relationships. It would help if you built up the network when you leave training. Nine out of 10 people enter employment classified as an employee. There are a few specialties that are more likely only to offer independent contractor opportunities.
So, for whatever reason, anesthesia and dermatology use independent contractor agreements much more liberally than any other position. Now, if you work for a hospital or hospital network, you’re always going to be an employee. You’re not going to work as an independent contractor. The only time you’d work as an independent contractor, or a better way of saying that is the organizations that offer these, are usually smaller physician-owned groups, between two to eight physicians. And in that scenario, they may offer it.
Do you want the security of having all those benefits?
First, the flexibility of being an independent contractor where you can get in and out of the contract, meaning the notice requirement to get out of it will be less. You can work for multiple organizations simultaneously. Now, one other consideration is restrictive covenants. So, non-compete, non-solicit. Almost any employment contract for a physician will have a non-competition clause if you’re not in a state where they’re prohibited.
There are four or five states where non-competes are entirely prohibited, just illegal. However, most states do allow non-competition clauses.
How Physicians In Residency Can Look For A Job
The easiest way I’ve found is through colleagues. They’ll usually know of a recruiting place—if you’ve trained with somebody. Or maybe they joined a practice during their career. They say it’s a great environment that we’re looking to add another physician in a specialty, and perhaps you should look at it.
Now, it can vary wildly in location, and location is significant to some while less important to others. So, it can go all over the place if you get leads from fellow residents or fellows. One way is to talk to colleagues, mentors, or other people you’ve met in training. And that’s also a great way of determining the market value at the time.
Applying Through Recruiters
One of the tips is to start applying to physician recruiters. There are two types of them.
You have in-house recruiters. Many extensive hospital networks employ physician recruiters who attend different residency programs. Maybe there’s a job fair, something like that. Or they’ll specifically reach out to people in training, saying, “hey, I have this opportunity in this place. Would you be interested?” They’re free to physicians. You do not have to pay the recruiter or anything. The employer is the one that pays the recruitment fees.
So, physician recruiters. Both in-house and those that are just private groups where they go out and broker these deals. Typically, they would get a percentage of the first-year salary of the physician or maybe a flat fee—something like that. But there’s no harm in discussing positions with recruiters. It’s a usual way of doing business nowadays. They usually have their ear on the ground and know many different opportunities that could be exciting for physicians.
Start Applying Online
Another way is if you have a specific region in mind. It’s just doing job searches for clinical practices in your specialty in a particular area. Most places will have job posts on regular job sites if they’re looking. Then you can search for those in the city you want, find that, and contact them from their work listing. That’s another way.
So, those are the three most significant ways and tips to start your career. Word of mouth through colleagues, doing it through a physician recruiter, or searching in specific cities through job search websites. Now, for those who are maybe J-1 or something like that, that’s an entirely different job search. And I can do a separate post about that. But this is more geared towards those looking for the average position just coming out of training.