By Emily Margosian, assistant editor
While the term “side gig” may have once called to mind the image of a musician, self-taught photographer, or college kid making extra cash doing pizza delivery, in the wake of the 2008 financial crisis, more Americans than ever have picked up a side job to supplement their income. In 2018, Harvard Business Review reported that approximately 150 million workers in North America and Western Europe engaged as independent contractors, with more than half of Americans (54%) reporting income from short-term or task-based work according to a 2019 SunTrust survey.
Fueled in part by the rise of platforms such as Etsy, AirBnb, and Uber, the growing popularity of side work has produced its own thriving “gig economy.” However, for many, the appeal of a side gig is often more than just financial, providing a creative outlet and change of pace from everyday work. For physicians in the midst of burnout, a side gig can offer an engaging supplement to their income. For others concerned about modifications to reimbursement, side work can offer a financial buffer against future changes in medicine. “When I talk to physicians about burnout, there’s often a feeling that people are stuck — worrying about paying off student debt, unable to find part-time options. Having an additional income stream takes off some of the pressure to stay in a situation that may not be ideal,” wrote radiologist Nishi Mehta, MD, on her blog Physician Side Gigs.
This month, Dermatology World explores popular physician side gigs — what’s out there, how to get started, and what type of experience you need.
Expert witness
Physicians interested in taking their professional expertise out of the exam room and into the courtroom have the opportunity to do so as expert witnesses. In general, the role of a physician expert witness is to give opinions in a criminal or civil trial by explaining any relevant medical evidence of a case in a way that the judge or jury can easily understand. While physician expert witnesses can be called for all types of cases (famed dermatopathologist A. Bernard Ackerman, MD, got his start as an expert witness in a much-publicized murder trial involving another physician), typically they involve medical malpractice, personal injury, and pharmaceutical companies.
Once known as “an area that transcends both medicine and the law,” (Semin Cutan Med Surg. 2013;32:234-235) expert testimony has begun to see some regulation in recent years. Disciplinary action related to giving false or misleading testimony during trial is reportable to the National Practitioner Data Bank, and if a physician falsifies facts or credentials, a licensing board or other credentialing group has legal grounds to act (Semin Cutan Med Surg. 2013;32:234-235). Individual states are also beginning to turn a regulatory eye toward the practice. Florida, for example, requires certain medical experts to either be licensed in-state, or procure an expert witness certificate.
How do you get started?
“Getting started in expert witness work requires a bit of marketing on your part,” explained Kansas City neurologist Nancy Hammond, MD, in a 2018 blog post. Dr. Hammond recommends that physicians update any professional networking profiles to include their areas of expertise and consider reaching out to local law firms to offer their services. Physicians can also create listings in expert witness directories to open themselves up to a broader audience or consider creating their own website so that lawyers looking for an expert witness can find them. Some potential witness directories include SEAK (https://seak.com/expert-witness-resources/) and American Medical Experts (https://americanmedicalexperts.com).
What kind of experience do you need?
“All that is generally required is that a dermatologist be an expert in his or her specialty. To qualify as an expert, the dermatologist must be able to opine as to the ‘standard of care,’” explained David Goldberg, MD, JD, a dermatologist-attorney from New York. “Although there are some exceptions, generally this is a national standard of care and does not vary from state-to-state.” According to Dr. Goldberg, courts will often recognize board certification in dermatology as a qualifying feature for expert testimony.
Physician expert witnesses should also be mentally prepared to have their opinions and credibility challenged in court. “Your report becomes part of the official record of the case and you will be asked about your report in depositions and at trial,” said Dr. Hammond. “Make sure that you have adequate peer-reviewed scientific evidence to back up your opinions.”
Dr. Goldberg agrees that physician expert witnesses should be prepared for the challenging environment of a courtroom. “It is acknowledged that there can be different views held by different experts, and such views can be radically different. In most civil suits, a jury must decide who is more believable among the experts,” he said.
How do you set your rates?
Most physician expert witnesses request an upfront retainer fee, which is generally based on demand and area of expertise, and as such can vary widely. “$2,000 to $3,000 is a standard starting rate per case,” advised Dr. Hammond. “Rates for chart review and report preparations average $300 to $400 per hour. Average rates for deposition and testifying at trial are slightly higher at $400 to $500 per hour.” When setting their individual rates, physicians should keep in mind that at minimum, they will be missing at least one day of work to testify at trial, and potentially more if travel is required. Online calculators can help physicians get a sense of how to set their rates based on specialty and their state of residence. One example can be found at www.theexpertinstitute.com/expert-witness-fees.
Dermatologists should also remember to bill for all time spent on a particular case, including time spent reviewing records and medical literature, as well as phone calls and emails related to the case. “Lawyers are used to this type of billing, but we physicians are used to giving away our advice for free,” said Dr. Hammond. Given the unpredictability of trial scheduling, physicians may also want to consider a cancellation fee for trial or deposition.
On an ethical note, physician expert witnesses should ensure that they do not accept any compensation contingent on a trial’s outcome. Likewise, any deliberately deceptive or fraudulent opinions given in court can result in long-term consequences for the physician. “If an expert is found to have lied, they will be disqualified for testifying further in the case,” said Dr. Goldberg. “Such a disqualification then becomes part of the public record and will be discoverable by other attorneys and prevent future testimony.”
What is the time commitment?
Expert witness work can involve a considerable time commitment, both in prep work leading up to the trial itself and time spent in the courtroom. “My most recent case took 40 hours for medical record review and report writing. Usually this work happens on a deadline and you need to be willing to put in time at night or on the weekends to meet the deadline,” said Dr. Hammond.
The magic of dermatology
At just 10 years old, dermatologist Angela Funovits, MD, began teaching herself magic. Even today, Dr. Funovits splits her time between the two worlds, sometimes spending a day in clinic before flying out that evening to give a performance. To read more, visit staging.aad.org/dw/monthly/2019/november/magic-of-dermatology.
Chart review
While chart review can take several forms, generally it involves a physician or other health professional formally reviewing a piece of medical documentation to make a recommendation or answer a predetermined question. Common types of chart review can include reviewing for:
● Medical necessity (typically for prior-authorizations and concurrent hospitalization)
● Disability and workers’ compensation claims
● Insurance underwriting
● Legal cases
● Clinical documentation and coding
● Quality management and oversight
● Collaborating agreements (generally required for physicians collaborating with nurse practitioners, however, there are consulting positions available)
● Medical research
Physicians can be employed to do chart review for insurance companies, an independent review organization, state agency, union, legal firm, or a hospital depending on the type of review being requested.
How do you get started?
Dermatologists can find an introductory list of independent review organizations at www.nairo.org/members, many of which allow physicians to apply online. “Usually they will contact you and tell you what they are expecting in regard to time and expertise, and you can choose to take it or not,” explained Dr. Mehta. “For some companies, the more reviews you do for them, the more work they will offer. Others may prefer to hire you for formal full-time or part-time positions.”
What kind of experience do you need?
Most hospitals require board certification and a license to practice in order to qualify for chart review, although exact qualifications can vary depending on the setting. However, companies may have looser requirements and allow chart review from physicians who are not actively practicing.
Physicians looking to obtain more competitive work may consider additional certifications, such as that offered by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP). However, all physicians performing chart review are expected to provide an objective and impartial review regardless of employer or job type.
How do you set your rates?
“Pay varies greatly. For some companies, you can set your rates, and for others they’ll tell you what they offer,” said Dr. Mehta. “It’s a supply and demand thing for most — if a company has a large number of physicians to choose from, they usually aren’t willing to pay as much. If it’s related to a niche group with a certain expertise, you will be able to charge more.” Dr. Mehta recommends that before physicians set or accept any rates, they should consider cumulative time spent and the size of the chart, with a ballpark average of between $100 to $150 an hour.
What is the time commitment?
One major appeal of chart review is that it can often be done on a flexible schedule. However, depending on the demand for physicians from a particular specialty or subspecialty, time commitment can vary widely. While some organizations require a commitment of a set number of hours, others will only hire physicians for chart review as a formal full- or part-time position. Typical turnaround time for a review is 48 hours, which can include time spent reviewing the chart, speaking to the referring physician, and documenting findings and recommendations.
Medical surveys
While many of us enjoy giving our opinions online for free, medical surveys can be a nice way to earn extra cash for doing so. These surveys are typically offered by companies looking to leverage physician expertise into their work. For those seeking a side gig with extremely flexible hours, the ability to participate remotely on one’s own terms can make medical surveys an attractive option. Beyond the financial incentive, “Medical market research can be intellectually exciting. It often corresponds to new developments in fascinating areas of pharmaceutical, biotechnology, and medical device research,” according to a 2018 Modern MedEd article.
How do you get involved?
While there are many paid survey opportunities available to physicians online, not all are worthwhile. Some reputable medical market research companies include: Reckner Healthcare, Curizon, InCrowd, GLG Consulting, M3 Global Research, ZoomRX, Sermo, and Medical Advisory Board. However, availability of surveys depends on which medical specialty’s expertise is currently being sought.
What kind of experience do you need?
In general, most survey companies require board certification in your specialty or area of expertise and will request some substantiation of licensure. While certain companies require a lengthier verification process than others, those that do typically offer better rates in terms of compensation.
How do you set your rates?
Compensation is paid according to survey length, often by the minute. This payment can vary significantly from company to company, so be sure to look at the specifics for each survey before deciding if it’s worth your time. Typically, $1 to $3 per minute is considered to be relatively well paid as far as compensation for medical surveys.
What is the time commitment?
For most, the primary appeal of medical market research as a source of side revenue is that it can be done in a relatively short amount of time on an ad hoc basis. While some companies offer “micro surveys” ranging from one to five minutes, on average, most medical surveys take between 10 to 60 minutes to complete.
Laughing matters
After a visit to Chicago’s famous Second City comedy theater, dermatologist Michael Greenberg, MD, knew he was hooked. Now, Dr. Greenberg continues to hone his improv skills both while seeing patients and performing as part of his comedy troupe. To read more, visit staging.aad.org/dw/monthly/2017/november/laughing-matters.
Industry consultant
“There are many different industry jobs for physicians,” said Barbara Mathes, MD, former AAD secretary-treasurer, who has held a variety of industry roles across her career. Options can include consulting, working in medical affairs, or clinical or basic research. “There are a number of physicians who now function as sort of representatives of a company in the field,” said Dr. Mathes, who took her first industry job in medical affairs at a pharmaceutical company where she was responsible for developing educational products for internal and external use. “It was really fun for me to teach — both staff at the company and doctors out there who might want to use the drug,” she said.
Industry roles can broaden physicians’ professional networks considerably and provide insights into the sometimes opaque drug-development process. “I was very fortunate to work with amazing people: physicians from all specialties, scientists, safety experts, marketing and sales people, and legal experts,” said Dr. Mathes. “I learned an incredible amount about the details of how drugs get developed and what you need to do to get drugs approved. We had a few products that could have been used in dermatology but didn’t meet the financial threshold for developing a drug for a particular indication. That was my awakening to how decisions in the business of drugs are made.”
As with other side gigs, physicians considering an additional industry role should always keep patients at the forefront of their minds. “There’s no question that there are conflicts for physicians working in industry, and one needs to make sure that they are working for a company with integrity. Unlike others, physicians have taken an oath,” said Dr. Mathes. “It’s important for physicians, regardless of the work they do, to remember that our commitment is to patients, and what we do should be in the best interest of patients.”
How do you get started?
Dr. Mathes pivoted to her first industry job after a move to a new city. “I had heard from a colleague that a pharmaceutical company in that town was looking for a dermatologist because they were developing a drug in the dermatology sphere. I thought, I’ve done clinical medicine and teaching for almost 20 years; I can try something new. So, I applied for the position, interviewed, and was hired,” she said.
For those interested in the research side of industry, Dr. Mathes recommends getting involved in clinical trials as a way to get a foot in the door. “Ultimately it depends on the type of position that you want to have, but a lot of people start out by doing clinical research, either at an academic institution or private clinical trial center, which can be a part-time job,” she said. “If you do a number of trials, are good at recruiting patients, and completing the studies, you can be an investigator of interest to companies.”
Trialing it out
Learn more about developing a successful research practice at staging.aad.org/dw/monthly/2018/july/trialing-it-out.
What kind of experience do you need?
Given the wide variety of industry roles available to physicians, required expertise can vary. “If you pull up any major biopharma company’s hiring site, you’ll see positions for physicians. Some of them require very specific credentials, like a MD/PhD in molecular biology, but for clinical and medical affairs, many want a physician who has expertise in a particular specialty or general area,” said Dr. Mathes.
Experience with clinical trials and the drug development process can also open doors for a consulting career. “If you have expertise in a particular class of drugs, know pharmacology, understand drug safety and statistics, or you’re somebody who has experience with the FDA, that opens up a lot of consulting opportunities to you,” said Dr. Mathes. “There are also physicians who serve as medical liaisons for drug companies. Some people are wary about these positions, seeing them as glorified drug reps, but their primary function isn’t sales, it’s education, answering questions and providing greater scientific expertise about disease and drug mechanisms.”
How do you set your rates?
Rates can be highly subjective depending on role, individual company, and a physician’s own level of experience in a given setting. “If you’ve developed a drug and brought it from start to FDA-approval and marketing, you have a level of expertise that very few of your colleagues have, you can set your own fees and your phone will be ringing. Depending on the type of project, consultants typically have hourly or daily rates, though sometimes you may charge by the project. Cash payment is typical but with start-up companies that are cash-strapped, you might negotiate for stock or stock options,” said Dr. Mathes.
What is the time commitment?
Similar to salary, the level of time commitment depends on the role itself — ranging from a few hours to a few per week or month in clinical trials, to nearly round-the-clock work while working to bring a drug to market. “The type of position and your role in the project will define your time commitment, but if you’re involved in clinical studies you usually need to be accessible,” said Dr. Mathes.
Travel, too, can be a major factor. Some industry positions have no or little travel; others have considerable travel. If you want to maintain a clinical practice, you need to consider this. Some companies prefer physicians to maintain a clinical connection, but there are jobs with so much international travel, and unpredictability, that it’s impossible to maintain a clinical practice. Some physicians in industry have clinical appointments in universities and volunteer their time supervising residents’ clinics or seeing overflow patients to keep connected with clinical medicine, but if you’re on the road 70% of the time and don’t maintain a regular schedule, this may not be workable.
Consulting jobs are more likely to have hours one can define for themselves and better allow dermatologists to maintain their private practice or academic work. Regardless of job type, “It’s important to understand what’s involved in the job from the very beginning,” advised Dr. Mathes. “Who will cover for you when you’re away, are you expected to be answering emails at midnight or participating in teleconferences at 3 AM? If you’re working on a drug that’s very close to being approved, you may be working almost non-stop.”
Spilling the tea
Sometimes all it takes is a little serendipity in the spam folder. Dina Strachan, MD, a dermatologist in private practice in New York, got her start as a recurring personality on a literary webseries when an unexpected casting call appeared in her inbox. To read more, visit staging.aad.org/dw/monthly/2018/november/spilling-the-tea.