The Executive Suite: How physicians can earn money, expand their careers with moonlighting

Physicians are hardworking professionals. But did you know that many of your colleagues work multiple jobs?

In our 2002 Medical Economics® Physician Report, nearly one out of three physicians told us that they earn secondary income by moonlighting. The most popular forms of secondary work include consulting, teaching and, perhaps surprisingly, work that does not involve a medical degree. The average income earned from these jobs? About $40,000 per year.
Many physicians may now be wondering: Where do I find these opportunities? And how do I know what is the right fit for me? Medical Economics® sat down with Suneel Dhand, M.D., an internist who moonlights and co-founded a company called DocsDox that helps physicians find secondary income opportunities, to discuss ways you can find opportunities for yourself. The transcript has been edited for length and clarity.

Medical Economics (ME)®: What is secondary income or moonlighting? What kind of options are out there for physicians?
Dhand: Basically, secondary income is any type of income on top of a physician’s main source of income. That could be a full-time job or it could be a part-time job..

ME: How many physicians are taking on secondary income? Is this common? And is there a growing interest in this kind of career diversification?

Dhand: Yes, we are seeing a vast expansion in the number of doctors who are going down this route. It used to be an absolute minority of physicians, especially when we were in the era of physicians basically owning their own practices. Where was there ever time for secondary income? … Some estimates suggest it’s now the majority of physicians who in some ways are pulling in secondary income.

ME: So how do you find secondary work, as a physician? Where do you go to find good opportunities that may fit your own circumstances?

Dhand: I did it all. From my own networking, I tried to maintain a larger professional network, which I met through previous jobs, at conferences and so forth. I’ll give you an example: My current main outpatient practice is in a wellness and preventive medicine clinic, and I basically found that on LinkedIn. It was random; I didn’t go through recruiters. So it really depends on the physicians’ own circumstances, what their network is and what they’re looking for.

ME: What are some of the benefits of this work?

Dhand: There are lots of benefits for the physician. First, it will give you variety in an era of exploding physician job dissatisfaction and burnout, which we’ll come back to soon. It obviously helps with that. It avoids anything becoming too monotonous in terms of what we do. Also, purely in terms of income — I mean, let’s be realistic from the financial perspective — it can really work out well for the individual doctor.

ME: What are some examples of secondary income? What’s out there?

Dhand: Physicians, as a group of professionals, don’t understand the value we can bring to many different organizations, even those that are outside medicine. We historically undersell ourselves. We’re not trained in marketing. ... And many doctors end up being one-dimensional thinkers; they think in terms of “I’m going to have this job and go down this route.”

Some examples would be if you’re going down the clinical medicine route, you could find many organizations — probably in your immediate vicinity — that would need your services for exactly what you want to do if you wanted to try something different. Say you are a generalist, and you are working at an internal medicine practice. You could check out urgent care facilities or you could work in educational institutions. As far as nonclinical opportunities go, a myriad of them are available. If it’s your cup of tea, you can work for the insurance industry or you can work in chart reviews. There’s a ton of startups out there that desire the physician perspective. And then you’ve got the pharmaceutical companies, of course, which will always need physician advisers and a physician perspective, and they value that if you can bring your clinical experience to the table.

ME: What factors should physicians consider, broadly speaking, as they’re evaluating different opportunities?

Dhand: Well, once a physician decides to go down this route, it’s important to be clear about what you would enjoy. I’ll give you a personal example. I know I’m a very clinical, hands-on person; I like the patient contact. And I know that the secondary income opportunities I choose should be in that field. If I were to, say, do chart reviews, or work for an insurance company, it may be lucrative and it may suit me for a bit, but I know, long term, I wouldn’t be happy. So it’s important for a doctor to really be honest with themselves and ask: What do you enjoy about being a doctor? If they don’t really enjoy clinical medicine … go down a nonclinical route. Don’t just go for something because it sounds like a cushy opportunity. These opportunities will come physicians’ way. But they’ll realize very quickly if they do that, if it’s not for them, they’re not going to be happy.

ME: Let’s stick with the happiness discussion. Earlier you mentioned rising career dissatisfaction among physicians, and we all have heard about physician burnout. It may sound counterintuitive to some to say that taking on more work may help your burnout. Can you talk a little bit about the relationship there?

Dhand: The explosion in physician burnout and dissatisfaction is clear to everybody out there. I’ve seen research suggesting that the majority — 60% — of all doctors are clinically burned out. We need to take a step back for a moment and ask: Why has this happened?

Well, 30 years ago, doctors used to finish residency and enter practice. They used to be small-business owners and had a lot of autonomy and ownership. In this … world of employed medicine, which has escalated over the past 20 years, (most) doctors will finish residency and become employees in large organizations.

I feel that there is an inevitable conflict that will arise because the types of people that go into medicine are very independent thinkers, and the corporate world really doesn’t fit well. And sooner or later, a doctor will reach that conflict in their career where they’re not going to like working for a big organization.

So how can secondary income help? Well, physicians have to again realize everything doesn’t have to be a set career path; they can cut back on their regular clinical work. So it doesn’t mean that your secondary income is necessarily adding to it, and I actually wouldn’t advise doing that if you already work 80 hours a week. And again, using my own example, I was practicing internal medicine, doing the same thing week in, week out, and then decided to pull back on that. I thought: Well, let me think. … What can I do that will be satisfying but also avoid that sense of monotony? … If you can reach that kind of balance, it can really add a lot of variety to your career.

ME: Another factor is volunteering. Are there any ways to approach a volunteer opportunity differently from something that you’re paid for?

Dhand: If a physician is looking for an outlet away from clinical medicine and finances are not an issue, volunteering is always a great thing to do. It’s a wonderful thing to give your time to a good cause, one that you feel passionate about. I know a lot of doctors that volunteer, but I don’t know many, to be honest, that do it so much, that it’s anything more than, say, a few hours a week.

ME: If you are a physician who works for a large organization, what should you check before taking on a secondary gig?

Dhand: The only potential conflict or reason for any concern from an organization would be if you’re going to work with a direct competitor. From what I’ve seen, though, having met thousands of physicians, medicine is usually the last one that is particularly strict about that because there’s just such a need out there. I’m in the Boston area, and lots of doctors will go and moonlight in the neighboring organization, and it’s very rarely a big deal. It’s something that is commonly done.

But yes, you should check with your organization and make sure it’s OK. But rarely will it be an issue as long as you can go and do your own job when you’re paid to do it and not take side phone calls during working hours.

ME: Is there anything that we haven’t talked about that you think is important for physicians to keep in mind as they look for secondary work?

Dhand: If you have that itch to try something different, you feel that your job is not where you want it to be, whether that’s because you’re burned out, or you just feel a general sense of drudgery, go ahead and try secondary work as soon as possible. I wish I had years before I did because there are so many opportunities out there for doctors, we historically undersell ourselves and don’t market and understand our value even in other arenas. So, if you feel the urge to do that, go ahead and do it as soon as possible. Don’t wait, and you will surprise yourself.

If you don’t want to go part time in your current job … try something a couple of evenings a week or on weekends and see whether it suits you first. There’s no point, if you’re already bored or unhappy with your job, (doing something) you know is going to be equally draining for you. Pick something that you’re passionate about.