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Per-diem-contracts can be the first and most attainable step towards Doctoring Differently. Instead of being a full-time employee, it is possible to convert to a part-time or full-time contractor. It allows one to remain at their same institution or within their same community and continue to generate income in a safe and familiar environment. In such cases, the EMR system and support staff is familiar and such a physician would be immediately efficient and a profitable asset to the department. Per-diem employees are paid an hourly rate and often can accrue paid sick time. As a per-diem employee, health benefits and retirement contributions are not provided. But not to fear, you can procure those benefits on your own.
For most of us, it started near the end of residency. The barrage of calls, texts, and emails from locums recruiters promising piles of money in exchange for practicing in a rural community in a state you’ve never even visited. Perhaps you, like me, found yourself briefly daydreaming about hopping on a flight (or a couple of flights) to arrive in that town, work for a couple of weeks, stuff your well-earned dollars into an extra suitcase and go home.
Let’s start by dispelling a common myth. Not all locums assignments require flight travel. It is very possible that there are high-paying locums assignments within driving distance of your home. Community hospitals even a few hours from major cities often experience a dearth of physician coverage and are willing to pay large sums of money for short-term or long-term staffing. Additionally, I am a proponent of exploring locums opportunities in states where you are already licensed. Given the amount of time, money, and paperwork it takes to obtain a state license, exploring states where you already hold a license will expedite the process and give valuable experience.
Private locums agencies are hired by hospitals to recruit and credential physicians for short or long-term staffing assignments. The assigned agent is not a medical professional, but an intermediary essential in the negotiation process. The agent will present an applicant’s resume to the contracting hospital and, if accepted, facilitate credentialing, negotiate schedule, provide malpractice insurance coverage, and arrange travel and lodging accommodations. The physician will be paid directly by the locums agency rather than by the hospital.
The need may be inpatient or outpatient or a combination of both. Many positions also offer a 24-hour on-call rate (just to remain within a certain radius of the hospital for emergencies) and an hourly on-call rate. As a locums contractor, health benefits and retirement contributions are not provided. But not to fear, you can procure those benefits on your own.
Negotiation of all terms. From salary to schedule, every aspect of a locums offer is negotiable (never accept the opening salary offer). Increased pay rates on Thanksgiving, Christmas, New Year, can frequently be negotiated as well. Finally, nurses aren’t the only ones who can collect holiday pay!
Malpractice Insurance Coverage Provided. The locums agency will provide high-quality malpractice insurance.
Travel. Explore a new town or community through a short-term locums assignment! They will undoubtedly be happy to have you.
All Travel and Lodging Expenses Covered. Nothing will be at-cost to you.
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Botox, fillers, laser treatments. You’ve heard these ubiquitous words even if you have no idea what they mean or what they do. So you’re not in dermatology or plastics? Most of these cosmetic procedures can be performed by nurses, but in most states, the “Medical Spa” practice must have majority ownership by an MD/DO of any specialty. In my community, many MedSpas are owned by Family Medicine doctors, Emergency Physicians, Anesthesiologists. And as a Pediatrician, I’ve enjoyed the procedural aspect and customer service aspect of providing medical cosmetic procedures.
I started my aesthetics practice after a conversation with a retired surgeon who shared how he was approached about starting an aesthetics arm of his practice late in his career and his only regret was not starting it 10 years earlier. He described a short, but steep learning curve and recommended taking a few courses to refresh myself on facial anatomy and learn the safest procedures and most effective techniques. I found one of the many 1 and 2 day independent courses taught by expert injector doctors and nurses that will provide CME credits and give hands-on practice with guidance and supervision.
This Industry is growing at such a rapid pace and will continue to be rewarding and lucrative for practitioners who enjoy procedures, customer service, or who desire to grow a small practice into a full-fledged business.
Salary: Unlimited earning potential!
Flexibility Meter: 10/10. It's your private business, work when you want to.
Veteran Disability Exams (otherwise known as Compensation and Pension Exams) are independent medical exams for military veterans who are claiming injury or disability during their time in service. The Department of Veterans Affairs ensures that all eligible military veterans receive injury or disability compensation in addition to life-long healthcare. The VA contracts directly with civilian companies that, in turn, hire and facilitate the execution of these exams by civilian physicians.
You may be thinking “Well why can’t military hospitals and military personnel perform these exams?” There are many more Veterans than there are military clinicians and facilities to perform C&P exams. Active military physicians provide acute care and diagnostic treatment, but disability exams are non-clinical and non-treatment in nature and their only purpose is to ensure that veterans are fairly compensated for their service-related injuries or conditions. A physician performing the disability exam is NOT the treating physician. There is no diagnosing new conditions or ordering diagnostic testing. The examining physician does not prescribe medication nor do they follow up with the veteran. The note/questionnaire associated with a disability exam is purely legal in nature.
As this is considered non-clinical work, board-certification is not required to perform Veteran Disability Exams and a physician need only hold an active state medical license. Doctors of any specialty can be trained to perform disability exams. The contracting organizations who facilitate these exams provide comprehensive training and offer 24-hour support to their clinicians. During a disability exam, the civilian physician will obtain a pertinent medical history from the veteran, perform a focused physical exam based on the injury or condition, and execute a chart review of the Veteran’s medical record. They are subsequently responsible for synthesizing the history of the Veteran with his or her service treatment records and pertinent labs or imaging that were ordered by their treating physician. The physician is compensated based on the number of questionnaires submitted to the VA which directly correlates to the number of claims a Veteran reports. Mental health professionals are contracted to specifically see Veterans claiming post-traumatic stress disorder or traumatic brain injuries.
States that have a large number of military bases like California, Texas, and Florida have significant needs for independent physicians to perform these exams. At the beginning of the Covid-19 pandemic, these exams were put on hold, but they have now been mandated as essential services and the VA is working hard to schedule Veterans veterans, so the need for civilian physicians to participate in this effort is significant.
Salary: This job has very high-earning potential. A physician performing disability exams will be paid by the number of disability claims per veteran. Physicians who have made this work a full-time career, can generate $40,000 PER MONTH in income.
Flexibility Meter: 8/10. If you live in a city or state with a military presence, there are likely organizations that are looking for physicians to perform these exams. Many are open 7 days a week and will schedule veterans according to your availability.
Physicians often cringe when I mention that I routinely participate in Medical Expert Witness work. They imagine sitting on a stand while a grumpy trial attorney attempts to discredit their knowledge and credentials. Understandably, we Physicians are instilled with some inherent fear and avoidance of the entire legal profession, but we are missing out on very exciting and lucrative work by shying away from it.
There are levels to medical expert witness work—it is not all juries, judges, and trials. A defense or prosecution team may simply need a physician expert to effectively translate medical records as it involves a specific case.
For example: Why was this child’s lead level tested? Is that standard for all children? Can high lead levels harm children? What is the treatment for high lead levels?
Physicians also imagine they will automatically be asked to testify in a case of medical malpractice. That is rarely the purpose of a medical expert witness.