Physician Side Gigs: A Data-Backed Guide to Extra Income, Autonomy, and Avoiding Burnout

Spencer Lee
12/12/2025 03:00 PM - Comment(s)

Reviewed by: Miyoung Won, M.D., FACOG

18 min read | TL;DR 3 min

How to build a physician portfolio career that protects your income and your wellbeing

A female physician prepping for surgery one day and taking a telemedicine call another day.

TL;DR — Key Takeaways

  • Think portfolio, not hustle. The monolithic "one employer for 30 years" career is fading. Side gigs are a strategic way to diversify income, build autonomy, and hedge against employer volatility—not a sign of desperation.
  • Calculate your Effective Clinical Hourly Rate (ECHR) first. Divide your total compensation by all hours worked (including admin, charting, call). If a side gig pays less than your ECHR, it needs to offer scalability, tax advantages, hedging value, or restoration to be worth it.
  • 1099 income unlocks major tax benefits. A Solo 401(k) lets you shelter tens of thousands in additional retirement savings. Most physicians only owe 2.9% Medicare tax (not the full 15.3%) on side gig income because they've already maxed out Social Security through their W-2.
  • Highest-yield clinical gigs: Locums ($120-450+/hr depending on specialty), tele-psychiatry, and expert witness work ($450-500/hr). Highest-yield non-clinical: pharma consulting and KOL work ($200-500+/hr).
  • Surveys aren't pocket change. Treat them like "airport work"—$10,000-30,000/year is realistic if you cherry-pick high implied hourly rates and route income through a Solo 401(k).
  • Watch the legal landmines. There's no federal non-compete ban (FTC rule was vacated). Your employer's malpractice policy almost never covers side gigs. Med spa directorships carry real board-action risk if you're not actively supervising.
  • Match the gig to your goal. Debt payoff → maximize hourly rate. Burnout recovery → choose gigs that restore autonomy. Exit ramp → build scalable or reputation-based income streams now.

The old model—one employer for thirty years, then retirement—is dying. I would argue that is it dead already.


The numbers tell a story that most physicians feel in their bones: compensation that barely keeps pace with inflation, student debt loads that stretch into six figures, and burnout rates hovering near fifty percent across major specialties. Meanwhile, corporatization and private equity consolidation have reshaped the employment landscape, leaving many doctors feeling like interchangeable parts in a system they no longer control.


Against this backdrop, physician side gigs have moved from the margins to the mainstream. They're no longer just "extra cash" for residents or a sign of financial distress. For a growing number of physicians, side gigs represent a deliberate portfolio strategy—a way to diversify income, reclaim professional autonomy, and hedge against the volatility of modern healthcare employment.


This guide offers a framework for thinking strategically about physician side gigs. We'll cover the financial math most articles skip (including how to calculate whether a gig is actually worth your time), the tax advantages that can significantly boost your after-tax income, and the legal and reputational risks that can derail even well-intentioned ventures. By the end, you'll have a clearer picture of which opportunities align with your goals, your bandwidth, and your tolerance for risk.

Why Physician Side Gigs Are Exploding

The End of the One-Track Physician Career

For most of the twentieth century, the physician career followed a predictable arc: medical school, residency, perhaps a fellowship, then decades of practice with a single institution or partnership. This "monolithic" model offered stability and a clear identity. It also assumed a covenant that no longer holds—that high personal sacrifice would yield unwavering job security, autonomy, and financial security.


That covenant has frayed. Hospital systems consolidate. Private equity acquires practices and restructures compensation. Contract cancellations happen with little warning. The relative value unit (RVU) treadmill accelerates. Physicians increasingly find themselves as employees rather than partners, with diminished control over how they practice medicine.


The response? A shift toward what might be called the "portfolio career." In this model, clinical practice isn't the whole story—it's the anchor asset. Side gigs become diversified holdings that generate additional income, provide autonomy, and create optionality. If your primary employer cuts hours or changes your contract, you have alternatives. If you decide to step back from clinical work, you have revenue streams already in place.


When Income and Inflation Stop Matching

The financial pressure driving side gig interest is real and measurable. While physician salaries have seen nominal increases, they've structurally lagged behind inflation. Recent compensation surveys show only low single-digit pay increases for many specialties—often in the 1-4 percent range—while inflation and practice costs have risen faster. Over time, that gap functions as a quiet pay cut.


This stagnation compounds over time. The physician who earned a "high salary" in 2015 may find that same salary buys considerably less a decade later. Add the burden of student debt—roughly one in five physicians carries significant loan balances—and the traditional model of delayed gratification starts to look less tenable. There's a growing need for liquidity and wealth accumulation earlier in the career cycle, not just in the final years before retirement.


The Burnout-Revenue Paradox

Here's the counterintuitive piece: many physicians pursue side gigs not despite burnout, but because of it. And when done thoughtfully, this can actually work.


Burnout in medicine is often less about total hours worked and more about lack of agency—the "moral injury" of being unable to practice according to your values because of systemic constraints. Surveys in 2024-2025 continue to show roughly half of physicians reporting burnout, with particularly high rates in fields like neurology and urology.


Side gigs can function as a restorative mechanism when they restore what clinical work has stripped away: control. Expert witness work, consulting, medical writing—these roles let you exercise different intellectual muscles in environments where you set the terms. The financial cushion they provide can also give you what some call "F-U Money"—the security to say no to unreasonable administrative demands, to reduce your clinical FTE to a sustainable level, or to walk away from a toxic work environment.


But there's a critical caveat. Recent 2024-2025 surveys consistently find roughly four in ten physicians with outside paid work, and those who stack side gigs on top of unchanged clinical loads often accelerate their trajectory toward total exhaustion. The strategy only works if you treat side gigs as a reallocation of your professional time, not just an addition to it.

Side gigs can function as a restorative mechanism when they restore what clinical work has stripped away: control.

Who's Actually Doing Side Gigs?

The demographics of physician side gigs reveal both opportunity and inequity. Studies on physician entrepreneurship show that male physicians have historically had higher rates of side gig adoption, particularly in ventures associated with innovation like biotechnology and health IT. This disparity matters because female physicians also report higher rates of feeling undercompensated and overworked.


The rise of flexible, remote-friendly side gigs—telemedicine, medical writing, surveys, chart review—may help democratize access. These options can be managed alongside the disproportionate household responsibilities many physicians (particularly women and caregivers) shoulder. The challenge is ensuring that the benefits of revenue diversification reach everyone who could use them, not just those with the most flexible schedules or the fewest outside obligations.

Before You Add a Side Gig: Foundations, Math, and Risk

Step 1: Calculate Your Effective Clinical Hourly Rate

Your most expensive resource is time. Before evaluating any side gig, you need a clear-eyed understanding of what your clinical time is actually worth—not just your base salary, but your Effective Clinical Hourly Rate (ECHR).


The formula is straightforward:

ECHR Formula

ECHR = Total Annual Clinical Compensation ÷ Total Hours Worked
(Clinical + Administrative + Call)

Calculate Your ECHR

Find out what your clinical time is really worth—then use it to evaluate any side gig.

$
Base salary + bonuses + benefits value

Include all the time—not just scheduled clinic hours.

Avg. hours, including weekends
Subtract vacation, CME, holidays

Most physicians underestimate their denominator. That 40-hour week often doesn't account for charting at home, administrative meetings, call coverage, or the cognitive overhead of staying current in your field. An attending who earns $400,000 and works 2,200 hours (including all the invisible labor) has an ECHR of roughly $182 per hour—not the $250+ they might assume from dividing salary by scheduled clinic time.


Once you know your ECHR, you can make rational comparisons. If a side gig pays less than your ECHR, it needs to offer at least one of these "alpha" factors to be viable:

  • Scalability: The potential to earn passive income later, where the hourly rate eventually decouples from time input (e.g., building a course or intellectual property).
  • Tax arbitrage: The ability to transform taxable income into tax-advantaged savings through 1099 structures.
  • Hedging: Diversifying income risk or building a "lifeboat" for career transition.
  • Restoration: Providing psychological relief that extends your overall career longevity.

The threshold varies by career stage. For residents earning $60,000 annually, moonlighting at $100-150 per hour can effectively double their take-home pay—a rational choice almost regardless of other factors. For mid-career specialists, side gigs often need to generate $300-500 per hour or offer substantial tax advantages to justify the intrusion into personal and family time.


Step 2: Understand How Extra Income Is Really Taxed

One of the most persistent deterrents to side income is the myth that earning more will somehow result in taking home less—that "jumping" into a higher tax bracket means your whole income gets taxed at that higher rate. This is a mathematical impossibility in a progressive tax system, yet it stops smart physicians from pursuing opportunities every day.


Here's how it actually works: A physician in the 32 percent marginal bracket who earns an extra $10,000 from a side gig pays 32 percent (plus applicable state and FICA taxes) only on that specific $10,000. The income earned in lower brackets remains taxed at those lower rates. Your marginal rate is not your effective rate. A single physician earning $200,000 might face a marginal rate of 32 percent, but their effective rate—total tax divided by total income—is typically closer to 20-24 percent.


Yes, high earners face "tax drag," where taxes reduce the compounding efficiency of investments. But this should not deter earning. Earning more money always results in more net wealth, provided the time investment is acceptable. The goal isn't to minimize taxes to zero—it's to maximize after-tax wealth while living a life you actually want.


Step 3: The 1099 Advantage and Solo 401(k)

Most side gigs classify you as a 1099 independent contractor rather than a W-2 employee. This distinction matters enormously for tax planning, and it generally works in your favor.


The crown jewel of 1099 income is the Solo 401(k), also called an Individual 401(k). As a self-employed contractor, you can open a Solo 401(k) for your side business. Unlike an employer 401(k), you act as both employee and employer. The contribution limits are substantial—in 2024, the overall solo 401(k) limit was $69,000, and in 2025 it increased to $70,000, with higher totals available for physicians using age-based catch-up contributions. You can contribute up to 20 percent of your net self-employment income as the "employer" contribution, even if you've already maxed out the "employee" contribution at your main job. These numbers change every year, so check the current IRS limits or talk to your CPA.


Beyond retirement contributions, 1099 income allows above-the-line deductions for legitimate business expenses: a dedicated home office, professional equipment, CME courses, licensing fees, professional subscriptions, and business-related travel. These deductions lower your Adjusted Gross Income (AGI), which can have downstream benefits across your entire tax picture.

Don't Forget Self-Employment Tax

Independent contractors pay both the employee and employer share of Social Security and Medicare taxes—a combined 15.3 percent. However, there's a ceiling on the Social Security wage base ($176,100 in 2025). Most physicians already exceed this limit through their primary W-2 job, which means they only owe the 2.9 percent Medicare portion on side gig income, plus the 0.9 percent Additional Medicare Tax if total earnings cross the high-earner threshold ($200,000 single / $250,000 married filing jointly). The exact numbers change annually, so confirm current limits with your CPA.

Step 4: When to Consider an LLC or S-Corp

For smaller or occasional side gigs—surveys, sporadic consulting, a few expert witness cases per year—a simple sole proprietorship or single-member LLC is usually sufficient. The administrative overhead of more complex structures isn't justified.


Once your side income exceeds roughly $80,000-100,000 in profit, it may make sense to elect S-Corp taxation status. The mechanism allows you to split income between a "reasonable salary" (subject to FICA taxes) and "distributions" (not subject to FICA). The potential savings can be meaningful, but they come with added complexity: payroll administration, separate tax returns, and more stringent record-keeping.


This is territory where a CPA familiar with physician side businesses earns their fee. Don't wing it.

Clinical Side Gigs That Maximize Your License

Locum Tenens: High Yield, High Friction

Locum tenens work—temporary clinical placement—has matured into a roughly $9 billion industry, with tens of thousands of physicians working locums positions annually. The market is driven by workforce shortages, vacation coverage needs, and the increasing reliance of rural health systems on temporary labor.


Rates vary substantially by specialty and geography. Anesthesiology currently commands $300-400+ per hour, driven by operating room staffing crises. Gastroenterology, with its procedure-heavy nature, ranges from $350-450+. Emergency medicine typically falls between $200-300 per hour, with significant variation based on trauma designation and urban versus rural setting. Psychiatry ranges from $180-250, increasingly delivered via telehealth. Family medicine tends toward $120-160, with the highest demand in underserved rural areas.


The "rural premium" is a dominant factor. Critical access hospitals in less desirable locations often pay 20-30 percent more than coastal metros. Physicians willing to engage in geographic arbitrage—living somewhere appealing while working locums in high-need areas—can maximize this spread. Many hospitalists we've spoken with use locums a few weeks a year as their "option B"—not as a permanent state, but as leverage when negotiating with their primary employer.


Working through an agency versus contracting directly involves tradeoffs. Agencies handle credentialing, travel logistics, and malpractice insurance, but they take a substantial margin—often 30-40 percent of the bill rate. Direct contracting captures that margin but requires you to self-manage credentialing, negotiate malpractice coverage, and handle travel. Low friction versus high yield: choose based on your bandwidth and deal-making appetite.

Watch for Malpractice "Tail" Gaps

Most locums assignments use "claims-made" policies that only cover claims filed while the policy is active. If a patient sues three years later, you're uncovered unless tail coverage was purchased. Reputable agencies typically provide this, but verify explicitly. If you're contracting directly, factor the cost (typically 150-200 percent of the annual premium) into your rate negotiations.


Telemedicine and Remote Clinical Work

Telemedicine has matured from pandemic stopgap to structural component of healthcare delivery. While rates have normalized from their COVID-era peaks, it remains a viable side gig for physicians who value flexibility.


Certain specialties benefit disproportionately. Psychiatrists report the highest share of telehealth-eligible spending at over 30 percent, followed by endocrinologists and neurologists. The cognitive and consultative nature of these fields translates well to video encounters.


Compensation models vary. Per-consult payment, common in urgent care platforms, typically runs $25-50 per encounter—a structure that can become a volume-dependent hamster wheel if you're not careful. Hourly arrangements, more common in primary care or longitudinal care, range from $100-150 per hour. Specialized services like tele-stroke, tele-ICU, and tele-psychiatry command higher rates due to their technical demands.


The licensure barrier remains significant. The Interstate Medical Licensure Compact has streamlined multi-state licensing, but you still need full licenses in every state where patients are located. The cumulative cost of maintaining multiple state licenses—fees plus CME requirements—can erode profitability for low-volume telemedicine work. Calculate the breakeven before committing.


Moonlighting and Extra Shifts

For attendings, additional shifts—urgent care coverage, nighttime hospitalist work, weekend call—represent the most direct path to extra income. The infrastructure already exists; you're just adding hours. This simplicity is both the appeal and the danger.

Residents face specific regulatory constraints. The ACGME imposes strict limits on resident work hours—the 80-hour work week averaged over four weeks—and moonlighting hours count toward this cap. A resident working 60 hours in the program who adds 25 hours of moonlighting puts their program in violation. Beyond the regulatory issue, residents found moonlighting without explicit Program Director approval can be dismissed for professionalism violations. This is a catastrophic career event, often making it impossible to match into another residency. The short-term income isn't worth the existential risk.


For both attendings and those residents with proper approvals, the key question is whether moonlighting serves as a bridge (accelerating debt payoff or building savings for a specific goal) or a burnout accelerant (simply piling more clinical hours onto an already-full schedule). Be honest with yourself about which dynamic is operating.


Medical Directorships and Med Spas

Medical directorships blend clinical oversight with administrative responsibility. These roles are common in nursing homes, infusion centers, dialysis clinics, and the expanding medical spa industry. Compensation typically runs $100-160 per hour for part-time work, often structured as monthly stipends of $2,000-5,000 for a set number of hours.


Compliance matters enormously here. Compensation must be "Fair Market Value" (FMV) to avoid violations of the Anti-Kickback Statute (AKS). Payments cannot be tied to the volume or value of referrals. Physicians must track hours meticulously to justify payments during an audit. This isn't paranoia—it's standard practice in a heavily regulated industry.


Med spa supervision deserves particular scrutiny. As the supervising medical director for aesthetic procedures performed by nurses or estheticians, you're liable for the clinical quality of the facility—even if you're rarely on-site. State medical boards have disciplined physicians for failing to properly supervise med spas, including cases where unlicensed staff performed procedures or where documentation was inadequate. Many states require specific chart review percentages or geographic accessibility. "Absentee directorships" are a primary enforcement target.


Non-Clinical Side Gigs That Monetize Your Expertise

Expert Witness Work and IMEs

Acting as a medical expert in legal cases is arguably the most lucrative side gig on an hourly basis. It requires solid clinical standing, board certification, and the ability to articulate complex medical standards to laypeople—skills most physicians already possess but rarely deploy in this context.


The fee structure, based on industry survey data from SEAK (a leading expert witness training organization), is substantial. Case review and preparation commands a median rate around $450 per hour. Deposition testimony—being questioned by opposing counsel—runs roughly $475 per hour. Trial testimony reaches approximately $500 per hour, often with minimum daily guarantees to compensate for the disruption of canceling clinical days. Most experts require upfront retainers before beginning work.

Independent Medical Examinations (IMEs) offer a related revenue stream. The average charge for an IME (examination plus report) runs in the range of $2,500-3,000, with hourly yields often exceeding $400 given the time investment.


The barrier to entry is reputation and organization, not certification. Attorneys prioritize experts who are currently practicing. A "professional expert" who has abandoned clinical practice loses credibility with juries, who may view them as a hired gun. This creates an interesting dynamic: expert witness work requires your primary clinical gig to exist as a credibility anchor.


Industry Consulting and Advisory Roles

Pharmaceutical and device companies need physician input on clinical trial design, product ergonomics, marketing messaging, and regulatory strategy. Key Opinion Leaders (KOLs) can command $500+ per hour for this work. Standard consulting rates for advisory boards typically range from $200-400 per hour.


There's a transparency dimension to consider. Under the Physician Payments Sunshine Act, all payments from drug and device companies are public record. For physicians in academic or public-sector roles, this requires careful management of disclosures to avoid conflicts of interest. Some institutions have strict limits on outside commercial ties; others simply require disclosure. Know your employer's policies before signing a consulting agreement.


Medical Writing and Content Creation

Medical writing spans continuing medical education (CME) content, regulatory submissions, grant writing, health journalism, and patient-facing materials. It's work that can often be done asynchronously—a significant advantage for physicians whose clinical schedules are unpredictable.


The income potential is meaningful. Industry data suggests freelance medical writers specializing in CME can earn six-figure gross revenue—notably higher than employed writers, reflecting the premium paid for specialized medical knowledge. Physicians can generally charge $100-200+ per hour for technical writing, though rates vary based on complexity, deadline pressure, and client budgets.


The downside is deadline management. Writing projects have firm deliverables, and balancing them against clinical responsibilities requires discipline. It's not clinical work, but it's also not passive.


Physician Advisor and Chart Review

Physician advisors help hospitals and payers with utilization review, clinical documentation improvement (CDI), and denial appeals. The work involves interfacing between clinical staff and administration to ensure documentation supports appropriate billing. Rates typically run $125-200 per hour, with growing demand for remote advisors.


Chart review for Independent Review Organizations (IROs)—evaluating insurance denials or disability claims—offers another entry point. Rates are generally lower ($85-150 per hour or per-case flat fees), and the work is volume-dependent. Efficiency matters here; physicians who can move quickly through cases without sacrificing quality earn more per hour invested. It's often considered an "entry-level" non-clinical side gig—low barrier to entry, but also lower ceiling.

Low-Friction Side Gigs: Surveys and Micro-Work

Medical Surveys and Market Research

Medical surveys often get dismissed by high earners as "pocket change." That's a mistake. With the right approach, surveys can generate $10,000-30,000 annually with high flexibility and zero liability. The work exists because pharmaceutical and device companies need real-time physician input on prescribing habits, treatment preferences, and market dynamics.


Typical rates range from $60-300 per hour, but they're usually paid in micro-increments—$50 for a 15-minute survey, for example. Key platforms include Sermo, M3 Global Research, All Global Circle, and InCrowd. To generate meaningful revenue, you'll need to register with multiple panels.


The survey market is highly stratified by specialty. Oncologists, neurologists, rheumatologists, and hematologists—physicians in fields with high-cost drugs and frequent R&D activity—receive the highest volume and best-paying survey invitations. Primary care physicians often "screen out" of high-value surveys because they don't prescribe the specific niche medications being researched.


Making Surveys Worth Your Time

Efficient surveyors treat this as a business. When an invitation arrives, calculate the implied hourly rate immediately. A $50 survey that takes five minutes equals a $600-per-hour rate—take it. A $50 survey that takes 45 minutes works out to $67 per hour, likely below your ECHR. Unless you're doing it in truly dead time (waiting for a flight, sitting in a parking lot), skip it. We regularly hear from physicians who treat surveys as "airport work"—only accepting invites they can finish while waiting for a flight or during other genuinely idle moments.

Tax Efficiency Tip

Survey income is 1099 income, which means it qualifies for Solo 401(k) contributions. If you're maxed out on retirement savings through your primary employer, survey income can create additional tax-advantaged space. A few thousand dollars in surveys, routed through a Solo 401(k), can reduce your current tax bill while building long-term wealth.

The Truth About "Passive" Income for Physicians

Real Estate Syndications: Lessons from 2020-2024

Real estate syndications—where physicians invest as Limited Partners (LPs) in large commercial or multifamily projects managed by a General Partner (GP)—have been aggressively marketed in physician finance communities. The promise: passive cash flow from rents plus equity appreciation upon sale, all with favorable tax treatment through depreciation pass-throughs.


The 2023-2024 economic cycle exposed the risks. Many syndications that purchased properties in 2020-2021 used floating-rate bridge debt to maximize leverage. When interest rates rose sharply, these deals faced severe cash flow crunches. Physicians who expected quarterly distributions instead received capital calls—demands for additional cash to prevent foreclosure. Some investments have been marked down substantially or lost entirely.


The tax benefits, while real, come with strings. Syndications often pass through depreciation losses, but for most physicians these Passive Activity Losses (PALs) cannot offset active clinical income (W-2 earnings) unless you or your spouse qualifies as a Real Estate Professional (REPS)—a demanding standard requiring 750 hours of annual participation.


None of this means syndications are inherently bad investments. It means they're not passive in the way they're often marketed. The due diligence required to evaluate deal structure, sponsor track record, debt terms, and market conditions is substantial active work. If you're not willing to do that work—or to accept significant loss of capital—these aren't the right vehicle.


Digital Products and Courses

Creating online courses or digital products ("How to Start a Direct Primary Care Practice," "Board Review for Pediatric Neurology") represents a genuinely scalable asset. Once created, the marginal cost of selling an additional unit approaches zero. The mathematics are appealing.


Success requires substantial upfront work and ongoing marketing effort. Building an audience, creating compelling content, managing a sales funnel, handling customer service—these are startup business activities, not passive investments. The market for physician-created courses is becoming saturated. Physicians without an existing platform or audience may find customer acquisition costs prohibitive.


If you have genuine expertise in a niche area and enjoy content creation, this path can work. If you're hoping to record a few videos and then collect checks indefinitely, recalibrate your expectations.

Protecting Your License, Job, and Reputation

Contracts, Non-Competes, and Duty of Loyalty

Before launching any side gig, pull out your employment contract. Look for three things: exclusivity clauses, intellectual property provisions, and non-compete language.


Non-competes have been in flux. In April 2024, the FTC adopted a rule that would have banned most non-compete agreements nationwide. Federal courts later vacated the rule, and in September 2025 the FTC dropped its appeals and formally acceded to that vacatur. In other words, there is no federal non-compete ban in effect. For physicians, enforceability still comes down to state law and the specifics of your contract. Some states (California, Minnesota, North Dakota) have strong bans on physician non-competes; in others, they're standard and enforceable. It's safest to assume your non-compete is binding unless a local attorney tells you otherwise.


Most employment contracts also include a "Duty of Loyalty" clause. Working for a competitor, referring patients to a side business you own (like a lab or imaging center), or using employer resources for side work can all constitute grounds for termination with cause. Even where it's technically permitted, the optics matter. Transparency is generally the safer path.


Malpractice Gaps and Vicarious Liability

Here's a mistake physicians make regularly: assuming their employer's malpractice policy covers side gig work. It almost never does. Employer policies are site-specific and scope-specific. Moonlighting at a different facility, performing independent chart reviews, running a telemedicine practice—all require separate coverage.


The risk compounds if you supervise other providers. Physicians employing or supervising nurse practitioners, physician assistants, or other staff can be held vicariously liable for their clinical actions. A standard individual policy may not cover the acts of supervised employees. Review your coverage carefully and discuss scenarios with your insurance broker.


Conflict of Interest and Institutional Policies

Physicians are regularly terminated for side gigs that conflict with institutional policies—even when those gigs would be perfectly legal for someone without their particular employment situation.


Large academic and integrated systems (Mayo Clinic, Cleveland Clinic, and similar institutions) have rigorous policies regarding outside commercial ties. Physicians have been terminated for undisclosed conflicts or for activities deemed to compromise the institution's reputation. The bar for "compromise" can be lower than you might expect.


When in doubt, disclose. Check your institution's conflict of interest policy before starting any side gig. The conversation may be mildly awkward; the alternative—termination for cause with a damaged professional reputation—is considerably worse.


Social Media and Reputation in the Digital Age

The expansion into non-clinical side gigs, particularly content creation, blurs the line between private conduct and professional standing. Medical boards and employers have broad discretion to discipline physicians for "unprofessional behavior" online. Healthcare workers have been terminated for social media conduct or controversial online personas.


"Off-duty" conduct is rarely private in the eyes of an employer. If a side gig brings what's perceived as disrepute to the profession or your employer, it can be actionable—regardless of your legal right to engage in that activity on your own time. This doesn't mean you can't build a personal brand or create content. It means doing so with awareness of how your professional identity intersects with your public presence.

Building Your Physician Portfolio: A Practical Action Plan

Clarify Your Goal

Side gigs serve different masters. Before evaluating specific opportunities, get clear on what you're actually trying to accomplish:

  • Debt acceleration: You want to pay off loans faster and need maximum income per hour invested.
  • Employer diversification: You want to reduce dependence on a single income source for security and negotiating leverage.
  • Identity exploration: You're curious about non-clinical work and want to test whether it suits you before making bigger changes.
  • Exit ramp construction: You're building toward a career transition and need to develop alternative income streams before you can afford to leave clinical practice.

Different goals point toward different gigs. Someone focused on debt acceleration should prioritize high hourly rates and immediate income (locums, expert witness work). Someone exploring identity might accept lower rates for the chance to try medical writing or consulting. The math changes when you know what you're optimizing for.


Run Candidate Gigs Through the Filters

For any side gig under consideration, work through these five questions:

  • ECHR comparison: How does the gig's effective hourly rate compare to your clinical rate? If it's lower, what alpha factor justifies it?
  • Burnout impact: Will this feel energizing or draining? Does it restore autonomy, or does it just add hours to an already-full schedule?
  • Legal and contract risk: Does your current employment contract permit this? Do you have appropriate malpractice coverage?
  • Tax and entity implications: Is this 1099 income you can run through a Solo 401(k)? At what income level does an S-Corp make sense?
  • Scalability: Is this purely time-for-money, or does it build toward something larger (expertise reputation, intellectual property, exit options)?

Guardrails by Career Stage

Residents and fellows: Your constraints are real. ACGME hours, Program Director approval, and the existential risk of dismissal all limit options. Focus on sanctioned moonlighting (with explicit approval) or low-time-commitment options like surveys. Protect your training position above all else.

Early-career attendings: This is often the highest-leverage period for side gigs. Student loan balances are fresh, lifestyle inflation hasn't fully set in, and you have energy. Prioritize debt payoff, skill building, and low-risk experiments in non-clinical work. This is the time to open that Solo 401(k).

Mid-career physicians: If burnout is a factor, focus on gigs that restore autonomy rather than just adding income. Locums can provide geographic variety and schedule control. Expert witness work and consulting leverage accumulated expertise. This is the stage where serious portfolio construction becomes possible.

Late career and pre-retirement: Consider directorships, consulting, teaching, and advisory roles that let you stay engaged without full clinical intensity. These "glide path" gigs can ease the transition to retirement while maintaining professional identity and income.


From Hustle to Portfolio

The goal isn't to hustle harder. It's to build a portfolio of professional activities that supports your health, your wealth, and your autonomy—a career architecture that gives you options rather than trapping you in a single dependency.


That means treating side gigs as businesses, with appropriate professional support. A CPA who understands physician side businesses can help you optimize entity structure and retirement contributions. An attorney can review contracts and ensure you're not inadvertently violating employment agreements. Malpractice coverage needs to match your actual scope of work, not your assumptions about what's covered.

Start Here

Pick one side gig that aligns with your goals and current constraints. Calculate your ECHR. Review your employment contract. Open a Solo 401(k) if you're generating 1099 income. These concrete steps move you from contemplation to action—from feeling stuck in a system you don't control to building a career that reflects what actually matters to you.

The monolithic physician career is fading. What replaces it is up to you—and our goal at Physician Living is to give you the tools to build a portfolio that supports your health as much as your net worth.

Sources and References

The data and statistics in this article are drawn from the following sources. Specific figures may change over time; we review this article periodically for accuracy.

  1. Physician burnout rates: Medscape National Physician Burnout & Depression Report (2023, 2024); American Medical Association survey data.
  2. Physician compensation trends: MGMA DataDive Provider Compensation; Medscape Physician Compensation Report (2023, 2024); analysis of compensation growth vs. CPI.
  3. Student debt statistics: Association of American Medical Colleges (AAMC) Medical School Graduation Questionnaire; Medscape surveys on physician debt.
  4. Side gig prevalence: Physician entrepreneurship and side gig surveys (various industry sources, 2023-2024).
  5. Locum tenens market data: Staffing Industry Analysts; AMN Healthcare locum tenens reports; specialty-specific rate surveys from locum agencies.
  6. Expert witness fees: SEAK Expert Witness Fee Survey (most recent edition at time of publication).
  7. Telehealth utilization: FAIR Health data; CMS telehealth utilization reports; specialty-specific telehealth spending analyses.
  8. Medical writing compensation: American Medical Writers Association (AMWA) salary surveys.
  9. Solo 401(k) and tax rules: IRS publications on retirement plan contribution limits; general CPA guidance. Contribution limits and wage bases are subject to annual adjustment.
  10. FTC non-compete ruling: FTC Final Rule on Non-Compete Clauses (April 2024); federal court vacatur; FTC accession to vacatur (September 2025). There is currently no federal non-compete ban in effect.
  11. ACGME work hour requirements: ACGME Common Program Requirements (current edition); ACGME guidance on moonlighting.
  12. Real estate syndication market dynamics: Industry reporting on multifamily and commercial real estate performance (2023-2024); analysis of floating-rate debt and capital call events.

Disclaimer

This article is for general educational purposes only and does not constitute medical, legal, or tax advice. Tax laws, employment regulations, and licensing requirements vary by state and change over time. Please consult your own attorney, CPA, and employer policies before pursuing any side gig or making financial decisions based on this content.

Spencer Lee

Spencer Lee

Managing Editor Physician Living
https://www.physicianliving.com/

Spencer combines a 20-year career in business strategy with seven years of direct experience managing the professional entity for a physician partner. He specializes in the logistics of the "incorporated physician"—including entity payroll, SEP-IRA administration, and tax flow strategy.