Why Side Gigs Can Let You Say No to Overwork and Pay Cuts

Side gigs are all the rage these days, even among physicians. While those outside of healthcare are often surprised to hear this, chances are if you ask a medical professional about the trend, they'll know why physicians are pursuing alternate ventures with increasing fervor.

Dr. Nisha Mehta, MD

As founder of an online community with over 92,000 physicians interested in side gigs, I see the reasons for this on a daily basis. A few years ago, if you asked me whether physicians need side gigs, my answer would have been a resounding "No, but there are several benefits that make them worth pursuing."

These days, though, I'm forced to pause and consider how to answer the question. While I still feel that physicians can achieve significant financial success in medicine without a side gig and that side gigs aren't for everyone, I also know how critical secondary income streams can be in helping physicians shape the medical career they want.

Side gigs provide options and leverage. These are also the tools physicians need to fight back against shortsighted decisions in a healthcare system riddled with issues that compromise quality of care and threaten career longevity.

While many physicians still cite traditional reasons for pursuing side gigs — such as tackling student loans, enjoying a hobby outside of medicine, or the desire to have some additional spending money — the primary motivators I increasingly hear about are the need to leave clinical medicine, create financial freedom, or walk away from bad situations.

Ultimately, this desire is driven by worsening conditions for physicians within the healthcare ecosystem and decreased faith in the system as a whole. Due to a trend toward the devaluation of physician expertise and time, physicians increasingly see the need to seek financial security elsewhere and gain the power to say no.

Burnout — a prominent problem prior to the onset of the pandemic — has been exacerbated over the past few years. Despite being called "healthcare heroes" since the beginning of the pandemic, physicians have been fighting pay cuts, are being asked to make personal sacrifices, are given increased workloads without meaningful appreciation or reward, and are dealing with staffing shortages, among other issues.

The healthcare system has grown to expect the altruism of physicians and other medical professionals in order to function. Physicians rarely join unions or go on strike, and usually refuse to compromise patient care as a bargaining chip. As a result, they have little leverage in a system that values profits over quality of care.

Multiple times every year, physicians have to fight against proposed cuts to CMS Medicare fee schedules. Instead of targeting expenses fiercely guarded by profit-making entities with lobbying power, the system usually goes after physician compensation.

Recently, physicians were asked to take an almost 10% cut in reimbursement, amid rising inflation and after stepping up to care for patients during the pandemic, often at great personal sacrifice. While most professionals would expect a raise for going above and beyond, physicians have to fight just to maintain compensation.

In fact, physician salaries make up a very small percentage of healthcare expenditure in this country (< 8%!), and cutting physician salaries by a few percentage points will have a negligible effect on curbing healthcare expenditures. What these cuts do, though, is threaten the sustainability of independent practices, decrease quality of and access to care, and augment disenchantment with the healthcare system.

While physicians don't strike, they do experience burnout. And when that happens, they quietly plan to exit or look elsewhere for fulfillment. Pay cuts, too, motivate physicians to consider escape options. These options include switching jobs, shifting practice models, declining to care for patients with insurance that reimburses poorly, cutting back clinically, and leaving medicine entirely.

This is where side gigs come in as a potential solution. The extra income can allow physicians to drop clinical hours, call requirements, or insurance contracts that frequently deny claims. It also can allow employed physicians to say no to unreasonable requests by employers and maintain some revenue while figuring out their next move. Side gigs that ultimately fulfill physicians' financial needs may also result in physicians electing to leave clinical medicine for a practice model that allows them to spend more time focusing on the aspects of doctoring that they enjoy.

Physicians can use their medical skills for consulting, nonclinical careers, non–patient-facing roles, health coaching, medical writing, and other pursuits. While a lot of these jobs pay less than doctoring, they can offer more personal time, boundaries, or fulfillment. Some physicians use the clinical income they have earned over the years to invest in cash-flowing income streams that can allow them to be less dependent on clinical income, giving them the financial freedom to do medicine only if they choose to. With increasing frequency, we see posts on our websites declaring independence from medicine altogether or shifts to alternative career paths.

It's often said that your best tool at a negotiating table is the ability to walk away. With side gigs, alternative income streams, and more business and finance knowledge, many physicians are leveraging this tool. Indeed, the physician financial trajectory is unique, and the shackles that burden physicians at early stages of their careers (student loans, mortgages, years of lost retirement contributions) are eventually shed. Once debt has been cleared and retirement secured, many physicians are able to consider making less money or even retiring.

Physician demographics are changing. Millennials often choose lifestyle over money, and a larger number of physicians are positing that they don't need as much money but do need more happiness and less burnout.

The point here is that physicians are finding that they can walk away, say no, or set boundaries, and they're demonstrating this with increasing frequency. As physician compensation and expertise continue to be devalued, more physicians are deciding that the demands and frustrations of clinical medicine aren't worth it. They're hearing the message that they aren't valued by policymakers and are choosing to leave a system where physician shortages are being felt throughout the country. We hear more and more voices from the frontlines saying enough is enough.

There is an increasing sentiment that if the healthcare system simply views physicians as cogs in a wheel, physicians don't owe the system the same loyalty that they have traditionally demonstrated toward their patients and employers. Therefore, despite loving the science and their patients, they choose to leave.

From a policy perspective, these facts should terrify anyone concerned about the sustainability of the current healthcare system and access to patient care. Attempts to squeeze more out of physicians, either financially or from a workload standpoint, are shortsighted and will directly impact access and quality of care.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Nisha Mehta. Why Side Gigs Can Let You Say No to Overwork and Pay Cuts - Medscape - Aug 25, 2022.