Physician Side Gigs That Actually Pay (And the Ones That Waste Your Time)
Every physician I know has looked at a side gig at some point. Usually it happens in one of two moments: when the loan balance finally registers, or when the main job starts to grind and a second income stream looks like an escape hatch. Both are legitimate reasons. But most of the advice out there is written by people selling you a course, and it treats every side gig as equally wonderful. They are not. Some pay well for the hours you put in. Some pay terribly and eat the only free time you have left.
I am going to walk through the common options the way I would explain them to a resident in my office: what the work actually is, what it pays relative to the time it takes, and who should bother. The single most useful habit you can build here is dividing every opportunity by hours. A gig that pays a lot but requires enormous unpaid ramp-up time can be worse than a boring one that pays a moderate hourly rate starting on day one.
First, do the math on your baseline hour
Before you take any side gig, figure out roughly what one hour of clinical work pays you at your main job. Physician compensation varies widely by specialty and region, so I will not pretend there is one number, but you can calculate your own in five minutes: take your gross pay, divide by the hours you actually work, including charting at home. That number is your benchmark. Any side gig that pays meaningfully below it needs a nonfinancial justification, like building a skill, building a network, or building an exit.
Also be honest about opportunity cost. An hour spent on a survey is an hour not spent sleeping, exercising, or seeing your kids. Burnout is expensive. A side gig that pushes you into resentment at your main job is a net financial loss, whatever the invoice says.
The gigs that actually pay
Moonlighting
Extra clinical shifts, either inside your own institution (internal moonlighting) or at another facility. This is the highest-yield option for most residents and early-career attendings because there is zero ramp-up: you already know how to do the work. Hospitalist coverage, urgent care shifts, and overnight cross-cover are the usual formats. The pay is real clinical pay, and you can often stack shifts when you want money and stop when you do not.
The catches are real too. Residents need program approval, and duty-hour rules still apply. You need to confirm malpractice coverage for the moonlighting site, because your training program's coverage usually does not follow you to an outside job. And check your fatigue honestly. If you moonlighted Saturday night and you are presenting sick patients Monday morning, your primary job will feel it. If you are still learning how to run a service efficiently, our rotation guides exist precisely so the clinical work itself stops being the hard part.
Locum tenens
Locums is moonlighting scaled up: temporary coverage contracts, often out of town, ranging from a weekend to several months. Daily rates are strong, and travel and lodging are typically covered. For attendings between jobs, or anyone who wants to compress a lot of earning into a defined block, locums is one of the best deals in medicine.
The friction is licensing and credentialing. Getting a new state license and hospital privileges can take months, so locums rewards people who plan ahead and keep their paperwork tight. It also pays you as an independent contractor, which brings tax consequences I will cover below. Do not sign the first agency contract you see. Rates are negotiable, and agencies count on you not knowing that.
Telemedicine
Asynchronous and video visits through a platform, done from your couch. The appeal is obvious: no commute, flexible hours, work in scrubs bottoms and a respectable shirt. Pay per encounter varies a lot between platforms, and the honest summary is that telemedicine pays decently for high-volume, low-complexity work. If you are efficient and the platform keeps your queue full, the effective hourly rate can be respectable. If the queue is empty, you are sitting at your laptop earning nothing.
Watch three things: whether you are paid per encounter or per hour, whether the platform requires you to hold licenses in multiple states (and who pays for them), and what the malpractice arrangement is. Multistate licensing is the hidden startup cost of telemedicine.
Expert witness work
Reviewing medical records for attorneys and, occasionally, testifying. Hourly rates here are the highest of anything on this list, often several multiples of clinical pay. The work is genuinely interesting if you like careful chart review and forming defensible opinions.
The barriers: it usually requires board certification and active clinical practice, cases arrive irregularly, and your first case will take you far longer than you bill for because you are learning the format. Your reputation is the product. Take only cases in your actual area of expertise, write opinions you would defend under cross-examination, and never become the expert who will say anything for a fee. That person's career ends badly.
Chart review and utilization review
Insurance companies, disability carriers, and review organizations pay physicians to review charts and render opinions on medical necessity. The pay per case is moderate, the work is steady and predictable, and you can do it at 10 pm in silence. Nobody codes, nobody pages you. For physicians who want reliable supplemental income without patient contact, this is the workhorse option. It will never make you rich, but the hourly math is usually fair once you are fast at it.
Medical writing and reviewing
Writing CME content, question banks, patient education material, or reviewing manuscripts and educational content for accuracy. Rates vary enormously. Established medical writers with a portfolio do fine. Beginners often earn embarrassingly little per hour until they get fast and get known. Treat the first year as paid training. If you actually enjoy writing, this compounds: your rate rises with your reputation, and the work is portable anywhere. If you do not enjoy writing, this is the wrong gig, because the only way through the low-paid early phase is liking the work.
Precepting and teaching
Community preceptors take medical students or NP and PA students into clinic. Some arrangements pay a modest stipend, some pay nothing but offer adjunct appointments and CME benefits. Financially, precepting is weak. I include it because the nonfinancial return is real: teaching sharpens your own practice, and watching a student learn to present a patient properly is its own compensation. Take students because you want to teach, not for the stipend.
Paid surveys
Market research firms pay physicians for opinions on drugs, devices, and practice patterns. Individual surveys pay small amounts for short time commitments. The hourly rate on the surveys you actually qualify for is often decent; the problem is volume and screen-outs, where you spend five minutes on qualifying questions and get rejected. Surveys are fine as pocket money you earn in the gaps of a day. They are not an income stream and were never going to be. Sign up with several panels, answer honestly, and never let a survey displace an hour you could bill clinically.
Time versus money, summarized
| Side gig | Effective pay for time | Ramp-up cost | Best for |
|---|---|---|---|
| Moonlighting | High | Low | Residents (with approval) and early attendings |
| Locum tenens | High | Moderate (licensing, credentialing) | Attendings with schedule flexibility |
| Expert witness | Very high per hour | High (reputation, irregular flow) | Board-certified attendings in active practice |
| Chart review | Moderate | Low | Anyone wanting steady, quiet income |
| Telemedicine | Moderate, volume dependent | Moderate (licenses) | Efficient clinicians in shortage specialties |
| Medical writing | Low early, better later | High | People who genuinely like writing |
| Precepting | Low | Low | People who want to teach |
| Surveys | Fine per minute, tiny volume | None | Pocket money only |
The ones that waste your time
A few categories deserve a warning label. Multilevel marketing pitched at physicians, usually supplements or skincare, is not a side gig. It is a way to convert your professional credibility into someone else's revenue. Decline.
Generic content creation, meaning the podcast, the YouTube channel, the Instagram account, is not a side gig either. It is a startup with a years-long unpaid runway and a low probability of meaningful income. Some physicians make it work. Most earn nothing for hundreds of hours. Do it if you love it. Do not do it for money.
Day trading and speculative crypto deserve their own sentence: physicians are famous marks for bad investments precisely because we have income and confidence. A side gig pays you for work. Speculation is not work, and it is not a side gig.
Finally, be suspicious of anything that requires you to pay substantial money up front to start earning: courses that teach you to do the gig, certifications nobody asked for, franchise-style arrangements. Real side gigs pay you from the first hour.
The tax side, in plain English
Almost everything above pays you as an independent contractor rather than an employee. That changes several things, and you should understand them qualitatively before your first invoice.
- Nothing is withheld. The check looks bigger than it is. A meaningful slice belongs to the government, and you generally need to send estimated tax payments during the year rather than settling up in April, or you can face penalties.
- You pay both halves of payroll taxes on self-employment income, which surprises people the first year.
- You can deduct legitimate business expenses: licenses and DEA fees allocable to the work, malpractice tail coverage you purchase, equipment, some home office costs if you meet the rules. Keep records as you go, not in April.
- Self-employment income can open additional retirement account options with meaningful contribution room, which for a high earner is often the single biggest financial benefit of 1099 work.
- An accountant who works with physicians is usually worth the fee once your side income is more than trivial. This is not the place to learn by trial and error.
The rules here change, they have thresholds and exceptions, and your situation is specific. Get real advice before you rely on any of it.
Bottom line
If you want money soon, moonlight or do locums. If you want quiet, steady income without patients, do chart review. If you want the highest hourly rate and have the credentials, build an expert witness practice slowly and honestly. If you want to write or teach, do it with open eyes about the pay. And if a gig requires you to recruit, speculate, or pay to play, walk away.
One more thing. The best side gig decisions I have seen were made after talking to physicians already doing the work, not after reading a listicle, including this one. Ask around, compare notes, and if you want a place to do that, the free community at historyandphysical.net/community is full of residents and attendings comparing exactly these numbers. You can also browse the rest of the blog for the companion pieces on physician finance.
Where HistoryandPhysical.net fits in
Most side gig math ignores the cheapest lever available, which is spending less on the things you already buy every year.
- Study resources are a recurring cost. $400 to $600 a year is normal for a single large exam bank. Membership here is $10 a month or $59 a year at the founding rate for 46 banks and over 3,800 questions.
- No separate purchases. The timed exams, the specialty banks and the AI analysis are all inside one price rather than sold individually.
- Cancel when you are done. Two clicks, with a 30 day refund window on any payment, and pausing available if you step away.
- The free layer costs nothing at all, including the rotation guides, calculators and note templates.
The comparison page puts the published prices next to each other, including the cases where a competitor is the better buy.
Keep going with Alo Academy
Writing a good note is one part of the job. Passing the exams that get you there is another. Alo Academy covers those with question banks kept current with the exams, explanations that show the reasoning rather than the answer, and AI analysis that finds the specific mistakes costing you points, plus a dashboard that turns it into what to study next.