Should spine surgeons take a side gig?

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Spine surgeons often start their careers with debts from their education and training, and they might want to pursue extra work to make extra money.

Six spine surgeons discuss whether side hustles are a good idea for early-career spine surgeons or if they should hone in on one area first.

Note: Responses were lightly edited for clarity.

Question: What work should early-career spine surgeons do to supplement their income?

Joseph Ferguson, MD. MedStar Health (Washington, D.C.): Young surgeons should focus on getting more experience as opposed to diversifying what they do and trying to figure out other ways to supplement income. It's a tremendous shift from training to becoming an attending in terms of income, and there are other ways. You have to become an expert and have things to offer at some point. But early on, you're essentially a brand new attending. I'm not sure what you have to offer a practice or a device company early on.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Early on in your career, finding side hustles to make up some cash, or get an early start on repaying student loans is difficult. Locum tenens is one consideration, but makes it hard to focus on building your practice.  Early on, it is difficult to get consulting gigs due to "greenness." I would advise taking calls that are paid and potentially joining in real estate investment groups, starting very small.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): There are many opportunities for physicians to supplement their incomes. The choices may be somewhat limited for early-career spine surgeons, since they typically have not yet built up sufficient capital to invest in passive income opportunities that could be offered either through their practice (buy-in into physical therapy, imaging, ASC, etc.) on in their area (startup businesses that need capital). The easiest choice for supplemental income for an early-career spine surgeon is to "sell their time" as a licensed physician somewhere else other than their main practice.  This could be taking additional paid ER calls, performing medical record reviews for insurance companies or law offices, and performing independent medical exams. There are also opportunities for consulting and medical device development. More entrepreneurial physicians could also consider opening a completely different business, but they may be limited in how much time they could devote to it in addition to the time they already spend at their main practice.  

William Taylor, MD. University of California San Diego Health: Early career spine surgeons should consider multiple avenues for supplementing their income that lay outside of simply increasing patient volume.

In addition, each one of these can lead to an increase in volume, better patient mix and new opportunities.

Most people think of working with industry, but the real advantage comes from considering how in your practice area and what opportunities you have to become a key opinion leader. This includes working on development projects, teaching courses and consulting. However, to do this, the individual spine surgeon needs to put work in to advance their reputation, both locally and internationally, that would include spending time and money to ensure participation in local regional and national meetings to advance their cause. Consider investments in research personnel to their practice and OR group.

I think many people forget that quite often clinical trials can be a source of both patient advancement in your career and providing financial stability in your practice, when run correctly. This will advance your career and increase the possibility of moving into a leadership position p within your area of expertise.  

My advice would be to first consider an area of specific specialty advancement that fits in with your practice pattern and patient population.

Timur Urakov, MD. University of Miami (Fla.): Bottom line is important but should not be the primary focus of an early-career spine surgeon. Instead, concentrate on safe practice development, patient care and buildup of surgical technique armamentarium. Young surgeons should further develop trusting relationships with their mentors and peers. Strong clinical base will open many opportunities, but a rushed early lucrative deal may shut it all down.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Concentrate on your specialty, referral patterns and growth within one's region. An excellent strategy to build one's exposure and reputation is by taking additional calls in a reputable hospital with trauma services and appropriate ICU back-up. Willingness to assist in caring for all patients in the community seems to be the rarity and is welcome among larger health systems versus pervasive profit-centric mentalities.  

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