Psychiatry side gigs abound for those who want to hone their skills and boost income. Panelists at APA’s Annual Meeting outline important considerations, jobs they’ve tried, and how to land a gig.

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A panel of psychiatrists who have tried their hand at just about every psychiatry side gig there is shared their wealth of expertise at a packed session during APA’s 2019 Annual Meeting. Here’s what you need to know.

Nearly three-quarters (73%) of psychiatrists have a side gig, according to a survey of 200 individuals who responded to an informal questionnaire posted on the sites of two psychiatry social media groups. The findings were presented by Abhisek Chandan Khandai, M.D., M.S., a session panelist and consultation-liaison fellow at the University of Washington Medical Center in Seattle.

Moonlighting, which was defined as part-time, in-person clinical work, was the most common side gig reported by survey respondents (who were predominantly female), followed by physician surveys, paid speaking engagements, and telepsychiatry.

Khandai said one reason it is easy to moonlight in psychiatry is that there is little to no equipment or additional staff needed to practice, aside from perhaps a room in which to sit down with patients.

Christina Girgis, M.D., says that her moonlighting gig gives her an opportunity to work with patient populations that are different from those she treats in her full-time work. At right is Eli G. Aoun, M.D. Linda M. Richmond

The most common reasons given by respondents for taking on a side gig in psychiatry included a desire to boost disposable income, add variety, and increase enjoyment, Khandai said. Other common reasons included paying off educational debt, honing psychiatric and clinical skills, increasing access for patients/the visibility of the profession, and allowing for part-time work/career flexibility.

Eli G. Aoun, M.D., a general, addictions, and forensic psychiatrist and forensic psychiatry research fellow at Columbia University, is passionate about his many side gigs—from crafting mental health policies for government agencies to completing forensic work to doing clinical care—because they provide him an opportunity to use different skills

Side-Gig Considerations

Psychiatrists debating whether to pursue a side gig need to consider the following:

Employment contract: Psychiatrists working under an employment contract need to confirm whether the contract forbids other paid employment, Khandai advised.

Time and money: Khandai also recommended that psychiatrists verify how much time the side gig will require, including time for training, conducting research or writing, answering pages and emails, dealing with insurance companies, and writing prescriptions. It’s also important to confirm the compensation arrangement for both the position as well as these extra duties, including time spent on-call, Khandai added.

Liability: Potential liability, particularly malpractice exposure, is another important consideration, particularly if the position involves patient care or forensic work. Aoun said he finds it helpful to call his malpractice risk management service for advice before proceeding with any new gig.

Pros and Cons to Weigh

Panelists also reviewed the pros and cons of some common side gigs:

Moonlighting in emergency departments: Christina Girgis, M.D., said she supplements her full-time position as medical director of the Consultation-Liaison Psychiatry Services at Edward Hines Jr. Veterans Administration (VA) Hospital and associate program director of the Psychiatry Residency Program at Loyola University Medical Center with a wide variety of side jobs. One job involves working a 12-hour shift every month in the emergency department at a county hospital. This moonlighting gives her needed variety in her work. “I mostly see older male patients at the VA. This gives me the chance to work with children and women. I love being able to see people in an acute setting.”

Completing chart utilization reviews: Girgis also conducts chart utilization reviews for a health plan to help determine whether treatment should be extended for inpatients who are running out of coverage. Sometimes she suggests a change to a patient’s treatment regimen. “I feel like I’m contributing in a positive way,” she said. “The company I work for has never pressured me to approve or deny continued care.”

Conducting psychiatric evaluations: Girgis also has worked for state contractors conducting psychiatric evaluations for individuals who have applied for disability benefits. For these she performs a straightforward assessment, providing a likely diagnosis and statement about the individual’s functionality. Girgis found this type of work discouraging at times because in some cases individuals were not getting good mental health care, she explained.

Setting up a small private practice: Aoun has a very small private practice for which he often receives patient referrals from colleagues or websites. “This is easy to do on the side in urban centers, where there is ample office space for rent designed for mental health professionals,” he said. He advises patients up front that it can take up to 24 hours for him to respond to messages and that they should seek emergency help from the emergency department or call 9-1-1 if the need should arise. He advises psychiatrists pursing this to arrange for formal clinical supervision.

Pursuing forensic work: Aoun finds his forensic work very rewarding, which involves assessing the mental health of individuals involved in criminal cases and then writing a report in laymen’s terms. He also does consulting work in this area, which he said is lucrative. The majority of cases are settled out of court rather than proceed to trial, he said. “I am careful to inform individuals that we’re not meeting as a patient and a doctor and that the things they tell me are not going to be private or confidential.” he said. “It’s very important to make these boundaries clear.”

Completing physician surveys: Although close to a quarter of survey respondents said they complete physician surveys on the side to earn extra cash, panelists and attendees both agreed these are time consuming and not a meaningful source of revenue. One attendee remarked that after completing a lengthy survey, he didn’t receive the promised compensation.

Other side gigs that Girgis has done include paid academic speaking gigs, giving grand rounds presentations at other hospitals, and reviewing potential medical malpractice cases for a plaintiff’s attorney to determine whether a case should move forward.

How to Land a Side Gig

All of Girgis’s side gigs came through referrals, as a result of networking with friends and colleagues, she explained. Similarly, Aoun said he has established a name for himself in forensic and addiction psychiatry and gets many referrals for work in this area as a result. Aoun said he does some writing for free, such as writing articles for APA’s publications, to help establish himself as a subject matter expert. ■