A few years ago, I interviewed for a full-time hospital medicine job in a new city.
Halfway through the interview, they asked if I'd be ok seeing 26 or more patients a day on average.
I told them that was a patient safety issue. And politely ended the interview right there.
That wasn't the only bad offer. When I moved, the job market was worse than I expected. Lower pay, terrible call schedules, no real path to earning more. I had done everything right up to that point yet felt like I was just another cog in the wheel.
So I tried locums. Not because I had a plan, but because I had no other option.
And that's when I was forced to learn something nobody taught me in medical school: how to think about my career like a business.
Which eventually led me to the question I now get asked: "How do I start building income outside of clinical work?"
In today’s newsletter:
PCPs are banding together to increase market power
How to start your journey into a side hustle
Locums and your non-negotiables
What I’m Reading
Primary care physicians are joining Independent Physician Associations (IPAs)
PCP practices have merged nationwide with large hospital systems but the doctors at Valley Medical Group joined an IPA to keep their autonomy
Doctors mentioned that joining a large health system not only takes away clinical autonomy but also siphons away money to the larger system
Congress passed a bill extending telehealth services for two years
Telehealth was expanded during Covid and this has been extended for another two years
If you’re looking to get into telehealth, this is still a good time to do so
The Real Reason You Haven’t Started
Most physicians I talk to say the same thing when the topic of side income comes up: "I just don't know where to start."
I get it. I was there too. When I first started thinking about building income outside of clinical work, I kept hitting the same wall: I couldn't figure out what skills I had that anyone outside of medicine would actually pay for. Honestly, I felt stuck.
That's the first trap. You've spent a decade or more becoming an expert in one thing. Your identity is tied to being a physician. So when you try to think about what else you bring to the table, your mind goes blank.
The truth is that you have more transferable skills than you think. Communication, systems thinking, high-stakes decision making, leadership under pressure, research literacy. These don’t just work in clinical medicine. They’re valuable skills that expand well beyond the hospital or clinic. The problem is we're trained to see ourselves as clinicians first and everything else second.
The second trap is thinking it has to be something you're passionate about. It doesn't. It just has to be something you can stick with long enough to get decent at.
A few years ago I tried breaking into healthtech. I spent months networking, went deep on it, and almost landed something. Then it fell through. I got burned out and stopped trying.
Looking back, I quit too soon. Not because healthtech was the right path (it wasn’t for me). But because I've come to realize that if I had kept going, something else would have landed. The networking, active outreach, and the informational interviews I did were not a waste. I just didn't give it enough time.
Which brings me to the thing nobody talks about enough: you are going to suck at first. But that’s the whole point.
Physicians are not used to being beginners. We spent years becoming the most competent person in the room. Starting something new means going back to zero. And that's uncomfortable in a way that's hard to explain until you're in it.
The skill gap is almost never the real problem. It's the ego gap. Physicians struggle to tolerate being mediocre at something, even temporarily. So they wait until they feel ready. And they never start.
Don't wait to feel ready. Start bad and stay consistent. You will get better.
💡The Practical Win
Take a few minutes today to write down five non-clinical skills you have.
If you’re stuck, input your professional work and education background into Claude or ChatGPT and ask: “what non-clinical skills does this background suggest I have?”
Then pick the one that interests you most and spend 30 minutes researching how other physicians are monetizing that same skill. You'll be surprised what's already out there. Use google, AI, and social media to help with your research.
The Locums Corner
🚀 How to quickly evaluate a locum tenens offer
Before you look at anything else, know what you won’t compromise on
Rate: Know your floor and don’t go below it. First offers are rarely the best.
What you DON’T want: Procedures? Nights? Define your limits early.
Specialty support: Smaller facilities have fewer consultants. Understand how comfortable you are without that support.
Travel distance: One flight away or two flights and a long drive? Too much travel can lead to more burnout.
Call expectations: In-house vs at-home call makes a big difference. Ask for specifics from the recruiter.
Keep in mind that not everything is negotiable, but most things are.
What’s Coming Next
Contract red flags that limit your options
Negotiating and how to do so skillfully
What to do when you’ve identified a side hustle you want to start
What is the #1 thing stopping you from creating a secondary income? Let me know and I’ll address it on a future newsletter!