The One Thing Standing Between You and Leverage

I was calculating how many shifts I'd need to work per month to cover my mortgage, my loans, and the life I thought I was supposed to be living. The number was high. The margin was thin. And the only lever I had was "work more hours at the same place for the same people”.

I realized something had to change.

I moved to a new city and started locum tenens work. Suddenly, I had to become a business owner. Luckily, it was one of the best decisions of my life.

In today’s newsletter:

At least nine new physician-ownership platforms launched in 2025 alone, all built around autonomy:

Federal loans for medical school are now capped at $200K total while average debt exceeds $234K.

Over half of physicians now have a side hustle. When I first saw that stat, I thought, "good for them." Then I thought about it more and realized the number should be higher.

Not because every doctor needs to be grinding on a passion project at midnight. But because having one income source as a physician in 2026 is a fragile way to live.

The U.S. Senate held hearings on physician burnout last month. The AMA published data showing that doctors who lack control over their work environment are more likely to burn out, quit, or cut hours. And a Becker's piece from January had five physicians debating whether autonomy in medicine is basically dead.

Here's what my takeaway from all of that was: you don't have to wait for the system to fix this. You can build your own margin right now.

One side income stream. Not five. Just one thing that puts money in your pocket from a source other than your primary employer. It’s one step to feeling autonomy.

When I started doing locum tenens work, something shifted in my head the first time that deposit hit.

That one stream gave me something I didn't realize I was missing: Leverage.

When you have even a little income coming in from somewhere else besides your W2 job, you negotiate differently. You make decisions differently and stop saying yes to things out of fear and start saying yes to things out of choice.

Not every side gig is worth your time. Physicians get pitched everything from MLMs to crypto courses to "passive income" real estate courses that are anything but passive.

Here's what's actually working for doctors right now, based on what I've seen, what I've tried, and what I'm hearing from physicians in the trenches.

Remote chart review. Companies pay physicians to review medical records, usually on a per case basis. You work from your laptop on your own schedule. The pay varies by specialty and complexity, but the barrier to entry is low and the flexibility is real. This was my first side stream. I picked it because I could do it between locums assignments without committing to a set schedule.

Expert witness work. You review medical records, write opinions, and occasionally testify. Specialties like emergency medicine, orthopedics, and internal medicine are in demand. The catch is inconsistency. Cases come and go. But when they come, the pay is significant.

Telemedicine. Platforms are everywhere now, and you can often set your own hours. It's clinical work, so it won't feel like a break from medicine. But it's clinical work on your terms. Some physicians use it as a bridge while others as a permanent supplement.

Medical writing and content. Pharma companies, medical education firms, and health tech startups need physicians who can write and review content. The pay ranges from modest to surprisingly good depending on the client and the scope. You don't need to be a "writer." You need to be a physician who can explain things clearly. Lower bar than you think.

These aren't the only options. But they're real and most importantly, they're accessible, and they don't require you to quit anything.

Here's what I'd tell a colleague if they sat down next to me and said, "I want to do this but I don't know where to begin."

Build a resume. Most physicians only have a CV. Great for academic jobs and credentialing. Useless for side gigs. A resume is one to two pages, skills forward, and tailored to the opportunity you're going after. If you don't have one, make it your first project this week. It forces you to think about what you bring to the table outside of your clinical title. Look at examples of good resumes online.

Start with what's closest to what you already do. Don't try to learn an entirely new skill set on top of your clinical load. Use what you've already built. You've been reviewing charts your entire career. You've been explaining medical concepts to patients for years. The skills transfer.

Set a small goal. Don't aim for $10K a month on the side. Aim for your first dollar. Your first case or just your first gig. The psychological shift from zero side income to any side income is the biggest jump you'll make.

Don't wait until you're miserable. The best time to build a side stream is when you don't desperately need one. Desperation makes you take bad deals, accept bad rates, and rush into things you haven't vetted. Start from a position of curiosity, not crisis.

I'll be honest. The locums market for hospitalists is slow right now. I'm seeing it firsthand. Fewer assignments coming through with longer gaps between contracts. Other specialties may be different, but if you're a hospitalist out there looking and it feels harder than usual, it's not just you.

Here's what I'm doing about it instead of waiting around.

Slow markets don't last forever but make sure you’re ready when they pick up.

What’s coming in the next few issues: