8 Ways to Earn Extra Income From Medical Activities

Leigh Page


March 22, 2016

In This Article

5. See Nursing Home Patients

There's a reason why physicians caring for nursing home patients usually do it part-time, says Reuben Tovar, MD, a hospitalist who serves as medical director at two nursing homes in Austin, Texas. "If you're working full-time, going to many different facilities," he says, "you lose your focus, and the quality of care suffers."

Dr Tovar says the best way to work in a nursing home is to serve as medical director and see patients there as well, which is what he does. The medical directorship is necessary, he says, because Medicare and Medicaid don't pay well for patient visits. But nursing homes prefer their medical directors to provide patient care because they're therefore more engaged with how the facility operates.

A medical director job requires at least 20 hours of work a month, usually in regular meetings with staff and to comply with deadlines for regulations, Dr Tovar says. The medical director typically spends another 10 hours a month seeing patients in the facility.

Salaries for nursing home medical directors run from $54,000 to $103,000 a year, and the median is $78,000, according[8] to PayScale, an Internet-based research firm. In addition, reimbursements for treating individual patients can bring in $75-$150 an hour, if coded correctly, according to a 2010 report published by the Kaiser Family Foundation.[9]

Nursing homes are looking for medical directors who are empathetic and reliable, and who have a lot of older patients in their practice who might consider using the facility someday, Dr Tovar says. Physicians who want to be medical directors should go to classes endorsed by the American Medical Directors Association (AMDA), which represents nursing home medical directors, and obtain AMDA certification, he says. Dr Tovar didn't take that route, though. He began by visiting a nursing home when one of his patients was admitted, which ultimately led to the administration asking him to be medical director.

Nursing homes are frequently sued for malpractice or elder abuse, but only one fifth of these lawsuits name a physician, according to a 2003 study[10] published by the journal Health Affairs. Dr Tovar says that's because these cases often involve problems that occur when the physician isn't in the facility, such as patient falls.

Nonetheless, all the litigation has made it harder for medical directors to get malpractice insurance. A 2009 survey[11] by AMDA found that 11% of nursing home medical directors had problems obtaining coverage. Although that figure was down from 31% in 2003, the problems haven't gone away. Of the medical directors reporting problems in 2009, 16% said they had to modify their practices, and of those, fully one half had stepped down from their posts.

Certain physicians thrive in a nursing home environment, says Robert Milligan, MD, a family physician in Buffalo, Minnesota, and AMDA member.[12] "They have to love people and be extremely compassionate, and you have to like a good puzzle," he says. "The average individual we care for in a nursing home has seven medications and 10 diagnoses."

Nursing home physicians also have to deal with numerous phone calls from staff and demands from family members. "The main talent you need to have is patience," Dr Tovar says. "The conversations are slower for these patients, and the family needs to be involved."

Pros: Work in nursing homes is usually part-time, and it can pay well if you combine it with a medical directorship.

Cons: Physicians may be overwhelmed with calls from staff and families' demands. Facilities face numerous lawsuits for malpractice and elder abuse, but doctors are usually not named in them.


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