8 Ways to Earn Extra Income From Medical Activities

Leigh Page

Disclosures

March 22, 2016

In This Article

7. Provide Care to Prisoners

Treating inmates in state and federal prisons is emerging as a feasible way for physicians to earn extra income. Prisons have a great need for more doctors, and they have the cash to compensate them for their work.

What's changed? Prison systems are under growing pressure from the courts to improve their healthcare of inmates, which used to be atrocious. A 1976 US Supreme Court decision (Estelle v Gamble) established a prisoner's right to healthcare, and in recent years courts have been enforcing aspects of that decision.

From fiscal year 2007-2011, healthcare spending per inmate saw a median growth of 10% in 39 states studied[20] by the Pew Charitable Trusts and MacArthur Foundation. This is on top of a 50% median growth in healthcare spending from 2001 to 2008, the two groups reported in July 2014. In addition, the ACA has pumped $7.7 billion in Medicaid spending into prison systems, according to a recent report.[21]

Michael Puerini, MD, a family physician in Salem, Oregon, has been working part-time in correctional facilities for about 25 years. The payments are comparable to those of private practice, says Dr Puerini, a past president of the American College of Correctional Physicians.

But is it safe? Although there are many psychopaths behind bars, Dr Puerini says physicians have far fewer risks than with patients in a hospital emergency department. "I have never felt unsafe," he says, adding that women do the work without fear because guards are always nearby. Still, he advises keeping an emotional distance. "I put up boundaries immediately on every patient relationship," he says.

Dr Puerini says inmates will try to manipulate physicians' orders to achieve special status, such as sleeping on a lower bunk or acquiring orthotic shoes. "Outside, you wouldn't think of this as important," he says.

Prisoners also require a great deal of medical care, because they usually lacked adequate care before incarceration and have high addiction rates. Prisoners are "the sickest people in the country," Dr Puerini says, citing high rates of such chronic illnesses as HIV, cancer, emphysema, and hepatitis C. "Physiologically, they're older than their age."

As a result, doctors see prisoners frequently. In 2004, almost 70% of prisoners in state prisons, and almost 76% of those in federal prisons, were treated by a healthcare professional, according[22] to the Bureau of Justice Statistics.

Services are often outsourced to private companies. Miami-based Armor Correctional Health Services, which operates in five states, is looking to contract with both primary care physicians and specialists in orthopedic surgery, ophthalmology, cardiology, ob/gyn, infectious diseases, and psychiatry, according to John P. May, MD, the chief medical officer.

Dr May says that casting, radiography, minor surgery, and dialysis are generally performed onsite, and nurses staff the facilities around the clock. Work in county jails, he adds, is more demanding than in prisons. Because newly arrested felons start in a jail, that is where untreated chronic illnesses have to be stabilized and wounds sustained from eluding capture have to be treated. By the time felons are convicted and sent to prison, he says, these issues have often been resolved.

Advantages of correctional medicine include no out-of-pocket payments to collect and malpractice rates that are generally low. There's another perk, too: "I don't have to stay late at the end of the day dealing with paperwork," Dr Puerini says.

This appeals to physicians who want to cut ties with insurers and open direct-pay practices, where the only source of income is monthly payments from patients. Philip Eskew, DO, a family physician who is about to launch such a practice in Wyoming, is moonlighting in a prison while he builds his direct-pay practice. Prison medicine "allows you not to have to deal with third-party nuisances," he says. Because he has cut ties with Medicare and insurers, however, he can't moonlight in emergency departments or urgent care facilities.

Pros: Payment is competitive, and physicians have very little paperwork and generally lower malpractice risks. Telemedicine allows some services to be handled off-site.

Cons: Prisoners have multiple health problems, and many of them are mentally ill; however, guards are always nearby, and the work is considered safer than service in an emergency department.

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