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Business on the side as an anesthesiologist?

neuroride

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    Curious if any attendings have any business ventures on the side besides the normal anesthesia gig? I am talking about something outside of medicine.

    I was thinking that it would be good someday to have a business with someone (that you can trust) to have an additional income and also provide some diversity to the portfolio.

    Obviously time is an issue, but if you can provide some financial backing and go in with someone that is able to run the daily matters, it might be fun and provide some fallback if things go sour in medicine down the line.
     

    coprolalia

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      Whatever you choose to do, I highly suggest, for the sake of your own sanity and maintaining what income you do generate as a physician, you avoid the following:

      (1) The restaurant business.
      (2) Buying "short sell" properties to "flip"
      (3) Daytrading
      (4) Providing fee-for-service "propofol naps" for high-paying clientele, especially if they are an international music pop icon.

      Good luck.

      -copro
       
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      coprolalia

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        Oh, and the quote in your tagline should actually read like this:

        Jeremy: If you go though the Pearly Gates, backwards, in a fireball, that's a cool way to die!
        Richard: I love that vision of just blasting through the gates, backwards, in a flaming Swedish supercar! "Yes! I'm here! Where are the women?"

        (Much funnier when fully quoted.)

        -copro
         
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        checkov

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          Whatever you choose to do, I highly suggest, for the sake of your own sanity and maintaining what income you do generate as a physician, you avoid the following:

          (1) The restaurant business.
          (2) Buying "short sell" properties to "flip"
          (3) Daytrading
          (4) Providing fee-for-service "propofol naps" for high-paying clientele, especially if they are an international music pop icon.

          Good luck.

          -copro

          I'm curious about the warning against daytrading.

          I've met more than one attending who keeps a browser window Alt-Tabbed to Fidelity or Charles Schwab's online trading sites.

          Daytrading seems to be a natural fit for many of the abilities which are found in good anesthesiologists (i.e. ability to predict short-term trends, ability to make decisions quickly, ability to produce a substantial amount of solvent capital)
           

          DOme2009

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            supposing you had the income to invest in something like an imaging center or an ambulatory surg. center, would that be advisable? would that be legal, or does it very from state to state? i would guess it shouldn't be a problem since you're not a radiologist or a surgeon and there shouldn't be any conflict of interest really (assuming you're not doing pain procedures at the ASC).
             

            coprolalia

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              supposing you had the income to invest in something like an imaging center or an ambulatory surg. center, would that be advisable? would that be legal, or does it very from state to state? i would guess it shouldn't be a problem since you're not a radiologist or a surgeon and there shouldn't be any conflict of interest really (assuming you're not doing pain procedures at the ASC).

              You just can't refer patients to your own center, per the Stark regulations.

              Always, always, always check with an attorney specializing in employment law, and specifically the Stark regulations, before signing anything. The large print giveth, the small print taketh away.

              -copro
               

              cleansocks

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                Curious if any attendings have any business ventures on the side besides the normal anesthesia gig? I am talking about something outside of medicine.

                I was thinking that it would be good someday to have a business with someone (that you can trust) to have an additional income and also provide some diversity to the portfolio.

                Obviously time is an issue, but if you can provide some financial backing and go in with someone that is able to run the daily matters, it might be fun and provide some fallback if things go sour in medicine down the line.

                I'm only an intern but I've planned to do this since I began my career track. Got an MBA with my MD and have always planned to use the capital I generate physician as well as general medical expertise to "invest wisely" in venture capital or angel investments in the healthcare sector. As an intern I feel I should've just skipped the MD but hopefully I'll feel better about that in a year (doubt it!).

                The problem as I see it for you is that there are a lot of "not so common sense" things you need to know to avoid more than anything else. For example you say "someone I can trust" as if that is easy to find. It is nearly impossible to bank on someone you trust. Even close fathers and sons stop speaking to each other without an iron clad contract that stipulates exactly how the business will be managed and the money distributed. More cases in business school focus on failures than successes because there are so many pitfalls.

                If I were to give advice, I'd say absolutely go for it, but pick an area of business and initially "invest" a lot more sweat equity than you do monetary equity. Build connections in the industry and the area. "Ease your way" into making large investments. There are an enormous amount of opportunities in medicine and you're very unlikely to "hit the big one" right away anyway, so start small. But start. Don't think you can just invest theoretically until you find the perfect one and then go all out. You need to put real money in and track it.
                 
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                pgg

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                  I'm curious about the warning against daytrading.

                  I've met more than one attending who keeps a browser window Alt-Tabbed to Fidelity or Charles Schwab's online trading sites.

                  Daytrading seems to be a natural fit for many of the abilities which are found in good anesthesiologists (i.e. ability to predict short-term trends, ability to make decisions quickly, ability to produce a substantial amount of solvent capital)

                  The odds are probably a bit better than the blackjack table, but probably not by much.

                  I've seen some very smart people burn through very large sums daytrading, trying to "time" the market, picking can't-miss or "undervalued" stocks with the intent to sell before the next downturn ...

                  But hey, someone's got to put money into the market so the insiders can make a living, so good luck. :)
                   

                  panetrain

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                    The truth is that you will need someone else, a partner, to handle most of the leg work. If you don't have such a person who is business minded then forget it. A lucrative career in anesthesiology (requires many hours in the box) will not afford you the free time to pursue additional business ventures unless you are willing to dedicate ALL time spent outside of the OR towards there success.
                     

                    kazuma

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                      Whatever you choose to do, I highly suggest, for the sake of your own sanity and maintaining what income you do generate as a physician, you avoid the following:

                      (1) The restaurant business.
                      (2) Buying "short sell" properties to "flip"
                      (3) Daytrading
                      (4) Providing fee-for-service "propofol naps" for high-paying clientele, especially if they are an international music pop icon.

                      Good luck.

                      -copro

                      My dad knows an Anesthesiologist that actually quit practicing medicine about 4 or 5 years ago to do sell stock options full time since he was doing so well with it part time. He ended up losing all of his capital in the gig (well over a 1-2 million). :scared: He might have been better off doing the "propofol nap" gig.
                       
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                      Eta Carinae

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                        http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=1
                        Interesting article...not exactly addressing the OP's question, but touches on the "entrepreneurial" culture that is overtaking medicine.

                        Very nice, I must have missed that one. I usually keep up with all the medicine (and other) essays in the NewYorker.

                        As usual, Gawande hit the nail on the head. I wonder why Washington doesn't pay attention to him...instead, they propositioned pretty-boy-Nsgn-turned-TV-celeb, Gupta for SurgGen.

                        Thanks for putting it up
                         

                        2win

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                          Very nice, I must have missed that one. I usually keep up with all the medicine (and other) essays in the NewYorker.

                          As usual, Gawande hit the nail on the head. I wonder why Washington doesn't pay attention to him...instead, they propositioned pretty-boy-Nsgn-turned-TV-celeb, Gupta for SurgGen.

                          Thanks for putting it up
                          " I usually keep up with all the medicine (and other) essays in the NewYorker."
                          Nice read - very liberal and stinky.
                          2win
                           

                          MDInvestor

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                            Daytrading is no different than gambling. The house will always win.

                            For example, how are you going to outsmart private equity firms or even Goldman Sachs who will funnel millions into high powered supercomputers, who have preference to see your trade but trade ahead of it (flash trading), who hire top notch MIT mathematicians and computer science grads to built algorithms that take advantage of the slightest swings in the market?

                            See
                            http://seekingalpha.com/article/150397-flash-trading-goldman-sachs-front-running-everyone-else
                             
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                            2win

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                              Daytrading is no different than gambling. The house will always win.

                              For example, how are you going to outsmart private equity firms or even Goldman Sachs who will funnel millions into high powered supercomputers, who have preference to see your trade but trade ahead of it (flash trading), who hire top notch MIT mathematicians and computer science grads to built algorithms that take advantage of the slightest swings in the market?

                              See
                              http://seekingalpha.com/article/150397-flash-trading-goldman-sachs-front-running-everyone-else

                              day trading is not the answer - I would say swing trading.
                              2win
                               

                              pgg

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                                day trading is not the answer - I would say swing trading.
                                2win

                                Poe-TAY-toe, poe-TAH-toe ... :)

                                You can pick a time interval, whether hours or days or months, but it's still market timing. Most people can't consistently do it and come out ahead.

                                It's a rare person who can do it long-term and beat the true players who have the resources, inside information, and privileged trading opportunities MDInvestor mentioned. Day/swing trading isn't about choosing good companies and earning money from their success long term; it's about extracting profit from system volatility. The big firms' profits aren't coming from a company's growth but they do come from someplace, and that someplace is the small investor trying to compete with them.

                                What's more, the market's a hell of a lot less rational today than it was almost a decade ago when tech stock daytrading was the 'in' thing to do amongst my circle of friends.
                                 

                                Dirtball

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                                  I started doing my own billing after my old billing co. closed shop. Being solo it's hard to get any billing co. to take good care of you. Now I have 4 other docs as clients. I won't retire on it, but I am keeping some nice people off the unemployment roster.
                                   

                                  2win

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                                    Poe-TAY-toe, poe-TAH-toe ... :)

                                    You can pick a time interval, whether hours or days or months, but it's still market timing. Most people can't consistently do it and come out ahead.

                                    It's a rare person who can do it long-term and beat the true players who have the resources, inside information, and privileged trading opportunities MDInvestor mentioned. Day/swing trading isn't about choosing good companies and earning money from their success long term; it's about extracting profit from system volatility. The big firms' profits aren't coming from a company's growth but they do come from someplace, and that someplace is the small investor trying to compete with them.

                                    What's more, the market's a hell of a lot less rational today than it was almost a decade ago when tech stock daytrading was the 'in' thing to do amongst my circle of friends.

                                    Yes and no.
                                    PGG - this is my hobby and we can talk a lot about that. Send me a PM and we'll see.
                                    2win
                                     
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                                    SurferBoyMD

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                                      Rehashing this topic. Wondering if anyone does anything on the side, and how you got into it? I think it would be interesting to be a consultant in some type of health technology start up; however, I have no clue on how one even gets started.
                                       

                                      dr doze

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                                        Rehashing this topic. Wondering if anyone does anything on the side, and how you got into it? I think it would be interesting to be a consultant in some type of health technology start up; however, I have no clue on how one even gets started.

                                        For the overwhelming majority of us, nothing is going to pay more per hour than our clinical work. You can "earn" a fortune over a thirty year career by learning about personal finance and and financial markets and take the lessons of saving well and investing wisely to heart. I recommend bogleheads website and whitecoat investor website as excellent starting points.
                                         
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                                        caligas

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                                          For the overwhelming majority of us, nothing is going to pay more per hour than our clinical work. You can "earn" a fortune over a thirty year career by learning about personal finance and and financial markets and take the lessons of saving well and investing wisely to heart. I recommend bogleheads website and whitecoat investor website as excellent starting points.

                                          Correct. A lot less than 30 years if you work hard and make good choices.
                                           

                                          aneftp

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                                            Correct. A lot less than 30 years if you work hard and make good choices.

                                            To add. It's not what you earn but what you keep.

                                            Most of us have been guilty of overspending. I was really good with saving for first 5-6 years. The past 3 years just bad spending habits. Heck i looked at past 7 months. We did two 7 day Disney cruises with kids. Most people do one Disney cruise once or twice in their lifetime. And kids have been on 6 of them. And we did one bed room suite as well. Plus new appliances when old ones still worked. And spring break at luxury resort for 5 days.

                                            And I am looking at the bills. We could have just prepaid college for the kids Tutuion for 4 years with the money we just spent in 7 months.
                                             
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                                            dhb

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                                              To add. It's not what you earn but what you keep.

                                              Most of us have been guilty of overspending. I was really good with saving for first 5-6 years. The past 3 years just bad spending habits. Heck i looked at past 7 months. We did two 7 day Disney cruises with kids. Most people do one Disney cruise once or twice in their lifetime. And kids have been on 6 of them. And we did one bed room suite as well. Plus new appliances when old ones still worked. And spring break at luxury resort for 5 days.

                                              And I am looking at the bills. We could have just prepaid college for the kids Tutuion for 4 years with the money we just spent in 7 months.
                                              are you married to my wife ;)
                                               
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                                              PainDrain

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                                                I started buying farmland 15 years ago. I've tripled my initial investment and I'm getting 3% return on my investment. No hassles easy money.

                                                How does one go about doing this? Do you actively farm the land or rent it out to others? What state (if you don't mind me asking)? I am sure this is a great investment in the Midwest, I know Iowa is going through a farmland boom.
                                                 

                                                Wiscoblue

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                                                  Wisconsin Iowa Minnesota. You have to connect with realtors in the county where you want to buy farmland. Iowa is going crazy. Tillable land used to be $1000 an acre just 10 years ago and now it's going for close to $7000. Fertile land near the big river.

                                                  Rent could be anywhere from 150 to 300 an acre depending on yield.

                                                  Southern Minnesota has beautiful black dirt. Very fertile land. My brother bought 100 acres last year at $4k an acre. He gets $250 in rent and taxes are low.

                                                  I rent out my land. The non tillable is for hunting.
                                                   
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                                                  Mman

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                                                    Many private groups earn money through real estate. Buy a building, rent it out. As the loan gets paid down, buy another building and rent it out. Rinse, repeat. Over time you can build up quite a real estate portfolio spitting out lots of cash.
                                                     

                                                    pjl

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                                                      I have a couple buddies who own breweries, including some nationally known ones (spouses run them though). One just has a restaurant that brews that launched statewide in the spring. 2-3% ROI from restaurant, ~16% from bottles. I dont know details of others, but based on lake mansions, they seem to do well. These are MDs with early savings that seeded the business.

                                                      Another friend invested in medical marijuana dispensary and related growing. That one is pretty shady to me, but I am sure he will make plenty of money since it is one of just a few in that particular state. I cant bring myself to invest in that stuff. It is being run by spouse of another of his partners.

                                                      Some groups own a portion of their hospitals/surgery centers, so I dont know if you count that. They are more involved with the business end of those facilities than the typical group, and apparently they can kick out a very good ROI.

                                                      Many are doing "small scale" real estate, 1-30 properties. Come to think of it, I know one guy who owns one of the two sides of main street in his small town, literally. This includes malls, restaurants, grocery stores, drug stores, etc. This was built over a career with money from anesthesia, and then from that endeavor feeding itself. Quiet, humble guy you would never expect it of, nor would you know it unless you looked at the deeds. Drives a camry, modest house.

                                                      Owning farm land is a common one in the Midwest, almost nobody does the work themselves, but if you just do veggies all you have to do is plant and they will harvest. Largest guy I know owns 600 acres, farms 800, but he has significant help from brothers.

                                                      I dont know of any except the guy owning main street who are the primary business manager and work full time within anesthesia. They all do a fair amount of work, but the brunt of it is being done by their spouses.
                                                      Also, none of these people do as well as the partners who have invested wisely in businesses being run by non-MDs, with the exception of the nationally known microbrew guy, but his spouse was a great business woman with her own career before they started that.

                                                      Suffice to say that there are more MDs out there than you would expect that have fully funded FU accounts and backup careers, but still slug away in the OR daily.
                                                       
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                                                      dr doze

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                                                        Lots of people are discovering that it is much harder to attain and keep meaningful ownership in anesthesiology these days. That is why people are looking for it elsewhere, e.g., MBA, JD, day trading, running restaurants, real estate speculation/landlord, etc.
                                                         

                                                        Mman

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                                                          That is why people are looking for it elsewhere, e.g., MBA, JD, day trading, running restaurants, real estate speculation/landlord, etc.

                                                          I sincerely hope physicians have for the most part given up "day trading". It's just not a strategy that lets you hold on to your wealth long term.

                                                          As a doc, none of us needs to get rich off our investment ideas to retire comfortably, we just need to avoid disaster wiping us out. I'd focus on low risk strategies in outside business like rental properties or partial ownership stake in a business you are comfortable with that somebody else (reputable) will be running. The bar/restaurant business is notorious for being a bad investment unless you are the one running it full time.
                                                           
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                                                          Mman

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                                                            LOL! Good luck with that. CRNAs got that bullshiggity locked down TIGHT where I'm at.

                                                            Want to know why?

                                                            1) they are cheaper
                                                            2) they do whatever they are told. They won't cancel the case when the patient has unstable angina. They won't even ask that question. In a world of low risk procedures, you can get away with a ton of bad decisions and it's only rarely that you'll see the death and everyone wonders WTF they were thinking.
                                                             
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                                                            saratoga733

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                                                              park some money in real estate esp in big city hot markets (nyc, sf) during the next market down turn. rent it out and have mortgage paid for. my preference is one bdrm condo apts with low maintenance. diversifies a portfolio but is not headache free. don't just rent to any joe schmoe off the street. be very picky!

                                                              btw, yes be careful with day/swing/momentum trading... you may do well for a stretch but over the long haul most people lose money.
                                                               

                                                              BIGphysician

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                                                                park some money in real estate esp in big city hot markets (nyc, sf) during the next market down turn. rent it out and have mortgage paid for. my preference is one bdrm condo apts with low maintenance. diversifies a portfolio but is not headache free. don't just rent to any joe schmoe off the street. be very picky!

                                                                btw, yes be careful with day/swing/momentum trading... you may do well for a stretch but over the long haul most people lose money.

                                                                The real money is in horse racing, let's go in on a nice horse at the Saratoga summer sale.
                                                                 

                                                                periopdoc

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                                                                  I think most folks don't consider the tax advantages of having a side business. One of the biggest problems with physician income is that it is income, and it is taxed as such, and there really aren't many expenses/ deductions we can take to offset our ridiculously high marginal tax rate.

                                                                  I rent out 70% of my property for grazing, and I have a 9 tree orchard. All of that land is therefore taxed at agricultural rates. Most land improvements, maintenance, etc becomes a business expense which reduces my taxable income.

                                                                  Mostly, I run the business at a loss every year. Which is fine by me. Every dollar I lose is a dollar less that I have to pay taxes on. You can get pretty creative with expenses when doing this. It isn't a big income generating business like the thread is asking about, but the ultimate result is keeping more of what you make.

                                                                  Saving on taxes is awesome.

                                                                  -pod
                                                                   
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