Do academic hospitals allow you to have your own private practice on the side?

[hypnorpheus]

I am considering looking for an inpatient / CL psychiatry job in an academic center after graduation (around 0.7 FTE). I would also like to slowly start building a solo private practice on the side even if it is for 2-3 half days a week. I am under no illusion that I will fill all days sufficiently to have a good income, but I feel the hospital salary would hopefully allow me to subsidize the private practice during the early phase.

But, I am wondering how common is it nowadays for academic hospitals to allow you to have your own private practice. Does it help that I will be doing inpatient psychiatry/CL in the hospital and outpatient in my private clinic? Would that be considered outside of the non-compete clause as I will be doing different things?

Also, what if I am asked to do some outpatient clinic in the hospital to fill my FTE? How common is it to allow you to have your separate private practice in such a case?

I have heard that this type of a dual model used to be common among older psychiatrists, but I hardly see any current attendings doing this anymore.

Appreciate any input and sorry if this has been discussed before.

---

Members don't see this ad.

 

[clausewitz2]

I am considering looking for an inpatient / CL psychiatry job in an academic center after graduation (around 0.7 FTE). I would also like to slowly start building a solo private practice on the side even if it is for 2-3 half days a week. I am under no illusion that I will fill all days sufficiently to have a good income, but I feel the hospital salary would hopefully allow me to subsidize the private practice during the early phase.

But, I am wondering how common is it nowadays for academic hospitals to allow you to have your own private practice. Does it help that I will be doing inpatient psychiatry/CL in the hospital and outpatient in my private clinic? Would that be considered outside of the non-compete clause as I will be doing different things?

Also, what if I am asked to do some outpatient clinic in the hospital to fill my FTE? How common is it to allow you to have your separate private practice in such a case?

I have heard that this type of a dual model used to be common among older psychiatrists, but I hardly see any current attendings doing this anymore.

Appreciate any input and sorry if this has been discussed before.

Some places allow it, some places allow it but take a hefty cut, and some places ban it altogether. The ones taking a cut usually provide some nominal support, like allowing you to use your office. I had an attending in residency who split mornings between an inpatient teaching service with multiple residents and afternoons with his private pay outpatients. This had exactly the effect on the distribution of his thought and effort across his workday as you'd expect.

 

[dl2dp2]

Highly variable. Even within the same academic "system" different organizations have different policies. You should ask the job itself that question in the form of "do you regulate outside employment/do you have a non-compete"? If the answer is no, don't probe further in terms of the exact nature of outside employment. If the question is no but you are required to disclose and be reviewed, then disclose at hiring by filling a piece of paperwork and never mention it to your supervisor.

If the answer yes, it's called a non-compete. It'll be spelled out clearly in your contract, including the faculty practice tax. Sometimes you can get RID of it, and if you really like the job you can ask. Often you cannot.

Anything that's not explicitly forbidden is allowed. Very often academic jobs have no contract. In that case it's allowed. But NEVER ask for an explicit permission.

You might find that when you ask attendings these questions, the answers are inaccurate, and the real prevalence of side gigs is much higher than you imagine. You can gather a portfolio of answers to gather an overall picture. Keep in mind, non-competes are OFTEN violated. Some faculty don't pay faculty tax for every moonlighting gig they technically should disclose. All kinds of things happen. Academic centers don't pursue everyone who violates contracts--they don't have the bandwidth and it's cost-prohibitive. It's also very much legally questionable that non-competes of this type are even enforceable per se, and hence if they did come back and try to chase you, as long as you signed nothing, it's very hard to do anything. And even if you did sign something, the exact nature of the outcome is determined by some kind of binding negotiation, not the exact thing that you signed. I know of several examples of people who clearly violated stipulations in the non-compete, but have known no examples where these cases were discovered and the university chased the person for damages (the quantity is simply too small to matter). The worst they can do typically is to fire you--and they won't, because the quantity of money here is below the cost of replacing you. Most likely if they don't like what you do what they'll tell you to is to stop, and you can decide what you want to do after that.

 

[splik]

This is commonly misunderstood, but non-competes govern your working arrangements AFTER you leave a position, not while you are working. For example, in California non-competes are illegal but it is standard for many academic centers, Kaiser, and some of the large group practices to prohibit certain types (or all) outside work. This is sometimes on the basis of "conflict of commitment" (i.e. they may argue it is affecting your ability to do that work or you are affecting their branding). It really is quite variable between institutions whether you can have a private practice. Even if they do allow it, they may take a cut. Some institutions allow you to have a faculty practice through the university. This is pretty common set up in psychiatry, where you basically get a % of collections (between 50-90% depending on the institution after departmental and dean's taxes) for patients (typically with insurance). As the rates these institutions are able to negotiate are sometimes outrageous, it may pay similar or more than you would be able to charge cash paying patients.

It will also depend on your FTE, what your academic series is, whether you are faculty or not. Usually if you are 50% or less, they can't didacte what you do with the rest of your time.

 

[comp1]

It's usually allowed to some extent at academic centers (as opposed to Kaiser.) Ours locally takes a cut, but the amount and extent depends on your faculty track. Definitely something to consider as you can get plenty of inpatient or CL jobs that aren't going to want any sort of cut and there are lots of ways to stay an academic affiliate without having a job at a med center. I second the above about non-compete definitions, but just wanted to again clarify...never, ever take a job that has an actual non-compete. That should be a non-starter and immediately negotiated out. We're not talking about non-competes here though.

 

[DOBound2019]

I know for child attendings in the New England area it’s pretty much standard practice to have a “side gig” in fact bostons children has a didactic lecture series about setting up your side gig if you stay with an academic hospital.

 

[NickNaylor]

My institution seems to be particularly draconian in that full-time faculty are "required" to hand over all "professional" income - which is not limited just to clinical work and includes just about anything that uses your credentials to complete - which they will return to you at approximately 70% several months later. This effectively makes doing any outside work impossible if you were to follow the terms of the agreement explicitly.

Of course, it's relatively easy to skirt the rules depending on the nature of the outside work you're doing. Starting a full practice likely isn't going to be feasible, but other types of work - for example, expert testimony work - can be done since it's more difficult for a gigantic institution to be aware of what you're doing unless you tell someone.

 

[dl2dp2]

This is commonly misunderstood, but non-competes govern your working arrangements AFTER you leave a position, not while you are working.

You are right. I am wrong.

I was using the term “non compete” in a loose colloquial sense. What we are talking about here is a type of variably restrictive employment covenant.

 

[Stagg737]

My academic center does not allow it d/t the potential conflict of interest and "kickback" from referring patients on the service to yourself (among other things listed above). However, they are very good about supporting attendings who want to have their own specialty clinics (one of my attendings has a clinic treating professional athletes) and the RVUs go fully toward their primary contract RVUs.