What is your side gig?

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cyanide12345678

cyanide12345678

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Let's face it, insurance companies have huge lobbying power, the new legislature will pass sooner or later.

So... What side gigs of supplemental income do you guys have?

Edit: how much are you making from this supplemental source? Ballpark figures please 🙂
And how much time are you investing in these side gigs.
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southerndoc said:
Consulting work for a hedge fund, expert witness review, EMS medical director. I make very close with consulting work as I do with clinical work.
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I'm assuming it's difficult to get employment with the hedge fund/this type of consulting work in general?
 
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How do you even go about developing a side gig. I've thought about a lot of options but it's hard to know where to start
 
Instructions for my side gigs:

Urgent Care (newly constructed)
1. Do your homework to educate yourself about how to open and run an urgent care. The urgent care association of America offers a course that will walk you through this complete with starter floor plans, staffing ratios, etc (or at least they did 10 years ago when I opened mine).
2. Decide if you want to have partners or not. If so then develop your business plan with your partners.
3. Pick a location. Pick broadly based on demographic info and then pick specifically within that area based on traffic counts, house counts, and distance from other urgent cares.
4. Pitch your business plan to several banks to secure funding.
5. Draw up your construction plans with an architect
6. Get bids on your plans then pick your construction company.
7. Start building it.
8. Purchase the equipment you need
9. Hire your staff.
10. Start marketing and credentialing.
11. Finish up construction and get ready to open the doors.
12. Open up and start seeing patients.
13. Sweat bullets during the ramp up stage while you watch the expenses pile up and the insurance companies hold on to your reimbursements.
14. Start fine tuning your system since it will be inefficient.
15. Get to your break even point where your volume is paying for all of your expenses.
16. Start looking for employee physicians to hire so you can start phasing yourself out of working there clinically.

Real estate
1. Buy books, listen to bigger pocket podcasts. Research for about a year before you pull the trigger on any big deals.
2. Figure out what your niche will be.
3. Start analyzing deals so you’ll develop your ability to quickly recognize a good one when you find it.
4. Meet with banks ahead of time to set up financing.
5. Start developing your system to keep this as passive as possible.
6. Purchase property.
7. Hire property manager.
8. Start cash flowing

Timber
1. Start learning about timber. Learn costs, revenue, local government subsidy programs in your area as well as surrounding states.
2. Buy timber property.
3. Develop forestry management plan.
4. Stick to the plan, harvest timber, prep and replant. Repeat.
 
Hercules said:
Instructions for my side gigs:

Urgent Care (newly constructed)
1. Do your homework to educate yourself about how to open and run an urgent care. The urgent care association of America offers a course that will walk you through this complete with starter floor plans, staffing ratios, etc (or at least they did 10 years ago when I opened mine).
2. Decide if you want to have partners or not. If so then develop your business plan with your partners.
3. Pick a location. Pick broadly based on demographic info and then pick specifically within that area based on traffic counts, house counts, and distance from other urgent cares.
4. Pitch your business plan to several banks to secure funding.
5. Draw up your construction plans with an architect
6. Get bids on your plans then pick your construction company.
7. Start building it.
8. Purchase the equipment you need
9. Hire your staff.
10. Start marketing and credentialing.
11. Finish up construction and get ready to open the doors.
12. Open up and start seeing patients.
13. Sweat bullets during the ramp up stage while you watch the expenses pile up and the insurance companies hold on to your reimbursements.
14. Start fine tuning your system since it will be inefficient.
15. Get to your break even point where your volume is paying for all of your expenses.
16. Start looking for employee physicians to hire so you can start phasing yourself out of working there clinically.

Real estate
1. Buy books, listen to bigger pocket podcasts. Research for about a year before you pull the trigger on any big deals.
2. Figure out what your niche will be.
3. Start analyzing deals so you’ll develop your ability to quickly recognize a good one when you find it.
4. Meet with banks ahead of time to set up financing.
5. Start developing your system to keep this as passive as possible.
6. Purchase property.
7. Hire property manager.
8. Start cash flowing
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Agreed with everything about real estate. Bigger pockets and White coat investor is basically my go to podcast on my commute to work.

Though if I personally started an urgent care, I would buy one that is somewhat established with positive revenue generation - bizbuysell.com has a few on sale at all times.
 
real estate i also have another side gig. Find something you like, educate yourself. none of this is easy. Everyone thinks it is easy when they read about it.

The key is dont be intimidated and know what you are good at. MedSpas, vein treatment, laser hair, ketamine clinics and even pain clinics are all things I know ED docs doing. Same for Wellness coaching and of course marijuana related stuff.

A bunch of guys I know did telemedicine. Everything from a telemedicine version of a suboxone clinic to DPC telemedicine stuff. Some really interesting ways to leverage that for money.

Lastly, the most passive thing you can do. Invest in the stock market. I cant wait for the day when my investments outearn my clinical work.
 
psychapp121 said:
so you make like 400k from EM then another 400k from consulting for a hedge fund? Damn..
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southerndoc said:
No, more.
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Dude, don't you get it? I met @southerndoc when he was interviewing on the trail all those years ago, and, despite a rather dull expression (if you don't get it, view "Backdraft" again), and, even then, his head was on straight. Dude is, straight up, killing it right now. I mean, like, "rich" killing it. Like, beyond ******* doctors seeing pts for their primary chops - upper middle class, at best. He's, no BS, rich.

Which I ain't. By a LONG shot.
 
irJanus said:
How do you even go about developing a side gig. I've thought about a lot of options but it's hard to know where to start
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Well you avoid analysis paralysis and some day just take the plunge. You'll fail the first few times 🙂

I personally went into med school knowing that my stable medicine job will be my source of financing for something bigger.

Here is a brief summary of how I started a side gig recently - it's one way to start I guess 🙂

My 3rd LLC came into existence 10 days ago. I was off for 6 days and had plenty of time and was bored out of my mind. In these last 10 days I created an LLC, bought and customized two ecommerce webstores - one of whom was cash flow positive. Purchase made at flippa.com. Found myself a SEO and social media expert on the other side of the world for dirt cheap to work for me at roughly $3.33/hr to start on SEO work and organic search rankings. One store is basically fully automated, customer puts in an order, order automatically goes from my website and is forwarded to my wholesaler's website. I can have credit in the wholesaler account, so things will just automatically ship out by the wholesale dropshipper while I sleep. I basically just set up a google adwords campaign for the products that will be sold on that website. I have done a few google campaigns back in the day in college when I used to hustle 😉 And then ofcourse the long term SEO play for organic traffic. I'm not making money on this right now, infact the adwords campagin had 600-700 clicks for $100 with 0 conversions. Normally websites should have a 2-3% conversion rate for google, especially since you're getting users looking for a certain product. I figured the product data pages needs to be improved, which I kind of already knew, so I paused the cash burn on google for now and focused on website 2. The product data page improvement is a $1300 cash burn which imports a improved catalog of 14000 products from above wholesaler with more information, images etc. Right now current website has the 14000 products, with one image, and bare minimum descriptions which is likely the reason for 0 conversions despite 600-700 unique visitors in a few days. Anyway, so website 1 is currently paused.

Website two isn't as beautifully automated as website 1. This one was the cash flow positive store. In 10 days basically I set up 120 products on the store, set up a Fb ad campaign, facebook page, facebook product catalog, re-designed things that I didn't like about the website. The SEO dude is working on both websites. The website is about 90% automated. Customer buys something -> Order goes to my store -> I have to do exactly 3 clicks to process the order -> Order goes to dropshipper for fulfillment -> I have to update tracking with 1 click after a couple of days. Like I said, this website was profitable. The person whom I bought this store from, spent $960 on FB ads and generated $4600 in sales. $2600 was cost of product purchases through dropshipper. and roughly $1500 was profit on the store in 2 months. My thought process when I bought the store was to ramp up the Fb advertisement slowly. FB campaign is set up, I just plan on starting it day after tomorrow. Today I have to do a couple of test runs to make sure everything is running smoothly before burning $$$ on FB ads. Hoping to get conversions *Fingers crossed*.

In all, I've burned $2200 so far in the last 10 days, considerably less than one shift, and I have two very well designed and optimized webstores, extremely professional looking - $100 hosting (4 yrs); $1800 2 websites ($1000 website 1, $800 website 2); $100 google ads, $100 Wyoming LLC, and then miscellaneous small items.

If anyone is curious, I can let you guys know how the FB campaign goes for website 2 😛 If 1 dollar of marketing leads to anything more than 2 dollars of sales, then I'm profitable. I guess I'll find out tomorrow onwards.

Grand plan is to hire someone for $2-3/hr eventually to do the customer service email responses, and to do the 3 clicks to process the order from my website to the dropshipper while the SEO/marketing dude takes over FB page posts and marketing. A guy doing marketing and social media for 10 years can probably do it better than me, it's a plus that he only costs $3.33/hr. Once someone takes over those two tasks, I'll basically go into a complete oversight/managerial role in my free time rather than dealing with the day to day crap. And then eventually if/when profits come in, I plan to use that money to increase my FB ad marketing budget - A part of me is really curious what will happen if my 20 dollar a day marketing budget goes to $1000 per day.
 
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Southerndoc and I need to sit together some day and chit chat, I could probably learn a few things from Southern. Other than WCI, Southerndoc is one of the few EM docs on Bogleheads forums too. So he/she definitely is finance minded.
 
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Apollyon said:
Dude, don't you get it? I met @southerndoc when he was interviewing on the trail all those years ago, and, despite a rather dull expression (if you don't get it, view "Backdraft" again), and, even then, his head was on straight. Dude is, straight up, killing it right now. I mean, like, "rich" killing it. Like, beyond ******* doctors seeing pts for their primary chops - upper middle class, at best. He's, no BS, rich.

Which I ain't. By a LONG shot.
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what does that mean? Any EM doc can make 700k grinding it out hardcore, how rich is he that he makes that look bad? I bet he’s prolly in the 900k-1.1 mil range which is great but by no means RICH..hedge fund managers are rich
 
southerndoc said:
I work a lot. Clinically 17-18 shifts/month (10-hour shifts). Consulting gigs add more hours, some of which I don't even keep track of. I work hard while I can.

Been through expensive cars (don't want or care for them anymore). Now I find more pleasure in donating to my daughter's school, church, and other charities. My wife and I maintain a donor advised fund at Fidelity. It has been one of the best pleasures I've ever had and makes my hard work worthwhile.

Sold the ultra luxury car and kept the my BMW that I purchased brand new. Now has 170,000 miles on it. Can easily purchase a new one, but choose to spend my money donating to charity.

It's all in what makes you feel good about yourself.
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This doesn't really make a ton of sense to me... Sounds like you're FI, savvy, and making better money than 90% of people on this subforum. You've essentially won the game. Why are u still grinding 180 hr/month and working a consulting position on top of that? Dude, relax... I get that charity is important, but why not enjoy some life on the side while you still can?
 
psychapp121 said:
what does that mean? Any EM doc can make 700k grinding it out hardcore, how rich is he that he makes that look bad? I bet he’s prolly in the 900k-1.1 mil range which is great but by no means RICH..hedge fund managers are rich
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Part is sarcasm, but, a larger part of that is that he has the ability and preference to be one of those hedge fund Richie Rich's. I have nothing but respect for him.
 
Don't forget that your "side gig" doesn't necessarily have to be anything other than aggressive, long-term investing, either in your 401k/Roth/retirement options or otherwise. If you have $500,000 in investments, and the market goes up 20% in a year, guess what? You just made $100K in passive and unrealized income that year, without lifting a finger, as your side gig.

If you prefer a more active side gig, like acquiring/managing real estate, a Free Standing ED or other business, then that's great. Those options (and others) can be great if you have the time, interest and motivation. If not, invest your earnings wisely, hold on to them patiently and wait for returns. It takes time, but when it starts to build, it's pretty awesome.

Due to current economic policy and circumstances, we're in a Golden Age of stock market investing. Hopefully, you've positioned yourself to benefit. If not, make sure you're in position for the next one.
 
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TheSingularity said:
Everyone has an amazing side gig that makes a million dollars a year, but they won't tell you how to get your own - they'll just tell you they have one.
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Probably the easiest is simply signing up with an agency such as the Expert Institute for expert witness testimony. The more diverse the clinical and administrative experience you have, the better and most law firms like people coming from academic institutions to “wow” the jury.

Next in line would be private industry consulting. There are various entities ranging from pharma to venture capital. The easiest way is again through academia by being site PI for industry-sponsored clinical trials. Another gig is chart review for CMS compliance (obs vs. in-patient), insurance authorizations, ED design, etc. A google search is how I found a side job doing CMS compliance about 10 years ago (from home, company out of Phili, about $120/hr).

The hardest is US and foreign govt work. People with prior military, law enforcement, or other governmental agency work typically get the best gigs. This often doesn’t pay well and it may involve foreign travel but scratches an itch for a subsegment of EPs. PM me if prior LE or .mil and I can fill in the specifics for a given background and expected income.

Finally, I seem to recall lectures at this past ACEP on non-medical careers for EPs. A quick search of the ACEP website and I bet you could find them as all lectures are recorded and available for purchase.
 
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Old_Mil said:
One of these days when I have seen my last patient, I’m just going to post the link to my LinkedIn profile on here.

Medicine is the side gig now... 10-12 days a month main gig yielding 275k a year now.
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That's the second time (of which I recall, myself) where you have mentioned a side gig that makes as much as medicine. Also, last I recall, you were up in Canuckistan, Alberta, to wit.

What is the general area of this non-medical cash cow?
 
Kudos to you all. I think the lesson to the youngins is plan, plan, plan. I have multiple income streams and that doesnt even include rental real estate. Find something you enjoy and are good at outside of medicine. Save aggressively. I love personal capital cause i sometimes look and see my net gain over the past 90 days and think.. holy cow thats a lot of money.

Save, invest and keep your eyes peeled for new opportunities. I literally will listen to anyone. 99% of the ideas are not for me. Once in a while you get a home run idea. When that happens im ready.

im into buying duplexes that follow the 1% rule. I finance them for 15 years and they still cash flow. I usually look for some secondary upside too, new manufacturing being brought in, a duplex on decent land, or a large development with a big cash infusion.

I literally have 5 different reasons why I get deposits every month and that doesnt include my real estate holdings. my most profitable one was something I lucked into like a chump. someone said.. hey we have this need can you do it. I said sure.. then i grew it outside of that initial purpose. Wasnt super hard.

The key again is to have interest have some money available to deploy and try to find things that require little of your time. I work a lot but I enjoy it. I could drop any one of the 5 things and would be ok. I save like nobodys business but I live well.

The key is having your eye on the prize.
 
EctopicFetus said:
Kudos to you all. I think the lesson to the youngins is plan, plan, plan. I have multiple income streams and that doesnt even include rental real estate. Find something you enjoy and are good at outside of medicine. Save aggressively. I love personal capital cause i sometimes look and see my net gain over the past 90 days and think.. holy cow thats a lot of money.

Save, invest and keep your eyes peeled for new opportunities. I literally will listen to anyone. 99% of the ideas are not for me. Once in a while you get a home run idea. When that happens im ready.

im into buying duplexes that follow the 1% rule. I finance them for 15 years and they still cash flow. I usually look for some secondary upside too, new manufacturing being brought in, a duplex on decent land, or a large development with a big cash infusion.

I literally have 5 different reasons why I get deposits every month and that doesnt include my real estate holdings. my most profitable one was something I lucked into like a chump. someone said.. hey we have this need can you do it. I said sure.. then i grew it outside of that initial purpose. Wasnt super hard.

The key again is to have interest have some money available to deploy and try to find things that require little of your time. I work a lot but I enjoy it. I could drop any one of the 5 things and would be ok. I save like nobodys business but I live well.

The key is having your eye on the prize.
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how much you make yearly with all your income sources?
 
EctopicFetus said:
Kudos to you all. I think the lesson to the youngins is plan, plan, plan. I have multiple income streams and that doesnt even include rental real estate. Find something you enjoy and are good at outside of medicine. Save aggressively. I love personal capital cause i sometimes look and see my net gain over the past 90 days and think.. holy cow thats a lot of money.

Save, invest and keep your eyes peeled for new opportunities. I literally will listen to anyone. 99% of the ideas are not for me. Once in a while you get a home run idea. When that happens im ready.

im into buying duplexes that follow the 1% rule. I finance them for 15 years and they still cash flow. I usually look for some secondary upside too, new manufacturing being brought in, a duplex on decent land, or a large development with a big cash infusion.

I literally have 5 different reasons why I get deposits every month and that doesnt include my real estate holdings. my most profitable one was something I lucked into like a chump. someone said.. hey we have this need can you do it. I said sure.. then i grew it outside of that initial purpose. Wasnt super hard.

The key again is to have interest have some money available to deploy and try to find things that require little of your time. I work a lot but I enjoy it. I could drop any one of the 5 things and would be ok. I save like nobodys business but I live well.

The key is having your eye on the prize.
Click to expand...

A lot of time the side gig is for personal interest, hobby, or fulfillment aside from money. I know a retired executive who spends time as a Strength Finders coach (part of Gallop Corp). He certainly doesn’t need the money but derives a lot of satisfaction out of traveling to schools, universities, and businesses and helping people.
 
Saving a ton and paying off my mortgage so I can exit in the next three years.

I hope to do some combination of the 4% rule, occasional clinical shifts, chart review (so easy and fun, but not highly remunerative), and living cheap in the desert.
 
ShockIndex said:
A lot of time the side gig is for personal interest, hobby, or fulfillment aside from money. I know a retired executive who spends time as a Strength Finders coach (part of Gallop Corp). He certainly doesn’t need the money but derives a lot of satisfaction out of traveling to schools, universities, and businesses and helping people.
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That’s called volunteering or a hobby. I define a side gig as a side job that makes you money. Maybe I’m wrong.
 
I don't have any side gig and I'm not particularly motivated or interested in taking on excessive financial risk, nor do I want to spend my free time outside of work doing....more work. I've met a lot of docs who assumed they would be just as good in business as they were in medicine and lost an enormous amount of money. I can still remember talking to a friend (ER doc) who told me one night "Groove...I'm living paycheck to paycheck and I make 500K, how crazy is that?" He had invested in a side gig involving boutique cosmetic medicine (botox, lasers, lipo, etc..) and concierge medicine and dug himself into a hole for years setting back his retirement savings significantly. I have another ER doc friend who owns an urgent care and is building another and investing into some real estate but all he does is work on those projects on his day off. He's either in the clinic or making calls and managing his other properties. I understand how some people might get their rocks off on growing a business in their free time but me....I just really don't want to be bothered on my days off. I like to relax and do whatever the hell I feel like doing.

My personal philosophy is work hard and invest aggressively. All I do is sink my extra money into investments and I've had tremendous gains, all with an extremely diversified portfolio. I rarely try to time the market and when it dips, I view it as a great discounted buying opportunity and I buy up more stocks. I'm right on track to retire in my late 50s with the 4% rule and will be able to live life extremely comfortably. I'm not one of these people that needs 10,15 or 20 million. My lifestyle would be just fine with 4 million and 5 or 6 million would be gravy but I'm not sure I can attain that given I had a late start in life.

Regarding real estate...lots of real estate guys in here. I've never liked real estate, nor do I consider it capable of reliably outperforming the market over the long haul. I realize there are a lot of different opinions on this but the below article sums up most of my reservations nicely. In brief, I don't particularly like the leverage risk, tax disadvantages (rent taxed as ordinary income), time and effort required to manage and maintain property, illiquidity, the transaction costs that most people forget about when buying/selling, dealing with tenants, etc.. But hey, to each his own. I totally get the psychological income that comes from "owning" something tangible that you can see, feel and touch, but having most of my money tied up into the market has never really bothered me, especially when I see my annualized compound growth rate from year to year. Yes, I understand that the inherent leverage risk in real estate can compound returns (if you're lucky and make smart investments) but as I stated earlier, I got a late start in life so perhaps if I were younger, I'd be willing to take on additional risk but for me and my current situation...it's just not worth it if I plan to stay on track.

Real Estate versus Index Funds | The Wealthy Accountant
 
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Groove said:
I don't have any side gig and I'm not particularly motivated or interested in taking on excessive financial risk, nor do I want to spend my free time outside of work doing....more work. I've met a lot of docs who assumed they would be just as good in business as they were in medicine and lost an enormous amount of money. I can still remember talking to a friend (ER doc) who told me one night "Groove...I'm living paycheck to paycheck and I make 500K, how crazy is that?" He had invested in a side gig involving boutique cosmetic medicine (botox, lasers, lipo, etc..) and concierge medicine and dug himself into a hole for years setting back his retirement savings significantly. I have another ER doc friend who owns an urgent care and is building another and investing into some real estate but all he does is work on those projects on his day off. He's either in the clinic or making calls and managing his other properties. I understand how some people might get their rocks off on growing a business in their free time but me....I just really don't want to be bothered on my days off. I like to relax and do whatever the hell I feel like doing.

My personal philosophy is work hard and invest aggressively. All I do is sink my extra money into investments and I've had tremendous gains, all with an extremely diversified portfolio. I rarely try to time the market and when it dips, I view it as a great discounted buying opportunity and I buy up more stocks. I'm right on track to retire in my late 50s with the 4% rule and will be able to live life extremely comfortably. I'm not one of these people that needs 10,15 or 20 million. My lifestyle would be just fine with 4 million and 5 or 6 million would be gravy but I'm not sure I can attain that given I had a late start in life.

Regarding real estate...lots of real estate guys in here. I've never liked real estate, nor do I consider it capable of reliably outperforming the market over the long haul. I realize there are a lot of different opinions on this but the below article sums up most of my reservations nicely. In brief, I don't particularly like the leverage risk, tax disadvantages (rent taxed as ordinary income), time and effort required to manage and maintain property, illiquidity, the transaction costs that most people forget about when buying/selling, dealing with tenants, etc.. But hey, to each his own. I totally get the psychological income that comes from "owning" something tangible that you can see, feel and touch, but having most of my money tied up into the market has never really bothered me, especially when I see my annualized compound growth rate from year to year. Yes, I understand that the inherent leverage risk in real estate can compound returns (if you're lucky and make smart investments) but as I stated earlier, I got a late start in life so perhaps if I were younger, I'd be willing to take on additional risk but for me and my current situation...it's just not worth it if I plan to stay on track.

Real Estate versus Index Funds | The Wealthy Accountant
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I think having to invest money into a side gig is a misnomer. Sometimes yes. Most of the successful ones I know took little financial risk. My side gig was essentially 0 risk. I had customers and therefore i knew I would be ok. I did invest a fair bit of time up front.

I think it is foolish to invest money into your side gig if the numbers are significant or that requires a lot of your time unless you are passionate about that gig.

I think the market is ideal but real estate gives diversification and depreciation is tax advantaged. The issue with real estate IMO is that it takes time to get those ideal type returns. For me it allowed me to invest in something different and I enjoy the hunt for a deal.

I think if you buy your own it isnt crazy to get a 15+% return and depending on the real estate you buy it can be fairly recession proof as much of the rental real estate market (mid to low end) is recession proof. When people get foreclosed on they need a place to live. I currently own one SFH and a duplex. They are/can be a pain even with property management but leverage is your friend and you can create multigenerational wealth.

I personally think investing in real estate without maxing out retirement and other tax advantaged accounts is a mistake but thats just me.

I have enjoyed learning about rental properties and hope to add another 10 properties over the next 10-20 years. I may or may not depending on life. I honestly dont even take those things into account in my race for FI. That being said I want to live a very comfortable retirement and this is the fluff. If I had 10 properties making me 1k a piece thats 10k a month and would increase with inflation.

While real estate and a side gig arent for everyone I think it is worth exploring if you have an interest. IMO finding a side gig is tougher as the opportunity cost is quite high.

As we all make $200/hr or more I would assume it would take 1-200 hours of your time at a minimum to get a side gig going and then some ongoing management. Thats 20-40k. I didnt cut back my shifts to do my side gig but it was nice cause that work could be done when my kids were asleep or in school.

I value my family time so I didnt want something that cut into that.

Over time I have outsourced some of the work to a VA and thats been great though I think i could do it better. But for $20-$25/hr plus them handling other nonsense in my life it is well worth it.
 
There's generally 2 types of real estate investors. The fix and flippers and the buy and hold crowd. Statistically, up to 40% of the former will sell to break even or at a loss. Average annual returns for the buy and hold investors runs between 7-10% historically. Sure, you have potential to generate upwards 20%+ annual return in a really good market, but you have to have some innate talent for this sort of thing and be really good in identifying favorable market factors, depreciated properties with potential, etc.. Not all of us are very good at that. For me, I'm just not a handy man or a fixer upper. I don't have that kind of vision and have zero interest in that kind of endeavor with a property. If I were to go out and try to identify properties with potential, I'm far more likely to make a bad investment than someone else who's good at that sort of thing.

Diversification into real estate is good during recessions and typically will outperform the market during a recession, but if you have a lot of your savings trapped up into real estate, that's the opposite of diversification and makes you extremely overexposed to losses if the housing/commercial local real estate market takes a dive. Liquidity risk is another thing that not all of us are crazy about. I can't stand the idea of my money being "trapped" in a real estate investment. Then you've got occupancy risk, taxes, maintenance costs, insurance, all sorts of out of pocket expenses that are not always anticipated.

Why not have your cake and eat it too with an REIT? I get many of the same benefits of direct real estate investment (rental profits) and none of the liquidity risk and lack of diversification. Depending on what you look at, REITs have average annual returns of 9-11% which is typically greater than averaged annualized returns of direct real estate investing. 90% of the REIT's annual profits are paid as dividends and not subject to corporate taxation. Since 2017 (Tax Cuts and Jobs Act), you get the benefit of pass through deduction allowing REIT investors to deduct up to 20% of their dividends therefore you avoid the "double taxation" of corporate tax AND personal income tax. REITs are sheltered from corporate tax so the investors are only taxed once. There are also huge cost efficiencies resultant from large scale advantages of REITs with billion dollar portfolios. Brokerage, property management, maintenance, leasing, interest expense, etc.. more efficiency with a smaller portfolio. There's also lower leverage risk in an REIT vs personal direct real estate investing or even a real estate fund. Excessive leverage is great in a hot market or when the market is doing well but can be disastrous during downturns.

I could keep going...big fan of REITs. That's about as close to real estate investing as I'll probably ever get and it's plenty close for me. Sure, I give up control and I'm still a passive investor but I get most of the advantages of real estate investing without as much risk and without having to spend any of my personal time managing anything other than a few point and clicks of my mouse through my brokerage site.
 
Groove said:
There's generally 2 types of real estate investors. The fix and flippers and the buy and hold crowd. Statistically, up to 40% of the former will sell to break even or at a loss. Average annual returns for the buy and hold investors runs between 7-10% historically. Sure, you have potential to generate upwards 20%+ annual return in a really good market, but you have to have some innate talent for this sort of thing and be really good in identifying favorable market factors, depreciated properties with potential, etc.. Not all of us are very good at that. For me, I'm just not a handy man or a fixer upper. I don't have that kind of vision and have zero interest in that kind of endeavor with a property. If I were to go out and try to identify properties with potential, I'm far more likely to make a bad investment than someone else who's good at that sort of thing.

Diversification into real estate is good during recessions and typically will outperform the market during a recession, but if you have a lot of your savings trapped up into real estate, that's the opposite of diversification and makes you extremely overexposed to losses if the housing/commercial local real estate market takes a dive. Liquidity risk is another thing that not all of us are crazy about. I can't stand the idea of my money being "trapped" in a real estate investment. Then you've got occupancy risk, taxes, maintenance costs, insurance, all sorts of out of pocket expenses that are not always anticipated.

Why not have your cake and eat it too with an REIT? I get many of the same benefits of direct real estate investment (rental profits) and none of the liquidity risk and lack of diversification. Depending on what you look at, REITs have average annual returns of 9-11% which is typically greater than averaged annualized returns of direct real estate investing. 90% of the REIT's annual profits are paid as dividends and not subject to corporate taxation. Since 2017 (Tax Cuts and Jobs Act), you get the benefit of pass through deduction allowing REIT investors to deduct up to 20% of their dividends therefore you avoid the "double taxation" of corporate tax AND personal income tax. REITs are sheltered from corporate tax so the investors are only taxed once. There are also huge cost efficiencies resultant from large scale advantages of REITs with billion dollar portfolios. Brokerage, property management, maintenance, leasing, interest expense, etc.. more efficiency with a smaller portfolio. There's also lower leverage risk in an REIT vs personal direct real estate investing or even a real estate fund. Excessive leverage is great in a hot market or when the market is doing well but can be disastrous during downturns.

I could keep going...big fan of REITs. That's about as close to real estate investing as I'll probably ever get and it's plenty close for me. Sure, I give up control and I'm still a passive investor but I get most of the advantages of real estate investing without as much risk and without having to spend any of my personal time managing anything other than a few point and clicks of my mouse through my brokerage site.
Click to expand...


I think the differing viewpoints from you and Ectopic are great...and both correct!

Personality, interest, and skills/knowledge make all the difference. Any EM doc who uses self-introspection to pick the correct path individually should do well.

That said, REITs that are not in tax-advantaged (ie retirement accounts, typically) miss out on two-advantages of "traditional" investment in real estate you missed in your post.

1. Depreciation (although used by REITs) allows traditional RE investors with high incomes (hopefully most docs here) to pay very small or no taxes on income early in accumulation; where as the income you receive from REITs is taxed at "your" (ie the typical doc's) very high marginal interest rate.

2. The tax-free returns that can be obtained through re-finance of stable rental properties after significant equity has been built up (or earlier if significant improvements have been made to properties that increased the appraised value). This can given intermittent boluses of hundreds of thousands of dollars every ten years or so that are tax-free!

Again, I still think a doc following your path or Ectopic's, depending on their unique factors, will do well. In fact, for most docs, I would suggest just index funds and more index funds and more index funds with >50% saving rate. This would lead to rapid wealth over about 15 years that is truly passive.

HH
 
Not really a side gig but many EPs incomes are supplemented by admin positions. Whether or not this is lucrative depends quite a bit on your practice set up. Some admin jobs pay crap and are total nightmares, while some pay quite well and allow one to practice less but make more.
 
I am not arguing at all with anyone about it. I like real estate. My issue with REITs is that they mirror the stock market more than anything else. At that point may as well just invest in stocks. If you want dividends CEFs are often better with their returns.

For me I like trying new things, I have some free time and have some experience. I like the returns and am pretty picky. My last property took me over 6 months to find. I have strict criteria and am fairly inflexible. I also am not embarassed to offer a number that I think will work for me. They can tell me no. I dont care. I wrote 5 offers (2 were over asking) before my 6th got accepted.

I do believe in the 1% rule and I do believe 15-17% returns are out there. For me the stock market is high. Outside of my main home which I dont consider an investment (can argue if it is or isnt) only about 10% of my net worth is in directly owned real estate. I have goofed around with Fundrise and Realty Mogul but they typically underperform their IRR.

I think it is totally right to just invest in the market. Real estate gives me some coverage when the economy slows. My target acquisitions are in the lower end of the market. Effectively I rent to lower middle class. They are typically good hard working people who pay the rent on time without games.
 
ShockIndex said:
Probably the easiest is simply signing up with an agency such as the Expert Institute for expert witness testimony. The more diverse the clinical and administrative experience you have, the better and most law firms like people coming from academic institutions to “wow” the jury.

Next in line would be private industry consulting. There are various entities ranging from pharma to venture capital. The easiest way is again through academia by being site PI for industry-sponsored clinical trials. Another gig is chart review for CMS compliance (obs vs. in-patient), insurance authorizations, ED design, etc. A google search is how I found a side job doing CMS compliance about 10 years ago (from home, company out of Phili, about $120/hr).

The hardest is US and foreign govt work. People with prior military, law enforcement, or other governmental agency work typically get the best gigs. This often doesn’t pay well and it may involve foreign travel but scratches an itch for a subsegment of EPs. PM me if prior LE or .mil and I can fill in the specifics for a given background and expected income.

Finally, I seem to recall lectures at this past ACEP on non-medical careers for EPs. A quick search of the ACEP website and I bet you could find them as all lectures are recorded and available for purchase.
Click to expand...

Anybody know what a reasonable expert witness compensation is nowadays ??
 
NYEMMED said:
Anybody know what a reasonable expert witness compensation is nowadays ??
Click to expand...
Defense?
I quote $600/h for all work outside of court. Minimum to appear in court is $1500 for 2h and $700/h beyond. plus expenses I did this recently and the plaintiff didn't even blink at covering it. Perhaps I need to raise my rates.

Plaintiff?
I haven't been asked yet, but I'd start with $20K cash up front just to consider reviewing documents and then $2K/h minimum to actually do anything. My soul is for sale, but not cheaply.
 
gutonc said:
Defense?
I quote $600/h for all work outside of court. Minimum to appear in court is $1500 for 2h and $700/h beyond. plus expenses I did this recently and the plaintiff didn't even blink at covering it. Perhaps I need to raise my rates.

Plaintiff?
I haven't been asked yet, but I'd start with $20K cash up front just to consider reviewing documents and then $2K/h minimum to actually do anything. My soul is for sale, but not cheaply.
Click to expand...
But, you're onc, which is a big bit away from us dumb ER docs. I would guess that the onc part of litigation is a much juicier piece of the cash.
 
I actually really like clinical medicine, although EM is in serious decline. There aren't really any clinical escape routes, though.
 
NYEMMED said:
Anybody know what a reasonable expert witness compensation is nowadays ??
Click to expand...

I do $400/hr to review a case, $500/hr for depositions, and $2000+ travel for court appearances.

Most of my early referrals came from the Expert Institute. I’ve now developed a relationship with several firms that call on me pretty regularly.
 
miacomet said:
I actually really like clinical medicine, although EM is in serious decline. There aren't really any clinical escape routes, though.
Click to expand...
Do a fellowship like @Birdstrike ? To me being about 10 years out of residency.. its stack cash, make safe smart investments and hold on for the ride. I think my SDG is safe but as emergentmd says nothing is guaranteed or forever. I would like to believe my SDG has another 15+ years left since we have been here for 40+ but who really knows. Short term I feel great. Long term what we know is that EM is a field in flux and no one can see the future.

FInd a non medicine or at least a non EM side gig especially if you have an entrepreneurial bend.
 
miacomet said:
I actually really like clinical medicine, although EM is in serious decline. There aren't really any clinical escape routes, though.
Click to expand...

I left EM after many years practicing for CCM. Yes, it was a giant pay cut for 2 years. However, I’m much happier and it reinvigorated me towards medicine - it was either fellowship or hang up my stethoscope.
 
I have to admit, none of these appeals. Pain, CCM, palli...I'm already queasy. I have no clue how to be an entrepreneur.

I'll do what I have to, of course.
 
Thinking about taking a plasma donation center medical director gig, less than 8 hours per month, pay is about the same a telehealth and tele utilization review. Probably wouldn't enjoy the work, so not sure I should take it.
 
TooMuchResearch said:
Thinking about taking a plasma donation center medical director gig, less than 8 hours per month, pay is about the same a telehealth and tele utilization review. Probably wouldn't enjoy the work, so not sure I should take it.
Click to expand...

I’m not sure I follow. If it doesn’t pay much AND you don’t really want to do it...why do it?


Sent from my iPhone using SDN mobile
 
Groove said:
How old were you when you switched to CCM?
Click to expand...

Sorry for the late reply as I just saw this question.

I was on the downside of 45

I practiced EM for about 15 years after residency with a mixture of full and part-time community, military, and academic work. I also had a period of federal work unrelated to EM, but had to leave because the stress on my family was pretty rough. By the time I left EM, I was pretty jaded and felt that customer service delivery to the “not sick at all” was being emphasized to the detriment of caring for the critically ill. In academics, I was a professional phone operator - spending most of my time finding the ideal intern to write the H&P for admissions that could be handled by a trained monkey and putting in bed requests.

Now, I work hard. It’s also long hours. However, it’s meaningful work to me, and my waking hours are spent manipulating complex physiology instead of dispoing chronic back pain. I also don’t have a medicine PGY2 telling me to call the ICU on every patient with a BS > 300 because, “They might be developing DKA and need an insulin drip.”

However, this is not for everyone. First, it’s a big pay cut especially when accounting for lost salary. Second, be prepared for the fact that the learning curve will be steep even for seasoned EPs. Third, the 12 on / 12 off lifestyle is not for everyone, although academic life can be more reasonable and jobs with shorter hours are out there. I’d mostly recommend it to people who still love medicine but no longer believe in the concept of EM as designed by the US healthcare system.
 
Last edited:
TooMuchResearch said:
Because I could cut my EM clinical time a bit. For something easier, probably boring, daytime hours.
Click to expand...


Ah I think I misinterpreted what you meant by possibly not liking the work.

If the work doesn’t involve anything you find sketchy than go for it. Who cares if it isn’t the most scintillating work? You may actually find you like it or it may lead to still other opportunities.

And sometimes boring can be awesome.


Sent from my iPhone using SDN mobile
 
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