I want to start making money.

[NJWxMan]

US grad. Just passed Part III boards. My program does not allow moonlighting in our emergency psychiatry room. Fiance is moving away to another job. I now have time. I will have a license and DEA# in a few months.

Since I'm not getting responses, I will throw out there that I'm thinking about renting a small office in a rural area and seeing patients at night for 3 hours x 3 days per week; cash only. Also, I only average 48 hours per week at this time as a resident.

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[sunlioness]

I'm not sure where you are located, but it's really hard to get cash only patients. Most people have insurance and want to be able to use it. The ones who don't have insurance can't afford to pay you cash anyway. And the ones who have money and would be willing to pay out of pocket even despite having insurance are generally only willing to do so in order to gain a more experienced provider with a specific expertise. They would generally not be willing to do so for someone who hadn't finished residency yet. Also, unless you were doing psychotherapy and therefore scheduling people frequently, you would need to have a lot of these cash patients in order to fill your schedule.

Other things to consider, you would need to buy your own liability insurance. This is expensive and might be difficult to obtain for what you propose given that you're not board eligible yet. So this plus renting the office space probably isn't cost effective.

You might want to look into nursing homes, assisted living facilities, that kind of thing for moonlighting opportunities. They're not as fun, but it's an hourly income that is steady and these places will cover your liability while working for them.

 

[whopper]

You are thinking of starting the equivalent of a private practice as moonlighting?

I'm not certain about this, but I think that might be illegal. From what I understand, moonlighting has to be approved by the program before you can do it, and you have to be working in an institution, not on your own.

If I were you, double check the legal fine print before you do this. Your program has to approve of what you're doing before you do it anyways so they're a good start. Do not go over the program's head and intentionally leave them in the dark. That is illegal. I've seen residents do this, and those that have got off with a slap on the hand because IMHO the PD was too wimpy. If a resident did that in my program, I'd seriously consider kicking that person out with strong words on their record that they at the least did not do their responsibilty to make sure they were engaging in a legally accepted practice.

I can tell you this, even if this were legal, if a resident were to want cash-only and I was the program director, I wouldn't let it happen. IMHO the resident in this case is too unrestricted. There is literally no one the resident has to answer to, and if that resident did something that went wrong, you betcha a lawyer will be thinking of pointing the legal guns and trying to find the program liable.

Another problem with starting cash-only at your point in your career is there are several things you have to consider if you want out of this practice. You will likely want to move onto bigger and better things by the time you graduate. You will be required to refer your patients to another doctor, and depending on your state may be required to give 3 referrals, typed up, with specific office appointments made for the patient and mailed to them via certified mail.

That's just the tip of the iceberg. Are you certain you know what you're getting into? I didn't mention you may be required to keep your patient's records in fire-proof cabinets, hold onto the records for at least 3 years, have several forms written up for the patients such as release of information forms, waiver forms, consent forms, etc.

Do you really want to have to buy a weight scale, BP monitor, fire-proof cabinets, type up a bunch of forms, just for a moonlighting gig?

(Are you manic?)

 

[Chrismander]

US grad. Just passed Part III boards. My program does not allow moonlighting in our emergency psychiatry room. Fiance is moving away to another job. I now have time. I will have a license and DEA# in a few months.

Since I'm not getting responses, I will throw out there that I'm thinking about renting a small office in a rural area and seeing patients at night for 3 hours x 3 days per week; cash only. Also, I only average 48 hours per week at this time as a resident.

Depending on your comfort with the morally gray, have you thought about joining a suboxone practice part-time? Two residents at my program have been moonlighting at a recent graduate's clinic doing suboxone. They take 70% of what gets collected from each patient and work evenings or Saturdays. No start-up costs, established practice support, easy to get going. Things might be different in your locale, but in my city there are no available suboxone slots for patients, so the demand was huge.

 

[Wednesday]

I don't think you can practice as a psychiatrist until you are fully trained. But this might be specific to my program/state.

What about disability evaluations? That's what people in my program do.

 

[whopper]

One can practice before being fully trained. It's called moonlighting. Moonlighting has specific rules attached to it. Those rules as far as I'm aware (and they vary between states) are that the PD has to approve, the resident has to have a medical license to practice in the state, the institution that accepts the moonlighter has to agree to cover their liability (hence, that's why moonlighting has to be in an institution), and because it's done in an institution, this limits the type of practice done...e.g. ER psychiatry, admissions, H&Ps only.

Doing the equivalent of private practice is not worth it as a moonlighter if you are in charge of it. To make a private practice requires a lot of capital to buy the require equipment and furnishings. It requires a lot of secretarial work, tax forms, good bookkeeping, someone calling the patients to remind them of their appointments, etc.

If one were to open up their own private practice, expect it to be a commitment. Moonlighters need a job where they can walk away from it if need be. E,g, if you just do ER or H&Ps, if the residency has to under the gun, you can walk away from the moonlighting. Private practice requires a continual commitment to be available to patients.

For that reason, I believe starting one as a resident is illegal, but even if it were not, I would not allow a resident to make one on his/her own. I would, however, allow a resident to moonlight in a private practice that is owned and controlled by someone else.

 

[Wednesday]

Thanks Whopper, but I know about moonlighting. In my state/program (as I indicated) we are not allowed to practice (or "moonlight") as a psychiatrist until we are fully trained. We can do disability evals and such and many people do.

OP, can you talk to any senior residents about options in your area? It seems that different states have different regulations anyway. You could also ask your PD if the private practice thing is legit, it's almost certain that they'll have to know about it anyway.

 

[ICHCB]

I remember hearing about an FP doc in New York City who had a housecall-only practice and a big part of that was suboxone. That would cut a lot of overhead I would think, not having an office. I actually considered that, but realized like was pointed out above that I'd need my own malpractice insurance. What is more, in order to get paid, I'd need to figure out how to accept health insurance and how to submit claims, etc. which really seems byzantine. I gave up on that.

 

[whopper]

I hope that doctor didn't carry the suboxone on him.

I think if this doctor's business was open knowledge, he'd get an invitation to a home, and when he entered, he'd either be blackjacked or mickey finned and wake up with his suboxone missing.

 

[OldPsychDoc]

I hope that doctor didn't carry the suboxone on him.

I think if this doctor's business was open knowledge, he'd get an invitation to a home, and when he entered, he'd either be blackjacked or mickey finned and wake up with his suboxone missing.

C'mon--it's got a street value, but only because it keeps folks from having fullblown withdrawals while they're looking for their next hit of the Real Thing. And how much does the guy carry (if any--maybe he just writes scripts and collects pee....) that would make it worth a felony assault?

My fondest hope is that someday, if I have demystified this whole Suboxone thing a bit, it will have made my tenure on this board worthwhile...

 

[whopper]

I wouldn't recommend any doctor carry any controlled substance as regular practice if going into the home of someone he does not know very well.

 

[OldPsychDoc]

I wouldn't recommend any doctor carry any controlled substance as regular practice if going into the home of someone he does not know very well.

Well, YEAH. I mean isn't that why we have PHARMACIES now???

 

[whopper]

Yes, and that's why I recommended he not carry it---because we got pharmacies.

 

[PharmaTope]

get certified in botox, go and do botox parties each week and do it a little cheaper than others offer in the area.

show up, blast it out, all cash

 

[Ibid]

The botox idea is good but why don't you just short BP down to about £2.50 (that its approx Net Asset Value). Set a stop loss at what ever you can afford so you dont have too sweaty a time incase they plug the leak. Pray for the integrity of the well head to fail and then just retire

 

[Scorcher31]

I'm going to be in a similar scenario in New Jersey in one-two years. I don't want to hijack this away from the private practice thing, but how does one generally go about finding moonlighting jobs? My program will allow moonlighting, but not with them. Is there a place I can look for psych only moonlighting opportunities? What's the general protocol? Do I just randomly start calling every hospital, nursing home, and state psych facility in the area? Who would I even try and contact there HR?, psych chair?, some director somewhere? Any opportunities for perhaps just 1 Sat or Sun a month?

I'd prefer it to be call like in nature (doing new psych admits, managing problems on the floor, covering an inpt unit on a sat when the main attending isn't around, dealing with psych patients in the community hospital ER, or consults) I'd prefer not to be doing medical admits or disability claims.

Just more info on moonlighting in general would be a great help for me and hopefully for the OP as well. Thanks!!

 

[whopper]

Ask the chief resident and senior residents. They'll know the under the table stuff. Ask the PD what moonlighting gigs the other residents have done.

 

[sunlioness]

Agreed. The best way is to take over a moonlighting gig from a graduating senior.

 

[kugel]

Consider moonlighting in prisons, where there generally is a hierarchy that is responsible for basic safe practice.

Consider psych evals for a pharmaceutical testing company.

 

[reedman]

C'mon--it's got a street value, but only because it keeps folks from having fullblown withdrawals while they're looking for their next hit of the Real Thing. And how much does the guy carry (if any--maybe he just writes scripts and collects pee....) that would make it worth a felony assault?

My fondest hope is that someday, if I have demystified this whole Suboxone thing a bit, it will have made my tenure on this board worthwhile...

some people are chewing and swishing the suboxone in theirs mouth, then spitting it out. apperently they absorb some buprenorphine this way but very little naloxone.

 

[OldPsychDoc]

some people are chewing and swishing the suboxone in theirs mouth, then spitting it out. apperently they absorb some buprenorphine this way but very little naloxone.

Then they are wasting their time--the bpn is supposed to be absorbed transmucosally, the naloxone is not absorbed at all if used correctly--it is only there to prevent parenteral abuse.

I never cease to be amazed by the addicted brain...

 

[hippiedoc13]

Then they are wasting their time--the bpn is supposed to be absorbed transmucosally, the naloxone is not absorbed at all if used correctly--it is only there to prevent parenteral abuse.

I never cease to be amazed by the addicted brain...

 

[reedman]

lol! so they are actually just wasting it? seems like an addict would feel the difference. i guess there is a little placebo effect? thats really funny.