12 Ways to Earn Extra Income From Medical Activities

Leigh Page


December 17, 2013

In This Article

Good Pay and Very Little Danger

2. Provide Care to Prisoners

Physicians can find work 1 to 2 days a week in prisons or jails at a compensation level comparable to private practice, according to Michael Puerini, MD, immediate past president of the Society of Correctional Physicians.

Dr. Puerini, a family physician in Salem, Oregon, started his correctional career 22 years ago with part-time work in a juvenile facility. Among the advantages he and others cited were no out-of-pocket payments to collect, generally low malpractice rates, and minimal paperwork. "I don't have to stay late at the end of the day, dealing with paperwork," he said.

However, prisoners are "the sickest people in the country," Dr. Puerini added, citing high rates of chronic illnesses like HIV, cancer, emphysema, and hepatitis C. "Physiologically, they are older than their age."

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

Part of the job involves resisting inmates' efforts to manipulate physicians' orders to achieve special status, such as sleeping on a lower bunk or acquiring orthotic shoes. "Outside, you wouldn't think of this as important," Dr. Puerini said.

Prisoners generally get better care than they had before incarceration. A 1976 US Supreme Court decision established a prisoner's right to healthcare. Prison systems have tried to keep costs in check by introducing telemedicine, which removes the expense of transporting prisoners off-site with armed guards.

Services are often outsourced to private companies. Miami-based Armor Correctional Health Services, which operates in 5 states, is looking to contract both primary care physicians and specialists in orthopedic surgery, ophthalmology, cardiology, ob-gyn, infectious diseases, and psychiatry, according to John P. May, MD, the chief medical officer.

He said casting, obtaining x-rays, minor surgery, and dialysis are generally performed on-site, and nurses staff the facilities around the clock. Work in county jails, he added, is more demanding than in prisons, he said. Because newly arrested felons start in a jail, this is the place where physicians have to stabilize untreated chronic illnesses and fix wounds sustained from eluding capture. When felons are convicted and sent to prison, he said, their health status can be stabilized.

Dr. May said many physicians who start part-time end up choosing prison medicine as a full-time career. "Once you've worked inside, you'll find it very rewarding," he said. "It's not so scary and intimidating as you might think."

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

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


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