12 Ways to Earn Extra Income From Medical Activities

Leigh Page


December 17, 2013

In This Article

Expanding Your Patient Base

10. Treat Nursing Home Patients

There is a reason why physicians caring for nursing home patients usually do it part-time, says Reuben Tovar, MD, a hospitalist who serves as medical director at 2 nursing homes in Austin, Texas. "If you're working full-time, going to many different facilities," he says, "you lose your focus, and the quality of care suffers."

Dr. Tovar says that the best way to work in a nursing home is to serve as medical director and see patients there as well, which is what he does. The medical directorship is necessary, he says, because Medicare and Medicaid do not pay well for patient visits. But nursing homes prefer their medical directors to be engaged in patient care because they are more engaged with operations, he says.

A medical director job requires at least 20 hours of work per month, usually in regular meetings with staff and to comply with deadlines for regulations, Dr. Tovar says. The medical director would spend another 10 hours a month seeing patients in the facility, which can be done in a single afternoon, he says.

Nursing home medical directors can earn $70,000-$80,000 a year, according to the Website Simply Hired. In addition, reimbursements for treating individual patients can bring in $75-$150 an hour if coded correctly, according to a 2010 report published by the Kaiser Family Foundation.[5]

Nursing homes are looking for medical directors who are empathetic and reliable and have a lot of older patients in their practice who might consider using the facility, Dr. Tovar says. Physicians who want to be medical directors should go to classes endorsed by the American Medical Directors Association (AMDA), which represents nursing home medical directors, and obtain AMDA certification, he says. Dr. Tovar did not take that route, though. He began by visiting a nursing home when one of his patients was admitted, which led to the administration asking him to be medical director.

Nursing homes are frequently sued for malpractice or elder abuse, but only one fifth of these lawsuits name a physician, according to a 2003 study published in Health Affairs.[6] Dr. Tovar says that's because these cases often involve problems that occur when the physician is not in the facility, such as patient falls.

Certain physicians thrive in a nursing home, said Robert Milligan, MD, a family physician in Buffalo, Minnesota, and AMDA member, who spoke in an AMDA sound clip.[7] "They have to love people and be extremely compassionate, and you have to like a good puzzle," he said. "The average individual we care for in a nursing home has 7 medications and 10 diagnoses."

Nursing home physicians also have to deal with numerous phone calls from staff and demands from family members. "The main talent you need to have is patience," Dr. Tovar says. "The conversations are slower for these patients, and the family needs to be involved."

Pros: Work in nursing homes is usually part-time, and it can pay well if you combine it with a medical directorship.

Cons: Physicians may be overwhelmed with calls from staff and families' demands. Facilities face numerous lawsuits for malpractice and elder abuse, but doctors are usually not named in them.


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