The Side Gigs of an Orthopedic Surgeon in His First Year of Retirement

Before we dive into the side gigs of today’s guest author, I think a few disclaimers are in order. Hopefully, this will head off the nearly inevitable comments on what constitutes retirement and what a side gig is.

I’d also like to congratulate Dr. Jerome Enad on meeting his financial goals, retiring from his main gig, and finding ways to utilize his knowledge and skills in medicine and orthopedics after leaving full-time employment.

Disclaimers: A side gig suggests that someone has a primary gig, and this is something they’re doing on the side. With the gig economy rising in prominence, it’s quite common for someone to have one or several smaller gigs with no main gig at all. I think Dr. Enad’s main gig might be enjoying a more relaxed lifestyle, and what he describes below are side gigs to that.

As far as a retired person doing paid work, I have no problem with it whatsoever. Retirement purists seem to balk at any type of post-retirement work, be it paid or unpaid, but I think of retiring as something you do at least once and maybe a few times rather than thinking about retirement as a state of permanent and uncompromising leisure.

This article was submitted by Dr. Jerome Enad.

Why I Retired

In 2020, at the age of 54, after 29 years in medicine, I decided to call it quits from practicing clinical medicine. The long weekly commutes, frequent ER call nights, undesirable surgical cases, (not to mention clunky EHR entry, challenging pre-authorizations, MIPS/quality reporting, opioid prescribing restrictions) all led me to professional burnout.

Fortunately, I was already receiving a nice military pension from 24 years of active duty (including the 4 years of medical school), and I had maximized my 403(b), 457(b), and backdoor Roth IRA contributions over a subsequent 9 years of a hospital-employed practice.

As such, my 3-fund portfolio in pre-tax, Roth, and taxable accounts projected a 100% success rate for at least a 30-year retirement on FireCalc and i-orp at my desired asset allocation and annual expenses. So I pulled the plug and joined the ranks of the Financial Independent Retire Early community.

Retirement Plans get Quarantined

Early retirement was going to be filled with adventure for me and my wife, also a retired physician. We front-loaded plans to increase our international travel habit that we cultivated over the past several years. Visiting new historic places and returning to old favorites were planned with eager anticipation.

That is, until the Covid-19 pandemic hit, and international travel became restrictive and downright impossible. So we stayed home, and I spent a lot of my time completing “honey do’s” and maintenance around the house – working in the garden, touch-up painting the house, restoring some patio furniture, and changing the filters and headlights on the cars.

I also made time to do some form of exercise every day (in addition to walking the 3 dogs). Outgoing social activities were completely non-existent.

You can take the man out of the work, but…

During my working career, I considered learning as much as I could about orthopedics and sports medicine not just my job, but also a hobby. So early in retirement, I continued reading journal articles (I am a reviewer for two orthopedic journals) and signed up for Ortho Webinars online.

I could not get medicine out of my system, even though I did not want to go back to work anymore. I eventually found two opportunities that were like a job and a hobby, but I was able to do both on my own terms at my own discretion.

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Uncle Sam Needs You

First, I am able to provide my orthopedic expertise as a Specialty Consultant for the VA system. In an effort to relieve the backlog of disability claims, in 2016 the VA elected to outsource their Compensation and Pension (C&P) disability exams to independent civilian firms – awarding multi-billion dollar contracts to five contracting firms.

These firms hire specialists and primary care providers to perform the C&P exams that were once only under the purview of VA hospitals and clinics. I decided to apply to one of these firms, knowing that my own status as a military veteran would probably make me a desirable candidate. I was hired within a few weeks of applying.

How am I able to see patients without having my own office? Well first, the contracting firms have their own medical offices in which to work, and second, the disability evaluations are really non-clinical. They sound a lot like IMEs, but they are more like Expert Witness medicolegal work.

For the specialty of orthopedics, our main role is to determine whether a Veteran’s claimed symptoms are an actual condition, and whether the condition is related to their time in military service. There are strict definitions and criteria to substantiate or refute the service connection. As long as you know the definitions, it becomes pretty straightforward what your opinion will be.

The VA will sometimes ask specific questions, such as whether the new condition for which you are seeing the Veteran has been aggravated beyond its natural progression by an entirely separate, service-connected condition that he already has. Only a qualified specialist has the depth of experience to accurately make such an assessment. You, as the examiner, do not determine how much or whether the Veteran will receive compensation.

Preparation for the encounter is the most labor-intensive part of the job. As a specialist, first you review the Veteran’s service medical records, which typically consist of several hundred to a few thousand pages scanned into their claims file. In the review, you are searching for clues in the Veteran’s previous medical history that might be related to their current claim.

You then interview the Veteran to fill in any gaps in the history, and you examine the Veteran to document their current level of function. You must document your findings and opinion on the VA’s form, the Disability Benefits Questionnaire specific for their claimed body part, on the civilian firm’s EHR software. Once you have done a few, it gets easier to navigate through the EHR.

The appealing thing to me about the encounter is that there is no doctor-patient relationship established. There is no treatment rendered to the Veteran. You may order x-rays or labs for the appointment, but no prescription meds or medical recommendations are made. You have no commitment to the Veteran other than the truthful documentation of the facts and your professional opinion of the questions asked by the VA. You, as the examiner, do not determine the compensation for their condition. You will not be deposed for your opinion. The private contractor pays for omissions and error insurance.

There are also other civilian firms that perform complete physical exams for VA disability claims. They hire all types of medical providers to essentially perform a comprehensive Level 5 baseline physical exam on the Veteran. Again, you use the contracting firm’s facilities for the evaluation and their own EHR to document the exam. No opinions are made. I actually applied to one of these companies to do these comprehensive physicals as a side gig because they had a local office close to my home.

I even bought a new Welch Allyn battery for the oto/ophthalmascope handpiece that I’ve had since medical school. However, I found out that as a specialist, the daily rate to perform orthopedic exams far exceeds the rate I would get for the comprehensive exams, so I passed on the full physical opportunity. I don’t think I could have gotten away with the Orthopedic Triple Point on auscultation anyway.

Another aspect that I enjoy as a specialist doing VA C&P evaluations is the travel. There are Veterans all over the country that need an Orthopedic C&P exam and not enough orthopedists to do them. So I will fly to another state just to do the C&P exam. The firm that I contract with has a pretty good travel service, so I work with them on the travel arrangements to maximize my personal frequent flier miles and hotel rewards.

The firm reimburses all flight, hotel, rental car, and meals. The jobs have allowed me to somewhat fulfill my travel itch during the first year of retirement, and I get to visit new places and give feedback on new hotels and restaurants on Trip Advisor. Ultimately, the most rewarding part about being a VA Specialist Consultant is that I get to give back to the military community that I was a part of for so long.

The Pen is Mightier than the… Scalpel

There has been another opportunity that just evolved organically for me. Over the past few years, I have been regularly perusing a few internet forums on topics I find interesting – personal finance and the FIRE movement, bicycling and sports, and of course orthopedics and sports medicine. I even did a one-year writing fellowship with Doximity to improve my writing skills.

I soon found myself contributing detailed answers to these forums, receiving positive feedback and appreciating the “likes” my posts would garner. This experience spurred me to pursue freelance writing opportunities. At one point several years ago, I dabbled with my own blog while trying to promote my orthopedic practice, but it was a one-man shop and the commitment was just too much for me. I am much more comfortable with just writing thoughts and opinion rather than arranging all that is involved with page setup and maintenance of a site.

In retirement, I wanted to try my hand at writing again, so I signed up on a few freelance writing job boards to see if anyone needed a medical writer. I actually had success being hired by two websites for which I now ghost write material for their blogs – one that has to do with sports medicine and footwear and the other that is a vendor that sells surgical training kits.

Sure, I get paid a nice little sum for each blog post, but what I enjoy even more is that I get to educate a reading audience on subjects that I know well, and I get to remain anonymous. The posts also help keep me current on these topics.

Guilty of Still Working

So maybe the internet retirement police would say that I am not really retired, since I was able to find paid work in the field of medicine in my first year of FIRE.

The “work” really only takes up a few days a month of my time. I wouldn’t be doing either of these gigs if I didn’t find them interesting. And I approach them as “paid hobbies” that I do when I want to rather than because I have to.  They have made the transition into my first year of retirement much easier.

Start Your First Side Gig

PoF: One of the most popular side gigs for physicians and other healthcare workers is one of the easiest to get started with. You can get paid for completing short medical surveys and even get paid just for signing up with some of our survey partners:

• All Global Circle (bonus of up to $50 per physician, depending on specialty)
• Curizon (new registrants referred from PoF entered into $250 drawing each month)
• MD For Lives ($20 signup bonus for all)
• Incrowd
• ZoomRx
• GLG