You may not have the control over your nursing staffing level like you would if you owned your own freestanding emergency department. You may not have the control over physician staffing levels, shift lengths, and the vacation calendar like you might have in a small democratic group. You may not have access to the additional profits that come with a successful business. But you do have something that in some ways can be just as valuable: an in-demand skill set and the potential for an extreme amount of flexibility. Your job as the CEO of You Inc. is to get as much as you can in exchange for your work and value. The more flexible you can be, the higher the rate for which you can exchange your time.

There are many situations where hospitals, CMGs, and other employers have difficulty staffing the emergency department. It may be a relatively undesirable town to live in or a difficulty in covering night, weekend, or holiday shifts. (You might be amazed to learn the going hourly rate for covering Christmas Eve in a difficult-to-staff location.) Maybe the emergency department has poor levels of support staff or call coverage. Or perhaps the CMG just acquired the contract and is still scrambling to find doctors interested in working there in the long term.

Whether you relocate your family or simply commute to fill these shifts, they’re all opportunities to increase the revenue of You Inc. and gain benefits you might not have as part of a small democratic group. As a “gunslinger” for a CMG or locum tenens company, you can set up your personal finances such that you spend much less than you earn. This will allow you to take sabbaticals lasting weeks or even months, which a partner in a small democratic group could never do. For many docs, this extreme flexibility can more than make up for the inconveniences of not knowing what emergency department you may be working in six months from now.

ADD REVENUE STREAMS

You Inc. should also keep its eyes open for additional revenue streams. By virtue of the fact that most ED shifts don’t occur during banking hours, emergency physicians have discovered the value of having multiple weekday mornings off each week. While this time is often used for resting, recovering, and recreating, it can also be profitably used to develop other revenue streams.

This is the time to feed your entrepreneurial streak. You can be an EMS medical director, do medical legal work, consult for insurance companies, or start a business unrelated to medicine. Perhaps you’ve wanted to become a writer, speaker, or politician. Emergency medicine lends itself to these side pursuits far better than many specialties that are locked into standard clinic or operating room hours. These additional income streams reduce the risk of disability, job loss, contract loss, and other financial catastrophes. After a while, and especially if you keep living expenses down, they may even free you from the need to practice medicine for money at all.