Job Stacking for Doctors: A Modern Approach to Work-Life Balance

Job Stacking for Doctors: A Modern Approach to Work-Life Balance

by Tod Stillson MD, originally published on KevinMD 11-23-23

The medical profession has long been associated with intense personal commitment and time-consuming work. However, in recent years, a new concept called job stacking has emerged, and it is revolutionizing the way physicians work.

In this post, I will explore the concept of job stacking for doctors, discuss its benefits, and provide guidance on how to implement it effectively.

What is Job Stacking?

Job stacking is the practice of working multiple jobs in multiple locations that additively create an income and lifestyle that you prefer. It represents a modern approach for physicians who no longer want to be confined to one job in one location. Job stacking involves working in various clinical settings and can encompass any combination of W-2 and 1099 jobs that align with your preferred lifestyle. It supports location-independent work, enabling you to live in your preferred location while offering professional services elsewhere.

Benefits of Job Stacking for Doctors

Job stacking offers several benefits for doctors. First, it allows for the diversification of income sources, which helps to mitigate the financial risk that comes with relying solely on a single income stream. Secondly, working in various settings enhances your skills and promotes career growth. It also increases job satisfaction and improves work-life balance, reducing the risk of burnout. Lastly, it enhances your professional autonomy by giving you control over the jobs you choose to take on, and since many of these jobs are as non-employees, it allows you to have more control over your life.

Examples of Job Stacking

The most powerful concept of job stacking is that you have the power to create a more sustainable workload that aligns with your preferred lifestyle and income. This option to individualize your professional work life is very appealing to doctors who don't want to sell their souls to a single large corporate employer that demands their full attention and loyalty. The traditional model of being 100% aligned with a single employer in a full-time job is quickly becoming less common for doctors, particularly younger ones who seek a better work-life balance.

Let's examine some examples to gain a better understanding of job stacking.

The Non-Full-Time Job Stacker

Dr. Smith, for instance, works 0.6 FTE as a W-2 employee at a NY Hospital System for three days a week. Additionally, he works one weekend a month and receives a 1099 income for hospitalist work at NJ Hospital System. In addition, he conducts telehealth visits for 8 hours per week on a national telehealth platform as a 1099 employee. He also supervises 5 Nurse Practitioners per month using a national NP Collaborative platform, earning 1099 income at a rate of $500 per NP.

The Full Time Job Stacker

Another example is my own experience where I work a full-time job and then take on side work on top of my full-time work. I work as a 1.0 FTE as a 1099 employee in an employment lite contract earning >$600,000 annually. In addition, I serve as the Assistant Medical Director of a local ECF, earning an annual income of $12,000. I also take hospital calls for obstetrics, which brings in $60,000 annually. Furthermore, I supervise three Nurse Practitioners through collaborative agreements, earning $7500 per year. I prefer to receive all of my professional income as a non-employee through my professional micro-corporation. This is due to the numerous tax advantages that small businesses enjoy over W-2 employees. By utilizing this structure, I can retain 10-15% more of my income compared to traditional W-2 employment and maintain an effective tax rate of less than 20%.

How to Implement Non-Full-Time Job Stacking

Implementing non-full-time job stacking involves first downshifting your primary job from a 1.0 Full-Time Equivalent (FTE) position to a 0.6-0.8 FTE. This option is being adopted by many employers as a physician recruitment and retention strategy. This structure is particularly appealing to younger female physicians who experience the tension of launching their clinical careers while also starting a family and striving to be a mother. This transition to a non-full-time status allows for flexibility in taking on work that aligns with their schedule, income needs, and preferred lifestyle creating a better work-life balance. It is not uncommon to come across stackable jobs that combine both W-2 and 1099 income. The income earned from these jobs can be maximized if you have a business structure in place to optimize the cash flow.

To implement job stacking ideally, certain prerequisites are necessary.

These include owning a business that can receive and manage your professional 1099 income. While many physicians default to sole proprietor status for its ease of integration and pass-through tax status, I believe they often overlook the advantages of a professional micro-corporation. This structure offers greater control over the cash flow into your household. Regardless of the business structure you choose, you will be working as an independent contractor when you earn a 1099 professional income.

To excel as an independent contractor, you need to adopt a small business mindset that isn't solely dependent on a single employer or a lifetime role. While doctors may not receive extensive small business education during their training, the practical knowledge required to run a virtual single-member professional business can be easily taught to doctors due to their high aptitude. This is one of the many reasons why I have created SimpliMD, as a small business community for doctors that provides a host of resources to help doctors grow their small business competency. At SimpliMD, we are here to help you with various aspects of your professional life with our membership that supports the growth of your small business and entrepreneur competency within the marketplace.

Lastly, job stacking involves maintaining a commitment to preserving your professional autonomy. By not relinquishing full control of your professional life to a single full-time employer, you are more likely to avoid burnout. The current burnout crisis in medicine is, in part, due to the loss of professional control associated with traditional employment. You can avoid this by not aligning solely with a single employer.

5 Considerations for Job Stacking

There are 5 primary considerations to keep in mind when it comes to job stacking.

By taking these considerations into account, you can optimize your job-stacking approach and create a successful and fulfilling professional path.

1. Identifying Diverse Job Stacking Opportunities

The first step in effective job stacking is to identify the diverse opportunities available. Physicians possess a wide range of skills beyond clinical expertise, and it is crucial to recognize these talents. Whether it involves writing, teaching, consulting, or engaging in healthcare technology, each avenue presents an opportunity to expand one's professional footprint. Understanding the full scope of possibilities is crucial for creating a well-rounded and fulfilling job-stacking strategy.

2. Building a Job Stacking Strategy

Crafting a comprehensive job-stacking strategy is like designing a roadmap for professional success. Physicians should align their diverse interests with specific goals, creating a synergy that enhances their overall impact. This requires careful consideration of time management, setting realistic expectations, and prioritizing activities that align with personal and professional aspirations.

3. Navigating Legal Aspects

Micro-Business Formation, Licensing, Credentialing, and Compliance: When it comes to physicians engaging in job stacking, having a clear understanding of the legal landscape is of utmost importance. Micro-business formation provides a distinct approach to organizing these various professional endeavors. You should work with a legal professional to explore the intricacies of establishing micro-corporations, acquiring the required licenses, navigating credentialing prerequisites, and ensuring compliance with relevant regulations. Establishing a strong legal foundation is essential for physicians to confidently pursue their job-stacking endeavors. At SimpliMD we do this work for you by vetting out physician-centric legal professionals for you to work with through our recommended professional network.

4. Marketing, Branding, and Developing Your Micro-Business Persona

Effective marketing and branding are essential components of successful job stacking. Physicians need to cultivate a distinct micro-business persona that resonates with their target audience. You should consider strategies for building a strong online presence, leveraging social media, and establishing a brand identity that reflects the multifaceted nature of your professional pursuits. A well-crafted micro-business persona not only attracts opportunities but also fosters credibility and trust.

5. Managing Financial Structure and Tax Planning

Job stacking introduces a new dimension to financial management for physicians. You should manage the financial structure of your job-stacking endeavors and engage in tax planning. For many doctors, their tax preparers will funnel them towards receiving their 1099 income as sole proprietors because of its ease. However, tax planning professionals (as opposed to tax preparers) will often point out that a professional micro-corporation taxed as an S-Corp or C-Corp provides more tax strategies and options for doctors. Don’t miss out on this! By understanding the financial implications of job stacking, physicians can enjoy the rewards of their diversified efforts while maintaining financial security and growing their net worth more rapidly.

Next Steps

If you're interested in job stacking, here are some next steps that you can take to empower your professional life, create a balanced lifestyle, and thrive as a modern physician:

1. Commit to learning more about unleashing your micro-business powers as a physician through my free e-book on why every physician should form their own micro-corporation.

2. Tap into this innovative approach to your professional work by becoming a member of our exclusively for physicians where you will find micro-business support and free weekly resources and blog posts that will help you grow your small business competency.

3. You can reach out to me for $99 business consultation to discuss whether you would benefit from micro-incorporation.

4. You can sign up for 1 on 1 micro-business coaching through SimpliMD’s Micro-Business Coaching Program

5. You can purchase a copy of my best-selling book “Doctor Incorporated: Stop The Insanity of Traditional Employment and Preserve Your Professional Autonomy” which unpacks my journey from traditional employment to independent contracting and job stacking.

Job stacking offers physicians a transformative approach to their professional lives, enabling them to embrace a variety of roles and pursuits. By identifying opportunities, building a strategic framework, navigating legal aspects, honing marketing skills, and managing finances wisely, physicians can unlock the full potential of job stacking. In the ever-evolving landscape of healthcare, job stacking stands as a testament to the adaptability and resilience of physicians committed to shaping their professional destinies.