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Doing Disability Exams, Chart Reviews, or IMEs as a Physician Side Gig: Pros and Cons

Performing disability exams is a side gig opportunity that comes up frequently in our online physician communities as there are many companies looking for doctors to complete these. Given that they don’t require an additional skillset past your knowledge as a physician, many physicians, including residents and retired physicians, see them as an easy way to add an additional income stream. However, these jobs can vary quite a bit in how they are performed and compensation, depending upon the entity you are doing disability exams for (insurance companies, Social Security, and for veterans are common examples) and the type of position (physicial exams only, remote chart review, or IME), and the environment in which you do them (your own office, from home, versus at another office). Many doctors on the group who have tried this side gig have mixed feelings about them, with several saying that they aren’t worth it due to low compensation and other hassles, while others say that they are a low stress way to make some additional cash. Physicians considering this side gig have questions ranging from understanding how billing and coding works for these exams, how much they can expect to get paid, how to find opportunities, and the pros and cons of this side hustle. Below, we’ve compiled the questions we’ve seen the most often to help doctors evaluate whether performing disability exams is the right side gig for them.


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Overview of the key points of performing disability exams as a doctor side hustle


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Who hires physicians to do disability exams or reviews?


When physicians on our communities reference doing ‘disability exams,’ it’s important to note that there are many different companies or entities who hire physicians for these side gigs, and these jobs will be different in terms of responsibilities, where you conduct the work, and compensation. Some examples of people looking to hire physicians for disability exams, worker’s compensation claims, and disability review work include attorneys, employers, insurance companies or independent review organizations, and government agencies, like the SSA, VA, and the Department of Labor for your state. 


There are many companies that hire physicians and other healthcare professionals to conduct these exams. However, you don’t necessarily need to do disability exams through a company. There are several side gigs within the disability exam space where you can contract directly with the entity needing the exams. For example, physicians in private practices often do this.


Not surprisingly, if you perform disability exams through a company, the middleman fees are substantial, with some of our physicians reporting that the intermediary companies take between 50 to even above 60%.


In a side gig where compensation is already on the lower side, it may be well worth the effort to find these opportunities on your own instead of going through a company, or at the very least, negotiate for a higher rate. With so many companies in need of physicians to complete these exams, you should know your worth, as many of the frustrations expressed by physicians is related to feeling that the compensation is not worth the effort. See more about this below.



What does a side gig doing disability exams or reviews entail?


Side gigs relating to disability exams can have a few different components. Some of these gigs are very basic, where the physician primarily does the physical exam +/- a few basic additional things like answering some predetermined questions on a form. Others require you to do an extensive review of a chart and weigh in on whether the patient is disabled. The most complex of these is the Independent Medical Exam (IME), where you not only do a full chart review, but also do a history and physical, as well as then prepare a report on your findings and whether the patient meets criteria for disability. Often times this report follows a very specific structure that is formatted per specific guidelines and answers specific pointed questions.


In general, determination of disability is based on the following things:

  • What the diagnosis is

  • Whether they are disabled or impaired (and potentially to what degree)

  • Whether this is expected to last

  • Whether they can still perform their last job

  • If they can do any job, including different types of work


Depending on your job description, you may be weighing in on one or several of these parts of the disability determination process:

  1. Performing physical of the individual and/or taking a history

  2. Analyzing the chart and compiling the evidence for or against their case

  3. Ordering any necessary additional imaging or tests

  4. Rendering a final medical opinion on their condition or in the case of worker’s compensation, for assessing if you think the inquiry was work related or not


Three main types of disability exams to consider for a physician side gig


Physical exam predominant disability reviews


You will be asked to perform a physical exam to assess a patient for a possible disability claim. Sometimes you will also have to review the results of some basic tests like EKGs or basic imaging. This type of work can be done for governmental agencies such as the Social Security Administration (SSA), the Office of Veteran Affairs (VA) or a department for your local state.


Individuals may need an initial exam to assess eligibility for disability benefits, or may need a follow up exam to review and determine how their condition has improved or otherwise changed. In these situations, you will often go to an office where a company has scheduled multiple patients, or even sometimes go to a patient's home.


Note that in these scenarios, you are not usually involved with the actual determination of disability. Many physicians do very basic, state-mandated physical exams for state disability exams. These are not independent medical examinations (IMEs) where you weigh in on whether the patient should get benefits. This is often cited as a good side gig for residents and fellows, as this type of examination usually pays a relatively low rate, around $100/hour.



Disability review (virtual or mostly virtual)


Disability reviews are a type of chart review that can be done independently of a physical disability exam, such as a review done for an insurance company, where you largely review the electronic records for a disability case and then render an opinion or recommend more evaluation. Again, you will likely have a general template with specific questions that you use to compile a final report. This report use objective evidence drawn from your chart review to weigh in on things like whether the patient is disabled and potential to what degree, whether this is a new condition or was related to a preexisting condition, what the diagnosis is and whether they can perform their current job, and whether this is expected to be a long term problem.




Independent Medical Exam (IME)


In many ways, this can be like a more complex office visit, except with a patient that you don’t have a pre-existing relationship with. You or your practice will have a set fee schedule that is contracted ahead of time and billed directly to the entity requesting the exam, whether it be a disability insurance company, an employer, or a government agency. Make sure that your practice doesn’t bill it to the patient’s insurance! Per our community members, most IMEs will be level 4 or 5 visits, and you should have some provision for especially complicated cases where your review of their medical records takes particularly long . Some additional testing may be covered, while other things may require approval before completion, so make sure you’ve clarified everything ahead of time.


Because of the volume of medical records that need to be reviewed, many physicians will review the patient’s records before the visit. That way, when the patient comes, you will mostly be focused on doing a comprehensive H & P and documenting your findings thoroughly. It is not your job to treat the patient, offer them suggestions for their management, or refer them anywhere. The sole exception to this may be if you find something that has not been addressed that could be very clinically significant, such as a cancer or other suspicious finding that you don’t see as having been worked up. In those cases, you will want to include it in your report +/- contact the patient’s physician and document it, just to ensure that you are also covered from a malpractice standpoint.


After they leave, you will determine a diagnosis for the patient and an opinion on whether they are impaired or qualify for disability based on what their professional or work responsibilities are. You should back this up with as much data as possible. Many companies will also ask you to determine how long the disability is expected to last. You may want to recommend a time frame for when the patient should be reevaluated, if applicable.


Then you will generate your report and send it to the entity that ordered it (not the patient’s physicians!). 



Examples of Specific Disability Exam Work as A Physician


Physical exams for the Veterans Affairs Department


This job supports the Veterans Affairs Department by helping to perform disability examinations on behalf of the VA. It can be done in certain offices located throughout the country at certain pre-set times, or in your own office. Many of our members report doing a few hours on a Saturday where they schedule 1-2 patients an hour. You will submit reports called Disability Benefits Questionnaires (DBQs), which are VA created worksheets that have all the rating criteria, with specific questions that are designed to get the information necessary for evaluation of disability for each condition. Our members report that these usually pay about $100/hour if done with a company, but that there is a significant x factor on how much you can earn depending on how many patients show up, how much time you need for transportation, and how much time each exam takes.


Disability exams for the Social Security Administration


Our physicians report that you must be trained to do these, and that this training takes time (often up to 200 hours). That said, every state has a Disability Determination Services office, which contracts or hires physicians to review every application for disability. In this role, you must review the applicant’s medical reports. In some cases, you may have to dig deeper and actually speak to other physicians that were involved in the patient’s care, or order additional workup, exams, or imaging before making a determination. 



Disability exams for an insurance company or IRO


These are mostly virtual, and the companies will generally send you relevant files electronically. They don’t generally care what time of day you do the reviews, so long as you complete them within the specified amount of time, which can be a quick turnaround of 1-3 days. Therefore, it’s a good side gig for someone who’s working clinically and wants to pick up some extra cash in the nights and weekends.


As you know, we are big fans of disability insurance for physicians. In this side gig, you could be on the other side of the table where a physician or other professional with DI could be claiming their disability benefits. As these can be large payouts a year, the company will want you to review the available medical records and insure that the claims have merit.



Which doctors should consider doing disability exams or chart reviews for supplemental income?


Disability exams often require a lot of chart review work, especially for complex cases with extensive medical histories. This side gig can be a good fit for doctors who are detail-oriented and don’t mind the administrative and paperwork aspects of medicine. Physicians who enjoy doing research and analyzing data may also enjoy this line of work.


Some doctors in our community mentioned that this type of work can have a steep learning curve at the beginning given the rigid templates and requirements for the exam, review, and corresponding report. Since pay is often determined by case, this can lead to less overall earnings in the beginning, though they note it can become quite lucrative once you become more efficient. Physicians who are quick learners and adapt quickly to new systems can potentially make a good income quickly with this side gig.


Physicians interested in nonclinical opportunities often consider this side gig. If you’re looking for something to balance your clinical work, you may enjoy doing disability exams. While this side gig often includes a physical exam, they are low stress and, as noted above, the bulk of the process is usually chart review and reporting work that isn’t patient facing.


Physicians in private practice can add income with their current setup. While this type of work isn’t limited to physicians in private practice, physical disability exams can be an easy addition for family medicine physicians, psychiatrists, and other specialties to add to their existing private practice and clinical work as an ancillary private practice revenue stream. Scheduling exams around your regular administrative time saves you from having to commute to another facility for the physical disability exams and can help you reprioritize your time more efficiently in the case of no show patients. Additionally, many new practices may want to consider doing it as a way to fill up some time on their schedule as they build their patient panel and get busier.



What does doing disability exams or reviews pay?


Generally speaking, doctors who perform disability exams are paid a fixed, flat fee for conducting the exam and providing a report to their client. You will usually be paid as a 1099 physician for this type of work. 


Rates can vary depending on who you work for and the complexity of the case. For physical exams, we have seen rates ranging anywhere from $50-60 per case where physicians could typically do three exams an hour to more complex cases that ranged closer to $200 each. As a very broad, general gut check, around $100 minimum seemed to be a starting point with many of the typical agencies and companies who hire for this kind of work.


Doing disability chart reviews for insurance companies or independent review organizations can earn anywhere between $100-300/hour. IMEs in medical practices can pay significantly more, but can also take more time and compensation will tend to vary based on specialty, with those with more specific expertise being able to charge more.


Depending on the efficiency in which this can be done, in aggregate, this can add up to a substantial additional or alternative income stream for doctors in some situations. For example, if done virtually and there is a lot of volume, you may be able to do more, with some physicians doing this type of work reporting 6 figure incomes despite doing the work part time. There are physicians doing this within their private practices that report adding $1,000 - $2,000 a week to their private practice.  Residents doing the physical exams only report about $1000 in income per day that they do it, with several resident physicians reporting about $50,000 in income for the year if they performed these every Saturday.


Note again that if you’re not in a private practice, you may have to go to other locations to perform these examinations, and often aren’t paid for the commute. In these situations, you may also have to get your own errors and omissions malpractice insurance. This can quickly eat into the profits of doing this side gig, especially if working through a middleman that skims off another layer of the compensation. However, this could be a good side gig for a resident or fellow, or a side gig for a retired physician who is looking to stay clinically connected and enjoys the work.


As it’s reported that many patients ‘no-show’ to their appointments, make sure that you check what the no-show compensation is if you’re doing this through a company. Some of our members say that as many as half of their scheduled patients don't show up. We’ve heard that the no-show compensation rate can be as low as $25, which can quickly wipe out the opportunity cost of blocking out time for these appointments either from your weekend or your private practice clinic schedule.


Explore different opportunities and ask around with other physicians who have worked for the specific clients you’re considering to get an understanding of what the typical rate is and what the average amount of time commitment is for their cases so you can assess an effective hourly rate.


Another note of caution: some companies are notoriously bad at very delayed payments, and sometimes even with withholding payments. Others pay promptly twice a month. Again, ask your colleagues for their experiences before signing on with a company.



What are the pros and cons of doing disability exams or reviews?


The pros and cons of doing disability exams as a side gig


Advantages of doing disability exams or reviews


Low risk and low stress. Generally, disability exams and review are low stress opportunities, although some doctors warn against difficult cases that may be stressful just from the level of frustration and time required. With the set standards and rigid questionnaires provided, there is usually low liability risk since you aren’t treating anything. 


Opportunity to meet and help those in need. While we saw mixed reviews with some stating frustration with the system and how it treated individuals, especially veterans disabled in the line of service, many commented that performing disability exams was a unique way to meet and help those who have been injured while in service to their country. Some physicians enjoy hearing the patients’ fascinating stories and digging into their complicated medical histories, while getting paid for the privilege to do so.


Flexible scheduling for disability review. While disability exams have to be scheduled on site, the review portion can be done on nights and weekends around your schedule, offering a higher degree of flexibility than many other medical side gigs for doctors. If this is a high advantage for you, consider looking at opportunities that are disability review only. These can often be available through insurance companies or independent review organizations (see the NAIRO website for examples).


Can lead to a full-time opportunity if you’re looking for a career change. As we’ve noted when discussing what to consider before leaving clinical medicine, getting experience in a nonclinical role can not only give you an advantage when looking for and applying to positions, but it can allow you to try out a new career before making the jump. If you are interested in nonclinical career options for doctors, there are full-time positions available in this field.



Disadvantages of doing disability exams or reviews


Burnout can be high (emotional factor). Not all agencies that require disability exams have set standards for physicians to evaluate what constitutes as different levels of disability, which can leave this line of work highly subjective. Evaluating individuals who are in desperate need of government assistance due to their disability can take an emotional toll on doctors, as well as open you up to adverse reactions from patients who do not ultimately qualify for disability assistance. As the stakes are high, although most physicians in this line of work want to give their patients the benefit of the doubt, many have stories of patients that lied or exaggerated symptoms to try to qualify, putting them in an awkward position.


Some disability exams/reviews can take hours, which significantly lowers potential earnings. Disability exams can often pay by the exam or case, but not all patients are the same complexity. Some exams may be quick to complete, while others can take hours if the particular individual has a multitude of complaints and a long medical history that you have to review records for. Several physicians commented that the paperwork can be a hassle and that especially at the beginning, cases will take much longer than the company may indicate, therefore lowering your hourly income significantly if you are paid a fixed rate per case.


No show may mean less or no pay. Many physicians commented that they only received compensation for completed exams or that they received less pay for no shows (as little as 25% of the regular rate). No shows can be prevalent with this kind of work, with physicians on our communities mentioning as much as 50% of their appointments being no shows, which can make them difficult to recover from and to recoup the associated cost of that time you set aside.


Income isn’t always steady or reliable. Depending on who you work for, pay can come in waves. This can be fine for a side gig where you want some extra fun money in your budget, but isn’t great if you’re looking for a more steady income stream short term, such as a side gig to help bridge the gap between leaving your W2 employee job and growing a private practice.


You may have to provide your own malpractice insurance. A lot of this work is 1099 contracted work, which means you are not covered by an employer’s malpractice insurance policy and will need to provide your own. Many physicians comment that while this is low liability work, you will still need to be covered by an errors and omissions (E & O) policy, even if the company indicates otherwise to get you to come on board. If you’re in private practice, this may be covered by your practice policy.




How do I get started with a side gig doing disability exams or reviews?


As mentioned above, doctors can perform disability exams and disability review work for a variety of different clients. These can include:

  • Attorneys

  • Employers

  • Government agencies (SSA, VA, Department of Labor for your state, etc.)

  • Insurance companies


You can either potentially add this onto your private practice as an ancillary income stream or look for work with one of the companies that is contracted or subcontracted to do this work for large organizations, such as the VA. Some of the contractors have been around for a while, while subcontractors can come and go depending on need. Asking others who do this type of work can be a great way to learn more about the companies with current contracts. Researching insurance companies can be another way to find opportunities. You may even find opportunities available on job board websites such as Indeed or by looking up independent review organizations on the NAIRO website.


If you’re looking to perform disability exams at your private practice, you may consider reaching out to companies in your local area and directly to your state, as they often hire practices or individual doctors directly. Look up “Disability Determination Services” or similar to find the state entity or specific websites for the determination of disability. It’s important to know that different states can have different requirements for this type of work, including certifications or training courses as noted below. Florida, in particular, was noted by several physicians as a difficult state to work with in the past. In contrast, some physicians stated that their states didn’t have any formal training requirements to get started. Additionally, if you’re required to supply the office space and malpractice insurance, it may not make sense for you if you are not in private practice. 



What do companies that hire doctors to do disability exams or reviews look for when interviewing?


First and foremost, they’ll want you to be a good doctor that’s capable of reviewing the information, incorporating relevant medical information, and making a fair assessment.


As there can be a large volume of these exams that need to be done, companies are looking for physicians that are able to make themselves available either during the workweek or on weekends, and who are reliable, as disabled patients often have to make arrangements to get to the exams. Many insurance companies and independent review organizations have a relatively quick retired turnaround time, and may need the exam completed within 1-3 days. 


Since you’re writing a report, these companies hiring physicians for disability examinations also want to see that you have good communication and writing skills, and are organized. If you’re doing the reviews electronically, you’ll need relevant materials and skills.


Some, but not all, companies and agencies that outsource these exams require physicians who perform exams to be trained and certified in disability exams. If this side gig is of interest, there are several courses and certifications which can help you to get more positions and may have directories. For example, the American Board of Independent Medical Examiners offers a certification in independent medical exams, as does the International Academy of Independent Medical Examiners.



Disability Exams and Reviews FAQs from Our Physician Community


We often see questions about disability exams in our physician Facebook groups. Several of our doctor members have done this side gig in the past, so we scrubbed the groups for common questions and aggregated advice from fellow physicians. 


Summary of frequently asked questions about performing disability exams

Q: How do you code disability exams to get paid?


Generally, there is no coding or billing required. The agency or company you work for schedules all the claimants you will see, and you are paid a fixed fee for each exam you complete. You may receive additional pay if an x-ray or additional testing is required. 


If you are doing this within your private practice, you will have a set fee schedule that is contracted ahead of time which is usually better than what most insurance companies pay - and they’ll actually pay you the full amount. Per our community, most of these IMEs will be at a level 4 or 5 visit. If you do additional testing in your practice, you should know ahead of time what is covered. Certain basic exams will likely be covered, like EKGs, but if you are doing a more expensive test, you may have to get approval ahead of time. 



Q: What are common conditions you might be asked to assess for disability because of?


While this may vary, particularly if you’re in private practice and have a subspecialty, examples of conditions often claimed for disability include chronic pain conditions, mental health or psychiatric conditions, cancer, autoimmune or other immunosuppressed conditions, cardiopulmonary issues such as asthma, interstitial lung disease, and heart failure, sleep disorders such as narcolepsy, obesity, and nowadays, long COVID.



Q: Do those who perform disability exams on the side also read x-rays?


Some basic reads of x-rays ordered by the agency or company that hires you can be involved. Areas mentioned include basic joints and spine. Physicians in our group have commented that the disability exams they do aren’t IMEs (independent medical examinations) with a determination of disability and that these patients typically have already seen specialists and have submitted records to the state. In these situations, they are asked to review the x-rays and report if there are findings to support the complaint leading to the disability assessment.



Q: What kind of insurance do you need for disability exams?


While there isn’t usually a doctor-patient relationship with disability exams, there are cases of patients who have sued due to incidents that have occurred during the exams, so it’s important to make sure you are covered.


As noted above, this work is usually 1099 work, which means you will need to provide your own malpractice insurance. Many say that you need at least an errors and omissions (E&O) policy, even if a company tells you that you don't in order to lower the barrier to you saying yes to their proposal. Some physicians in our groups mention that if you are using your existing malpractice policy, you may need to get a rider on your malpractice insurance policy that will cover you for liability incurred during disability exams. We have partnered to provide malpractice insurance agents for physicians if you need to secure a policy or need a new policy with a rider.




Conclusion


Performing disability exams is a common side gig that physicians use to increase their income, though it has both advantages and disadvantages. The work can be highly flexible but isn’t always the most reliable for steady income. Disability exams are low stress but can still take an emotional toll given the situation and your part of the process. In the end, each doctor should weigh the pros and cons when considering this side gig opportunity.



Related Side Gig Resources for Physicians


If disability exams aren't the right fit for you but you’re interested in chart review work, explore our chart review opportunities for physicians. You can also explore other popular medical and non-medical side gigs for doctors and sign up for our physician side gig opportunity databases to be alerted of opportunities that match your interests.


If you need help with the business side of your side gig, learn more about:

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