For the first 4 years of his career in emergency medicine, Alex Mohseni, MD, occasionally took on extra shifts at the Virginia hospital where he worked. He might cover for a colleague whose child was sick or work a shift that didn’t have an assigned doctor at all. “I was young and had some medical school debt,” said Mohseni. “I didn’t realize doctors were selling shifts to me because they were burnt out. Seven or 8 years later, I was the one handing off my shifts to other people.”

In Mohseni’s experience, extra paid hours, typically on nights and weekends, were never “worth it.” He was already putting in an extra (unpaid) hour or 2 after each shift to catch up on documentation. He had so little free time that taking even one extra shift could see that time disappear for the week.

But Mohseni sometimes felt he had no choice. “The majority of times, doctors would work these extra hours not because they wanted to or needed the money but out of a sense of brotherhood,” he said. “Like for a colleague whose wife was in the hospital. I wanted to make sure when something like that happened to me, my colleagues would be there for me. We were in this together.”

When he worked night shifts at community emergency rooms (ERs), he was often not just the only doctor in the department but also “the only physician in the whole hospital,” he recalled. “They expect doctors to work magic. But you can’t be in three places at one time. It’s an untenable situation.”

With a projected shortfall of 13,500-86,000 physicians by 2036, doctors will likely feel even more pressure to work extra paid hours in the future. But what can feel like an emotional decision influenced by cash can be boiled down to one simple question: Is it worth it?

Working More but Earning Less?

When taking on extra shifts, you might find yourself working more paid hours but earning less take-home pay than you expected. “The biggest wild card that tends to pop up” is student loans, said California-based Anjali Jariwala, CFP, principal of FIT Advisors. Once you earn more, your required monthly minimum payments under an income-driven federal repayment plan could increase, she explains.

Another major issue doctors run into is not realizing that earning more could bump some of your additional income into a higher marginal tax bracket, points out Carolyn McClanahan, MD, CFP of Life Planning Partners, Inc. in Jacksonville, Florida. “Then they get a big tax bill unexpectedly at the end of the year when they did all that hard work.” Also keep in mind that if you’re married and filing federal taxes jointly, you’ll need to factor in your spouse’s income too, she says.

Be careful about any self-employment (1099) income: Not everyone understands that self-employed people must pay 100% of their “payroll” taxes — Social Security and Medicare — something employers split those taxes with W-2 employees. On top of federal, state, and local income taxes, you’ll owe the extra 6.2% in Social Security and 1.45% in Medicare an employer usually picks up (the Social Security income cap for 2026 is $184,500).

Also: If your total income is more than $200,000 if you’re single or $250,000 if you’re married and filing jointly, set aside an additional 0.9% for additional Medicare taxes.

“Work with an accountant to pay estimated taxes,” advised McClanahan. “You don’t want to have to pay penalties or interest for not paying the right amount.” If you have multiple W-2 employers, your CPA can help you ensure your employers are not overwithholding taxes from your income.

“Know the value of your time,” McClanahan said. “Is working more going to get you where you need to be, or are you going to increase your level of spending? Lifestyle creep can be a vicious cycle. A good financial planner will analyze your financial plan.”

Do Your Research and Negotiate

Always request to see the data your healthcare system is basing its calculations on for base and extra pay, Ohio-based Jessica Minesinger advises. It should be competitive with current per-shift rates in your specialty and area of the country.

In 2024, the chief of a surgical department at a large university reached out to Minesinger, founder and CEO of Surgical Compensation & Consulting, Inc. and physician compensation expert. The surgeon asked Minesinger to figure out why the turnover in her department was so high and why she was having trouble recruiting — apparently doctors and prospects kept citing compensation as the reason. Yet when the surgeon spoke with her institution, they claimed they were offering median pay based on faculty rank and using Association of American Medical Colleges data.

As Minesinger soon discovered, the institution was using data from 2017. Though it was an honest mistake, it pays to check the numbers.

Extra Income Sounds Tempting. Until…

More work hours could lead to burnout. Look at all the hours you’re already working, including unpaid administrative time and, if relevant, call hours.

“We’ve seen a shift in how people get paid for call,” said Minesinger. “A certain number of call shifts are outlined in contracts, maybe six per month. It’s just expected.” Don’t forget costs like commuting, childcare, and less recovery and personal time, Minesinger adds.

It’s crucial to factor in the potential risks of working more, like exhaustion and even impaired judgment. Though you may feel pressure to accept an extra shift, your well-being matters.

The extra hours Mohseni worked likely added to his burnout from clinical practice. Mohseni still recalls feeling dread when he arrived at the hospital, especially for night shifts. “You’d drive into the parking lot and see a line of ambulances parked in front of the ER and know that is all for you.”

When Extra Paid Shifts Pay Off

Houston-based Owais Durrani, MD, has had positive experiences with extra paid hours. Two years after becoming an attending in emergency medicine, Durrani shifted from employee to independent contractor status at his healthcare system so he could have flexibility to pursue outside interests like public speaking and working in media. Since then, he has worked eight to nine monthly shifts at his primary employer plus consulted with telemedicine companies and taken on paid shifts at other local hospitals.

“I have done it on my own terms,” said Durrani, who paid off his student loans after working long hours during his first 2 years of practice. “If I work four shifts in a row at my main hospital and the next shift is available for a bonus, I will probably say ‘no’ because I want to rest…I don’t work seven shifts in a row and pick up the next two for financial reasons. That’s what leads to burnout.”

Durrani chooses shifts that pay much more than his typical hourly rate, sometimes double,  and always at hospitals within 30 or 40 miles of his home. The total income he brings in “feels like full-time but without working full-time shifts,” he said. Plus, “the system or hospital really needs someone on that day, and I’m happy to be there. I’m well compensated for it and feel good about it.”

Durrani also recommends being schedule-aware when considering other time commitments. “Don’t join every hospital committee or volunteer for everything,” he said. “If you do that, you won’t have time to pick up extra shifts.”

Along with providing extra income, additional paid shifts can lead to career insights. This was the case for Jariwala’s husband, Udai Jayakumar, MD. After completing his residency in internal medicine in 2008, Jayakumar worked as a hospitalist, but occasionally, he also took on paid shifts at a local hospice center. Those experiences helped him realize he wanted to transition to palliative care.

“I was burnt out on primary care,” Jayakumar said. “The way the system was set up, the more detail-oriented you are and the more care you want to provide, the harder it is because of the time constraints. I wanted to give patients more time if they needed more time.”

Jayakumar leveraged that side work and is now chief of the Geriatrics and Palliative Care Department at Kaiser Permanente’s South Bay Medical Center in Harbor City, California.

Mohseni did the same in 2021, transitioning from clinical practice to national medical director of the Optum medical group. In 2025, he founded ClinX Academy, an executive training program to help his fellow physicians master the business operations side of medicine.

In a system where doctors are often overtaxed, setting boundaries is essential. “If you’re picking up shifts to make a little extra money, that is fine short term,” Mohseni said. “Later in your career, it could make you burn out.” On the other hand, extra work that enables you to “build things, learn, and keep your career growing” can be good for two bottom lines: bank account and practicing your best medicine.

The experts cited in this article had no relevant disclosures.