Side gigs for doctors have gained popularity, and one that’s getting attention is chart review for workers’ compensation cases.

In a Medscape survey report, 39% of physicians said they had side jobs. Of those, 15% said their extra work was chart review, which can be done for many types of health insurers or law firms that handle medical cases.

“Side work can be a way to try something new, gain different experiences, and earn some extra income,” said Michael Richardson, MD, founder of Bespoke Primary Care in Wellesley, Massachusetts, and American Academy of Family Physicians member. “We have skills that can make an impact well beyond our clinic walls.”

One type of insurer that hires physicians for assignments is workers’ compensation, which is a government-mandated insurance program for employers. Every state has its own workers’ compensation board that regulates the system and deals with claims. Employers and states often contract with private insurers or third party administrators to handle employee claims.

Whether chart review work is a good fit depends on the doctor, said Richardson. “You also have to ask yourself if the extra income is worth the time and energy, or if that time would be better spent resting, being with family, exercising, or enjoying a hobby. It is not just about money; it is about balance.”

What to Know About Workers’ Comp

Work-related injuries cover a large spectrum of accidents and impairment, such as back pain due to lifting; slip and fall at a worksite; accidents while operating heavy equipment or work vehicles, and serious construction accidents.

The National Safety Council listed the most common workers’ comp injuries during 2023-2024, the most recent data available; contact injuries (hurt due to physical contact with equipment, falling objects, or being caught in machinery): 499,270; impairment from overexertion and repetitive motions: 492,140; and ‘fall, slip, and trip’ injuries: 479,480.

Typically, injured employees are treated by their own physicians. As an outside chart reviewer, you would examine employee medical files to determine whether you agree with the treating doctor’s diagnosis. Was the accident the primary or contributing cause of injury? Is impairment permanent? The worker’s doctor may say the patient cannot continue to work — but the reviewing doctor may disagree.

You may also talk directly with the treating doctors or the patient. You’ll write your assessment into a report used by state workers compensation boards to determine the settlement amount.

Workers’ comp chart review differs from reviewing charts for commercial health insurers, Richardson said. “With workers’ comp, your decision can directly affect whether someone is able to return to work.”

How Much Can You Earn?

Compensation for file review assignments can range from $85 to $200 per hour, said James J. Mangraviti, Jr, a principal at physician continuing education and marketing firm SEAK, Inc., in his blog.“Physicians who do superior work can earn a large volume of business.”

Reviewing physicians may receive an hourly rate, or a rate per case. Payment is related to specialty and can vary widely. Sometimes the chart review will entail doing an independent medical examination of the worker, which can provide much more money.

Pros and Cons of a Workers’ Comp Side Gig

Pros:

• “Some chart review roles offer flexibility, which can be helpful,” said Richardson. You can work from home and choose your hours, although you’ll have a deadline or set turnaround time for each case.
• You already have the medical knowledge required for the job.
• Many doctors find the work an interesting diversion from clinical care.
• Rarely will you have to appear in court to defend your medical opinion.

Cons:

• The pay is often lower than for chart review jobs for commercial health insurers.
• The processes, rules, and paperwork involved can be complex and time-consuming.
• Your interactions with treating doctors may be tense if you disagree with their judgement.

“It can feel uncomfortable,” said Richardson. “As practicing physicians, we are used to pushing back against insurance companies to get our patients what they need, and we all know how frustrating that process can be.”

“When you’re on the reviewing side, possibly questioning or even denying a colleague’s plan, it is important to approach it thoughtfully and respectfully,” Richardson added. “Stick to established guidelines but also look carefully for nuance. Sometimes the treating physician is considering something that just was not fully documented.”

• Possible stigma: “There is sometimes a negative association with doing workers’ comp work,” said Robert Bernstein, an attorney in Parsippany, NJ. He said that some people feel that the doctors who do workers’ comp may be pressured by insurers to limit care recommendations.

How to Find Workers’ Comp Side Gigs

For most chart review jobs, physicians need to be board-certified and have a current state medical license. Workers’ comp regulations vary widely, so doctors should become knowledgeable about the rules in their state.

Specialties most in demand include orthopedic surgeons, occupational medicine specialists, neurologists, and pain management specialists.

Doctors can directly call the workers’ comp board in their state to be added to its list of physician reviewers. Also, WorkersCompensationshop.com, an agency that specializes in workers’ compensation insurance, carries a list of private workers’ comp insurers by state.

Independent Review Organizations and medical assessment firms often recruit physicians for chart review work. The National Association of Independent Review Organizations and the American Board of Quality Assurance and Utilization Review Physicians offer certifications for physicians for medical chart review. Networking with colleagues or with attorneys can also help direct you to some potential opportunities. Or phone workers’ comp insurance adjusters or case managers.

Advice for Physicians

Richardson said: “Before jumping into chart reviews, I recommend asking:

• What is my goal with this side gig?
• How will I know if it is meeting that goal?
• What are the signs that it is no longer worth it?

“Being clear on those answers from the start helps you set boundaries and protects your primary work, your personal life, and your overall well-being,” he said.