Side Gig vs Extra Call: Framework to Maximize Loan Payoff per Hour

The default advice to “just pick up more call to pay down loans” is lazy and usually wrong.

If you are a med student, resident, or early attending trying to crush loans, you need a hard, quantitative framework to decide:
Is one more hour of extra call better than one more hour on a side gig?

Not vibes. Not guilt. Not what your co-resident is doing. Math.

This is that framework.

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The Core Problem: You Only Have 3 Currencies

You do not just have dollars. You have:

1. Money
2. Time
3. Energy / Sanity

Hospitals will happily rent all three from you for cheap. Side gigs can, if chosen intelligently, pay you more per unit of all three.

The key question you must answer for every option:

“How many after-tax, after-expense, realistic dollars does this give me per hour of my life that I actually lose?”

If you do not calculate that, you are flying blind.

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Step 1: Know Your Real Loan Target (Not the Sticker Number)

Before you compare side gig vs extra call, you need a clear payoff goal. “I want to pay them off faster” is useless.

You need:

1. Loan balance
2. Interest rate
3. Time horizon
4. Repayment plan constraints (IDR, PSLF, private refinance)

A. Get your numbers in one place

• Total federal loans: Direct, Grad PLUS, etc.
• Any private loans: balances + interest rates.
• Current payment plan:
  • PSLF?
  • SAVE/REPAYE?
  • Standard 10-year?
  • Refinance?

If you are in PSLF, your goal is not maximizing payoff. It is maximizing forgiveness while not drowning. In that case, side gig vs call math focuses on life improvement and savings, not extra payoff.

For everyone else, you are effectively answering:

“How much extra per month gets these loans gone in X years?”

Use a simple amortization calculator later. For now, grasp the principle:

• Every extra $100 applied early to a 6–7% loan shaves a surprising amount of interest.
• But only if those dollars are actually extra, not pretend (ignored taxes, missed expenses, etc.).

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Step 2: Calculate Your Real Hourly Rate For Extra Call

Most residents and attendings wildly overestimate this number.

You are not paid “$150/hour for moonlighting” if:

• You sit for 3 hours unpaid before work starts.
• You drive 45 minutes each way.
• You are taxed at 30–40%.
• You get destroyed overnight and lose all productivity the next day.

We are measuring effective hourly rate, not the fantasy rate.

A. The formula

For any extra call / moonlighting shift:

Effective Hourly Rate (EHR)
= (Gross shift pay – Taxes – Direct costs – Realistic fatigue cost) ÷ Total hours lost

Where:

• Gross shift pay = what is on the contract.
• Taxes = marginal tax rate * moonlighting income.
• Direct costs = gas, parking, childcare, meals, licensing fees if unique to that job.
• Total hours lost = clinical hours + commute + charting + recovery penalty.
• Fatigue cost = value of lost next-day hours if you are non-functional.

Let me walk it concretely.

B. Example: Resident extra call

You are a PGY-3 internal medicine resident.

• Extra 24-hour call: paid $500.
• You go in at 7 am, leave at 7:30 am next day.
• Commute each way: 30 minutes.
• You are useless the whole post-call day until 5 pm.

Compute it:

1. Gross pay: $500
2. Marginal tax rate (fed + state + FICA): assume 25%
   • Taxes: $500 × 0.25 = $125
3. Direct costs:
   • Gas/parking/food: say $25
4. Hours lost:
   • In house: 24 hours
   • Commute: 1 hour
   • Post-call “dead zone”: 10 hours (7:30 am–5:30 pm where you cannot study, side gig, or be a functional human)
   • Total hours = 24 + 1 + 10 = 35 hours
5. Net dollars:
   • $500 – $125 – $25 = $350
6. Effective hourly rate:
   • $350 ÷ 35 = $10/hour

Yes, you read that correctly. Ten dollars an hour for that extra call. I have seen worse.

Even if you say the post-call day is “free time,” ask yourself honestly:
Are you doing anything high-value with it? Or just surviving?

C. Attending moonlighting example

Now a hospitalist attending:

• Extra 12-hour shift: $1,800 flat.
• Commute total: 1 hour.
• You are moderately wrecked the next day but still function at 60%.

Run it:

1. Gross: $1,800
2. Tax: assume 35% marginal
   • Taxes: $1,800 × 0.35 = $630
3. Direct costs: meals/parking: say $40
4. Hours lost:
   • 12 hours in hospital
   • 1 hour commute
   • 4 “impaired” hours at home next day (too tired to do meaningful extra work)
   • Total: 17 hours
5. Net: $1,800 – $630 – $40 = $1,130
6. EHR: $1,130 ÷ 17 ≈ $66/hour

Now we are talking about real money. But again: not $150/hour. More like $66/hour of your life.

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Step 3: Calculate Your Real Hourly Rate For Side Gigs

Side gigs are not magic. Many are trash once you do the math.

Use the same formula:

Side Gig Effective Hourly Rate
= (Gross income – Taxes – Direct costs – Platform fees) ÷ (Real hours spent, including learning and admin)

The trap: early on, learning costs are huge. As you gain skill, your rate often climbs dramatically.

A. Common physician/trainee-compatible side gigs

Here is a quick snapshot before we go deeper.

Option	Typical EHR Range	Startup Time	Scales Over Time?
Extra call / moonlighting	$10–$80/hr	None	Limited
Telehealth shifts	$40–$120/hr	Low	Limited
Expert witness chart review	$80–$250/hr	Medium	Limited
Clinical writing / reviewing	$25–$80/hr	Medium	Moderate
Tutoring / test prep	$30–$120/hr	Medium	Moderate
Niche consulting (med-legal, pharma)	$100–$300+/hr	High	High

Now let us actually run a couple.

B. Example: USMLE/MCAT tutoring

You tutor for a test prep company.

• Listed rate: $50/hour.
• You prep 20 minutes before each session.
• You spend 10 minutes after session writing a summary.
• You spend an extra 30 minutes per week unpaid calling anxious parents/students.

Assume you tutor 5 hours per week.

1. Gross: 5 hrs × $50 = $250/week
2. Total time:
   • Sessions: 5 hours
   • Prep: 5 × 0.33 hr ≈ 1.7 hours
   • Admin/parent calls: 0.5 hours
   • Total ≈ 7.2 hours
3. Pre-tax hourly: $250 ÷ 7.2 ≈ $34.7/hour
4. Taxes: At 25%: net/week = $187.5
5. Net EHR: $187.5 ÷ 7.2 ≈ $26/hour

Still better than that $10/hour extra call, and you are not getting crushed overnight.

But if you go independent later (direct clients, $100/hour, lower unpaid admin), that can jump:

• 5 hrs × $100 = $500
• Time: maybe 6 hours total
• After 25% tax: $375
• EHR ≈ $62/hour

C. Example: Telehealth shifts

You pick up video visits for a telehealth company.

• $90/hour logged in.
• 4-hour evening shift.
• 10 minutes unpaid per shift on chart clean-up, messages.
• No commute. You sit at home.

1. Gross: 4 × $90 = $360
2. Time: 4.2 hours
3. Pre-tax hourly: $360 ÷ 4.2 ≈ $85.7/hour
4. Taxes: Assume 35%: net = $234
5. Net EHR: $234 ÷ 4.2 ≈ $55.7/hour

Note that your fatigue cost is much lower than an overnight call.

D. Compare visually

Let us compare three options: bad extra call, decent moonlighting, solid telehealth.

Effective Hourly Rate: Extra Call vs Side Gigs

Category	Value
Resident Extra Call	10
Attending Moonlighting	66
Telehealth Side Gig	56

You see the problem: blindly taking extra call as a trainee is often the worst possible trade.

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Step 4: Convert Hourly Rate Into Loan Impact

Now you care about loan payoff per hour, not just income per hour.

The pipeline is:

1. Dollars per hour (net).
2. Portion you actually send to loans (not to lifestyle creep).
3. Interest rate of loans.

Let us keep it simple.

A. Define your “loan allocation rate”

Example:

• You commit: “Every extra dollar from side income or call goes 100% to loans.”
• Or more realistic: 70% to loans, 30% to savings / breathing room.

Let:

• EHR = effective hourly rate (after tax, full costs).
• L% = percent of that you will send to loans consistently.

Then:

Loan payoff dollars per hour = EHR × L%

Then estimate interest saved over full life of loan. Quick and dirty:

If your loan interest is 6%:

• Every $1,000 extra paid this year instead of at the end of a 10-year term saves you roughly $300–350 in interest. Earlier is better.

You do not need precision down to cents. Direction matters.

B. Example comparison (resident)

Resident choosing between:

• Extra call EHR: $10/hour
• Tutoring EHR: $26/hour
• Both: 100% of extra money goes to loans.

You have 20 hours/month of “extra work” capacity.

1. All call:
   • 20 hours × $10 = $200 to loans/month
   • Over 12 months = $2,400 extra principal
2. All tutoring:
   • 20 hours × $26 = $520 to loans/month
   • Over 12 months = $6,240 extra principal

Difference: $3,840 in year one.
Extend that over 3–4 years of residency and compounding, and you easily get five figures of extra interest saved.

C. Visualizing payoff potential

Annual Extra Principal Paid by Work Type (20 hrs/month)

Category	Value
Resident Extra Call	2400
Tutoring Side Gig	6240
Telehealth Side Gig	13392

Assumptions:

• Call EHR = $10/hr
• Tutoring EHR = $26/hr
• Telehealth EHR = $56/hr
• 20 hrs/month × 12 months × EHR

You do not need an MBA to see which strategy destroys loans faster.

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Step 5: Build Your Personal Decision Framework

Here’s the operating system you should run every new opportunity through.

1. Define your constraints first

• Max extra hours per month you can safely work without real burnout.
• Any hard schedule blocks (rotations, exams, family logistics).
• Your loan plan:
  • PSLF → side gig = lifestyle/savings, not payoff.
  • Private high-interest loans → side gig = payoff accelerator.
  • Mixed → prioritize highest interest first.

2. Score each option in 4 dimensions

For each potential side gig or extra call opportunity, rate 1–5 (5 is best):

1. Money (EHR) – from the math above.
2. Schedule control – can you cancel or move it?
3. Fatigue / burnout hit – how wrecked are you after?
4. Skill-building value – does it improve your CV or future income?

Then weight them. Here is a simple priority table.

Factor	Weight	Example Good	Example Bad
Money (EHR)	0.4	Telehealth	Low-pay extra call
Schedule control	0.2	Async writing	In-house 24h call
Fatigue impact	0.2	Light telemed	Overnight ICU
Skill-building	0.2	Tutoring, research	Generic PRN nurse coverage

You can literally create a quick spreadsheet, plug in numbers, and pick the highest weighted score.

3. Use a simple go/no-go rule

My rule when coaching residents:

“If a new opportunity’s effective hourly rate is below your current best option, and does not build a valuable future skill, skip it.”

You do not need ten side gigs. You need one or two very efficient ones.

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Step 6: Legal, Tax, and Contract Traps (Do Not Skip This)

This is the “I have seen people get burned” section.

A. Contractual restrictions

Check:

• Your residency / employment contract for:
  • “No outside clinical work” clauses.
  • Moonlighting approval requirements.
  • Malpractice limits (who covers you?).
• For telehealth / moonlighting:
  • Are you covered by their malpractice or are you using your own?
  • Tail coverage if the gig ends?

If you ignore this, you are gambling your license for an extra $30/hour. That is insane.

B. Licensing and credentialing costs

Side gigs that require:

• Additional state licenses
• DEA registrations
• Credentialing with multiple telehealth companies

Those costs must be baked into your EHR:

• If you spend $1,000 on a new state license for a telehealth gig that pays ~$2,000 total before you burn out, your real rate just tanked.

C. Self-employment taxes and retirement advantages

Side gig income = 1099 in many cases. That means:

• You pay self-employment tax (Social Security + Medicare), roughly 15.3% on top of income tax, with some offsets.
• However, you gain access to:
  • Solo 401(k) or SEP-IRA
  • Business deductions: home office, part of internet, work-related education, etc.

Done right, side gig income can be very tax-efficient and raise your net EHR. Done sloppy, it can be worse than W-2 call if you do not plan.

D. PSLF interaction

If you are on PSLF:

• Extra income from side gigs increases your IDR payment if it is large and stable.
• Extra call as W-2 might also raise AGI.

But:

• If that extra income goes into pre-tax retirement accounts or HSA, you can blunt the AGI increase.
• For some PSLF folks, it is smarter to:
  • Max retirement.
  • Keep loans on PSLF track.
  • Use side gig money to build an emergency fund / down payment.

Bottom line: talk to a tax pro who understands PSLF before you go all-in on a massive side gig strategy as a PSLF candidate.

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Step 7: Implementation Blueprint – Next 90 Days

Here is how you turn this from theory into an actual system.

Week 1–2: Get your baseline and pick a target

1. List all loans, rates, and repayment plans.
2. Decide:
   • “I want loans gone in X years” or
   • “I am PSLF; my goal is savings + sanity.”
3. Choose a monthly extra debt target:
   • Example: “I will send $500/month minimum from side income to loans.”

Week 3–4: Audit current extra work

1. For the last 2 months, estimate:
   • Extra call shifts.
   • Moonlighting.
   • Side gigs.
2. Calculate real EHR for each using the formulas above.
3. Identify your top-paying realistic option (and anything that is embarrassingly low).

Month 2: Optimize mix of call vs side gig

1. Drop or reduce any low-EHR / high-burnout shifts where possible.
2. Expand one high-EHR side gig that:
   • Fits your schedule.
   • Does not kill you.
   • Is legally clean.
3. Create a simple tracking sheet:
   • Columns: Date, Type of work, Hours, Gross, Net, EHR, Amount sent to loans.

90-Day Side Income Optimization Flow

Step	Description
Step 1	List Loans and Goals
Step 2	Calculate EHR for Call
Step 3	Identify or Test Side Gig
Step 4	Calculate EHR for Side Gig
Step 5	Shift Hours to Side Gig
Step 6	Keep Call and Reassess Options
Step 7	Automate Extra Payments to Loans
Step 8	Review and Adjust Monthly
Step 9	Side Gig EHR > Call EHR?

Month 3: Automate payoff and protect your time

1. Set up automatic transfers:
   • Side gig payouts → separate “Debt Attack” savings account.
   • Once a month, lump payment to highest-interest loan.
2. Install time boundaries:
   • Hard cap: “No more than X hours/week of extra work.”
   • Pre-scheduled no-work blocks (one full day off per week if at all possible).
3. Recalculate EHR as:
   • Your skills improve.
   • Your rates change.
   • Your fatigue tolerances shift.

Side Gig EHR Growth Over First 6 Months

Category	Value
Month 1	20
Month 2	28
Month 3	35
Month 4	42
Month 5	50
Month 6	58

A decent side gig often ramps like this as you stop fumbling and start operating smoothly.

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Step 8: Common Mistakes That Kill Your Payoff Per Hour

I have seen these repeat like a bad template note.

1. Ignoring fatigue
   Treating a 24-hour call like 24 hours instead of the 30–36 life-hours it actually consumes.

2. Chasing “prestige” over payoff
   Some academic-ish side roles pay pennies but look nice on a CV. They are fine if that is the actual goal, but do not pretend they are your loan weapon.

3. Not raising rates for side gigs
   Staying at the same tutoring/consulting rate for years. If you are booked solid and people keep coming, your rate is too low.

4. Letting extra income leak into lifestyle
   You “work more to pay off loans,” but your DoorDash and Uber budgets explode. That is not a loan strategy. That is just self-deception.

5. Forgetting taxes
   Looking at gross side gig pay and thinking you are rich. Then April shows up.

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What You Should Do Today

Open a blank page or spreadsheet and write three lines:

1. “My highest-interest loan balance is: ___ at ___%.”
2. “My best current extra work option is: ___ with an EHR of about $___/hr.”
3. “For the next 3 months, I will commit X hours/week to that option and send 100% of that net to loans.”

Then, before you sign up for a single extra call or side gig shift, run the EHR math once.

If the number embarrasses you, do not rationalize it. Change the plan.

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FAQ

1. I am a resident on PSLF. Should I still care about maximizing loan payoff per hour?
If you are committed to PSLF and expect to stick with a qualifying job for 10 years, your priority is not paying extra principal. Your priority should be:

• Keeping taxable income efficient (retirement contributions, HSA).
• Building an emergency fund and savings. Side gigs can still be useful for quality of life and savings, but your “loan payoff per hour” calculation sometimes becomes “savings per hour” instead. Different battlefield, same math.

2. Are non-clinical side gigs usually better than extra call for residents?
Often yes, because:

• They do not destroy your sleep.
• They build different, marketable skills.
• They can be done in small, flexible time blocks. But it depends on your rates. A non-clinical gig that pays $15/hour after tax is not automatically better than a well-compensated, low-intensity moonlighting shift that nets $60/hour. Run the numbers.

3. How many extra hours per month is “safe” to work without burning out?
There is no universal number, but I get very nervous when residents go above 20 extra hours per month on a sustained basis, especially if those hours are nights or 24-hour calls. For attendings, it depends heavily on baseline job demands. The real test: if your extra work is causing errors, chronic irritability, or you are too tired to handle basic life tasks, your marginal hour is negative value, no matter what it pays.

4. What if my program bans moonlighting and side gigs?
Then your levers are:

• Aggressive expense control.
• Smart use of IDR, SAVE, and potential PSLF.
• Maximizing future attending income by choosing a specialty and job with solid pay and sane hours. You can still prepare for future side gigs (build writing skills, start learning telehealth platforms, network, develop niche expertise), but you may not be able to monetize now. Do not risk your contract or your license sneaking around these rules; that trade is never worth it.

Now: pull up your last pay stub, list your current side options, and calculate one real effective hourly rate before you go to bed tonight. If you keep guessing, you will keep working too hard for too little.