Beyond the clinic

Companies developing oncology therapies, diagnostics, and devices pay practicing attendings for input on study design, indication choice, commercial positioning, and clinical workflow fit. Because the drug pipeline for solid tumors and heme malignancies is unusually deep, the deal flow is steady — more consistent than most specialties see. Engagements range from a one-off hour on a specific drug to recurring scientific advisory board seats across a product’s life cycle.

Compliance edges: employer rules about outside consulting (academic centers vary a lot), Sunshine Act reporting of payments from applicable manufacturers, and journal/society disclosure requirements if you publish or chair guidelines on topics you’ve consulted on.

Manufacturers maintain speaker bureaus for approved oncology products — paid presentations to peers covering mechanism, trial data, safety handling, and clinical fit. Engagements are typically per-event. The reputational effect is often more important than the per-talk check: visibility compounds into advisory invitations, guideline-committee visibility, and KOL status that opens the consulting pipeline above.

Compliance edges: slide content is sponsor-controlled, Sunshine Act reporting applies, and some academic centers prohibit speaker-bureau participation entirely. Confirm your employer’s policy before signing a bureau agreement.

Market-research firms recruit practicing oncologists for structured surveys on prescribing patterns, perceived efficacy of new agents, barriers to adoption, and workflow design. Oncology sees a disproportionate volume of invitations because new indications and approvals land constantly. Individual surveys run from a few minutes to about an hour; payment is per completed response. Low-friction and schedule-flexible — easy to layer into a lunch break.

Compliance edges: honoraria from market-research firms are usually not Sunshine Act reportable (not an applicable manufacturer payment), but employer disclosure may still apply.

Services exist that connect patients with cancer diagnoses to board-certified oncologists for a formal second opinion, delivered over telemedicine. The oncologist reviews outside records, imaging, pathology, and prior treatment, then produces a written opinion and a video conversation with the patient and family. Modern oncology regimen complexity (targeted therapies, immunotherapy combinations, biomarker-driven selection) makes patient demand strong and sustained, not a niche side activity.

Compliance edges: state medical licensure where the patient is located, malpractice coverage that explicitly extends to telemedicine and second-opinion work, and clarity on whether you’re establishing a treatment relationship or providing opinion only (two different liability profiles).

Litigation around oncology diagnoses and treatments generates sustained demand for practicing attendings: delayed-diagnosis cases, standard-of-care disputes, chemotherapy or immunotherapy adverse-event cases, and product-liability cases involving specific agents. Work starts with records review, moves to a written opinion, and may proceed to deposition and trial testimony. Rates scale with complexity and testimony risk; travel is sometimes required for depositions and trial.

Compliance edges: cases take months-to-years to resolve, so cash flow is lumpy; conflicts-of-interest screening is on you; and ongoing expert testimony becomes discoverable in future cases — the reputational tail is real.

The two biggest end-of-fellowship money decisions are what to do with federal student loans (stay in a federal plan with PSLF if your employer qualifies, or refinance to private for a lower rate) and whether to use a physician-mortgage product (low or zero down, no PMI, underwritten against your contracted attending income instead of your fellowship paycheck). Both decisions interact with your W-2-vs-1099 structure and are much harder to unwind than to get right the first time.

Three policies carry different weight than they do for a general high-income earner. Disability should be an own-occupation, specialty-specific individual policy — employer group policies usually pay only if you can’t work in any job at all, which isn’t the risk you’re actually insuring against. Term life is sized to your projected lifetime earnings and any co-signed debt, not your current year’s income. Malpractice tail for hem/onc commonly runs $25k–$75k on a claims-made policy; who pays it is a contract-negotiation item (see the Contract pillar).

Attending income phases most physicians out of direct Roth contributions, so the standard moves are backdoor Roth(via a nondeductible traditional IRA) and, for 1099 side income or partnership draws, mega-backdoor Roth inside a Solo 401(k) that allows after-tax contributions and in-plan conversions. The HSA is often the best-sheltered vehicle you have access to — triple-tax-advantaged if you pay healthcare out of pocket and let the HSA grow. The compressed accumulation window (you start saving at age 32+, not 22) means the first five attending years disproportionately determine your 60-year-old net worth.

Hybrid income (W-2 attending + 1099 moonlighting, locums, consulting, or honoraria) triggers quarterly estimated payments, multi-state filing when locums work crosses state lines, and the chance to run 1099 revenue through an S-corp election. Standard deductions for 1099 physician income — malpractice premiums, CME, licensing, DEA, home office, mileage, health insurance premiums — collectively move the needle at top marginal rates. A physician-focused CPA is usually a positive-ROI expense by the end of your first attending year.

For physicians the asset-protection conversation is less about wealth and more about malpractice-judgment exposure. The usual stack is an umbrella liability policy on top of auto and home, titling choices for jointly-held assets, and — once there’s meaningful net worth — trust structures that separate professional-liability exposure from family assets. Estate planning (will, healthcare proxy, financial POA, beneficiary designations) should exist at attending year one; trusts and more complex structures are a mid-career conversation.

If you decide to delegate, the two features that matter most are fee-only fiduciary (compensated by you, not by product commissions) and physician-literate (understands backdoor Roth, 1099 structure, loan-forgiveness mechanics, and the attending-salary trajectory). Flat-fee or fixed-monthly engagements avoid the AUM-fee drag that silently costs six figures over a career. Many physicians run successfully without an advisor by sticking to a boring index-fund portfolio and spending the hour a year on tax optimization.