Can You Actually Build a Side Hustle During Medical Training?
I started a business during fellowship. Not after. During.
If that sounds reckless, I get it. My weeks regularly hit 70 hours. I have call shifts, research deadlines, and a board exam looming in the background at all times. Starting a company wasn’t on the fellowship curriculum.
But here’s what I realized halfway through my first year: I was already doing the work. Every night I was making study cards, reading journal articles, breaking down guidelines into something I could actually remember at 2am on a call shift. The question wasn’t whether I could find time to build something. The question was whether I was going to keep doing all that work for free.
Why training is actually a good time to start
This sounds counterintuitive, I know. You’re exhausted. You’re underpaid. You barely have time to do laundry. But there are real advantages to starting something now that disappear once you’re an attending.
You’re already studying. If you’re prepping for boards, you’re generating content whether you realize it or not. Flashcards, summaries, teaching materials. That stuff has value beyond your own exam.
Your overhead is also basically zero. You don’t need an office or employees. You need a laptop and some focused hours on the weekend.
And then there’s the money piece, which matters more than people admit. Fellowship salaries are rough. The median fellow salary sits around $67,000 according to Medscape’s 2025 compensation report. On the West or East coast, that doesn’t go far. Even a few hundred dollars a month from a side project changes the math on groceries, loan payments, and whether you can actually do something fun once in a while.
What I built (and what it actually looks like)
My side hustle is a medical education subscription service. Subscribers get a daily board-style question and a weekly literature digest, all focused on their subspecialty.
The idea came from my own study routine. I was already writing board questions for myself. I was already reading and summarizing the latest papers for my own knowledge. The product is literally my study habits, packaged and sent to other people’s inboxes.
I’m not going to pretend it was easy to set up. There was a learning curve with email platforms, payment processing, and figuring out how to actually market something when your entire professional network is other trainees who are also broke. But the barrier to entry was lower than I expected. The content was already being created. I just needed a way to deliver it.
What else works (and what probably doesn’t)
I’m not the only trainee doing this. Here’s what I’ve seen actually work for people in residency and fellowship:
Medical education products are the most natural fit. If you’re studying, you’re creating. Question banks, study guides, visual summaries, podcast episodes breaking down topics. The 2024 AAMC Physician Education Debt report found that 73% of medical school graduates carry educational debt averaging $200,000. People will pay for tools that help them pass boards and reduce that timeline.
Tutoring and test prep is another one. USMLE and COMLEX tutoring pays well, typically $75-150 per hour, and you can do it on your own schedule over Zoom. If you scored well on Step exams, there’s a market for your knowledge.
Content creation is growing. Medical YouTube, Instagram education accounts, and newsletters have real audiences. It takes longer to monetize than people expect, but once it clicks, the income can be surprisingly consistent.
Consulting is underrated. Hospitals and startups need clinical expertise. I know residents who’ve done chart review work, consulted on health tech products, or advised on clinical workflows. It’s usually project-based, so you’re not committing to regular hours.
What doesn’t work well: anything requiring a fixed schedule. Your clinical schedule is going to blow up whatever commitment you made. MLM schemes, which target trainees more than people realize. And anything that requires significant capital upfront. You’re already in debt. Don’t add to it.
The time management question everyone asks
“When do you have time?”
This is the first thing every co-fellow asks me. The honest answer is that I don’t have a lot of extra time. Nobody in fellowship does. But I’ve found pockets that work.
I batch-create content on my days off. Not all day. Usually 2-3 focused hours on a Sunday morning before I do anything else. That’s enough to write a week’s worth of questions and get the literature digest mostly done.
I automate everything I can. Email sequences go out automatically. Payment processing is handled by Stripe. I use AI tools to help with first drafts, formatting, and editing. Not to replace my clinical thinking, but to cut out the tedious parts that used to eat an hour here and there.
I protect call nights. If I’m post-call, I’m sleeping, not writing newsletter copy. This boundary matters. Burnout is real and building a side project is supposed to improve your life, not wreck it.
A 2022 study in Academic Medicine found that resident burnout rates hover around 44%. I think about that number a lot. The whole point of this project is to build something sustainable, not to trade one form of exhaustion for another.
The tools that make it possible
Five years ago, this would have been much harder. The tools available now make solo entrepreneurship actually doable on a fellowship schedule.
I use Beehiiv for my email newsletter platform. It handles subscriptions, payments, and analytics without me needing to build anything from scratch. Stripe manages the money side. Canva handles the occasional graphic I need. And I use Claude for drafting, editing, and brainstorming content ideas, which probably saves me 3-4 hours a week.
The AI piece deserves a mention because it’s changed the equation for people like me. I’m not using it to write clinical content from scratch. I write the medical questions, verify the answers, cite the sources. But for things like formatting emails, writing promotional copy, or turning my messy notes into something readable? It’s removed a bottleneck that used to make this feel impossible.
If you’re thinking about starting something
A few things I wish someone had told me before I started.
Start with what you’re already doing. Don’t invent a new project from nothing. Look at the work you do every day and ask whether any of it could help someone else. Your study materials. Your teaching slides. Your approach to a clinical topic that took you forever to understand.
Start small and ugly. My first few newsletters were not pretty. The formatting was off, the schedule was inconsistent, and I had maybe 15 subscribers who were mostly friends. That’s fine. You’ll improve as you go. Perfectionism will kill a side project faster than lack of time will.
Don’t let anyone make you feel guilty about it. There’s a weird culture in medicine that treats any interest outside clinical work as a distraction or a sign you’re not committed enough. That’s nonsense. You’re allowed to earn money from your expertise and have a professional identity that goes beyond your clinical role.
And be honest with yourself about capacity. There will be months when the side project gets nothing from you. Busy rotations, exam prep, life stuff. That’s okay. The work will be there when you come back to it.
I’m not trying to build a tech empire from the call room. I’m trying to make sure that when fellowship ends, I have something to show for all those hours of studying besides a certificate and a lot of fatigue. So far, that’s working.
