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Many students and trainees are leveraging their academic qualifications to get a taste of the money they could earn as future doctors. Why wait until you finish medical training to start making money -- or take a load off medical school debt?

With a little free time and the desire to do good, some turn to social media. Others find opportunities in startups or medical school admissions consulting. And free time does exist, boosted more recently with curricular reforms such as pass/fail preclinical courses at some medical schools and classes made optional on certain days of the week.

Even with the best intentions, however, the marriage of medicine and entrepreneurship is fraught with ethical gray areas. Clinical careers may be helped or hindered.

To top it off, schools offer little guidance on best practices. For instance, only dictates that medical students who work in application consulting cannot serve on the admissions committee. Beyond that, there are no rules on where students can work or what they do with their personal social media accounts, according to a spokesperson.

So how are future physicians supposed to earn their spending money?

Pitfalls in Medical Influencing

Kevin Jubbal, MD, said he started because he wanted to help struggling students. His first videos appeared before he started residency in plastic surgery. He now has over 1 million subscribers to dedicated to physician and student lifestyle content.

It's common for medical influencers to have so many followers across platforms. Some monetize it by shilling for anything from cars to iPhone cases in sponsored posts. Those who aspire to bigger audiences and bigger contracts can attend networking events to gain social media clout. One such event, , was created in 2018 by a doctor and a nursing student and sponsored by a company that sells lab coats and scrubs.

Yet depending on the specialty, strong social media activity is not necessarily a plus on future residency, fellowship, or job applications.

"If anything, it could be viewed unfavorably by admissions committees. There's more risk for them if you make them look bad or if they think you're not serious about medicine. Sometimes older generations may not be as accepting of the benefits of social media. It can be seen as distracting you from pursuing clinical medicine," according to Jubbal, who kept his own YouTube channel anonymous until he started in the plastic surgery program.

The good news, he said, is that a social media presence is more accepted now than it was in 2016, the year he applied for residency.

Perhaps a bigger problem for medical influencers is the potential conflict of interest that may arise when they are perceived as peddling medical advice.

Jubbal says it's for this reason that he refuses to sell supplements. "For me personally, I'm very picky about who I do and do not do sponsorships with," he said. Part of his decision-making is whether the product in question would benefit his audience. His sponsors have included companies selling tech gadgets and study aids.

Dishonesty is another problem in the medical influencer world, according to Jubbal, who has seen people online calling themselves doctors without having finished medical school.

"People want to help others, and if they can decrease their own loan burden that's a plus," he said. "How much of this is driven by ego? Seeking recognition? I don't really know."

Jubbal himself quit residency in 2018. Balancing the program's demands against his social media activity, admissions consulting, and duties at a biomedical incubator proved impossible.

"I had a lot of things I wanted to do outside residency. That's what forced me to make the decision, am I doing one thing or the other? I can't put 100% into everything. For most people, medicine is the main focus. For me, if I wanted to do everything, there aren't enough hours in the week," he said.

A Question of Ethics in Consulting

Admissions consulting companies are another avenue for trainees to earn extra spending money before they officially enter the healthcare workforce.

These companies offer premeds a leg up on the competitive medical school admissions process. For thousands of dollars each, clients receive advice, essay editing, and interview prep from coaches who are usually current medical students or residents.

The price tag has generated criticism that these services exacerbate existing socioeconomic disparities.

Jubbal, who founded during medical school, acknowledged the racial gap in medicine.

"One thing we've been doing is an annual scholarship. We're reconsidering how we can expand that scholarship. I don't think that's a final solution, but that's one thing we have done. We are expanding both the dollar amount and the number of recipients of that scholarship," he said.

Ryan Brewster, a fourth-year student at Stanford School of Medicine, has worked at Med School Insiders for 3 years.

"I've had a lot of ethical qualms about this. I don't think the experiences and advice that we can dispense should have a price tag. It's a little unfortunate that it's become commercialized in some way. It only reinforces a lot of the inequalities that we're already seeing in the diversity of the healthcare workforce," said Brewster.

To offset the paid work, he also gives free advice to students from underrepresented backgrounds, who may have no one else to ask. During his second and third years, he also helped lead a that hosts several successive weekend workshops for prospective medical students still in high school or early college.

"I liken it to the Robin Hood model where I will do the service and, being a poor grad student, any amount of monetary compensation helps. That's a strong factor in my involvement. But a more social calling and purpose is achieved with the work I do for free, pro bono, with these lower-resource communities, knowing that the impact can be a lot larger," he said.

Brewster is one of many medical students across the country who volunteer their advising services to those at a financial disadvantage.

is one program that matches students to mentees, typically first-generation college students or those who are from underrepresented groups.

"These students are not compensated at all for their time, and they are all involved because of a desire to pay it forward. Most of us received mentorship services for free at some point in our medical school application journey, and we adamantly feel that a price tag should not be placed on mentorship," said founder Abdikarin Abdullahi, a second-year medical student at the University of California San Francisco.

"Teaching and mentorship are integral to the profession of medicine, and this is our opportunity to use our personal experiences to help future colleagues," he said.

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