Did/do you moonlight?

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I'm entirely undecided on this issue. I'm approaching the end of my time in the primary call pool in my program and have a full medical license. Some of my classmates are signing up for moonlighting gigs, and I'm slacking out of ambivalence I guess. You can make a lot of money ($3.5k/weekend), but that's a weekend where you have to work, and I'm a little sick of working weekends. But it's a lot of money, and while I'm able to pay my bills and meet my basic needs, I can't say I couldn't use more money to fund buying a house and maybe some vacations, etc.

Is moonlighting as miserable as call, or does the money make up for it? Is it good training? Also, professionally I'm headed towards a likely 100% outpt path, and the big pay moonlighting opportunities are all inpatient.

I'm going into my 6th year of training and this will be the first year I'm going to moonlight. There is really one main reason I'm doing this--the money. We have a baby coming and need the extra cash. I value my free time too much and never felt the need to do it before. If you don't need or want the money, I say keep your weekends to yourself. If you want some extra cash, then going in every once a awhile for a weekend shift probably isn't too bad, depending on where you'll be. I'm going to be working weekends in an inpatient unit every 5th to 6th weekend. I have been told that it looks good on your CV, but, hey, it's not that hard to get a job in psych, so I'm not sure that's a compelling reason.

Originally Posted by Chimed

There is really one main reason I'm doing this--the money.

I'm just curious: are there people who moonlight because it offers them a chance at some good experience?

My understanding was that all the jobs suck something awful, but the pay is incredible compared to the earnings of a resident.

edit
yikes, obviously didn't read through the posts well enough, sorry for posting!

Originally Posted by Doctor Bagel

I'm entirely undecided on this issue. I'm approaching the end of my time in the primary call pool in my program and have a full medical license. Some of my classmates are signing up for moonlighting gigs, and I'm slacking out of ambivalence I guess. You can make a lot of money ($3.5k/weekend), but that's a weekend where you have to work, and I'm a little sick of working weekends. But it's a lot of money, and while I'm able to pay my bills and meet my basic needs, I can't say I couldn't use more money to fund buying a house and maybe some vacations, etc.

Is moonlighting as miserable as call, or does the money make up for it? Is it good training? Also, professionally I'm headed towards a likely 100% outpt path, and the big pay moonlighting opportunities are all inpatient.

$3500 per weekend is a nice rate. In my residency we were quoted something like $1500 per weekend, and where I work currently it is $2500 per weekend.

I didn't do any moonlighting during residency, and I don't do it now. I just prefer to have more free time.

I started moonlighting 3rd year of residency. For the 1st 3 mos of it I worked 7 days a week straight, no days off. Grueling. Don't recommend it. Just remember to pace yourself. I viewed it as an issue with debt (just got married) and I'd rather channel my anxiety over finances constructively into working rather than sitting around worrying about it.

I also did a variety of settings which I'm certain made me a better psychiatrist (jails, private hospital coverage, AND disability evaluations). Use it as an opportunity.

The full weekend gigs can be pretty miserable. The money is good, but it isn't fun. Shop around for the best gig possible. Depending on the region, you may have many options.

Just know that once you start moonlighting, you can't stop. The tail coverage is expensive.

Originally Posted by TexasPhysician

Just know that once you start moonlighting, you can't stop. The tail coverage is expensive.

Can someone elaborate on this? I think my program will pay for your insurance if you moonlight (once you can). Is this like "once you eat one Pringle you can't stop" or is there some financial imperative to continue moonlighting that I don't know about?

Originally Posted by Bartelby

Can someone elaborate on this? I think my program will pay for your insurance if you moonlight (once you can). Is this like "once you eat one Pringle you can't stop" or is there some financial imperative to continue moonlighting that I don't know about?

Usually moonlighting for your own institution does not require additional malpractice insurance. No programs in Texas pay for outside malpractice insurance that I know of. Why would they pay higher rates voluntarily?

Part-time insurance in my region starts at about $1600/year without tail coverage for year 1. I think it will gradually increase over 2-3 years to $4200/year roughly. Year 2 is about $2400 i think. Full-time is probably close to 2x this in TX.

I compared this to inclusive coverage (covers you for life - no tail needed) at another company which quoted me at $6000/year roughly.

Assume you will make an extra $20,000/year moonlighting. Subtract taxes, license fees, and moonlighting insurance. It's a good chunk of change. Then decide to quit moonlighting and you will be hit with thousands of dollars to pay for tail coverage. It may actually be cheaper to just continue paying for insurance you aren't using.

Because most costs related to moonlighting are fixed and there are tax benefits you can utilize, it benefits you to maximize your moonlighting. The more you work, the higher the percentage of money you get to keep.

I never did. My institution didn't offer it and I didn't want to deal with the malpractice hassle. Plus I value my free time far far too much.

If I got paid 3.5k per weekend, I'd consider moonlighting more often. Considering the pay I receive in comparison, I may as well be getting reimbursed with food stamps.

Sign up for the extra experience and add it to your CV. Then moonlight whenever you feel like it. That's what I do.

Hmm, interesting thoughts. I certainly hadn't thought about the tail issue, and my program does not cover us for working at outside sites. We also don't have any inhouse moonlighting options. In fact, the high paying weekend gigs are all a one to two hour drive away, which might be why they pay so much. So I'm still thinking.

I would investigate insurance for your region first. Talk with your colleagues who moonlight and find out what they use. And see if they offer discounts (early career, part-time, etc). Malpractice costs but with enough discounts I didn't find it was prohibitory by any means.

Moonlighting has been one of the most educational experiences of residency. . . rates around here keep going up!

A problem with moonlighting is that some places require a commitment. E.g. you need to see patients every week because you're offering long-term care. Those patients could call up the 24 hour service at any time and demand help. If you're doing a scholarly project and want to focus on that, you still got to worry about your moonlighting job.

Other places come in a one-time serving. E.g. covering at the VA hospital. When you're done, you're done. You don't have to come back to work for weeks.

I did the first type of job in fellowship, and I was researching a project for a grand rounds that was going to be viewed by 4 of the top doctors in the country and I knew how I did was going to make a mark on my future. I still had to do my moonlighting hours and during the month before the presentation I actually came to the conclusion that if I continued to work this hard, I could have a heart attack if I worked all the time like that for years. I didn't have time to exercise, I started eating junk food because I had no time to make healthy meals, and my stress level was through the roof. My attitude was I was going to work on that project as best as I possibly could because this was the first time I felt like I was in an arena that took real use of all my talents.

I remember during my fellowship graduation, I sat on a chair thinking I need to rebuild my body after the hell I put it through being that fellowship was over. (That and my PD who is one of the best doctors in the country gave a speech while putting his hand on my shoulder saying what a great doctor I was and my wife forgot to record it!!! DAMN! When this happened, I was looking at her trying to give unspoken signals to get the camera out but didn't want to actually do anything too drastic being that everyone was staring at me. I was having a Seinfeld moment.)

Point being is that if you moonlight, you might have an easier life doing things like the VA where you can walk away from the job whenever you want.

Look into all of the various jobs in your area and make sure that you pick the one that is right for your work-life balance. I have worked in two settings so far, they both paid little ( 55/hr, they paid the insurance). The volume was quite low, so the money was easy. I'm switching jobs up now, more like the 3.5 K per weekend, with high volume, once every six weekends.

At 55/hour, I had a sweet state job. I saw less than ten patients per shift, and the shifts would range from 5 hours to 24 hours. But the weekend job I am picking up, I will be seeing 40 patients per day on average, including about 3-4 new admits per shift. I will be getting to work on Saturdays and Sundays at about 5AM, rounding all day, then going home. With the state job I recently left, I would have to stay in- house. I was not paid well, but I was reading books. Thus, I would really consider what you want for yourself. Most people who start moonlighting in residency do not stop. You start to get used to the extra paychecks.

I moonlight at a residential facility. It's kind of come and go as you please. I have some patients who I see weekly and others monthly. I do have to deal with administrative hassles like MD-MD reviews or the patient who decompensates.

There's no way I'd go back to not moonlighting. I get valuable experience on my job, and frankly, my family depends on the paychecks. When you have three kids, one of whom will be needing a car soon, well, life gets very expensive. It's allowed my wife to be a stay-at-home mom, maybe working 12-24 hours per month. It's just a lot easier for me to go in and make $100 per hour as opposed to her working at 1/4 of that.

It's interesting to see the rates for malpractice insurance. Mine ran $700 for the first year, $1200 for year 2, and maybe $1500 for year 3. Tail coverage may be more expensive for me, as I'm also seeing adolescents, but I was told it would be about as much as a year's coverage.

You do grow up quickly moonlighting. You have to develop your own system and work within a new one. You are the one fully responsible for your patients. You go home and read the literature on your own because you are responsible for those patients. You choose when it's time to step out into uncharted waters, and say, "Well, there aren't many double, randomized controllled trials for this, but we've got some evidence, and let's try."

Is it uncommon for psychiatrists to purchase occurrence insurance? I am from obgyn, and I have always demanded occurrence insurance (>$100,000 a year-yeah-it's pretty crazy) from my employers. Of course, the chance of psychiatrist being sued is probably a lot less than that of an obstetrician.

Both places where I moonlight pay for my malpractice - and I do think psychiatrists are one of if not the least likely to be sued.

Originally Posted by BobA

Both places where I moonlight pay for my malpractice - and I do think psychiatrists are one of if not the least likely to be sued.

Yes, psychiatry is pretty low risk relative to other specialties.
http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Originally Posted by belle54321

Is it uncommon for psychiatrists to purchase occurrence insurance? I am from obgyn, and I have always demanded occurrence insurance (>$100,000 a year-yeah-it's pretty crazy) from my employers. Of course, the chance of psychiatrist being sued is probably a lot less than that of an obstetrician.

Yes, in fact the two specialties are on opposite spectrums. In a 2010 AMA report, for what it's worth:

Number of claims per 100 ObGyn doctors = 215 (the HIGHEST of all specialties), with over 52% sued 2+ times.

Number of claims per 100 psychiatrists = 39 (the second lowest), with only 8% sued 2+ times (also the second lowest). Even pathologists had more litigations than psychiatrists in this report.

These numbers are a 2007-2008 snapshot:
http://www.ama-assn.org/ama1/pub/upl...claim-freq.pdf

How about the question about occurrence insurance vs. claims made insurance? A few of the posters have mentioned about purchasing tail which means they had claims made insurance. Is getting occurrence uncommon for psychiatrist?

Originally Posted by atsai3

Yes, psychiatry is pretty low risk relative to other specialties.
http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

In fact, when I did the maintenance of my obgyn board certification recently, this NEJM article was one of the required articles. Certainly confirmed that I was making the right career decision.

Originally Posted by belle54321

How about the question about occurrence insurance vs. claims made insurance? A few of the posters have mentioned about purchasing tail which means they had claims made insurance. Is getting occurrence uncommon for psychiatrist?

It likely varies by company and maybe field. Claims made insurance is cheaper up front, and since I am moonlighting in residency, this is the least I will ever earn. The company I use also provides free tail coverage when you retire if you stick with them for so many years. Since they are so cheap, I don't plan to change companies. For me, this makes claims made insurance much for affordable and just as effective.