Moonlighting and ideal environment

[da8s0859q]

I'm in a state which requires PGY3 standing for moonlighting. I'm a few weeks away from this, and in a three-year program.

I've read a few of the more recent moonlighting threads and figured I'd get some recent thoughts on this particular situation.

Around here, we have a few different options:

1. One of two lower-volume shops, single coverage, may sleep a little at night, variable acuity but not usually crazy, one not far from one of our motherships. Shifts are 12s, longer than our residency shifts. One place is a bit of a drive -- ~40-50 minutes one-way.
2. A higher volume, double coverage but lower acuity place, with midlevels to supervise.
3. One of a few fairly well-covered but busy, high-acuity places notorious for transferring out ICU level patients with some regularity.

Pay is similar for all of the above, though nowhere close to $175-$200/hr like some other locales have for EM moonlighting. Not a particularly physician-friendly state, though not the worst. Probably won't be staying in state after residency.

At all facilities, always have the option of calling to one of "our" facilities to run something by someone if need be.

Fully planned on moonlighting -- experience first, extra money second. Have done some paperwork for this and have gotten my PD's approval. See the appeal of any of the above. Just curious what our local SDN attendings / community docs did, why, and how they liked it, especially if you were in a similar situation.

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[deleted547339]

I'm about to start pgy3 and I'll be at a place like #2.

Don't like the idea of solo coverage. Don't like the idea of having a ton of critical care while moonlighting. Just one man's opinion.

 

[Hercules]

I did lots of moonlighting in about 5 or 6 small EDs similar to your 1st option. It was a great experience other than one place where I showed up for the first shift and they informed me I was supposed to be covering L&D as well as the ED. Not a big fan of that (nor was it mentioned prior to my arrival) and I never went back to that one.

Everyone is usually pretty nervous about solo coverage places but I thought they were good experiences that helped me to grow.

 

[deleted109597]

As long as you're near the mothership, you're not really solo coverage. You can always use your lifeline back to one of your bosses to ask for advice.
Remember, the sick patients are cookbook. It's the nuances that get you in this job. You might not be able to bounce questions off of your coworkers at a moonlighting gig.
I wouldn't supervise midlevels though.

 

[Birdstrike]

It's the nuances that get you in this job.

The 15 yr old chest pain that turns out to be a PE. The chronic migraine that turns out to be a walking, talking bleeding aneurysm. The groin pull while golfing that turns out to be psoas muscle abscess and impending death by sepsis. The chronic back pain that turns out to be AAA about to blow. The 28 yr old anxious female who has a normal ekg one minute and a tombstone vasospastic STEMI the next. Just keep rummaging through those haystacks of patients and you'll get poked by a needle eventually. Try finding them before your get poked.

 

[docdragon]

Solo coverage is great, and you might benefit from the random tough 12's if you haven't work a pounding 12 with any regularity. Supervising midlevels is difficult, and I'm not convinced it's useful while moonlighting. The midlevel coverage is the only thing in your list I would avoid.

 

[Hercules]

I'll echo the thought that supervising midlevels is a negative when moonlighting as a resident.