Moonlighting as a resident?

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How many of you all moonlight or have residents in your program moonlight in the ED setting?

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Most places I interviewed at said they had residents that moonlighted in the ED. Sometimes it was ED's that were nearby, but not at their primary site. Obviously if you're at a large University program, their ED is going to be well-staffed.
 
Almost all of our residents do some moonlighting, in our ER, Urgent Care, or hospitalist shifts here or at our sister hospital.
 
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How many of you all moonlight or have residents in your program moonlight in the ED setting?

Where I trained a good amount of us did moonlighting. Our PD was all about it. Most did ED shifts, others did urgent care and weekend clinics in rural areas. We even had residents that would pull 60 hour ED shifts starting at 7pm Friday and end on Monday 7am and go back to clinic at 8am. Obviously this only worked about once a month and during an outpatient rotation due to duty hours. We weren't allowed to moonlight when we were on inpatient hospital service or OB months, otherwise, it was all free game.
 
Is there any advantage to moonlighting, besides the money? Like do moonlighters get more hands-on learning or anything?

Maybe what I am trying to ask is, is there any disadvantage to not moonlighting?
 
Is there any advantage to moonlighting, besides the money? Like do moonlighters get more hands-on learning or anything?

Maybe what I am trying to ask is, is there any disadvantage to not moonlighting?
I liked moonlighting because generally are alone and running the show. Gives you practice outside of residency before graduating and having to totally be on your own. It's pretty scary to be in your own office as the attending those first few weeks and you have the revelation that you are totally responsible. I liked having that time before had doing urgent care in the evenings to have practiced being alone (but I still had call backup if I needed in a pinch). Yes and it was nice to have extra cash to pay down debt in the process.
 
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I don't know if this is true in every state - but NY prevents R1s from moonlighting. Also the moonlighting hours are added to service hours and cannot exceed 80hrs a week.

Disadvantages: You are more exhausted and give up sleep/free time.
 
I did my moonlighting as an R3 when I got my license, had a lighter rotation load. I still had to clear it with my PD as he had to approve and I couldn't go over my 80 hours between residency and the other jobs. Plus the PD would not approve any extra work time if the charts and dictations in medical records were not done.
 
I liked moonlighting because generally are alone and running the show. Gives you practice outside of residency before graduating and having to totally be on your own. It's pretty scary to be in your own office as the attending those first few weeks and you have the revelation that you are totally responsible. I likes having that time before had doing urgent care in the evenings to have practiced being alone (but I still had call backup if I needed in a pinch). Yes and it was nice to have extra cash to pay down debt in the process.

Truer words were never spoken -- moonlight all you can, don't take no for an answer when it comes to experiences that will help you, get all the freakin' procedures you can-- there's no help once you're out.....
 
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To be honest, I feel kinda intimidated to moonlight...especially knowing there won't be any help. I mean....my biggest fear is killing hundreds of patients daily in urgent care since there are no attendings to go over my plan D:

As a 3rd year resident, I'd probably be more comfortable and get practice to be on my own. Don't get me wrong, I'd love to get as much experience/exposure as possible. However, the sentence that I've heard the topic about moonlighting that made me second guess was: "Oh yeah, there's no attendings to precept you. If you **** up, it's all on you."
 
Advice I got from an attending:
PGY1 - moonlight urgent care. Anything you can't handle gets sent to the ER anyway.
PGY2 - moonlight in an ER setting where you are the second physician or have an experienced PA with you
PGY3 - moonlight in ER solo
 
Advice I got from an attending:
PGY1 - moonlight urgent care. Anything you can't handle gets sent to the ER anyway.
PGY2 - moonlight in an ER setting where you are the second physician or have an experienced PA with you
PGY3 - moonlight in ER solo
Unless its a podunk ER with nothing in the way of traumas OR you're ATLS certified and good with procedures, this sounds like a terrible idea.

Plus, I think interns moonlighting is unwise on several levels.
 
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None of the programs where I interviewed in SC and NC allowed interns to moonlight. I will most likely do so as soon as I can PGY2 though.
 
I would wait until 3rd year until moonlighting. That extra year or two of experience is really important. Patient care comes before money.
 
I would wait until 3rd year until moonlighting. That extra year or two of experience is really important. Patient care comes before money.
Depends on what the moonlighting is. Doing disability exams (one of my moonlighting jobs) could easily by done by a 2nd year. Weekend coverage of the local psych hospital, you're right, would be best left for 3rd years.
 
Advice I got from an attending:
PGY1 - moonlight urgent care. Anything you can't handle gets sent to the ER anyway.
PGY2 - moonlight in an ER setting where you are the second physician or have an experienced PA with you
PGY3 - moonlight in ER solo
I agree with VA that this is a terrible idea. First of all you need a license before you can moonlight and that is super hard to get as an intern, plus you KNOW NOTHING as an intern and wouldn't be able to recognize what could potentially be a really sick patient that needs to go to the ER ASAP. Don't do it until third year when you are experienced with codes and medical management and been in the ER first.

Heck I"m working this scary ER job right now and there is tons of stuff that comes through the door that I don't touch because I have no experience with that type of case (yes, I'm allowed to do that) and send them to the ER doc on the other side of the wall. The key is knowing what you don't know and realizing that you can't possibly handle every case that comes through.
 
I would wait until 3rd year until moonlighting. That extra year or two of experience is really important. Patient care comes before money.

I agree with patient care and experience. I was talking to some of the seniors who said moonlighting was the best decision they've made. It's something that I've been juggling on and off whether to jump on it.

However, I'm scared that I'm all by myself, and a bunch of complicated cases come into the urgent care. In the clinic, you are working in a protected environment. In moonlighting, you're the boss and having crashing patients is scurry. Hell, in the hospital, at the very worst, there are attendings on call...

For example, in the clinic, I sometimes forget to ask one or two questions, or forget to ask about a certain vaccination or if they are taking birth control. In those situations, the attendings were able to catch me on that, and I remember for next time. In the urgent care, when people come in, if I screw up, well this patient is gonna be harmed. And, as someone who feels like the dumbest intern in the group(although noone has said this, I wouldn't be surprised if they think it) it is daunting. Ideally, if they had at least someone to curbside consult.

And knowing my luck, my first night of urgent care will have people coming in with 10 medical problems with complex situations to manage :O
 
I agree with VA that this is a terrible idea. First of all you need a license before you can moonlight and that is super hard to get as an intern, plus you KNOW NOTHING as an intern and wouldn't be able to recognize what could potentially be a really sick patient that needs to go to the ER ASAP. Don't do it until third year when you are experienced with codes and medical management and been in the ER first.

Heck I"m working this scary ER job right now and there is tons of stuff that comes through the door that I don't touch because I have no experience with that type of case (yes, I'm allowed to do that) and send them to the ER doc on the other side of the wall. The key is knowing what you don't know and realizing that you can't possibly handle every case that comes through.

Honestly, I think that's the reason why I want to delay it until a 3rd year. While I've had my ED rotation, I haven't been on night call overnight and had codes overnight by myself. And like you mentioned, I know nothing as an intern. Like seriously, it's like everything I learned in med school was complete **** compared to what I need to know now...

Although, I am thankful for a decent 3rd year med school cores, that made me not as lost. Oh boy, if I did nothing as a 3rd year student, I'd be chewed out daily.
 
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