Serious question. I have my medical license and want to moonlight. But, program doesnt allow moonlighting. Obviously, wisdom would dictate not to but how serious of an infraction would that be?
Moonlighting without programs approval
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Bad.
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Nothing major--just gives your program a reason to check the "yes" box when the job reference form asks "Was this doctor ever subject to reprimand for unprofessional conduct? Please explain..."
So if that's not a concern of yours, just go ahead and do what you want.
So if that's not a concern of yours, just go ahead and do what you want.
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I know several residents that did this and none were caught. After all, how would they catch you? Well, people do talk, and you may end up seeing a patient moonlighting that gets seen by your program in some way and then your name is on the records. So I guess you'd always be at risk of being caught.
I don't know what your program would do, but I imagine they could fire you. Would this be an ACGME violation and therefore impact your chances of getting in another program, or am I just fear mongering?
I don't know what your program would do, but I imagine they could fire you. Would this be an ACGME violation and therefore impact your chances of getting in another program, or am I just fear mongering?
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The RRC for psychiatry forbids any PGY-I from moonlighting, even if you are doing your tenth PGY-I training experience. It is possible not to get fired for this, but every time I have heard of residents getting "caught moonlighting', the program has wanted to fire them. I'm guessing that residents in good standing who have unapproved moonlighting activities benefit from some selective looking the other way.
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It appears that it comes down to a work hours issue more than anything...
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Interestingly, outside moonlighting hours are not subject to duty hours where inside moonlighting is. I think it is the ACGME's realistic realization that they can't keep us accountable for things we don't know about or have no control over. The problem with unapproved moonlighting is when residents do poorly on tests, get behind in their work, and cut corners while finding enough time to moonlight.
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I imagine it would be easy to fire you if you did moonlighting when it was forbidden, and I imagine this would also follow you when trying to find a new position. Moonlighting when it's not allowed seems like a horrible, horrible idea. Income losses in residency suck, especially when you watch all that interest growing on your student loans, but it's a time limited thing -- killing your career to earn extra money doesn't seem worth it. I'm admittedly an anxious person, but I'm struggling to imagine that many residents would even contemplate moonlighting when not allowed to do so.
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Let this be another question for folks on the interview trail: ask a program's policy on moonlighting (internal and external) and timing.
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Hey, Who knows? Maybe in that explanation box when they write "this patient did extra work outside of regular duties even when asked not to" an employer will be excited!
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Interesting slip?
what your program doesn't know won't hurt them. And if they do find out somehow, just don't be brazen about it and tell everyone "Im not supposed to moonlight but am anyways and they know so **** them" and they will probably just look the other way to not make waves. Don't let your program dictate bs rules to you.....just be smart about it.
I agree and i am too much of a square to do it... but, i believe most employers would hire someone who moonlighted againts the program's approval, given there werent any other "serious" violations against said resident. All violations arent treated equally...is it a fireable offense tho?
Im sorry to say but program lied to me...they said yes, but much later on i discovered it wasnt true. There was no written polucty on it at that time so i took them at their word. My bad. Lol
You sound like eminems character on Eminem's song, guilty conscious ft dr. Dre lol...waiting for dr. Dre to respond lol
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I moonlighted through residency but it was allowed. I would not take the chance without a nod from the PD.
agreed.....most employers in the real world would actually consider a plus. They would say to themselves "this guy wants to get out and work and be productive...thats what we need".
Also, for the residents in here who are applying for there first jobs in the real world with community hospitals and such who are putting down people in their program as references: be sure to tell them what you would like them to say. You want them to say things like: hard worker, efficient, productive, etc. You don't want them to talk about how intellectually curious you are or whatever. That may even be a red flag for them.
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Sounds like a recipe for working **** jobs for **** pay, after working a couple months for free.
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The ones that do are also those who really don't give a &h1+ about rules anyway...and for that reason are probably already on the PD's "naughty list" for something or other.
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This is serious stuff that could really affect your future negatively. It is a fire able offense. One bad outcome and everybody gets sued, and your training hospital /PD will not have your back if you're doing it without permission. A better response would be to negotiate terms which would allow you and all other residents to moonlight if you meet certain criteria. It can even be an academic project. Anyway, who would hire you as a resident without checking a reference from your current PD?
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If it's a **** job and there are other better options, then I would advise residents to just do whatever in terms of references for the **** jobs and use my strategy for the better ones in the area
People who tend to play by the rules(especially when the rules are stupid and represent admin bs from people with nothing useful to do) tend to fall behind the ones who seize the moment and do what is in their best interests.
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Why would a psych residency not allow moonlighting? My home institution densest allow it, and per FREIDA the residents work~ 50hrs a week. And for the person who said ask about moonlighting, what if they lie about their policy or "twist the truth"
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Halfway through residency... Sometimes I'm not sure what I am...
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Your case example is likely the highest level of anecdotal evidence possible to challenge that.
Theoretically you could moonlight in secret and no one will find out, and none of your patients will have a bad outcome. However, prior to starting residency you probably signed a contract stating something to the effect that you will abide by the program's policies, or risk losing your position. I personally don't like to gamble, but the choice is yours. If someone did find out, my guess is that you'd be given a slap on the wrist and told to stop doing it, assuming the program director considers you to be a valuable resident and isn't looking for a reason to get rid of you. But if you persist in violating the rules, you'll probably be fired.
Perhaps, unless that particular employer doesn't allow you to moonlight as an attending.
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Have to jump in here:
When I see someone was unable to make it through residency following the rules, that sets off all sorts of alarm bells about how well they'll be able to follow rules at my place of business. If they had the hubris of choosing which policies to follow while a resident, I can only imagine which rules they'll choose to follow when they're getting paid. Are they going to care about the showing up on time rule? How about the no dating patients rule? What about the documenting risk assessments rule (or doing them for that matter)?
No, that screams cowboy. And folks who do things cowboy are great in the cop movies, but medically they tend to get people killed or at the very least sued.
I'm not a particular rule follower, but you learn the ones that you can bend and you learn the ones you need to follow. If you're in training and moonlighting when it's forbidden by your program, that screams bad judgment. If you have a bad outcome at your moonlighting gig, you're going to get crucified in court. You're putting yourself and your employer at risk. People willing to do that are not people many employers like to hire.
Good lord...
OP- Your call whether you decide to roll the dice and moonlight, I just hope you don't do it with the delusional belief that if caught that it's in any way a plus. It's bad juju.
Most employers would not consider this a plus. Most employers do not look at flags for unprofessional conduct in a positive light. I'm sure there are employers like that out there, but they are not the norm and likely going to be at places you are less likely going to want to work.
When I see someone was unable to make it through residency following the rules, that sets off all sorts of alarm bells about how well they'll be able to follow rules at my place of business. If they had the hubris of choosing which policies to follow while a resident, I can only imagine which rules they'll choose to follow when they're getting paid. Are they going to care about the showing up on time rule? How about the no dating patients rule? What about the documenting risk assessments rule (or doing them for that matter)?
No, that screams cowboy. And folks who do things cowboy are great in the cop movies, but medically they tend to get people killed or at the very least sued.
Cite your source. That was maybe true in high school, on a sales floor for a Plymouth dealership, or trying to pick someone up in a bar, but an inability to follow rules is actually a kiss of death in medicine. People who can not follow the rules in medicine are huge risks for patient safety and litigation. See questions above about whether or not this person is going to choose to follow the rules on my unit to keep people safe, well, and lawsuit-free.
I'm not a particular rule follower, but you learn the ones that you can bend and you learn the ones you need to follow. If you're in training and moonlighting when it's forbidden by your program, that screams bad judgment. If you have a bad outcome at your moonlighting gig, you're going to get crucified in court. You're putting yourself and your employer at risk. People willing to do that are not people many employers like to hire.
Good lord...
OP- Your call whether you decide to roll the dice and moonlight, I just hope you don't do it with the delusional belief that if caught that it's in any way a plus. It's bad juju.
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When interviewing for psych residencies (or anywhere, really), if you have any question that's important, ask it of multiple people. For moonlighting, definitely ask the PD, but I'd also ask some senior residents to confirm the finer points.
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Don't moonlight for now, but keep in mind you've just learned something, and maybe not for the first time:
Every single job will have hidden down sides or expectations. The goal of course is to minimize these down sides in your career by asking lots of questions and negotiating strongly when you can.
I agree with the idea of gathering other residents who want to moonlight and making a reasonable proposal to your program director. If moonlighting is still not allowed, you haven't lost anything but can show you are professional no matter the outcome. If it is a truly big deal to you then you might consider trying to switch programs ( I know that is difficult).
I let your first snide comment pass and just appropriately deflected it out of courtesy, but after this one.....go **** yourself. You don't know jack about the situation keeping me here, and in spite of the limitations I'm able to carve out a decent lifestyle and career and do things above board(ie not give 30 outpts a day 6mg Xanax like many providers here do). I'd make more money somewhere else and have a shorter commute and better lifestyle, but that's life and I've acknowledged as such.
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The ACGME requires that programs have a moonlighting policy. It doesn't say anything about what policy is allowed, only that you have to have one.
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I think the vast majority of PDs try very hard to work with struggling trainees and seldom switch to working on getting rid of anyone. I still think that it is never smart to give your boss an easy trigger to pull no matter how much you are on the good list. I also think that residents are fairly clueless about which rules are important for what reasons.
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I believe its an ACGME requirement for them to have some sort of moonlighting policy. So this will either be on the website or you could ask for a copy of it. Some hospitals have a blanket policy against moonlighting which then applies to the psychiatry residency.
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Seems like programs lying to or misleading applicants is way more common than anyone is willing to admit
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So.... Which rules ARE important?
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I'm very grateful my PD and attendings took the time to explain the reasons behind residency and hospital policies as much as possible, preparing us for leadership and limiting misunderstandings. I think that is one of the marks of a good program.
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never give your program any reason to fire you
sometimes these things come out of seemingly nowhere (at least what a lot of terminated employees will say)
if you can't get an OK from the PD, just, don't
sometimes these things come out of seemingly nowhere (at least what a lot of terminated employees will say)
if you can't get an OK from the PD, just, don't
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My fellowship promised lots of easy opportunities to participate in ongoing research. Turned out that was sort of an embellishment, and a common one at that.
My current job promised no call. Not entirely true. Always assume they are not entirely truthful somehow. Applying for jobs is like dating. Everybody tries to look perfect at first meeting. Is this person or job good enough you can overlook a few faults? What do you do when you find out the banal truth?
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The best answer is all of them at some point. Rules are often made in response to bad outcomes. They are like entropy, always seeming to go up over time and seldom reviewed or eliminated. The trick is to understand the back ground of what prompted them and then get a sense of the odds of this happening again and the degree of risk. Things like looking at charts when you are not involved in care seems trivial until you see people lose their jobs when the hospital gets fined. Sharing pass words, Pre-signing documents, parking in car pool spots, all seem small stuff until bad things happen.
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No employer would like to lose your time and energy (most importantly) to something else. Residency is employment and they want and like you to work. It's not a generosity package.
BTW, "unprofessional conduct" has become code word for "they don't do what we like them to do, damn it". The bottom point, go over your contract and see what you can do with it, just like any job.
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The problem is that many of us applicants/incoming residents go in with the wrong perspective and are unfamiliar with how the actual working world operates. We've been flooded with moralizing language during medical school, and we think these are the rules of the game and expect those in charge to upheld them. They are not. The only thing that counts is what you sign under your name, and that is the case with every job out there . It does not help when residents still think they are going to school. (for example, 75% of my incoming "class" did not know how to calculate their vacation days and requested far less than what they should get. They didn't even ask for clarification...).
A big issue is duty hours. If you're cynical, PDs don't want to risk a duty hours violation and lose ACGME accreditation. There might also be a slim chance that they don't want you compromising patient care and your own education on 3 hours of shoddy, beeper-filled sleep.
I think this particular case is referring to a CAP fellowship program. It is a little unusual for residency programs to restrict moonlighting (particularly in the 3rd and 4th years, when your schedule is more flexible and they want you to get the experience of being a junior attending). CAP programs (especially the first year), are often regressions back to being a junior resident, with increased call and inpatient responsibilities, accompanied by the handholding you get with any pediatric field.
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I'm not sure what gave you that impression - the OP is a general psych resident. it would be even crazier for a CAP residency to ban moonlighting than it would for a general psych residency given how uncompetitive child is and that adding an extra year (or two) to training is likely to encourage moonlighting (not to mention the additional moonlighting opportunities available that may be available to 5th yr child residents)
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Ethics are supposed to be an integral part of medicine.
Yes I see several doctors without ethics but it's supposed to be an integral part.
Will you get caught? Likely not but is it worth a few thousand dollars to take the risk? Further psychiatry is not a large world. It's small. How many psych departments are in a city? Often times none to just a few. Not likely getting caught but not infinitesimally small either.
All the attendings in a city are like baseball players in a team. All of the department heads and people hiring figure out who all of them are and try to trade them like kids trading baseball cards.
I can tell you this. If a resident was caught lying on something, willfully lying, I would strongly consider kicking the resident out of the program and did on a few occasions when asked as a faculty member on a resident's fate. I believe in giving 2nd and 3rd chances to residents not doing well but being honest and trying to do their best. For liars, no, even if they do good work.
Yes I see several doctors without ethics but it's supposed to be an integral part.
Will you get caught? Likely not but is it worth a few thousand dollars to take the risk? Further psychiatry is not a large world. It's small. How many psych departments are in a city? Often times none to just a few. Not likely getting caught but not infinitesimally small either.
All the attendings in a city are like baseball players in a team. All of the department heads and people hiring figure out who all of them are and try to trade them like kids trading baseball cards.
I can tell you this. If a resident was caught lying on something, willfully lying, I would strongly consider kicking the resident out of the program and did on a few occasions when asked as a faculty member on a resident's fate. I believe in giving 2nd and 3rd chances to residents not doing well but being honest and trying to do their best. For liars, no, even if they do good work.
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My CAP fellowship didn't allow moonlighting in the first year but did in the second. I've no idea how common this is.
Based on prior posts, OP is looking at CAP fellowship. I forget the timeline/year, but it's easy to read his history.
Agreed that it's a small world and getting caught is not worth it. I don't think moonlighting against residency rules is"lying". No offense, but it's convenient for someone without much student loan debt to take this position on a residency banning moonlighting. Some people actually have bills to pay and families to support.
My first clue was the fact that the OP used the word "program" instead of residency, that he had a medical license entering into the program, his username alluded to a love of video games, and finally, the fact that every one of his previous posts have been related to child psychiatry (including a previous one about moonlighting during fellowship)..
I'm not sure how the majority of CAP programs deal with moonlighting, but from what hamstergang mentioned, it makes sense they wouldn't allow it first year. The competitive programs can afford to do it because they're still relatively competitive, and the lower tier programs probably want to keep their fellows chained to the hospital. I know its not uncommon for people to actually start a small adult private practice in their second year, which makes more sense to me than moonlighting per se.
As someone who has been in significant debt: if things are really that dire that you need to break an established rule in your program to feed your family, I'd recommend talking to your PD and addressing it directly to see if there's some arrangement that can be worked out. If thats not an option, then you're at the wrong program. Also, you can make money in ways other than moonlighting.
Other ways to make money? Other than moonlighting?
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When I was an intern I donated plasma for 3k a year.
I still do surveys through sermo. I might get $100 a month from that.
I still do surveys through sermo. I might get $100 a month from that.
