Residency won’t let me moonlight with PTL in California

[Neurozot]

Hi All,

PGY2 in FM here

Recently told my program that I would like to moonlight with my physicians training license.
Despite the California Medical Board saying that in-house moonlighting is allowed, they told me that I can’t.

My program is an FQHC (Federally Qualified Health Center) and they say that California law prevents us from getting reimbursed for a PTL physician.

Does anyone in California have this same issue?

It’s frustrating, because I made sure to choose a program that allows for moonlighting. I feel swindled. After 6 years of training I can’t adjust lisinopril on my own.

I feel they want to infantilize us to no end.

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[VA Hopeful Dr]

Can you not get an unrestricted license?

 

[Candidate2017]

It’s frustrating, because I made sure to choose a program that allows for moonlighting. I feel swindled. After 6 years of training I can’t adjust lisinopril on my own.

I feel they want to infantilize us to no end.

Yes, residencies and lawmakers want to infantilize you. Don't forget to contribute you future attending dollars to lobby against the 3 year requirement for moonlighting.

You can get an unrestricted license in a neighboring state and moonlight. But your program seems like they would veto that too.

 

[Neurozot]

Ya definitely thought about that route, I haven’t brought it up to them, but I would be shocked if they would sign off on moonlighting in a neighboring state.

I definitely won’t forget how weak our physicians lobbies are. In fact, they leave me no choice but to be perpetually reminded...

 

[Neurozot]

Can you not get an unrestricted license?

Unfortunately not in California, they just changed the rules that you need 3 years post grad training in an ACGME residency before they will grant you a full license.

 

[galactus]

I thought moonlighting is based on the residency, not the state. I ranked programs depending on if I can moonlight or not. Ultimately it's the PD that has to allow it, because moonlighting counts towards duty hours.

 

[Splenda88]

Unfortunately not in California, they just changed the rules that you need 3 years post grad training in an ACGME residency before they will grant you a full license.

That's what I despise about the system...

A nurse with an online degree plus 500 hrs preceptorship can practice medicine in these states who want physicians to have 3 yr postgrad training to be fully licensed.

 

[Neurozot]

I thought moonlighting is based on the residency, not the state. I ranked programs depending on if I can moonlight or not. Ultimately it's the PD that has to allow it, because moonlighting counts towards duty hours.

Yes and no. Our program has allowed moonlighting, however a recent change in California law has made it so the program cannot be reimbursed for residents.
This is a brand new issue. The residents the year above us could moonlight. We can not.

 

[chocomorsel]

Ya definitely thought about that route, I haven’t brought it up to them, but I would be shocked if they would sign off on moonlighting in a neighboring state.

I definitely won’t forget how weak our physicians lobbies are. In fact, they leave me no choice but to be perpetually reminded...

Why do they need to know?

 

[chocomorsel]

Unfortunately not in California, they just changed the rules that you need 3 years post grad training in an ACGME residency before they will grant you a full license.

So you have to wait until you have three years under your belt before you can apply? Or you can apply in your last year of training but it won't be granted till you graduate?
Doesn't that slow down the process of getting credentialed in these California hospitals then? Most places I have worked at don't start credentialing you until you have an unrestricted license. Not all, but most. Guess they will have to change that otherwise people will be out there flapping waiting months for jobs to start.

 

[Keona]

Yes and no. Our program has allowed moonlighting, however a recent change in California law has made it so the program cannot be reimbursed for residents.
This is a brand new issue. The residents the year above us could moonlight. We can not.

Can you work in an urgent care setting with a resident license? In my state we don’t get an unrestricted license until completion of residency but could moonlight outside the residency system but we couldn’t moonlight inside our own hospitals. Anthem wouldn’t pay for us to see patients though so they tried to have us set up in places with two providers so the one who would get paid would see all the anthem patients.

 

[Calvinball_Expert]

Bumping this thread to say we're having the same problem at our institution. During ranking we were told that the law change would most likely not be a problem for internal moonlighting, but now midway into PGY-2 we are being told it's probably not going to happen. Program leadership is saying that the HR people are reluctant to recognize the PTL as a "real" license for the purposes of moonlighting. Pretty dispiriting since, like you, I factored ability to moonlight heavily into my ranking.

I am hearing similar stories at other institutions. It looks like at this point that resident moonlighting is probably dead in California, at least for the time being. They added that throwaway line into the law about "internal moonlighting" with PD approval, but the reality seems to be that no program is willing to assume the weird gray-area liability of having any moonlighter that's not fully licensed. So in effect the new law has done away with resident moonlighting even though they claimed that wasn't the intent.

Bottom line for graduating med students: if moonlighting is important, I would 100% stay away from CA for now.