Resident Moonlighting $$$

[MedicineDoc]

I am curious how much moonlighting goes on at other programs other than my own and how much per hour. My salary has doubled since I began moonlighting at the beginning of second year with moonlighting 60 hours per month at 65 per hour in our in house urgent care center. Would like to hear about some other programs and a subject we can all agree is interesting. Money.

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[DaveinDallas]

At a pre-interview dinner the other night, one of the chief residents of a program in Dallas alluded to $115 an hour with a doc-in-the-box in the area. During flu season when it was hard to get docs, they upped it to $165/hr.

In a program near Houston, I've heard of $60/hr in a night clinic run by the residency. You could start signing up for shifts 6 months into your intern year.

The first place required you to be a 2nd year and have your license.

 

[lowbudget]

$115 per hour? Damn. That's a lot of money if you're talking about just a walk-in clinic. There's gotta be a catch, because that sounds too good to be a walk-in clinic.

If you worked 40 hours a week, 50 weeks per year, the rate of $60 per hour puts you at $120,000 which, in a big city, where you take no call, no hospital work, no OB, no nadda except give out anti-histamines & antibiotics is just about right. At a rate of $65 per hour, you're on pace for $130,000 and at a rate of $75 per hour, you're on pace for $150,000. These are just about average starting salary for an hourly working FP doc with little-to-no risk, easy lifestyle, able to work full-time no-frills practice.

At $115 per hour, that puts you at $230,000 if you went full time, which equates to either a partnership/senior physician in an no-frills outpatient only FM practice; or a high volume urgent care (and thus higher liability) or low volume ED... but almost always, no one works 40 hours x 50 weeks in those settings. At $165 per hour, if you worked that full-time, you're on pace for $330,000.

My guess is that the chief residents were alluding to a job with either moderate-to-high volume urgent care/walk-in clinic, moderate-to-high liability setting. Hopefully, these residents who are moonlighting there are practicing some fierce defensive medicine.

Correct me if I'm wrong; but generally, you need to justify your salary by bringing in 3x your worth in revenue if you're doing outpatient primary care/urgent care work. So, if you're making $115 per hour, you need to bring in $345 per hour in revenues. If the typically outpatient visit (99213) reimburses by Medicare $50 per visit, you need to see 7 patients per hour, which is 8.5 minutes per patient. You better hope patients have easy complaints in order to move that fast. I've done it before at that pace, but not as a 2nd year resident... I'm willing to bet either the acuity (and thus reimbursement rate) is much higher than the average outpatient cough/cold or the volume is consistently high in order for the clinic to afford to pay the doc-in-a-box that much.

 

[montessori2md]

I think the urgent care in question is the ED-lite variety -suturing and the like, but limited/no imaging, anything over their heads getting bussed up the road to the ED. We have piles of them in our area, and they are reimbursed like an ED (higher copay, in theory more procedures). 1 doc, 7 beds, no midlevels, you're pretty much on your own. So yeah, defense would be good.

 

[DaveinDallas]

$115 per hour? Damn. That's a lot of money if you're talking about just a walk-in clinic. There's gotta be a catch, because that sounds too good to be a walk-in clinic.

If you worked 40 hours a week, 50 weeks per year, the rate of $60 per hour puts you at $120,000 which, in a big city, where you take no call, no hospital work, no OB, no nadda except give out anti-histamines & antibiotics is just about right. At a rate of $65 per hour, you're on pace for $130,000 and at a rate of $75 per hour, you're on pace for $150,000. These are just about average starting salary for an hourly working FP doc with little-to-no risk, easy lifestyle, able to work full-time no-frills practice.

At $115 per hour, that puts you at $230,000 if you went full time, which equates to either a partnership/senior physician in an no-frills outpatient only FM practice; or a high volume urgent care (and thus higher liability) or low volume ED... but almost always, no one works 40 hours x 50 weeks in those settings. At $165 per hour, if you worked that full-time, you're on pace for $330,000.

My guess is that the chief residents were alluding to a job with either moderate-to-high volume urgent care/walk-in clinic, moderate-to-high liability setting. Hopefully, these residents who are moonlighting there are practicing some fierce defensive medicine.

Correct me if I'm wrong; but generally, you need to justify your salary by bringing in 3x your worth in revenue if you're doing outpatient primary care/urgent care work. So, if you're making $115 per hour, you need to bring in $345 per hour in revenues. If the typically outpatient visit (99213) reimburses by Medicare $50 per visit, you need to see 7 patients per hour, which is 8.5 minutes per patient. You better hope patients have easy complaints in order to move that fast. I've done it before at that pace, but not as a 2nd year resident... I'm willing to bet either the acuity (and thus reimbursement rate) is much higher than the average outpatient cough/cold or the volume is consistently high in order for the clinic to afford to pay the doc-in-a-box that much.

There is one other alternative, my dear Watson, that you haven't considered.....or maybe you have, yet found it so plebian as to not warrant any further consideration or discussion.....

That being - perhaps said resident was studing up (or studetteing up) to try to impress someone with their ability to generate wealth, power, prosperity and happiness.......not saying that's what happened.....

 

[lowbudget]

There is one other alternative, my dear Watson, that you haven't considered.....or maybe you have, yet found it so plebian as to not warrant any further consideration or discussion.....

That being - perhaps said resident was studing up (or studetteing up) to try to impress someone with their ability to generate wealth, power, prosperity and happiness.......not saying that's what happened.....

Are you hinting a Texas Tall Tale?

I don't deny that residents can make that much moonlighting. Glad that kind of work is out there and glad people are getting that kind of work. And trust me, it's much deserved.

But I wasn't born yesterday. When I see salary/pay that's a couple of standard deviations out there, I ask questions. And if I were you, I'd ask questions too... before you sign the contract. Some of these numbers can be seductive & mesmerizing... I know of one FP out in Oklahoma who as a resident was moonlighting at a rate that would put him on pace with $250,000. He didn't make that much, but if he had worked full time, his hourly rate would have put him on that track. But it was ED work, with ED charges, and thus ED liability. I'm just saying that you should obtain an informed consent before signing contracts.

 

[cabinbuilder]

So I just finished residency, did a bunch of different moonlighting jobs.

1. Director of Plasma Center 4 hrs/week $65/hr

2. Did physicals for a wt loss program $20/per physical ~ $80/100 hr

3. Urgent care clinic 4-8 hrs week $75/hr

4. Beeper call for cancer center doc $150 for 4 hrs (they never called)

 

[MossPoh]

I know several EDs/Urgent care clinics that offer 115/hr+ for moonlighting. That doesn't mean they pay the normal docs there equivalent amounts. To make some places attractive, you have to offer more money. Sometimes people want breaks and in order to get those breaks or fill in scheduling gaps, they have to offer a lot of cash to bring someone else in.

 

[MedicineDoc]

My salary went from about 40 thousand a yr to 86,800 with maxing out on moonlighting at 60 hours a week right after 2nd year began at Trover.

 

[deleted87716]

My income went from about 40 thousand a yr to 86,800 with maxing out on moonlighting at 60 hours a week right after 2nd year began at Trover.

Fixed it for you. I'm sure your residency stipend (what you might call a "salary," the definition of "salary" being fixed wages) didn't change because you were moonlighting.

It's nice to make more money, but don't forget that this much moonlighting will almost certainly kick you up into a higher tax bracket. You also need to make sure that all of the appropriate income taxes are being taken out by the folks who are paying you, otherwise you could find yourself owing a lot of money when April rolls around. If that happens, you'll also probably end up having to pay estimated tax every quarter the following year, which is a pain.

 

[bunnymd]

You also need to make sure that all of the appropriate income taxes are being taken out by the folks who are paying you, otherwise you could find yourself owing a lot of money when April rolls around. QUOTE]

I'm doing disability exams for extra income during my fellowship and working as an independent contractor. As such, no taxes are witheld. I've been putting away 30% of each check. I don't have an accountant now so I haven't asked a professional, but no other doctors seem to have a good answer for what percentage I should set aside.

Am I safe with 30%

 

[deleted87716]

Am I safe with 30%

I don't know. I'd talk to an accountant.

 

[MedicineDoc]

They take care of us. It's all taken out and available for view online. We do call from home and our hours aren't that long. We get quality hours with attendings that aren't fresh out of residency. Almost all the second years at Trover max out. At least all the males.

 

[cabinbuilder]

You also need to make sure that all of the appropriate income taxes are being taken out by the folks who are paying you, otherwise you could find yourself owing a lot of money when April rolls around. QUOTE]

I'm doing disability exams for extra income during my fellowship and working as an independent contractor. As such, no taxes are witheld. I've been putting away 30% of each check. I don't have an accountant now so I haven't asked a professional, but no other doctors seem to have a good answer for what percentage I should set aside.

Am I safe with 30%

I paid my taxes quarterly the %30 and I got hosed during tax time. It wasn't enough and I still ended up paying another 2500 to the IRS. Work it how you want but don't expect a refund.

 

[Prncssbuttercup]

2000/yr? is that worth anyone's time?

 

[VA Hopeful Dr]

2000/yr? is that worth anyone's time?

Depends on how much time earning that took.

 

[Prncssbuttercup]

I've seen people post 2k/mo for 20hrs, that seems like it could be worthwhile, but 2k/yr (167/mo) wouldn't be worth it to me unless it took 12hrs/yr or less than 1hr/mo...

 

[superfly24]

@loljkttyl

I'm interested in what you've got to say. Fire me a PM with details if you don't mind.