Worried about moonlighting as a second year...advice?

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KnuxNole

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I fear that if I begin to moonlight as a PGY-2, I'm bound to be killing hundreds of patients, due to the fact that there are no attendings to go over my plan, or to catch things I miss. For ex: In the clinic or ED, attendings catch me if I forget to ask what someone does for birth control, when their last PAP was or asking for sick contacts at home, or checking a certain physical exam. However, with moonlighting, if I don't ask these questions, I would be screwed.

Im anticipiating walking into a night shift at the urgent care, where people come with with MI, DKA, sepsis, pap appointments left and right and I'm by myself D:

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This seems pretty straightforward. If you are sufficiently anxious about moonlighting, then don't do it.

ETA: I'm not really sure what sort of meaningful advice to give. There are no shortcuts here. Everyone has a learning curve when independent practice starts. Ideally, that curve isn't as steep if you've finished residency, but only you can decide if you're ready before that.
 
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I fear that if I begin to moonlight as a PGY-2, I'm bound to be killing hundreds of patients, due to the fact that there are no attendings to go over my plan, or to catch things I miss. For ex: In the clinic or ED, attendings catch me if I forget to ask what someone does for birth control, when their last PAP was or asking for sick contacts at home, or checking a certain physical exam. However, with moonlighting, if I don't ask these questions, I would be screwed.

Im anticipiating walking into a night shift at the urgent care, where people come with with MI, DKA, sepsis, pap appointments left and right and I'm by myself D:

If you aren't ready then don't do it. You don't want lawsuits because you rushed things. Bad thing to have as a resident. Wait till 3rd year or don't do it at all
 
Don't do it until third year. May take that long after passing step II to get a license anyway. And remember that your residency malpractice does not cover you on moonlighting, you will need to purchase your own policy. Don't get caught without it.
 
That seems like a better idea. At least with another year of clinical training, there would be more time to build confidence/knowledge gained to not be sued, learn what specific things to document, and more importantly, knowledge to take care of the patient from literally dying in your exam bed.

I just felt a bit disheartened that I feel noone understands that it's daunting to practice independently after one year of training, especially with someone who feels like a bumbling idiot everyday. I've talked about this with people, with their sole advice being "I'm sure you'll be fine, moonlighting is easy!" with my response in my head going "It's easy for YOU, but it's insanely difficult for ME!". Ugh.
 
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Agree with everyone else. Don't do it if you don't think you're ready. Practicing medicine without a safety net is a big step. When you've built your confidence and skills some more, then you can think about doing it.
 
Or look for opportunities where there isn't as much "pressure" or responsibility.

I moonlight at a local LTAC where I pretty much just sleep in house overnight and respond to any codes or rapid responses and nothing more. May not be everyone's idea of good opportunity but I feel much more comfortable running codes and associated procedures (intubations, lines, etc...) than I do being solo in some urgent care clinic where who knows what can walk in. Not to mention I'm not trained in peds.

But I agree, if this worried then don't do it yet, or find some other opportunity.
 
If it makes you feel any better, I'm almost done with intern year and my program has pretty strong inpatient and there's no way in hell I'd feel comfortable doing urgent care. My state doesn't allow MDs to get a license after first year anyway (but DOs can).

I think it's better to feel like an idiot and worry about killing someone than it is to be overconfident and not to ask for help and then end up killing someone.
 
Or look for opportunities where there isn't as much "pressure" or responsibility.

I moonlight at a local LTAC where I pretty much just sleep in house overnight and respond to any codes or rapid responses and nothing more. May not be everyone's idea of good opportunity but I feel much more comfortable running codes and associated procedures (intubations, lines, etc...) than I do being solo in some urgent care clinic where who knows what can walk in. Not to mention I'm not trained in peds.

But I agree, if this worried then don't do it yet, or find some other opportunity.

I agree...a lot of the moonlighting around here seems to be some sort of very low-responsibility job where it'd be hard to screw up. One of the jobs involves monitoring a senior citizens' exercise room at one of our hospitals and basically being prepared to grab the AED/call 911 if someone goes down. I'm not even sure you need a medical degree for that.

I'd be a bit more apprehensive about actually being the focal point of care in any given situation (i.e., urgent care etc).
 
If it makes you feel any better, I'm almost done with intern year and my program has pretty strong inpatient and there's no way in hell I'd feel comfortable doing urgent care. My state doesn't allow MDs to get a license after first year anyway (but DOs can).

I think it's better to feel like an idiot and worry about killing someone than it is to be overconfident and not to ask for help and then end up killing someone.

That is a great point. I do agree that it's better to be a bit more cautious vs. going over your head and a patient is harmed due to being stubborn to ask help. It's April, and I ask my senior questions daily. Sometimes, he just nods and agrees, other times, he tells me not to do something and instead do XXX, and teaches why. It is comforting though, to know I'm not the only one...it seems everyone else feels they can handle patients on their own, and can't wait so they don't have to "waste time presenting to attendings", where I WANT to present to the attending so I don't **** up a person's life, and to confirm/deny if I'm doing something right compared to guessing if it's right/wrong.
 
Yeah, no worries. You're fine- other people are either putting on a confident front or they are just way overconfident. In our residency, the second years stop precepting things in clinic a lot, and the third years precept all the time, because the third years are freaking out about going into practice alone.
 
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