Best and Worst residency for Moonlighting.

[libertyyne]

What are some of the best and worst residencies for moonlighting.Are they usually internal or external? Am i wrong to assume it is difficult to moonlight in surgical subs considering you are probably pushing up against ACGME hour limits.

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[OnePunchBiopsy]

Very program dependent, regardless of specialty. Some programs never let you moonlight.

 

[Tenk]

Best is EM. Worst is anything with high residency hours (less time to moonlight if any) or programs that flat out don't let you moonlight as mentioned above.

 

[Dantrolene FC]

Good programs for moonlighting tends to be EM, radiology, and sometimes anesthesia. Family medicine can moonlight in the ED/urgent care if you’re in an underserved semi-rural area.

 

[ace_inhibitor111]

Psychiatry. Heard that 60% of residents moonlight and 90% of residencies encourage it, can often start PGY-2

 

[DO2015CA]

For our institution, FM has the highest number of moonlighters. EM is pretty high too since they just work X number of shifts per month when in the ER

 

[SLC]

It’s also state dependent. A significant number of states won’t issue independent licenses until after 2 years, while others will after completion of intern. Though often internal moonlighting doesn’t require an independent license as you work under supervision still.

my state Was a 2year state. I did internal moonlighting as a medicine consultant in an Obstetrics/Gynecology Hospital. The pay wasn’t amazing, but it wasn’t terrible either. I’d pull 12-24h shifts where the majority of the time I’d be sitting in a very nice call room watching television. And make $800-$1600 per shift. I was to respond to and lead all codes, but not once in 2 years did one occur on my watch.

Most of the consults I got were on GynOnc patients. I’d see them, make a plan, run it by an attending who was at home, and then send recs to the attending or resident over the patient.

pretty cushy.

 

[AMEHigh]

Good programs for moonlighting tends to be EM, radiology, and sometimes anesthesia. Family medicine can moonlight in the ED/urgent care if you’re in an underserved semi-rural area.

This is all so program and state dependent that I don't think you can make generalities.
At my FM program in one of the largest cities in the country people could moonlight and it was typically as a hospitalist in our hospital.
So yes FM can moonlight in the ED and urgent care, but they can also moonlight other places and it doesn't have to be in semi-rural areas.
I also know several psychiatry residents who moonlight, but never heard of any radiology residents who moonlight in my area. So yeah I think it all depends.

 

[twospadz]

Psychiatry or EM is the best. I am Pgy-3 Psych Resident. I currently moonlight externally for 140/hr. So some shifts I make between 1400-3300 for 10-24 hrs. For the whole PGY-3, Im on pace to make more than 140k+ from moonlighting alone. Ive never made less than 10k a month since starting last July. Only specialty, you can even remotely make that much in residency besides psych is EM. Case closed.

 

[Dantrolene FC]

This is all so program and state dependent that I don't think you can make generalities.
At my FM program in one of the largest cities in the country people could moonlight and it was typically as a hospitalist in our hospital.
So yes FM can moonlight in the ED and urgent care, but they can also moonlight other places and it doesn't have to be in semi-rural areas.
I also know several psychiatry residents who moonlight, but never heard of any radiology residents who moonlight in my area. So yeah I think it all depends.

My list definitely wasn't an exhaustive list. I have some friends applying to radiology and they generally have internal moonlighting where they just babysit a CT machine while they study/sleep for $75/hr.

 

[SLC]

Psychiatry or EM is the best. I am Pgy-3 Psych Resident. I currently moonlight externally for 140/hr. So some shifts I make between 1400-3300 for 10-24 hrs. For the whole PGY-3, Im on pace to make more than 140k+ from moonlighting alone. Ive never made less than 10k a month since starting last July. Only specialty, you can even remotely make that much in residency besides psych is EM. Case closed.

Naah, you could make that moonlighting as an IM resident at my institution; they got $350 per admission to do overnight admissions at one of the local hospitals. They’d come in at 5, do 6-8 admits and head out by midnight and the nocturnist would cross-cover the patients and sign them over to the resident teaching teams in the morning.

Guys were clearing 6 figures doing that 1-2 nights a week.

 

[takeurmeds02]

So I'm confused, you're going to base your residency choice on if you can moonlight?

 

[libertyyne]

So I'm confused, you're going to base your residency choice on if you can moonlight?

It's a consideration.
I like a lot of things in medicine. And have been interested in surgical subs and interventional ir/Dr.
Most of the fields I am interested in are longer training durations 5-7 years, so it would be nice to know in what fields i could moonlight to augment income,I have elderly parents and children that i need to support.

 

[CherryRedDracul]

Radiology hands down. No other specialty is even close.

Most moonlighting gigs for residents are contrast reaction coverage. Given how rare contrast reactions are, this translates to getting paid for sitting around and doing whatever like studying, watching Netflix, surfing the web, napping, etc.

The fact is that a licensed physician has to be present whenever intravenous contrast is being administered, and given how lucrative outpatient imaging is, it's better to pay off some resident to just sit around.

 

[libertyyne]

Radiology hands down. No other specialty is even close.

Most moonlighting gigs for residents are contrast reaction coverage. Given how rare contrast reactions are, this translates to getting paid for sitting around and doing whatever like studying, watching Netflix, surfing the web, napping, etc.

The fact is that a licensed physician has to be present whenever intravenous contrast is being administered, and given how lucrative outpatient imaging is, it's better to pay off some resident to just sit around.

Word on the street was that all the rads residents at my institution were clearing 100k starting r2, do the IR residents have similar opportunities?

 

[CherryRedDracul]

Word on the street was that all the rads residents at my institution were clearing 100k starting r2, do the IR residents have similar opportunities?

Sounds about right. At my institution, it's not very difficult to make 100-150k/year.

As for IR residents, it can be more difficult to moonlight depending on their schedule. At least where I am, the IR residents are often working past 5 PM which is when many moonlighting shifts start. They'll moonlight when they're on easier rotations (e.g. clinic), but they're usually pretty busy and use whatever free time they have to rest up and study.

 

[VA Hopeful Dr]

Radiology hands down. No other specialty is even close.

Most moonlighting gigs for residents are contrast reaction coverage. Given how rare contrast reactions are, this translates to getting paid for sitting around and doing whatever like studying, watching Netflix, surfing the web, napping, etc.

The fact is that a licensed physician has to be present whenever intravenous contrast is being administered, and given how lucrative outpatient imaging is, it's better to pay off some resident to just sit around.

FM does that in places that don't have radiology residencies.

Psych traditionally has more time than most to moonlight.

EM and FM have the greatest number of opportunities given their versatility.

I'm FM and had 2 different moonlighting jobs and had offers for 2 more that I turned down for lack of time.

 

[order66.exe]

Psych is probably the best and NSGY is probably the worst

 

[Cognovi]

Sounds about right. At my institution, it's not very difficult to make 100-150k/year.

As for IR residents, it can be more difficult to moonlight depending on their schedule. At least where I am, the IR residents are often working past 5 PM which is when many moonlighting shifts start. They'll moonlight when they're on easier rotations (e.g. clinic), but they're usually pretty busy and use whatever free time they have to rest up and study.

IR residents still have to do several years of DR and should get at least 1.5 years of six-figure potential (regular salary plus babysitting).

 

[libertyyne]

IR residents still have to do several years of DR and should get at least 1.5 years of six-figure potential for babysitting.

Im glad you are chiming in, I take it Neurosurgery get zero chances for moonlighting almost universally.

 

[Cognovi]

Im glad you are chiming in, I take it Neurosurgery get zero chances for moonlighting almost universally.

The rule across specialties is that moonlighting hours count towards duty hour limits. If your residency routinely pushes 70+ hours per week, you cannot meaningfully moonlight while on clinical service and can only moonlight on research blocks. For these residencies, that means there are generally few total opportunities to do so (as there are not enough eligible people to do it), and these opportunities consist of covering undesirable shifts (eg, a Saturday 24h call for an affiliated hospital).

 

[Chlorini]

Word on the street was that all the rads residents at my institution were clearing 100k starting r2, do the IR residents have similar opportunities?

Yes, IR has the same opportunities. I’m interviewing for radiology now and IR rotates with DR for the first 3 years. And yes, the moonlighting is clutch in radiology . I’ve seen anywhere between $65-$100 an hour for first and second years (babysitting the CT machine for contrast reactions) and up to $200 an hr (actually reading studies) for upper levels. Some places even have a gym and you can workout while “working” . It’s sweet—rads is awesome.

 

[radsisrad]

My list definitely wasn't an exhaustive list. I have some friends applying to radiology and they generally have internal moonlighting where they just babysit a CT machine while they study/sleep for $75/hr.

The contrast babysitting moonlighting is always very competitive in rads residencies, and can't really be counted on as a source of really substantial income. Several thousand a year, generally.

 

[Chlorini]

Word on the street was that all the rads residents at my institution were clearing 100k starting r2, do the IR residents have similar opportunities?

Yes, IR has the same opportunities. I’m interviewing for radiology now and IR rotates with DR for the first 3 years. And yes, the moonlighting is clutch in radiology . I’ve seen anywhere between $65-$100 an hour for first and second years (babysitting the CT machine for contrast reactions) and up to $200 an hr (actually reading studies) for upper levels. Some places even have a gym and you can workout while “working” . It’s sweet—rads is awesome.

The contrast babysitting moonlighting is always very competitive in rads residencies, and can't really be counted on as a source of really substantial income. Several thousand a year, generally.

True, but VERY institution dependent. I’ve been to 2-3 interviews where they double their incomes. But yes, in general most places allow moonlighting and you can expect a few thousand at the least.

 

[libertyyne]

The contrast babysitting moonlighting is always very competitive in rads residencies, and can't really be counted on as a source of really substantial income. Several thousand a year, generally.

What does competitive even mean in terms of picking up extra shifts ?

 

[bobjonesbob]

What does competitive even mean in terms of picking up extra shifts ?

The shifts are generally either split evenly between everyone or the more senior residents get first dibs so it might not be possible to get as many as you’d actually want.


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[CherryRedDracul]

What does competitive even mean in terms of picking up extra shifts ?

At least at my institution, shifts are assigned by seniority. And if there are a limited number of shifts, then the hungriest seniors take them away from the more junior residents. The shifts are usually divided evenly among the seniormost class.

Moonlighting is ample where I'm at though. But moonlighting is very variable among different institutions. Some don't offer any opportunities, or if they do, it's a mandatory service (yikes). Other places, you swim in cash money.

 

[aafisahar]

The rule across specialties is that moonlighting hours count towards duty hour limits. If your residency routinely pushes 70+ hours per week, you cannot meaningfully moonlight while on clinical service and can only moonlight on research blocks.

Treat administrators like mushrooms, feed them **** and keep them in the dark.

I routinely broke the 80 hour rule moonlighting. No one keeps track of your hours except you.

 

[VA Hopeful Dr]

Treat administrators like mushrooms, feed them **** and keep them in the dark.

I routinely broke the 80 hour rule moonlighting. No one keeps track of your hours except you.

I did too, but it's a risky thing to do. You could absolutely get fired for doing that in the reasonably unlikely event you get caught.

 

[Ho0v-man]

I could see ranking programs higher for moonlighting purposes, but picking an entire field for moonlighting opportunities? I mean you might end up at a program with minimal opportunities as mentioned above or there could be some new rule that comes down from on high while you’re an intern that kills moonlighting.

I feel like the only fields you could count on this being a substantial part of your income pretty much anywhere you go are FM and Psych.

 

[twospadz]

Im not sure how some fields like Radiology are doubling their income during R2 or R3 due to their demanding schedule. Like I said, this year Im tripling my income (140 hr) for psych but thats only because pgy 3 psych is entirely outpatient the whole year(40 hr a week) and call is only 1 weekend month. I have a friend who is IM pgy 3 who is making moonlighting money but limited due to people at his program wanting shifts. Im sure those contrast sitting jobs arent uncompetitive to obtain.

 

[takeurmeds02]

It's a consideration.
I like a lot of things in medicine. And have been interested in surgical subs and interventional ir/Dr.
Most of the fields I am interested in are longer training durations 5-7 years, so it would be nice to know in what fields i could moonlight to augment income,I have elderly parents and children that i need to support.

That's very fair. I rescind my judgement lol

 

[PatsyStone]

When I was derm resident, I had the opportunity to moonlight. It’s unfortunate that more programs don’t offer it because it’s a great way to earn money and hone your craft

 

[LoGo]

When I was derm resident, I had the opportunity to moonlight. It’s unfortunate that more programs don’t offer it because it’s a great way to earn money and hone your craft

How did that work for derm/how did you arrange something like that? I guess it’s really more “daylighting” for derm.

 

[operaman]

By no means a best or worst, but a number of ENT programs allow moonlighting. I remember from the interview trail that there were some place that resident were doubling or tripling their salary. At my program we are allowed to do it but there aren’t any internal opportunities for us and most people don’t bother with finding external ones. I know one resident who did it on her research block and a couple times on clinical services but it wasn’t a steady thing. I’m not sure if that’s because opportunities are scarce or if most people are like me and find that my resident salary goes a long way for me and I’d rather have the free time than the extra money.

All that to say: there are opportunities within surgical subs but probably not as reliable as other fields. Hours have never been a limiting factor for me - I could pick up a 12 hour shift per week and still be under 80 - but that’s very program specific.

 

[fleetfox]

It's program specific. I did ortho and while that's not generally a residency that leaves you with a lot of extra time to moonlight, we had a setup where the chief residents could do some IME type work on weekends. I probably tripled my residency salary that year.

You will generally find it more difficult to moonlight in Gen surg or any of the surgical subs with the exception of optho, probably.

I would caution you against choosing a residency based on this. Any extra money and peace of mind you'd get during the 4-7 years of training will pale in comparison to your job satisfaction for the following 30+ years. I've met very few people that could truly be happy "doing anything" in medicine.

 

[longhaul3]

Im glad you are chiming in, I take it Neurosurgery get zero chances for moonlighting almost universally.

The rule across specialties is that moonlighting hours count towards duty hour limits. If your residency routinely pushes 70+ hours per week, you cannot meaningfully moonlight while on clinical service and can only moonlight on research blocks. For these residencies, that means there are generally few total opportunities to do so (as there are not enough eligible people to do it), and these opportunities consist of covering undesirable shifts (eg, a Saturday 24h call for an affiliated hospital).

Since all nsg programs are 7 years now and there is a lot of variability in the elective time (up to 2 years with minimal call/OR coverage), there are opportunities to moonlight in some programs. Most have elective time somewhere between years 4-6, when the residents are basically at attending PGY level for other specialties, so some offer moonlighting in the NICU (can sometimes be at or above PGY level of the fellow/attending) which is usually pretty cushy. These senior residents are usually out of the primary call pool so they have most weekends free and only have to cover senior/chief call if someone is out. Not a particularly common arrangement but it exists.

 

[Scrubs101]

Our IR attending said she was pulling >100k/yr in residency by moonlighting a ton FWIW

 

[PhillyMed777]

How did that work for derm/how did you arrange something like that? I guess it’s really more “daylighting” for derm.

Ive found it difficult to moonlight as a Derm resident. I’m sure it’s program dependent but don’t care enough to find out.

we have basically two options. Clinic from 6-10 pm or weekend clinic. It doesn’t pay well IMO and is not worth the headache of the workload it results in, I.e the prior auths, call backs,etc

 

[NickNaylor]

A lot of people have a lot of fantasies about moonlighting that is often quite different once the opportunity presents itself. I did a lot of moonlighting as a PGY-3/4 (psychiatry) and roughly tripled by residency income. Doing that required working an average of ~30 hours/week outside of normal business hours (read: lots of late nights and weekends). Many people like the idea of making money, but when it comes to actually making the sacrifices necessary to make that money, magically a lot of people never end up following through.

Moral of the story: picking a residency - or even a specialty - based on your ability to moonlight for, at most, a few years is an incredibly short-sighted idea and assumes that you are going to even want to take advantage in the first place. After 4 years of grinding it out in medical school and at least one year of residency, the desire to voluntarily take on more work - even for what is probably the most money you have ever made up until that point - may be far less appealing than what it sounds like now.

 

[bluelamin]

Treat administrators like mushrooms, feed them **** and keep them in the dark.

I routinely broke the 80 hour rule moonlighting. No one keeps track of your hours except you.

someone's seen the departed lol

 

[NicMouse64]

Any time in IM to moonlight usually?

 

[NIK102989]

Any time in IM to moonlight usually?

Program specific, but at Vanderbilt Decent
opportunities in 2nd and 3rd year. Typically $1100 for a night cross covering 30-40 pts and doing 3 admits.

The most challenging aspect is that on inpatient blocks you get 1 day off per week and that can make it challenging to moonlight particularly if you have family. That’s why a place with dedicated clinic blocks was great. You could moonlight 3-4 times during every 2 week clinic block. Made an extra 30-40K during 2nd and 3rd year.

EM in my experience has the easiest time finding moonlighting gigs, although haven’t checked about that recently with the whole EM pandemic job market

 

[twospadz]

Program specific, but at Vanderbilt Decent
opportunities in 2nd and 3rd year. Typically $1100 for a night cross covering 30-40 pts and doing 3 admits.

The most challenging aspect is that on inpatient blocks you get 1 day off per week and that can make it challenging to moonlight particularly if you have family. That’s why a place with dedicated clinic blocks was great. You could moonlight 3-4 times during every 2 week clinic block. Made an extra 30-40K during 2nd and 3rd year.

EM in my experience has the easiest time finding moonlighting gigs, although haven’t checked about that recently with the whole EM pandemic job market

I would argue psych has the best moonlighting residency gigs. Right now I have a job as a pgy 4 for 150 an hr. Its not the pay thats good but there is so much need. Ive been pulling over the last several months between 16k-27k a month extra during residency. Honestly almost every single month has honestly been 20k plus too. This month is 16k only because I gave like 3 shifts and declined 2 because Im going on vacation 4 times this month since this my off month, Psych is really where its at now.

 

[VA Hopeful Dr]

I would argue psych has the best moonlighting residency gigs. Right now I have a job as a pgy 4 for 150 an hr. Its not the pay thats good but there is so much need. Ive been pulling over the last several months between 16k-27k a month extra during residency. Honestly almost every single month has honestly been 20k plus too. This month is 16k only because I gave like 3 shifts and declined 2 because Im going on vacation 4 times this month since this my off month, Psych is really where its at now.

Psych has the most availability compared to resident pool. FP and EM fight for lots of the same jobs so while there are more out there, there are also more people going for them.

When I was in residency I did some moonlighting at the local psych hospital. I also did disability exams, had 2 classmates do UC, one cross cover the hospitalist service, and another do fast track in the ED.

 

[m0biusace]

Yale New Haven Hospital IM. $100 an hour. Most common are 7am to 7pm shifts covering 5-8 patients on the cardiology service, 8am to 6pm on the hospitalist service rounding on 14 patients with no admits, or 6 hour shifts 6pm to midnight admitting 1-3 patients in the step down with no coverage responsibilities. During the COVID peak pay was actually $125/hr.