Did the new California essentially make resident moonlighting impossible?

[dangEras]

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They passed a bill SB 798 this summer. It changed the minimum GME requirement for a medical license from 12 months to 36 months. It goes in effect Jan 1 2020.

For anyone aware of how licensing applications process works, is there any chance we (current M4s) can get by it by applying for our license while in the first half of our intern year sometime between July 1 - Dec 30 2019?

It seems like a rotten deal that further affects how I rank the cali programs

 

[Tenk]

Yeah that would make moonlighting impossible for all 3 year or less residencies. I wouldn’t even rank California programs for EM, FP, or IM (if no fellowship plans) after that. Most other specialties it doesn’t matter much. Stupid.

You need to pass step 3 and be a PGY2 to get your license.

 

[alprazoslam]

What’s their motive for this besides that it’s california.

With crap like that in place hope they at least never give nurse practitioners independent practice there.

Californlol


I can imagine PDs not being happy with less applicants in the future possibly

 

[NITRAS]

Not on California, but we have residents moonlight and don’t require a license. They do cross over and admissions, but they have to be staffed.

 

[Rekt]

Not on California, but we have residents moonlight and don’t require a license. They do cross over and admissions, but they have to be staffed.

That's internal moonlighting and the pay is rarely worth the hours you would otherwise have off. Honestly just another reason to avoid California.

NPs making >120k a year after taking some online classes, then being able to work for several years while you can't even make more than 10$ an hour.

 

[NITRAS]

If memory serves, they get $75/ hour. It’s not attending pay, but they line up to do. I was not allowed to moonlight, but th FM residents bragged about getting $200+ at ERs in the middle of nowhere.

I have a strong dislike of CA, but they have no lack of residents or attending going to the state despite the high taxes, the ludicrous laws, or the one-sided politics.

 

[doc05]

Residents shouldn’t moonlight anyway. It does a disservice to patients.

 

[Mass Effect]

Residents shouldn’t moonlight anyway. It does a disservice to patients.

Citation? Moonlighting makes you a stronger clinician and I have yet to see a study about poor patient outcomes with moonlighters as opposed to new attendings.

CA is probably trying to prevent people who quit/get terminated in residency from getting a full license.

 

[Black Coffee 24/7]

I would rather do in-house OMM visits for $150-200/hr rather working an extra shift for a mere $200. Some of these people need to be educated about their real values.

 

[uname943]

They passed a bill SB 798 this summer. It changed the minimum GME requirement for a medical license from 12 months to 36 months. It goes in effect Jan 1 2020.

For anyone aware of how licensing applications process works, is there any chance we (current M4s) can get by it by applying for our license while in the first half of our intern year sometime between July 1 - Dec 30 2019?

It seems like a rotten deal that further affects how I rank the cali programs

Or you could just contact the program directors and ask how the changes affect you.

Quick Google search shows:
"Q: Can a trainee with a valid Postgraduate Training License moonlight?
A: The holder of a Postgraduate Training License may engage in the practice of medicine only in connection with his or her duties as an intern or resident in a Board-approved postgraduate program, including its affiliated sites, or under those conditions as approved in writing and maintained in the file, by the director of his or her program. Accordingly, a holder of a Postgraduate Training License may moonlight with written authorization from the program director."

Most residencies require program director approval for moonlighting anyways.

 

[mehc012]

I would rather do in-house OMM visits for $150-200/hr rather working an extra shift for a mere $200. Some of these people need to be educated about their real values.

I believe the person above was saying $200/hr, not per shift.

 

[dangEras]

Or you could just contact the program directors and ask how the changes affect you.

Quick Google search shows:
"Q: Can a trainee with a valid Postgraduate Training License moonlight?
A: The holder of a Postgraduate Training License may engage in the practice of medicine only in connection with his or her duties as an intern or resident in a Board-approved postgraduate program, including its affiliated sites, or under those conditions as approved in writing and maintained in the file, by the director of his or her program. Accordingly, a holder of a Postgraduate Training License may moonlight with written authorization from the program director."

Most residencies require program director approval for moonlighting anyways.

You didnt answer my question. I was asking about the timeline of getting a license.

In-house moonlighting is utter garbage. And asking to get permission from a PD is laughable. 90% have said no, yet their residents have been doing it on their own license

 

[Mass Effect]

I would rather do in-house OMM visits for $150-200/hr rather working an extra shift for a mere $200. Some of these people need to be educated about their real values.

I think you're misunderstanding the moonlighting gigs out there. First of all, a lot of them pay that an hour, not per shift. Second, depending on your specialty, there are some sweet gigs out there where you basically sit on your rear for 3 hours, watch Netflix and babysit a pager for that price. And you may never get paged. At some places, you get paid per admit or per consult. So say it's 5 pm and you're about to leave, but you hear about an admission coming up from the ED. You do the admission and get the $150-200 for what, a half hour worth of work? If you think you literally just stay at work and work a complete shift like you did that day for all moonlighting gigs, you're mistaken.

In-house moonlighting is utter garbage. And asking to get permission from a PD is laughable. 90% have said no, yet their residents have been doing it on their own license

Your original post says you're an MS 4, so how would you know about in-house moonlighting or what "90%" of PDs say? My PD actively and enthusiastically encouraged moonlighting because he said it made us better doctors to see and treat patients independently while still in residency. And he was right. Also, in-house moonlighting is how I paid for my new car during residency so suggesting it's "utter garbage" is short-sighted and again, gives a glimpse into your MS4 frame of reference.

 

[Postictal Raiden]

Yeah that would make moonlighting impossible for all 3 year or less residencies. I wouldn’t even rank California programs for EM, FP, or IM (if no fellowship plans) after that. Most other specialties it doesn’t matter much. Stupid.

You need to pass step 3 and be a PGY2 to get your license.

Don't forget about psych. I know of PGY3's doubling or even tripling their income with moonlighting

 

[uname943]

You didnt answer my question. I was asking about the timeline of getting a license.

Your thread title literally asks "Did the new California essentially make resident moonlighting impossible?". I answered that with a simple Google search. Which was a prompt for you to do the same. Btw, if you do the same Google search, you will find the exact same source page. And learn: "Scenario #2: First year residents who enroll in their residency program July 2019.
A: These residents will be required to apply for a Postgraduate Training License between
January 1, 2020 and June 30, 2020."

In-house moonlighting is utter garbage. And asking to get permission from a PD is laughable. 90% have said no, yet their residents have been doing it on their own license

Citation? Did you literally poll the residents and PDs on your rank list?

 

[Mass Effect]

Don't forget about psych. I know of PGY3's doubling or even tripling their income with moonlighting

Psych is a 4-year residency so it doesn't fall into the category the OP listed.

 

[Postictal Raiden]

Psych is a 4-year residency so it doesn't fall into the category the OP listed.

I realize that. However, in most psych programs moonlighting starts during pgy-3, and a good number of programs allow pgy-2's to moonlight internally.

 

[Mass Effect]

I realize that. However, in most psych programs moonlighting starts during pgy-3, and a good number of programs allow pgy-2's to moonlight internally.

This is true, but the point is, they will get to moonlight during residency and the thread is about outlawing moonlighting entirely during residency (which was also proven not to be entirely true by an above poster).

 

[Black Coffee 24/7]

This is true, but the point is, they will get to moonlight during residency and the thread is about outlawing moonlighting entirely during residency (which was also proven not to be entirely true by an above poster).

How much is the TYPICAL rate/hr on these moonlight gigs?

 

[Mass Effect]

How much is the TYPICAL rate/hr on these moonlight gigs?

This depends entirely on gig, place, and specialty. I've seen baseline pay for babysitting pager with additional $200 - $400 per admission if you get one. I've also seen baseline pay for babysitting pager with additional $200 per consult if you get one. I've seen overnight shifts that pay $2000 for 8 hours overnight just to babysit a unit. I've seen internal moonlighting paying $150 per ED evaluation. Just depends on all these factors.

 

[Black Coffee 24/7]

This depends entirely on gig, place, and specialty. I've seen baseline pay for babysitting pager with additional $200 - $400 per admission if you get one. I've also seen baseline pay for babysitting pager with additional $200 per consult if you get one. I've seen overnight shifts that pay $2000 for 8 hours overnight just to babysit a unit. I've seen internal moonlighting paying $150 per ED evaluation. Just depends on all these factors.

How much per hr if you don't get any work?

 

[Mass Effect]

Again, depends on the place, duration, and specialty. I've seen $200 overnight with no pages. And you do it from home so no disruption in your sleep. For weekends, some places will let you hold the pager all day on a Saturday or Sunday for base pay at your own home, then extra money for going in, but I didn't do that so don't know how much they got paid.

 

[dangEras]

I think you're misunderstanding the moonlighting gigs out there. First of all, a lot of them pay that an hour, not per shift. Second, depending on your specialty, there are some sweet gigs out there where you basically sit on your rear for 3 hours, watch Netflix and babysit a pager for that price. And you may never get paged. At some places, you get paid per admit or per consult. So say it's 5 pm and you're about to leave, but you hear about an admission coming up from the ED. You do the admission and get the $150-200 for what, a half hour worth of work? If you think you literally just stay at work and work a complete shift like you did that day for all moonlighting gigs, you're mistaken.



Your original post says you're an MS 4, so how would you know about in-house moonlighting or what "90%" of PDs say? My PD actively and enthusiastically encouraged moonlighting because he said it made us better doctors to see and treat patients independently while still in residency. And he was right. Also, in-house moonlighting is how I paid for my new car during residency so suggesting it's "utter garbage" is short-sighted and again, gives a glimpse into your MS4 frame of reference.

How's 14 different interviews stating their policy for you? 11 outright banned moonlighting. The ones that offered gave **** offers like $100 to take an extra call or $75/hour to stay extra.

The residents pretty much all stated they take per diems at snf and pain clinics for massive paycheck for a single shift.

 

[Black Coffee 24/7]

How's 14 different interviews stating their policy for you? 11 outright banned moonlighting. The ones that offered gave **** offers like $100 to take an extra call or $75/hour to stay extra.

The residents pretty much all stated they take per diems at snf and pain clinics for massive paycheck for a single shift.

Are all of these in Cali or restricted to one of the coasts?

 

[Mass Effect]

How's 14 different interviews stating their policy for you? 11 outright banned moonlighting. The ones that offered gave **** offers like $100 to take an extra call or $75/hour to stay extra.

The residents pretty much all stated they take per diems at snf and pain clinics for massive paycheck for a single shift.

Name some of these programs.

 

[ThoracicGuy]

Citation? Moonlighting makes you a stronger clinician and I have yet to see a study about poor patient outcomes with moonlighters as opposed to new attendings.

CA is probably trying to prevent people who quit/get terminated in residency from getting a full license.

Got any sources on this claim? If you are a resident staffing some middle of nowhere ER where there MIGHT be one other guy helping you, that's not an environment that is conducive to making you stronger. You could just as easily get in over your head. Unfortunately you may not know what you don't know, so patients may end up with substandard care.

 

[Mass Effect]

Got any sources on this claim? If you are a resident staffing some middle of nowhere ER where there MIGHT be one other guy helping you, that's not an environment that is conducive to making you stronger. You could just as easily get in over your head. Unfortunately you may not know what you don't know, so patients may end up with substandard care.

Of course that could happen. It could also happen to an attending. The more you care for patients independently, the more comfortable you become with it. What's scary is those with no insight into their own shortcomings and knowledge gaps and that could happen at any level, whether in training or not.

 

[ThoracicGuy]

Of course that could happen. It could also happen to an attending. The more you care for patients independently, the more comfortable you become with it. What's scary is those with no insight into their own shortcomings and knowledge gaps and that could happen at any level, whether in training or not.

It's more likely to happen to a resident with incomplete training than someone who has finished residency...

 

[Mass Effect]

It's more likely to happen to a resident with incomplete training than someone who has finished residency...

I don't know, I think that depends on a lot of factors. A PGY 3 versus a someone practicing for 10 years? Sure, the PGY 3 is more prone to mistakes and being in over his/her head. But a PGY 3 versus someone just out of ED residency? Or better yet, a PGY 3 at a busy academic residency who saw zebras daily and was thrown into the deep end of the pool versus an attending who just graduated from a community-based program that only saw the typical presentations of disease? My money would be on the PGY 3. This changes, of course, if the attending has been in practice for years. But I really think when it comes to moonlighting, residents should do it. Being on your own for the first time is scary, but necessary for your personal growth as a physician imo, and hopefully, you know when you're in over your head and can pick the gigs according to your own skills and talents.

 

[SLC]

That's internal moonlighting and the pay is rarely worth the hours you would otherwise have off. Honestly just another reason to avoid California.

NPs making >120k a year after taking some online classes, then being able to work for several years while you can't even make more than 10$ an hour.

Meh, I made $75 an hour doing internal moonlighting at one hospital. My duties involved medicine consults on OBGyn and Gyn-Onc patients; and being the default code leader for any codes. I mostly slept in a super swanky call room on the attending floor (we had a pool table, sauna, etc).

Made $200/admit doing after hours admissions and signing them off to the IM resident night float in another hospital. I could usually knock out 3 or 4 and still get home for dinner and a reasonable bed-time.

I ended up getting like $58k doing in-house moonlighting in my 2nd and 3rd year.

 

[Oo Cipher oO]

It will affect the ability of military physicians on GMO tours to moonlight when stationed in California. Can’t get a California medical license and not in GME so no training license.

 

[Splenda88]

Wow... Does that mean residents can't have an unrestricted license even after PGY2 year?

 

[Listen2Savage]

eyy guys whats the deal with this?

Trying to decide between Cali and FL

The PD can overwrite this bill?

 

[CherryRedDracul]

Glad to know I'm going to neither do my fellowship nor my practice in CaliforniLOL.

 

[nimbus]

I did residency in California when you could get a license after PGY1 year and passing step 3. None of my coresidents or I moonlighted. Our residency kept us more than busy enough.

 

[hallowmann]

This isn't as big of an issue as people are making it. Its literally the same requirement IMGs have in most states, and Nevada and Maine also require 3 yrs for unlimited licensure of US grads.

A lot of states (>10) already require 2 yrs of GME before getting unlimited licenses, and given that it takes a couple months to get a license, then another month or two to get a DEA, and at least another month to get credentialed at other places, chances are the earliest you are going to moonlight externally is middle of PGY-3 anyways.

A 6 mos-1 yr delay in moonlighting compared to like 20 other states, that's what this new law is.

 

[Splenda88]

This isn't as big of an issue as people are making it. Its literally the same requirement IMGs have in most states, and Nevada and Maine also require 3 yrs for unlimited licensure of US grads.

A lot of states (>10) already require 2 yrs of GME before getting unlimited licenses, and given that it takes a couple months to get a license, then another month or two to get a DEA, and at least another month to get credentialed at other places, chances are the earliest you are going to moonlight externally is middle of PGY-3 anyways.

A 6 mos-1 yr delay in moonlighting compared to like 20 other states, that's what this new law is.

NV and ME are assassins...

 

[Listen2Savage]

Is there a website that shows how many years you need before moonlighting by state?

Im an IMG and it seems to be different from the AMGs

 

[Splenda88]

Is there a website that shows how many years you need before moonlighting by state?

Im an IMG and it seems to be different from the AMGs

FSMB | State Specific Requirements for Initial Medical Licensure

www.fsmb.org

 

[gyngyn]

Trying to decide between Cali and FL

We have MICRA.

 

[MedicineZ0Z]

Residents shouldn’t moonlight anyway. It does a disservice to patients.

Got any sources on this claim? If you are a resident staffing some middle of nowhere ER where there MIGHT be one other guy helping you, that's not an environment that is conducive to making you stronger. You could just as easily get in over your head. Unfortunately you may not know what you don't know, so patients may end up with substandard care.

I assume ya'll very strongly oppose any and all midlevels then?

 

[Goro]

I assume ya'll very strongly oppose any and all midlevels then?

Just couldn't control yourself and had to work in a slam at midlevels?

 

[ThoracicGuy]

I assume ya'll very strongly oppose any and all midlevels then?

Midlevels have their place. What a midlevel can and cannot do really has no bearing on what you, as a resident, can and should be doing.

And really nice bump of almost a year ago's comments.

 

[BTDT]

California passed another regulation? Didn't see that coming.🙄

 

[twospadz]

That really sucks. Makes California programs much less attractive. In New York you can get your license after PGY-1 year. My place didn't have internal moonlighting but I found a place that accepted PGY-3s to moonlight and would start the credentialing process 4-5 months early if you had a license as a PGY-2. I was moonlighting the month of July which is when my PGY-3 year started.

 

[jdh71]

They passed a bill SB 798 this summer. It changed the minimum GME requirement for a medical license from 12 months to 36 months. It goes in effect Jan 1 2020.

For anyone aware of how licensing applications process works, is there any chance we (current M4s) can get by it by applying for our license while in the first half of our intern year sometime between July 1 - Dec 30 2019?

It seems like a rotten deal that further affects how I rank the cali programs

you arent ready to be taking care of patients after only 12 months. Sorry. Don’t rank California. Good on them.

 

[CidHighwind]

That really sucks. Makes California programs much less attractive. In New York you can get your license after PGY-1 year. My place didn't have internal moonlighting but I found a place that accepted PGY-3s to moonlight and would start the credentialing process 4-5 months early if you had a license as a PGY-2. I was moonlighting the month of July which is when my PGY-3 year started.

Make no mistake, Cali programs can make applicants from all specialties pay twice the price in app fees, add an extra year to the residency program, compete in a “Hunger Games” style battle Royale, and people will still be fighting tooth and nail to match there, no pun intended...

 

[blue.jay]

What’s their motive for this besides that it’s california.

With crap like that in place hope they at least never give nurse practitioners independent practice there.

Californlol


I can imagine PDs not being happy with less applicants in the future possibly

And look what they did now 🤣

 

[twospadz]

I transferred from a California to New York program during residency for psychiatry. Good thing I did. Ive been able to moonlight in residency since PGY 3 making no less than 10k a month extra. California just made itself much less attractive.

 

[scoopdaboop]

And look what they did now 🤣

Medicine is changing. Be a specialist, so when the "i know nothing about complex situation" NP sees a patient, they refer it to you. They should change reimbursement structure so the specialist gets paid more because of a NP consult vs a MD consult.