I have moonlighted. I prefer to work as an independent contractor over a salaried "employee." There are several reasons for this. First, any milage is deductable at the IRS rate of something like 44 cents/mile (check the IRS for the exact rate). 2. You can deduct professional expenses like the internet connection you use to check your patient load, imaging when you are called, or lab values you are concerned with, schedules and whatnot. Check with your tax advisor about this because you would have to divide the time you spend playing online games and non-related activities and only claim that portion of the expense related to work. 3. You can deduct professional dues/fees/journal subscriptions and amortize/expense textbooks if you are not reimbursed for these by your trainng program. All told, this adds up to a sizable deduction. 4. You have an additional measure of control over your availability which might help avoid excessive working hours.
Downside: You have to pay a 15% (employees pay 7.5%) social security tax on independent contractor earnings over and above any expenses you and your tax accountant can't cover.
In any case, take a very good and careful look at the med-mal arrangements. Pay very close attention to this and check with an attorney that you pay (deductable) to review this if there is any question at all in your mind. There are two types of med-mal insurance, cheap and expensive. These are "claims made" and "occurance based." Occurance based are very expensive relative to "claims made." The reason you want Occurance based is this:
You work for hospital ED as a moonlighter for six months and end your arrangement June 30 to begin your dream job at another hospital. The estate of John Doe sues you for his burst appendix that you failed to diagnose that resulted in his untimely demise. You treated John in May, but the statute of limitations is a year and you get served in December while establishing yourself in practice. You call your prior "claims made" insurance agent and he says, sorry, the claim is made after your policy ended and so we won't cover you. You call your present insurance company and they say, that happened before you had a policy with us so we can't cover it.
By now, you are thinking that perhaps Switzerland isn't a bad place to live.
With an occurance based policy, the policy coverage is for any "event" that leads to a lawsuit while the policy was in place. In this case, the suit would be defended by your "moonlighting" policy and any claims paid will be paid by the insurance policy then in effect. Switzerland is the furtherest thing from your mind.
Regardless of which form of moonlighting you decide to do, be mindful of the insurance, who pays and what protections you have. I'd also ask the question of who has the authority of authorize a settlement? If the insurance company doesn't need your permission, they may settle an otherwise frivolous case to save the cost of litigation.
Also, make sure there are no clauses that prevent you from working where you want to when you complete the locums/moonlighting. Some hospitals will have a restraint of trade clause. This is prohibited from residency contracts but outside of residency, it is caveat emptor. In addition, pay some heed to the ACGME hours requirements. If you work well in excess of the 80/30 farce, and something goes wrong, you can be it will not work in your favor.
My 2 cents.
