How to go about moonlighting?

Discussion in 'Military Medicine' started by denali, Feb 25, 2014.

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  1. denali

    denali Senior Member 10+ Year Member

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    For those of you who have moonlit, how did you go about finding a gig?

    I've put out some feelers locally for inpatient medicine work, and people are excited till I remind them about not billing TRICARE for my services, then the mood changes because evidently a lot of our beneficiaries end up at the local civilian facilities. However, I'm not excited about giving up extra precious off-time driving to a far-away place.

    I need to do this to head off skill atrophy; our census and acuities are down and I want to remain a competent and employable physician.

    Tips, thoughts, suggestions, warnings, war stories appreciated.
     
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  3. bricktamland

    bricktamland Duos habet et bene pendentes 7+ Year Member

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    My colleague and I moonlight at a practice far enough away that mutual patients and insurance issues aren't a problem. The commute, however, sucks. It's an hour drive each way. But it's definitely worth it. It helps to stem skill atrophy, but it's also great to work in a different setting and acquire skills you wouldn't otherwise develop in a military setting. Networking can be hugely beneficial as well. I would still recommend it even if you have to sacrifice some time in transit.
     
  4. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    Really depends a lot on specialty.

    Before PCS'ing, I used Google to find hospitals near the duty station I was going to. Emailed their HR or anesthesia dept (if contact info was listed) telling them I was in the military, moving to the area, looking for part time work. Visited and interviewed, signed a contract, started working. Pretty easy for an anesthesiologist - shift work is possible, no clinic overhead, no patient followup needed. The surgeons I know who moonlight usually cover call or weekends or vacation for individual surgeons in local groups, and do mostly urgent/emergent cases, with followup care coordinated with the person/group they're covering for.


    Not much to say about the Tricare billing issue. I get paid hourly, or a flat fee for a period of on-call pager coverage. If Tricare patients come in, I take care of them, write "do not bill / Tricare" on the billing sheet, and then it is officially Not My Problem. The group makes an effort to not schedule me in cases with Tricare insurance, but otherwise they just eat it as charity care. I assume they've done the math and have decided that paying me $X/hr and $Y/weekend on average isn't a money loser for them, despite the occasional Tricare patient they can't bill.


    Moonlighting is tremendously beneficial experience, especially if you're at a small command with low volume or low acuity. Even if you have to drive or travel a bit to get there, it's probably worthwhile.
     
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  5. bobbyseal

    bobbyseal Boat boy 10+ Year Member

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    I work with a locums company. I will take a week of leave and cover for someone. It's hard to find a local job on nights and weekends in my specialty.
     
  6. denali

    denali Senior Member 10+ Year Member

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    Thanks for the info so-far; good food for thought.

    Do you use a national locums outfit, or a more regional one? Do you like the company you're using? I'm kinda skeptical of them, like I am of the multiple headhunter emails I get.

    With regard to your schedule, does the Navy put a limit on your weekly hours, and if so has that caused you problems? Army MEDCOM limits us to 16 hours a week.
     
  7. bobbyseal

    bobbyseal Boat boy 10+ Year Member

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    I rarely moonlight. I've done maybe 3-4 weeks or so. Since I'm on leave status when I do, it's not that big of a deal. I haven't had any issues with my off duty employment. I did have to get the CO to approve it initially. But, if you're looking to do a moonlight job that's every other weekend, you might be under more scrutiny.

    And yes, I go with one of the national locum agencies. They are a bit pushy. I tend to get a phone call from time to time to discuss a need. But, other than that, they've been real easy to work with when it comes to licensure, etc.
     
  8. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    We're limited to 16 hours / week when not on leave. Most of my moonlighting is weekends and holidays (which count toward the 16), or bits of leave here and there (which don't count toward the 16). When I cover pager call, I report the hours I actually work, not the hours I carry the pager.
     
  9. DrMetal

    DrMetal To shred or not shred? Lifetime Donor 7+ Year Member

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    Who polices these rules? Is someone really checking to make sure youre not going over 16hrs/week? That youre not treating tricare patients? Or are you expected to police yourself?
     
  10. denali

    denali Senior Member 10+ Year Member

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    In Army fixed facilities, it appears to be closely tracked; there's a specific person in our HR shop designated to keep tabs on all ODE in the command. Before ODE is approved, your prospective employer is required to acknowledge things like weekly hour restrictions, not billing TRICARE patients, etc. in a memorandum. Soldiers engaged in ODE are required to submit an employer-certified memo by the 10th of every month detailing the number of hours worked by date for the previous month. Finally, every "healthcare provider" is required to annually submit an APEQS-tracked memo documenting their current ODE status.

    The governing regulation is a punitive one, meaning UCMJ action can result for failing to follow it. When I was an intern at MAMC, we were told the cautionary tale of a resident a couple years before who was kicked out of residency for unauthorized ODE. However, I've heard "unofficially" of many docs who violate it frequently; many of those guys were in line units, though, where things might not be as closely monitored.

    I plan on doing this straight legit; I'm not looking at moonlighting to maximize extra income (though it will be nice). My concern is that a 12 hour inpatient shift eats into that 16/week limit real fast so I may be limited to 8 hour shift opportunities.
     

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  11. bogatyr

    bogatyr Senior Member 10+ Year Member

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    Be careful with that. We had 7 members of our department get letters of reprimand from the 2-star dentist for not reporting hours on pager call. The JAG office had specifically approved it ahead of time. I'm sure the Navy is much more reasonable than the Army, however.
     
  12. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    We submit monthly memos attesting to the number of hours worked. To my knowledge, no one "checks up" on these.

    At some point you've got to trust the people working for you until given a reason otherwise; my belief is that people breaking the rules will eventually find themselves in a situation where they need to be in two places at once and it'll all fall apart. As DSS, I keep a general awareness of which physicians in my directorate are moonlighting (there aren't very many) and roughly how much, but I don't call their employers to verify.


    The instant DMHRSi has a spot to document "pager call" hours not spent in the hospital, is the instant I'll think about documenting "pager call" ODE in my monthly memo. The Navy's official timecard / manpower tracking system unequivocally states that those hours have neither cost nor value. I disagree, but it's what the Navy has decided, it's what the Navy has in writing, it's what I've been directed to not document, so it's what I do.

    I agree there is reason to be careful. If you take ODE pager call for a 24 hour period it's theoretically possible that you'll be called in and be actually working every one of those 24 hours, and thereby exceed the 16/week limit. If you're going to be taking ODE pager call, you need to have great confidence in average workload, accounting for the possibility of outlier perfect storm busy days. In the approx 4.5 years I've been moonlighting here, minus a deployment, I bet I've covered 35 or 40 weekends ... the longest I've ever called into the hospital was a memorable 10-hour dead gut case. That place is extremely low volume on weekends.

    You do have to be careful about is not letting ODE pager call extend into your 6-hour rest period prior to your day job ...
     
  13. deuist

    deuist Stealthfully Sarcastic Lifetime Donor 10+ Year Member

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    There was a general surgeon here who got busted for taking call at 2 locations and missing a case at the military hospital. He was eventually court martialed for other reasons, but the moonlighting case did result in a letter prior to being sacked.
     
  14. TurtleDO2012

    TurtleDO2012 7+ Year Member

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    Has there been any changes to rules on moon lighting? My command is stating in the memo sent to the practice I want moonlight at they can not bill Tricare, the DOD, Medicare, or Medicaid. I can understand the Tricare and DOD statements but can't understand how they can go and include Medicare and Medicaid.

    Has anyone had that listed on their authorization memos?
     
  15. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    I know of a retired O6 (now working as a contract) who routinely blew the weekly max out of the water. I assume he simply lied on his ODE reporting forms- and may have had his ODE employers report false hours. he routinely worked 30+ hrs per week moonlighting, and would be post call from those places when working his army job. he happened to be the supervisor (and consultant to OTSG and therefore in charge of assignments) of the one person who had all the evidence, so if he was "turned in" he'd know exactly who did it. he's out now and making 2x the money doing the same job as a contractor. and brags about how he is >150% disabled and getting checks every month while he hauls in >300k/yr. who do you call? fraud/waste/abuse? his salary alone for the type of job and amount of work he does is easily top 5% nationally. yet somehow JAG approved it, but only after knocking it down to below what the president makes (because that's the max you can pay a contractor, apparently).

    this is new to me, and for the several EM folks I know I do not believe the Medicare/Medicaid thing to be the case. if this is indeed true it would make ODE extremely difficult. when I did it as a generalist they'd just shuffle the TRICARE people to another provider or if I were alone just eat the costs.

    --your friendly neighborhood rules apply to everyone but some people more than others caveman
     
  16. TurtleDO2012

    TurtleDO2012 7+ Year Member

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    Discussed with regional command and like most things in the military the memo for the employer was poorly written or poor use of punctuation. Basically intent is to exclude those using Tricare, those using Medicaid but also have Tricare benefits, and those using Medicare but also have Tricare benefits. So end all, if anyone has Tricare of course can't bill them which we all knew already.
     
  17. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    thanks for the update

    --your friendly neighborhood "let's eat, grandma" vs "let's eat grandma" punctuation matters caveman
     
  18. Perrotfish

    Perrotfish Has an MD in Horribleness 7+ Year Member

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    Someone at my command apparently got caught doing something, because we abruptly started verifying those memos. Everyone now needs to submit some kind of verified schedule from wherever they moonlight.
     
  19. psychbender

    psychbender Cynical Member 10+ Year Member

    One of the problems with that is how do you record call? DHMRSI doesn't even have a way to properly code home call. If I take call for the weekend at OSH, I record the hours actually worked, just as they tell me I'm to do in DHMRSI for when I'm scheduled to be in call for the weekend at our hospital.

    Sent from my SM-G930V using SDN mobile
     
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  20. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    I r always recorded the amount of time in direct patient contact. For most of the bigger locums companies, that's a number you'll have anyway. Commands, at least in the Army, have been very fickle with regards to collecting these timesheets. They all technically require them, but I've had commands that start e-mailing reminders on the first of every month, and commands that basically forget all about them until someone screws up, like Perrotfish mentioned. Then they become real important real quick. So it's always best just to turn them in.
    But, yeah, if I'm on call in a hotel room watching TV and reading SDN I don't usually include that in my recording. However, if I don't see anyone then I'll usually put down at least an hour (for rounding or skimming the ER triage list, or whatever).
     
  21. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    The truth is, you're getting paid if you're on call, so you probably should record it. But my commands this far have had an issue with working more than 8 hours a day while moonlighting, even if I spend that time sleeping or at the gym.
     
  22. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    The pertinent issue isn't whether you're getting paid for pager call, but whether you're working. The purpose of the 16 hour/week limit imposed by most commands is to prevent undue fatigue due to moonlighting from interfering with the member's military duties.

    Recording the hours actually worked meets the letter and the spirit of the regulation.

    Don't overthink this. Act in good faith, do the right thing, record the hours you work, and be done with it. :)
     
  23. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Maybe that's true for your command. Certainly not for any that I have worked with. I'm on leave every time I moonlight, but I'm still limited to an unrealistic extent as to how many hours I can work. It would never interfere with my availability to the Army, because I'd be on leave anyway.

    In fact, on every justification letter I've ever written it has been strongly advised that I indicate that not only will I take leave to moonlight, but that I will also limit my hours. The first time I applied for ODE, it was denied because I listed a 40 hour work week. Even though I also stated I would take leave - in the same letter.
     
  24. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    Bizarre

    Our ODE instruction had the words " not on leave" in the limits.

    I'd take a week off and work 80 hours ...
     
  25. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Not just bizarre. Dumb. I would put money on the idea that they were enforcing some misunderstood, ridiculous interpretation of the rule. But that was what happened nonetheless.
     
  26. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    agree, but who determines the accuracy of the reported ODE hours? there is no audit process and they take it on good faith people report actual hours. I thought the system was pretty good until I saw it blatantly abused bordering on pillaged. best case you find a place that really needs you and work as much as you want. then submit whatever hours you want to your command. unless command asks for your payroll hours or something similar no one will ever know. there were weeks this person worked more hours outside the MTF than in it. and the funny thing was it was the worst kept secret in the department. go figure.

    --your friendly neighborhood if you ain't cheatin' you ain't tryin' caveman
     
  27. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    The entire thing is ridiculous to the point of insult.

    We're trusted with the actual, literal lives of other human beings yet we can't be trusted to manage our time in a way that gets us to work on time and awake enough to be safe?
     
  28. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    We have to have our hours sheets signed by whomever hired us. I mean, they could lie for us, I suppose. I've never asked.
     
  29. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    This has always been a point of contention for me with regards to numerous aspects of military life - accountability, cold weather training, calling the company to check in and out of leave....everyone is a 17 year old PFC in the eyes of the Army - ignorant and completely untrustworthy. I haven't been late to clinic for any non-clinical reason in at least 8 years, but you'd think I was working a job after school and smoking pot in the parking lot the way I'm (we) are treated. That's why I randomly get calls at 0500 to "verify my accountability." Where the $&@k do you think I am? I'll be at work in 1-2 hours like I am every other day.

    Regulating moonlighting may be, frankly, the most reasonable example of that mentality.
     
  30. narcusprince

    narcusprince Rough Rider 10+ Year Member

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    The military is bound by civilian laws as it pertains to moonlighting and inquiring about employment. If you have a moonlighting chit it serves as a document that states the military can call X hospital up and verify physician X's moonlighting. Without a chit, the military has no legal grounds to call any civilian institution regarding your off duty employment. How these hospitals know that moonlighting is occurring is through the medical staff office where your moonlighting institution verifies your credentials with the military hospital. This whole process is a bs especially if you have never been late for duty.
    I know many folks who skirted the system and never got caught. Counting the days.
     
  31. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

    So true. This truism often struck me when I was having my POV inspected by the wholly unqualified E5 when submitting my DA31s. Of course, I rarely traveled while on leave, making the inspections all the more asinine.
     
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  32. psychbender

    psychbender Cynical Member 10+ Year Member

    I had one of the other partners sign a stack of them at the start of the year, as the head partner was often one for whom I covered, and was this never around to sign my hours for the month.

    Sent from my SM-G930V using SDN mobile
     
  33. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    I'm not talking about my partners. I'm talking about the hospital credentialing office where I moonlight, or the Comphealth POC, etc.
     
  34. psychbender

    psychbender Cynical Member 10+ Year Member

    What did they sign on a regular basis? I used to moonlight at two hospitals, and the only civilian signature I was asked to produce by the Troop Command ODE nazi was that of the head of the department where I would moonlight.

    Sent from my SM-G930V using SDN mobile
     
  35. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Ah, I see. I thought you were referring to your partners in the military.

    Yeah, that may have worked. However, I've been the only guy basically everywhere I've done moonlighting. Im sure there were DOS chairs, but I never met a single one of them. So, it was always a non-provider signing.
     
  36. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    I don't answer my phone at 5 AM if I'm not on call. Or at 11 AM if I'm post call. Or on a weekend if I don't feel like it. If it's important, whoever it is will leave voice mail. And I'll get to it when I get to it, or not.
     
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  37. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Neither do I. But that's a band-aid.
     

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