Is this moonlighting? Do I need PD permission?

[WayChanger]

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Hey all, perhaps a bit of an odd question.

I'm interested in a part-time, telecommuting-based medical writing/medical editing gig with a pharmaceutical consulting company.

The issue is that I'm starting IM residency next month, and I'm kind of paranoid as to whether this would constitute moonlighting, or in any way be something I shouldn't be doing. My contract defines moonlighting as any job that uses my clinical, academic, and professional skills/training, and stipulates that I would have to ask the PD for written permission prior to doing taking on such a job.

I've always kind of assumed that moonlighting meant actually working as a physician though. Does medical writing/editing (or, for that matter, other things somewhat tangentially related, like medical transcribing, teaching/tutoring medical things) count as well? Should I ask my PD prior to going for the gig?

Cheers

 

[filter07]

You should ask. No brainer.

 

[Apollyon]

Ask your PD. (S)he will either say "yes" or "no". If it's "yes", you will be told that you will indeed be too tired to do it, but, if you try, and you screw up your first job (intern), even once, because you're tired, you're fired, and there's no recourse, and no rec letter.

However, agree with above. It's a no brainer.

 

[southerndoc]

My program defined moonlighting as any employment outside of normal residency hours. Even part-time work at Starbucks would be considered moonlighting. I agree with that definition because it doesn't matter what type work you do, outside work will take away from your time available to study.

 

[Law2Doc]

Ask your PD. (S)he will either say "yes" or "no". If it's "yes", you will be told that you will indeed be too tired to do it, but, if you try, and you screw up your first job (intern), even once, because you're tired, you're fired, and there's no recourse, and no rec letter.

However, agree with above. It's a no brainer.

Asking your PD has nothing to do with being "too tired" or "screwing up" your intern job. It has to do with the concern that you won't go over the 80 hour/week avg cap. Your residency has the right to work you right up to that limit, and anything you do that lowers the limit is up to the PD to decide if he'll allow because he owns you for all of that time. It's less about whether you will have enough time to study or be too tired and more about whether if he decides he needs you to work 80 hours/week, will you have used up too much of the time under that cap. So yes, under the definition given, which is common, you must ask him, or you are breaching your contract.

Expect a lot of moonlighting to be done away with in the next few years simply for duty hour reasons. If the duty hours get lowered further, you can expect all moonlighting to disappear.

 

[Parts Unknown]

My program defined moonlighting as any employment outside of normal residency hours. Even part-time work at Starbucks would be considered moonlighting. I agree with that definition because it doesn't matter what type work you do, outside work will take away from your time available to study.

Interesting. I brought a similar concern to the GME office at my residency training institution, and after being fed through the appropriate channels they defined moonlighting as work that needed a medical license. If I wanted to coach a little league team in my spare time, for instance, they determined it to be none of their business.

 

[the fat man]

My program defined moonlighting as any employment outside of normal residency hours. Even part-time work at Starbucks would be considered moonlighting. I agree with that definition because it doesn't matter what type work you do, outside work will take away from your time available to study.

Wow, I was aware residency makes you forfeit all your personal rights and freedoms inside the hospital, but apparently it's also OK with you for them to tell you what you should be doing on your own time?

I understand that we need to keep our primary focus on caring safely for our patients, but the way residents are paid currently, we are just one unexpected car breakdown or sick spouse, child, or self away from not making the rent. But when your average Joe hears that we're "doctors," all of a sudden we're simply crying crocodile tears over having to settle for the Mercedes C-Class instead of the E-Class.

 

[Law2Doc]

Wow, I was aware residency makes you forfeit all your personal rights and freedoms inside the hospital, but apparently it's also OK with you for them to tell you what you should be doing on your own time?
...

They certainly don't have to consider it "your own time" if it counts toward the 80 hour duty hour limits. Working at something unrelated probably shouldn't, unless it demonstrably affects your residency work, and I've never heard of a residency putting in language that might keep you from working at Starbucks and the like. But in all fairness, if they are only giving you the requisite 10 hours between shifts to sleep, and you choose to spend 5 of these hours doing something else, it's reasonable for them to say -- "hey that's not going to work". I mean, what's the point of cutting down residencies to 80 hours so that residents can be better rested, only to let them use that time to pick up odd jobs. If folks were going to be working during that time anyhow, that would be a really strong argument for undoing the duty hour restrictions.

 

[the fat man]

If folks were going to be working during that time anyhow, that would be a really strong argument for undoing the duty hour restrictions.

It would be. But like I said, what if money was really tight for a reason out of your control? Working 60 hours a week as a resident and 20 at Starbucks pays better than working 80 as just a resident. Plenty of people outside medicine will take second jobs if they really need extra money. (At least in an economy where jobs are more plentiful.) Their first employer can't just sweep in and say, "Bob, we don't want you spending your time and energy on a second job, but we can't stop you from doing what you want outside this building. So we've decided the solution is you will be working for us 60 hours a week instead of your usual 40. Oh, and we don't really have the money to pay you more, so you'll have to do it for the same salary."

 

[jonb12997]

on another note, you'll be working for a pharmaceutical company, so if you give a lecture or when you give your grand rounds you'll have to disclose your financial connections...

 

[notinkansas]

Funny, I wouldn't see a medical writing gig as moonlighting. It doesn't require working with patients, and wouldn't require working a certain shift (like Starbucks would...if patient goes south in the last 15 min before you're supposed to leave the hospital, you will wind up being late, and possibly late for your Starbucks shift). With writing, all you have to do is make a deadline.


I would caution you, though, to give yourself some time to adjust to being an intern. Focus on figuring out your schedule, make sure you are on an adequate reading schedule. Only then, slowly and cautiously, add writing gigs!

 

[NotAProgDirector]

My 2 cents:

I personally think that moonlighting of any sort should have absolutely nothing to do with me at all. What you do on your free time, whether it's volunteering, partying, flipping houses, or medical moonlighting is completely none of my business. The only reason you MIGHT need my permission to medically moonlight is if the BOM requires a statement from me that you're competent to do so, or same from an employer.

However, if your performance slips "I was moonlighting" is not an acceptable excuse.

on another note, you'll be working for a pharmaceutical company, so if you give a lecture or when you give your grand rounds you'll have to disclose your financial connections...

This is certainly true.

 

[Apollyon]

Asking your PD has nothing to do with being "too tired" or "screwing up" your intern job.

Uh, yes it does. If your work activities are not up to par, and it is due to fatigue that could be rectified, but you choose not to, you can be sanctioned by your PD. Just because you, the lawyer-turned-doctor, says it isn't so doesn't mean it isn't so - I say it is, because I've seen it.

And the prior post - by a program director - seems to support this, to wit:

However, if your performance slips "I was moonlighting" is not an acceptable excuse.

 

[WayChanger]

thanks for all the responses, guys!

if i end up seriously considering the gig, i'll certainly clear it with the pd beforehand, though personally i agree with a lot of the other sentiments expressed here. better safe than sorry! =]

 

[Parts Unknown]

I personally think that moonlighting of any sort should have absolutely nothing to do with me at all. What you do on your free time, whether it's volunteering, partying, flipping houses, or medical moonlighting is completely none of my business. The only reason you MIGHT need my permission to medically moonlight is if the BOM requires a statement from me that you're competent to do so, or same from an employer.

The only other thing my institution cared about was making sure that residents had malpractice coverage for their outside activities. They didn't want any confusion about which policy was on the hook should someone get sued while moonlighting.

 

[Law2Doc]

Uh, yes it does. If your work activities are not up to par, and it is due to fatigue that could be rectified, but you choose not to, you can be sanctioned by your PD. Just because you, the lawyer-turned-doctor, says it isn't so doesn't mean it isn't so - I say it is, because I've seen it.
...

Um no. I think you are missing my point (or seem blinded by the fact that I have a legal background, which BTW actually does give me some insight in contract stuff, even if you don't like to believe it🙄). If you are too tired to do your work, you can be sanctioned, and I don't disagree with that. But the actually having to ask the PD is there because it cuts into the exclusive control he has over your hours to the tune of 80 hours/week. Meaning if you moonlight 20 hours in the local ER, he suddenly is only allowed to work you 60 without putting the program in jeopardy. And since you signed a contract that gives him first dibs on your time to the hours ACGME allows, he gets to give permission. As far as doing other stuff that makes you tired, you don't need to get permission. I mean, do you have to get permission from him before you decide to stay up all night watching TV? Of course not. But you had better believe that if your performance slips, he has the ability to make you pay.

 

[Law2Doc]

It would be. But like I said, what if money was really tight for a reason out of your control? Working 60 hours a week as a resident and 20 at Starbucks pays better than working 80 as just a resident. Plenty of people outside medicine will take second jobs if they really need extra money. (At least in an economy where jobs are more plentiful.) Their first employer can't just sweep in and say, "Bob, we don't want you spending your time and energy on a second job, but we can't stop you from doing what you want outside this building. So we've decided the solution is you will be working for us 60 hours a week instead of your usual 40. Oh, and we don't really have the money to pay you more, so you'll have to do it for the same salary."

Your need for money is not the PD's problem. He is paying you what your contract says, and has a right to you to the tune of 80 hours/week. Any activity you do that cuts into that 80 hour cap (and I actually don't believe a Starbucks job does, unless your department has a more restrictive contract than the ACGME terms) is something he has the right to put the kibosh on. Now, as mentioned in the prior post, if you come in tired and useless, he can take steps that would "encourage" you to quit that Starbucks job. (which isn't the same as getting permission ahead of time). But he doesn't care about your money issues, he doesn't really care what you do outside of those 80 hours. He cares that he gets to use up to the full 80 hours if he needs it, and he cares that you do your job in a competent and professional manner. If you give him the full 80, hold down a job that doesn't count toward the ACGME cap and still show up on time doing the job well, he will be happy. You will probably drop dead from all the amphetamines you would have to be taking, though. (Or maybe Starbucks coffee is stronger than I think).

 

[the fat man]

Your need for money is not the PD's problem. He is paying you what your contract says, and has a right to you to the tune of 80 hours/week. Any activity you do that cuts into that 80 hour cap (and I actually don't believe a Starbucks job does, unless your department has a more restrictive contract than the ACGME terms) is something he has the right to put the kibosh on. Now, as mentioned in the prior post, if you come in tired and useless, he can take steps that would "encourage" you to quit that Starbucks job. (which isn't the same as getting permission ahead of time). But he doesn't care about your money issues, he doesn't really care what you do outside of those 80 hours. He cares that he gets to use up to the full 80 hours if he needs it, and he cares that you do your job in a competent and professional manner. If you give him the full 80, hold down a job that doesn't count toward the ACGME cap and still show up on time doing the job well, he will be happy. You will probably drop dead from all the amphetamines you would have to be taking, though. (Or maybe Starbucks coffee is stronger than I think).

Starbucks coffee usually tastes strong but I think caffeine-wise it's actually fairly weak compared to other places.

I was about to start shouting and screaming at your response...but you're totally completely right. I'm still having a hard time getting adjusted to the fact that the PD/program has more "rights on us" as you put it than we seem to have on ourselves.

 

[DrJosephKim]

First: Working for a consulting company, an education company, or a publisher is very different from working directly for a pharmaceutical company.

Second: You should definitely check your contract.

Third: Keep in mind that many faculty also "moonlight" as speakers, consultants, editors, etc.

Fourth: When in doubt, minimize your risk. Play it safe and ask.

 

[Law2Doc]

...
Third: Keep in mind that many faculty also "moonlight" as speakers, consultants, editors, etc. ...

They have no cap, so it's different.

 

[NotAProgDirector]

But the actually having to ask the PD is there because it cuts into the exclusive control he has over your hours to the tune of 80 hours/week. Meaning if you moonlight 20 hours in the local ER, he suddenly is only allowed to work you 60 without putting the program in jeopardy.

Rarely do I disagree with L2D, but this is not exactly correct. Residents are limited to 80 hours per week. Internal moonlighting (defined as moonlighting within any of the institutions your program is directly affiliated with) counts against the 80 but no other rules. Moonlighting outside your program does not count against any rules (although we personally ask residents to log external moonlighting and adhere to the spirit of the rule).

As mentioned already, if a resident decides to moonlight they are held to the same standards as someone who doesn't moonlight. If you're too tired to work and you moonlit last night, you risk an unsatisfactory evaluation. If you moonlight internally and then come up against the 80 hour rule, I'd be forced to remove you from the service to prevent a violation. And, you'd get some sort of unsatisfactory evaluation. And, the person pulled to cover you would be pissed. So, overall, it would be "bad".

 

[maxheadroom]

aProgDirector is correct (as he should be). While programs want to regulate moonlighting (and might try to write limitations into a contract), their ability to regulate your work off residency time if you have an unrestricted license is questionable. I know an IM guy who got into hot water with his PD a few years ago about this and the university counsel ultimately told the PD to back off unless there was a performance issue (which there was not).

Working on the side in publishing is fine, as long as it doesn't affect your performance. During residency I worked as a copy editor for several scientific/technical publishing companies. It was boring work, but it supplemented my income nicely. And gave me enough money to pursue my second side job of renovating and flipping houses. Neither of those jobs had any bearing on my job as a resident. I made sure that my performance at work was always above par and that I scored well on my in-service exams. I wouldn't bother mentioning the jobs to your PD. When you're presenting at Grand Rounds or a national meeting, you should include the disclosure that you receive compensation for _________ from company ________.