Moonlighting as an attending

[MD13]

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Is it common or feasible for an attending in another field to moonlight in a community ED one day/night a week or so? Obviously I'm referring to someone who hasnt done an EM residency or done the EM boards.

Thanks

 

[deleted109597]

Common? Most that do EM it do it all the time. Not many work in the ED once a week. Is it feasible? If someone gives you a job and you have the time. You won't be any good at it, so I wouldn't bother.

 

[xaelia]

Yes, there are a limited number of opportunities for non-EM to moonlight in certain EM situations on an intermittent basis.

 

[VeerTheTIGuy]

Is it common or feasible for a resident in another field to moonlight in a Dermatology/Internal Medicine/Pediatrics/Surgery clinic one day a week or so? Obviously I'm referring to someone who hasn't done a Dermatology/Internal Medicine/Pediatrics/Surgery residency or done the Derm/IM/Peds/Surg boards.

Thanks

/sarcasm

Substitute in any of those and you should have your answer.

 

[Hamhock]

Opportunities in small, rural areas still exist. Even in "cities" up to 40K, that I know of...

However, these opportunities are decreasing and as others have said:

You will not be good at it.

And I think that is the most important thing...for you and patients.

HH

 

[B-Bone]

where I was a resident, the small hospital EDs in little towns around our town were staffed by residents (acting as attendings, or just licensed physicians) pretty much every night and weekend. These people were residents in IM/peds/surgery/anesthesia/FP/ENT/urology for the most part with a rare EM resident. Generally made about $80-120/hour with some bonuses (think $1000-2000 for 12 hours) on top of that for hard-to-cover shifts (saturday overnight, etc). These EDs would be completely uncovered a large amount of the time without moonlighting residents.

I don't know anybody from another specialty that still does this now that they're out in practice in their primary field, but I doubt there's anything preventing them from doing it, except perhaps that they could make more money practicing their own specialty. I'm sure I could drive down to one of these places on my weekends off (despite the fact that I'm not an EM doc), but I'd make more money just working extra at my own job. Plus, who wants to work more than they already do, am I right?

 

[uncwalley]

I can think of several not too far from where I work. These are rural ED's that depend on moonlighters for coverage. If you have your heart set on it, contact a locums agency (but know that if you do, they will hound you constantly to fill shifts).

However, as others have said, you will probably not be good at it, and in doing so, you will hate it and the stress won't be worth the extra cash. Can you honestly say that you are good at intubating, central line placement, chest tube placement, LP, etc. On top of this, are you ready to practice in a more resource poor or malignant environment than you are used to (there is a reason these places have trouble filling shifts)?

 

[Cooperd0g]

How about deciding to "retire" early and living in two locations, say Arizona and Wyoming or Hawaii and Tahoe. You are a board certified EM physician. Can you just moonlight a couple of days per week instead of belonging to a group?

 

[EM_Rebuilder]

How about deciding to "retire" early and living in two locations, say Arizona and Wyoming or Hawaii and Tahoe. You are a board certified EM physician. Can you just moonlight a couple of days per week instead of belonging to a group?

Yes.

Although 'moonlighting' a couple of days a week is almost full time and is at least part time.

 

[Cooperd0g]

Yes.

Although 'moonlighting' a couple of days a week is almost full time and is at least part time.

My goal would be the flexibility to live in more than one location depending upon the season. Still keep up the skills and earn some money, but not be tied to one location.

 

[pinipig523]

How about deciding to "retire" early and living in two locations, say Arizona and Wyoming or Hawaii and Tahoe. You are a board certified EM physician. Can you just moonlight a couple of days per week instead of belonging to a group?

I think Hawaii has enough ER docs. That's a saturated market there.

 

[Apollyon]

I think Hawaii has enough ER docs. That's a saturated market there.

It's ironic you mention that, as you are exactly correct. Although HI in total is down 25% for doctors, the only specialty that has enough docs is EM, at 104%. (Yes, that means that, officially, HI does not have enough plastic surgeons.)

The irony is that my hospital is in Chapter 11, and may next week go to Chapter 7 (liquidation), and people are scrambling, and there isn't anything. Everybody is full up.

 

[tkim]

It's ironic you mention that, as you are exactly correct. Although HI in total is down 25% for doctors, the only specialty that has enough docs is EM, at 104%. (Yes, that means that, officially, HI does not have enough plastic surgeons.)

The irony is that my hospital is in Chapter 11, and may next week go to Chapter 7 (liquidation), and people are scrambling, and there isn't anything. Everybody is full up.

Moving back to mainland?

 

[deleted109597]

Apollyon, sorry man, that's tough. Not sure what other options you've got in an already saturated market. Maybe you could continue to live there and do some PNW locums where you work a week at a time or something.
Or move to New Zealand, although if you haven't started licensing then you'll be not working for awhile.

 

[EdibleEgg]

Common? Most that do EM it do it all the time. Not many work in the ED once a week. Is it feasible? If someone gives you a job and you have the time. You won't be any good at it, so I wouldn't bother.

There are a few of us part timers.

My evaluations from the EM boarded guys here are fantastic. Admittedly, they are biased. Without me, they are working 16 12's a month.

When I first came here, the gastro kicked and screamed about my endoscopy privileges. He still complains about my screening colonoscopies, but it only took a few days for me to be more than competent to manage uninsured acute bleeds/food impactions at two in the morning.

It's all relative.

Sorry to hear about that Apollyon. Good luck with your Job search. Let me know if you're willing to come to BFE.

 

[Apollyon]

Hey, thanks for the wishes, all. Right this second, I'm at my mother's house south of Buffalo, just hanging out (had some things to do here). I do not plan on moving back in the short term. Quite sincerely, I do not think that the hospital will shut down.

At the same time, even before all this hit the fan (intentional vague reference there), I'd been looking for part-time gigs elsewhere (on other islands or on the mainland) to fly in, work a block, and fly back out. One week in a rural area, make bank, spend 3 weeks in HI. I could deduct the travel costs for a second job, and it's just the cost of doing business. To make the same in a week that I would make for twice as many shifts in a month is fine.

I still have my SC license with my HI license, so I have an option here and there. What is funny is that I'd used that exact same way to refer to rural (BFE), versus so many ways to say it, when I was talking with a guy about SC or TN or AL or MS.

 

[Druggernaut]

My goal would be the flexibility to live in more than one location depending upon the season. Still keep up the skills and earn some money, but not be tied to one location.

The ED I worked in prior to medical school had a guy who lived in southern Florida, but hated the area hospitals. So he took a job with us in the Midwest, and would fly in for a week or two, work a slew of shifts (at a significantly higher rate than his home EDs), then fly back to his sunny beachside home for a few weeks.

Another guy at an affiliated ED was part time with the group, and periodically did locums work when he wanted a change of pace.

There's a lot of ways to structure your life if you find a flexible group. These guys were both board certified, though, so it's probably less applicable to the OP.

 

[officedepot]

Is it common or feasible for an attending in another field to moonlight in a community ED one day/night a week or so? Obviously I'm referring to someone who hasnt done an EM residency or done the EM boards.

I've heard of radiology residents moonlighting in the emergency room in community hospitals doing EM. Granted most probably just want to go and run the CT scanner but not all of them.

So yeah it's possible to find places to work in the ED even if you are not in an EM residency. Granted, as others have said you'll have to be pretty comfortable in that situation essentially on your own. Hospitals would also have to take the liability. But really it depends on the volume and type of cases that get sent your way.

I'd say if you are not EM trained stick to low volume, small ED and you'll probably be OK. I'm sure it's possible to get extra training somewhere as well to help you out.

 

[deleted109597]

There are a few of us part timers.
My evaluations from the EM boarded guys here are fantastic. Admittedly, they are biased. Without me, they are working 16 12's a month.

There are probably quite a few non BC/BE people out there who have taken it upon themselves to learn it the right way. However, from experience and also from reading the literature, they are in the minority.

From personal experience, taking checkout at rural places from part and full timers (for years!) that aren't EM, you can distinctively notice a difference. Things that make me pucker, they don't seem to even notice. One guy checked out a WPW in a fib to me. As he was talking, he said "Yeah, I put them on a cardizem drip, just waiting on cardiology to call back for transfer." They weren't in RVR, just slightly tachy at 108 when he started it. I cut checkout short to go personally stop the drip. Unfortunately, we all have gaps in our knowledge, but at least the EM people had to learn the "real bad stuff" in the theoretical in residency. The PC people learn some, but it isn't the same. And since they didn't work in an ED for 24 months of their residency, they weren't exposed as much then. Just a fact of the numbers needed to learn.

When I first came here, the gastro kicked and screamed about my endoscopy privileges. He still complains about my screening colonoscopies, but it only took a few days for me to be more than competent to manage uninsured acute bleeds/food impactions at two in the morning.

Yes, and for basically the same reason. While you may not be the "best" by whatever metric, you're likely pretty adequate. However, not all are the same. I've seen FMs lose their scoping privileges after too many perfs.


For the vast majority of EM, you never need to do something "right now." You can always go look it up, and many people simply don't out of pride or not being aware that they don't know the best way. There's also the time issue. But those "right now" moments are what make the difference.

 

[alphaholic06]

There are probably quite a few non BC/BE people out there who have taken it upon themselves to learn it the right way. However, from experience and also from reading the literature, they are in the minority.

From personal experience, taking checkout at rural places from part and full timers (for years!) that aren't EM, you can distinctively notice a difference. Things that make me pucker, they don't seem to even notice. One guy checked out a WPW in a fib to me. As he was talking, he said "Yeah, I put them on a cardizem drip, just waiting on cardiology to call back for transfer." They weren't in RVR, just slightly tachy at 108 when he started it. I cut checkout short to go personally stop the drip. Unfortunately, we all have gaps in our knowledge, but at least the EM people had to learn the "real bad stuff" in the theoretical in residency. The PC people learn some, but it isn't the same. And since they didn't work in an ED for 24 months of their residency, they weren't exposed as much then. Just a fact of the numbers needed to learn.


Yes, and for basically the same reason. While you may not be the "best" by whatever metric, you're likely pretty adequate. However, not all are the same. I've seen FMs lose their scoping privileges after too many perfs.


For the vast majority of EM, you never need to do something "right now." You can always go look it up, and many people simply don't out of pride or not being aware that they don't know the best way. There's also the time issue. But those "right now" moments are what make the difference.

Wow! That is scary.

 

[Cooperd0g]

Disregard.