Moonlighting before PD's okay

[akwho]

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I was getting my pre-employment health screening the other day before starting my internship, and was offered some urgent care shifts by the doc running the pre-employment health screening. I told him my program doesn't allow us to moonlight until year-III, and his response was, "everyone does it anyways."

My gut inclination is to turn this (and other moonlighting opportunities down), and to play it above board especially as a new intern. What are peoples thoughts on this? Do people really moonlight without their programs approval when the program expressly requires approval to moonlight? Sure would be nice to have some extra cash on hand as I will be living in an expensive city for residency, but I don't know if the career risk is worth it.

 

[agranulocytosis]

My understanding is that in order to moonlight, you'd need a permanent, or full, license. In many states, this requires successful completion of 1 year of post-graduate training, some require 2 for US-IMGs, so you'd be ineligible. On top of all this, you need explicit approval of the PD. Also keep in mind that moonlighting shifts do count towards your duty hours, and generally you're already putting in close to 80 per week on average as an intern. Although I can't speak for your PD, if he or she gets wind of this, you can kiss your training program good-bye. Definitely not worth it.

 

[QofQuimica]

Definitely do not do any moonlighting without your PD's ok. I guarantee you that UC doc will not offer you a new residency slot if your current PD decides to boot you out of your program for not following the rules.

 

[gutonc]

This sounds like a wonderful way to lose your residency position as well as your ability to get licensed in the future (as you would be practicing medicine without a license).

You'd also be terrible at it.

 

[link2swim06]

No offense. You aren't ready for "urgent care shifts" as a new intern.

 

[Perrotfish]

I was getting my pre-employment health screening the other day before starting my internship, and was offered some urgent care shifts by the doc running the pre-employment health screening. I told him my program doesn't allow us to moonlight until year-III, and his response was, "everyone does it anyways."

My gut inclination is to turn this (and other moonlighting opportunities down), and to play it above board especially as a new intern. What are peoples thoughts on this? Do people really moonlight without their programs approval when the program expressly requires approval to moonlight? Sure would be nice to have some extra cash on hand as I will be living in an expensive city for residency, but I don't know if the career risk is worth it.

1) You can't work without a license. Period. Its a felony and you go to jail. No moonlighting until PGY-2 for anyone.

2) Residency is not an environment where you skirt rules. Not on the first day, not in your second year, and not when you have three minutes left to graduation. Keep your f-ing head down. I don't know who this doc is but the fact that he's running pre-employment health screening makes me think he might have failed out of real medicine and is not someone you want to take advice from.

3) Intern year is not a time when you should expect to have any free hours to do extra shifts. You'll be lucky to sleep 6 hours a night. If you have free time exercise, clean,, and cook. If by some chance you get that done you should be reading.

4) You're not ready to take care of anyone yet in any event.

 

[backrow]

The ACGME common core requirements prohibit moonlighting by PGY-1 residents. (Obviously only applies to ACGME programs).



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[Doctor4Life1769]

Don't do it.
You could be a PGY-2/3 and you should still get permission before moonlighting. Without permission, if you do it and they catch wind you are toast.

 

[akwho]

See this is why I ask these things -- didn't even know we couldn't mooonlight until after intern year by law. The pre-employment health screen doc was definitely a little on the sketchy side. So thanks to everyone confirming what my gut told me. Still trying to figure out the big(er) leagues.

 

[doc05]

See this is why I ask these things -- didn't even know we couldn't mooonlight until after intern year by law. The pre-employment health screen doc was definitely a little on the sketchy side. So thanks to everyone confirming what my gut told me. Still trying to figure out the big(er) leagues.

more importantly, work on your judgement. it's obviously quite poor or you wouldn't have asked in the first place.

 

[deleted480308]

Independent moonlighting a month into residency? Do you hate those patients?

 

[akwho]

Lol. Did I commit a thought crime? Please pardon me SDN gods. 😉

 

[deleted480308]

Lol. Did I commit a thought crime? Please pardon me SDN gods. 😉

all joking aside....do you really believe 90days from now, you're ready to have the life of someone's kid or grandmother in your hands without oversight from an attending or senior resident?

that's the part that's crazier to me than risking the wrath of a PD

 

[Perrotfish]

more importantly, work on your judgement. it's obviously quite poor or you wouldn't have asked in the first place.

all joking aside....do you really believe 90days from now, you're ready to have the life of someone's kid or grandmother in your hands without oversight from an attending or senior resident?

that's the part that's crazier to me than risking the wrath of a PD

An attending physician told him 'everyone does it'. That attending was an idiot, but it's not exactly bizarre that it put the thought into his head that, maybe, everyone does this.

Its not like this is the last time he's going to hear something stupid in residency. Attendings love to say bizarre, unsupported things with condescending confidence. OP had exactly the right reaction: he realized it didn't sound right and asked around before he acted on the advice, but he also didn't dismiss the attending's opinion without asking. When he realized the consensus was against the attending he then shrugged his shoulders and ignored the advice.

 

[Winged Scapula]

An attending physician told him 'everyone does it'. That attending was an idiot, but it's not exactly bizarre that it put the thought into his head that, maybe, everyone does this.

Its not like this is the last time he's going to hear something stupid in residency. Attendings love to say bizarre, unsupported things with condescending confidence. OP had exactly the right reaction: he realized it didn't sound right and asked around before he acted on the advice, but he also didn't dismiss the attending's opinion without asking. When he realized the consensus was against the attending he then shrugged his shoulders and ignored the advice.

What makes you think this was an "attending"?

One of the oft recommended jobs for physicians who haven't/can't/won't finish residency is exactly this: pre-employment or insurance health screenings. Good chance this "attending" was some licensed schmoe hired to do these screenings and doesn't know diddily squat about licensure/moonlighting/laws etc.

 

[HooliganSnail]

more importantly, work on your judgement. it's obviously quite poor or you wouldn't have asked in the first place.

Obviously it is NOT "quite poor", that is why he asked. He knew something sounded not right about it.

Pretentious much?

 

[HooliganSnail]

Lol. Did I commit a thought crime? Please pardon me SDN gods. 😉

Ok here is the real deal regarding moonlighting

Moonlighting is like jerking off........everyone does and most people will admit that they do it sometimes, but NO ONE will admit that they do it as often as they do, and it is considered rude to talk to other people about doing it.

Moonlighting is VERY program dependent. It really depends on the culture of your hospital. At my program, they encourage us to moonlight as residents (not interns), because the PD feels it is important to be making decisions on your own without an attending to support you. I have friends at other hospitals that forbid moonlighting for all residents, some only allow the senior residents.....it really varies. Ultimately, you need to respect your program's rules. Just like the above posters state, don't outright violate the rules.

Almost all such places will have a "moonlighting must be approved by PD" clause in the contract. Some residents are ready to moonlight on week 1 of PGY-2, others......not so much. So for my instance, I had a chat with my PD at the beginning of PGY-2 and he told me I was OK to moonlight. I do NOT return to him every time an additional opportunity arises, I consider that original conversation to be sufficient.

Here's the rub though

1. When moonlighting, you need to make sure you have malpractice coverage, with tail coverage. This is confusing when you first get into it, but it is so important. Most places are legit, but there are some shady customers out there. If there is a lawsuit, and you did not have the malpractice coverage you thought you did.......bad news bears.

2. Technically the hours rules do apply, but NO ONE EVER CHECKS ON THAT.....on that same note, the money is usually really good, more than you have ever seen, and it can be kinda addicting. You have to learn to pace yourself, otherwise you will look back and realize you have worked 30 of the past 31 days, and you are dead inside.......

3. Keep it to yourself. While moonlighting is allowed at my shop, and everyone does it. It is not something that is talked about openly. Make sure you checks come to your house, and not the hospital. I never record those hours on my duty hours stuff, and I do not put all the places I moonlight on my CV that I turn in every year to Med Ed. It's not that I am doing anything wrong, it is just that it's none of their business. Especially if you are moonlighting as a 2. It sounds petty, but there can be jealousy among your seniors, especially if they weren't allowed to moonlight until PGY-3 or 4, and you are doing it as a 2.........next month's schedule could be brutal for you. Sounds messed up, but it's just best to be subtle about it.

Just some thought.....take them as you will.

 

[curiousneuro]

Somewhat related question: Incoming PGY-1. I've dabbled in programming over the past few years, and I'm now doing contract work developing a web application for a company, which I'm hoping to continue during residency. Is this considered "moonlighting", and would need express approval from my PD to continue doing this, or is only clinical work considered moonlighting?

Also - if this is not considered moonlighting, would it matter if I was a contractor (1099) vs W-2 employee?

 

[ProfMD]

Ok here is the real deal regarding moonlighting

Moonlighting is like jerking off........everyone does and most people will admit that they do it sometimes, but NO ONE will admit that they do it as often as they do, and it is considered rude to talk to other people about doing it.

Moonlighting is VERY program dependent. It really depends on the culture of your hospital. At my program, they encourage us to moonlight as residents (not interns), because the PD feels it is important to be making decisions on your own without an attending to support you. I have friends at other hospitals that forbid moonlighting for all residents, some only allow the senior residents.....it really varies. Ultimately, you need to respect your program's rules. Just like the above posters state, don't outright violate the rules.

Almost all such places will have a "moonlighting must be approved by PD" clause in the contract. Some residents are ready to moonlight on week 1 of PGY-2, others......not so much. So for my instance, I had a chat with my PD at the beginning of PGY-2 and he told me I was OK to moonlight. I do NOT return to him every time an additional opportunity arises, I consider that original conversation to be sufficient.

Here's the rub though

1. When moonlighting, you need to make sure you have malpractice coverage, with tail coverage. This is confusing when you first get into it, but it is so important. Most places are legit, but there are some shady customers out there. If there is a lawsuit, and you did not have the malpractice coverage you thought you did.......bad news bears.

2. Technically the hours rules do apply, but NO ONE EVER CHECKS ON THAT.....on that same note, the money is usually really good, more than you have ever seen, and it can be kinda addicting. You have to learn to pace yourself, otherwise you will look back and realize you have worked 30 of the past 31 days, and you are dead inside.......

3. Keep it to yourself. While moonlighting is allowed at my shop, and everyone does it. It is not something that is talked about openly. Make sure you checks come to your house, and not the hospital. I never record those hours on my duty hours stuff, and I do not put all the places I moonlight on my CV that I turn in every year to Med Ed. It's not that I am doing anything wrong, it is just that it's none of their business. Especially if you are moonlighting as a 2. It sounds petty, but there can be jealousy among your seniors, especially if they weren't allowed to moonlight until PGY-3 or 4, and you are doing it as a 2.........next month's schedule could be brutal for you. Sounds messed up, but it's just best to be subtle about it.

Just some thought.....take them as you will.

Remember to keep track somewhere. Licensing boards and hospital credentialing committees will want to know every place you worked - even if it was just a few moonlighting shifts.

 

[QofQuimica]

Obviously it is NOT "quite poor", that is why he asked. He knew something sounded not right about it.

Yeah, I don't think it's necessary to jump down the OP's throat for asking a simple question. I mean, he's never been a resident before. It's not like he knows all the ins and outs.

OP, I would caution you one more thing: make sure, no matter what, that you focus on doing well in your residency first before spending time and energy on moonlighting or any other distractions. Ultimately, the amount of money you make while moonlighting during residency will be a drop in the bucket compared to what you make during a career as an attending. So don't be penny wise and pound foolish. Focus on getting that residency completion certificate.

 

[HooliganSnail]

Remember to keep track somewhere. Licensing boards and hospital credentialing committees will want to know every place you worked - even if it was just a few moonlighting shifts.

You know who REALLY wants to know.......the IRS

 

[HooliganSnail]

Somewhat related question: Incoming PGY-1. I've dabbled in programming over the past few years, and I'm now doing contract work developing a web application for a company, which I'm hoping to continue during residency. Is this considered "moonlighting", and would need express approval from my PD to continue doing this, or is only clinical work considered moonlighting?

Also - if this is not considered moonlighting, would it matter if I was a contractor (1099) vs W-2 employee?

I only consider clinical work to be moonlighting. But if doing this we application stuff is impacting residency, then he might have a problem.

Most of my moonlighting is 1099, but some are W-2. Makes no difference. You just have to make sure you can pay your taxes. You can increase your withholding from your hospital check if you make a lot from 1099 to offset having to keep thousands stored away for tax season, or you may have to pay quarterly if it is a lot of money.

 

[Perrotfish]

Moonlighting is like jerking off........everyone does and most people will admit that they do it sometimes, but NO ONE will admit that they do it as often as they do, and it is considered rude to talk to other people about doing it.

My experience is that this attitude is unique to EM and lower tier FM Residencies. In most other specialties moonlighting is rare and, when done, is above board.

The main issue is the schedule. I couldn't have done any moonlighting even if I wanted to. We were almost always scheduled for 6 13 hour shifts a week (which were actually 16 hours long) with a ton of presentations/research/admin/studying to do on my day off. Everyone I knew in IM, good FM programs, OB, or any surgery program was in the same boat. Finding even a few hours a week to moonlight in most residencies is hard. To moonlight enough that its actually embarrassing to talk about you would need to be in a training program that considers doesn't even work you 40 hours a week. In other words, Emergency Medicine and lower tier FM programs.

 

[HooliganSnail]

My experience is that this attitude is unique to EM and lower tier FM Residencies. In most other specialties moonlighting is rare and, when done, is above board.

The main issue is the schedule. I couldn't have done any moonlighting even if I wanted to. We were almost always scheduled for 6 13 hour shifts a week (which were actually 16 hours long) with a ton of presentations/research/admin/studying to do on my day off. Everyone I knew in IM, good FM programs, OB, or any surgery program was in the same boat. Finding even a few hours a week to moonlight in most residencies is hard. To moonlight enough that its actually embarrassing to talk about you would need to be in a training program that considers doesn't even work you 40 hours a week. In other words, Emergency Medicine and lower tier FM programs.

Well......sucks to be you then.

 

[mvenus929]

To moonlight enough that its actually embarrassing to talk about you would need to be in a training program that considers doesn't even work you 40 hours a week. In other words, Emergency Medicine and lower tier FM programs.

And psych. Or so I hear...

But I agree--as a PGY-2, even on my non-inpatient or ED months, I was cross covering most weekends, and lived for my time off. I took a single moonlighting shift this past year, and it was during my call free month as I was coming back from vacation. As a PGY-3, I think I will technically have more weekends off (working 1 full weekend per month on my elective months), but that just means more call time where I can't really do anything other than more work because there's a good chance that I'll be called in for something or another, even if it's just for a few hours. Plus I have a lot of scholarly projects and presentations and whatnot to work on on my days off, and don't particularly feel like giving that up for a couple hundred dollars for an extra shift.

 

[Doctor4Life1769]

What's the typical policy for out of state moonlighting? My PD was against it.

 

[clausewitz2]

What's the typical policy for out of state moonlighting? My PD was against it.

Some places are very encouraging when it comes to this. I interviewed at Louisville, and the psych residents there had a pretty sweet moonlighting gig set up in Fargo (!), airfare and hotel included.

 

[dpmd]

What makes you think this was an "attending"?

One of the oft recommended jobs for physicians who haven't/can't/won't finish residency is exactly this: pre-employment or insurance health screenings. Good chance this "attending" was some licensed schmoe hired to do these screenings and doesn't know diddily squat about licensure/moonlighting/laws etc.

Yeah, but he is still more a doctor than the OP so I can understand not wanting to just ignore what he said without checking it out.

 

[dpmd]

Somewhat related question: Incoming PGY-1. I've dabbled in programming over the past few years, and I'm now doing contract work developing a web application for a company, which I'm hoping to continue during residency. Is this considered "moonlighting", and would need express approval from my PD to continue doing this, or is only clinical work considered moonlighting?

Also - if this is not considered moonlighting, would it matter if I was a contractor (1099) vs W-2 employee?

Probably not considered moonlighting but if it were me I would probably ask about it (can be done in a very casual way downplaying how much time you think you may end up doing it because if they think it will be taking a lot of your hours they might have more of an issue with it), but then again I am a pretty cautious person when it comes to rules.

 

[Winged Scapula]

Yeah, but he is still more a doctor than the OP so I can understand not wanting to just ignore what he said without checking it out.

Agreed and I understand the OP for wanting to check it out.

My response was to another user who called this person an "attending" and then went on a diatribe about attendings being wrong. Regardless of whether that was true (or relevant to the discussion), my point was that it was likely that the person the OP was dealing with was someone who hadn't finished training or knew much about licensing.

 

[j4pac]

Lol. Did I commit a thought crime? Please pardon me SDN gods. 😉

You need to realize that untrained docs kill their patients. You appear overconfident...bad things happen to overconfident docs. Just a heads up...not to criticize but looking out for you and your patients.

 

[MediCane2006]

My experience is that this attitude is unique to EM and lower tier FM Residencies. In most other specialties moonlighting is rare and, when done, is above board.

The main issue is the schedule. I couldn't have done any moonlighting even if I wanted to. We were almost always scheduled for 6 13 hour shifts a week (which were actually 16 hours long) with a ton of presentations/research/admin/studying to do on my day off. Everyone I knew in IM, good FM programs, OB, or any surgery program was in the same boat. Finding even a few hours a week to moonlight in most residencies is hard. To moonlight enough that its actually embarrassing to talk about you would need to be in a training program that considers doesn't even work you 40 hours a week. In other words, Emergency Medicine and lower tier FM programs.

Just as an FYI this is not strictly true. My gen surg program allowed moonlighting and we were an 80/hr week shop. (Obviously, no one ever went over their duty hours due to moonlighting 😉). It's amazing what you can put up with when you need the cash.

 

[dpmd]

Just as an FYI this is not strictly true. My gen surg program allowed moonlighting and we were an 80/hr week shop. (Obviously, no one ever went over their duty hours due to moonlighting 😉). It's amazing what you can put up with when you need the cash.

Where i trained we could moonlight nights and weekends for neurosurgery after you did the actual neurosurg rotation intern year. I never did any till chief year because of my black cloud (i felt i was giving back to the community by not being on so fewer bad head injuries or back injuries would happen) and becaise i enjoy free time, but i know people that earned big money doing it. And of course their work hour logs always managed to be at or under 80 hrs.