Moonlighting during residency

[Leukocyte]

I am thinking about moonlighting during residency to partialy off-set the huge pay-cut that I will be taking. To moonlight as a resident (at an urgent care for example) do you need to go through the extensive credentialing paperwork/process that one has to go through when getting a regular physician job?

Thanks

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[gutonc]

Yes because, wait for it, it's a regular physician job. The extent of the required paperwork will vary from job to job of course, but there will be plenty one way or another.

 

[Socrates25]

I am thinking about moonlighting during residency to partialy off-set the huge pay-cut that I will be taking. To moonlight as a resident (at an urgent care for example) do you need to go through the extensive credentialing paperwork/process that one has to go through when getting a regular physician job?

Thanks

You need to stick to in-house moonlighting to avoid the credentialing crap.

 

[Leukocyte]

Yes because, wait for it, it's a regular physician job. The extent of the required paperwork will vary from job to job of course, but there will be plenty one way or another.

Thanks gutonc. As always, blunt but honest. 🙂

You need to stick to in-house moonlighting to avoid the credentialing crap.

What is considered "in-house"? Does the fast-track that is part of the medical school's ER considered in-house?

If you do moonlight at an "in-house" facility, will you get paid as a regular physician, if you are a resident who is already BE/BC (did a prior residency in a previous specialty)?

Thanks

 

[belle54321]

Thanks gutonc. As always, blunt but honest. 🙂



What is considered "in-house"? Does the fast-track that is part of the medical school's ER considered in-house?

If you do moonlight at an "in-house" facility, will you get paid as a regular physician, if you are a resident who is already BE/BC (did a prior residency in a previous specialty)?

Thanks

I think a lot of this will depend on the program and the hospital. Some programs will only let you moonlight in certain specialties or have other restrictions. For example, for some reason at Duke psych, the residents can moonlight for medicine, but not for psychiatry. So, I think you will best get an answer from your future residency program.

I am in the same boat, BC in another field, but going back for a second residency. Personally, I have no interest in moonlighting. I will miss the attending money, but honestly I value my time off. Anyway, I thought you were trying to get away from clinical medicine.

 

[gutonc]

What is considered "in-house"? Does the fast-track that is part of the medical school's ER considered in-house?

If you do moonlight at an "in-house" facility, will you get paid as a regular physician, if you are a resident who is already BE/BC (did a prior residency in a previous specialty)?

Thanks

"In-house" simply means an opportunity within one of your affiliated hospitals with which you already have privileges as a trainee. In general, this requires the permission of your residency PD. The rate and manner of pay varies but should be the same for everybody doing it. The moonlighting gig I work at has residents, fellows and attendings that work at it. We all get paid the same amount/hr.

Also, you keep referring to this mystical "regular physician" and I have no idea what you're talking about. You need to either use standard terminology or define your terms.

 

[John146]

Change your status back to resident dude... It took me a few minutes to figure out why an attending was calling himself a resident

 

[Leukocyte]

Anyway, I thought you were trying to get away from clinical medicine.

Thanks for the info Belle. Yes, I am trying to get away from clinical medicine, and would rather not moonlight, but I am currently going through a tough time that requires extra cash. So if I can do something during residency that would help my financial situation, temporarily, then great. I only thing that I have experience doing (unfortunately) is urgent care and to a lesser degree, office based primary care. I do not know if it is even possible to find a non-clinical opportunity to moonlight in. I have never heard of non-clinical moonlighting opportunities before. Do they exist?

" Also, you keep referring to this mystical "regular physician" and I have no idea what you're talking about. You need to either use standard terminology or define your terms.

Thanks gutonc. Good to know that all medical providers doing the same job in a moonlighting opportunity are paid equally (regardless of their status). Sorry for the confusion. By "regular physician" I was trying to refer to a full-fledged board cerified attending physician.

Change your status back to resident dude... It took me a few minutes to figure out why an attending was calling himself a resident

LOL. No worries. I deleted my status to avoid any confusion.

 

[Buzz Me]

What's this second residency you're starting soon?

 

[Leukocyte]

What's this second residency you're starting soon?

Preventive Medicine. I would have loved to go into Pathology, but I guess it is not meant to be. If I wait this year out, and apply to Pathology in the next match, I will be almost 41 years old when I finish residency. And as we know, in Pathology one usually has to do a fellowship (or two), so I will be 42 years old then. Then I have to deal with the "less than ideal" Pathology job market. Would it be worth it? To me, yes off-course!...But I do have a family who are also counting on me to provide for them. It would be selfish of me to have them wait for me just because I want to follow my dream career. There is more to life than one's own career aspirations.

So I had to find a "happy medium" between my career aspirations and my family responsibilities. That HAS TO BE non-clinical. That "happy medium" is Preventive Medicine. Oh well, maybe someday my son or daughter could be a Pathologist.

 

[Groove]

Leukocyte, I may have missed what your first specialty was... but I think you have plenty of options to moonlight outside residency in your position where you have a state license as long as your comfortable working in that environment. The credentialing process is going to exist no matter what facility you want to work at, but Urgent care should be easy, even working in some low volume or VA ED's if you are comfortable in that environment. The VA only requires a single state license and doesn't see trauma for the most part, and you are protected from being sued since it's a federal institution, so if you feel comfortable working in the ED in an environment where you are more likely to see medical emergencies, then that's a good option. Most VA jobs pay less than private hospital ER's, but I think it's about $120/hr on average. You might look into it. Urgent Care should be easy and you should definitely look into that. Either option would supplement your income substantially if your residency will allow it and you have the time to spare.

I was really in a financial bind myself but was a foreign grad unfortunately in a state that required 3 years of post graduate training before I could get a permanent state license, so I had to look for opportunities outside of the state in ones that only required 2 yrs training when I was finishing PGY2. I finally found one relatively close by and moonlighted for a year out of state in a couple ED's. It was a pain but definitely helped out from a financial perspective. I'm glad that I don't have to go out of state any more, but I feel your pain. You might try some national or regional staffing firms that staff small ED's and also Urgent care clinics. Tell them the type of environment that you're looking for and let them do the grunt work in finding you a place. That way you only have to credential once through them, and then they can help you out in credentialing at whatever facility you want to moonlight at. If there's travel involved, they can set all of that up for you. In my case, all I had to do was show up at the local airport, they had my ticket, I flew in, they had my car, I hopped in and drove to work, stayed at the hotel they paid for and then flew out when I was done with my shifts. The travel was a pain but they made it as painless as possible.

 

[Leukocyte]

Leukocyte, I may have missed what your first specialty was... but I think you have plenty of options to moonlight outside residency in your position where you have a state license as long as your comfortable working in that environment. The credentialing process is going to exist no matter what facility you want to work at, but Urgent care should be easy, even working in some low volume or VA ED's if you are comfortable in that environment. The VA only requires a single state license and doesn't see trauma for the most part, and you are protected from being sued since it's a federal institution, so if you feel comfortable working in the ED in an environment where you are more likely to see medical emergencies, then that's a good option. Most VA jobs pay less than private hospital ER's, but I think it's about $120/hr on average. You might look into it. Urgent Care should be easy and you should definitely look into that. Either option would supplement your income substantially if your residency will allow it and you have the time to spare.

I was really in a financial bind myself but was a foreign grad unfortunately in a state that required 3 years of post graduate training before I could get a permanent state license, so I had to look for opportunities outside of the state in ones that only required 2 yrs training when I was finishing PGY2. I finally found one relatively close by and moonlighted for a year out of state in a couple ED's. It was a pain but definitely helped out from a financial perspective. I'm glad that I don't have to go out of state any more, but I feel your pain. You might try some national or regional staffing firms that staff small ED's and also Urgent care clinics. Tell them the type of environment that you're looking for and let them do the grunt work in finding you a place. That way you only have to credential once through them, and then they can help you out in credentialing at whatever facility you want to moonlight at. If there's travel involved, they can set all of that up for you. In my case, all I had to do was show up at the local airport, they had my ticket, I flew in, they had my car, I hopped in and drove to work, stayed at the hotel they paid for and then flew out when I was done with my shifts. The travel was a pain but they made it as painless as possible.

Thank you very much Groove for the great advice. My original specialty is Family Medicine, with experience in urgent care. Although I did not like urgent care, the salary was great. I am willing to suck-it-up temporarily, and pick-up some urgent care shifts here and there while I am in residency to make "ends meet". I am not sure if I am comfortable enough to work in a traditional ER (even with no trauma). I will certainly contact some recuiting agencies to inquire about available part-time UC opportunities, and I will also inquire about available "in-house" moonlighting opportunities. It is very interesting to know that if one works for the VA, they cannot get sued. I guess that helps greatly in saving money that is currently being wasted on "defensive medicine" practices that occur in almost all private sector ERs.

Wow. You used to fly to work?! That is very cool. I LOVE flying, and would rather fly to work than drive to work (every day/any day). 🙂

 

[belle54321]

It is very interesting to know that if one works for the VA, they cannot get sued. I guess that helps greatly in saving money that is currently being wasted on "defensive medicine" practices that occur in almost all private sector ERs.

It is not that one cannot be sued when they work for the VA. When you are named in a suit while working for the VA, if the VA determines that your actions are within standard practice, etc., then the US government will then replace you as the defendant in the suit.

 

[mlw03]

I thought you were going for pathology, Leukocyte?

 

[Leukocyte]

I thought you were going for pathology, Leukocyte?

I wish I could, but unfortunately Pathology does not want me. My "love story" with Pathology is unfortunately one-sided; I love her, but she does not love me back. I have tried applying to Pathology twice in the Match. My first attempt was when I was a medical student (did not get any Pathology interviews then, so I had to go into by back up "choice" which was Family Medicine. I then tried applying to Pathology again after finishing my Familiy Medicine residency and getting some work experience as an attending. I applied to a whopping 67 programs, and only got one interview. So I did not match into Pathology, yet again, for the second time. So what am I to do? "She" has rejected me TWICE. I guess it is just not meant to be. I could try "charming her" a third time, but "she'" is playing VERY hard to get. I guess I am not good enough for her (IMG, average step scores, no pathology letters - but I am a medical technologist by training and have worked extensively in the lab before).

The thing is I am getting older, and I have to move on. I also have the responsibility of proving for my family. If I wait this year out and apply again, assuming I got in, I will be 41 years old when I finish with my Pathology residency. Add a year or two of fellowships, and i will be 42 - 43 years old when all is said and done. I cannot possibly ask my family that need my support to wait that long for me. It would just be very selfish of me (they already waited for me during my FM residency). I had to find a "happy medium", in a non-clinical career, that I can "salvage" my medical career with. Preventive Medicine seems to be appropriate.

I would have loved to go into Pathology, but I guess it is not meant to be. If I wait this year out, and apply to Pathology in the next match, I will be almost 41 years old when I finish residency. And as we know, in Pathology one usually has to do a fellowship (or two), so I will be 42 years old then. Then I have to deal with the "less than ideal" Pathology job market. Would it be worth it? To me, yes off-course!...But I do have a family who are also counting on me to provide for them. It would be selfish of me to have them wait for me just because I want to follow my dream career. There is more to life than one's own career aspirations.

So I had to find a "happy medium" between my career aspirations and my family responsibilities. That HAS TO BE non-clinical. That "happy medium" is Preventive Medicine. Oh well, maybe someday my son or daughter could be a Pathologist.

 

[peppy]

If you did want to keep pursuing Path, I think applying earlier might make a significant difference. When you applied last time, it sounded like most programs would have already given out their interviews before they got to you.
But I definitely understand your concerns about being in residency for many more years, so I think your current plan is a sensible choice.

 

[Groove]

Thank you very much Groove for the great advice. My original specialty is Family Medicine, with experience in urgent care. Although I did not like urgent care, the salary was great. I am willing to suck-it-up temporarily, and pick-up some urgent care shifts here and there while I am in residency to make "ends meet". I am not sure if I am comfortable enough to work in a traditional ER (even with no trauma). I will certainly contact some recuiting agencies to inquire about available part-time UC opportunities, and I will also inquire about available "in-house" moonlighting opportunities. It is very interesting to know that if one works for the VA, they cannot get sued. I guess that helps greatly in saving money that is currently being wasted on "defensive medicine" practices that occur in almost all private sector ERs.

Wow. You used to fly to work?! That is very cool. I LOVE flying, and would rather fly to work than drive to work (every day/any day). 🙂

Leuk, I think that sounds like a solid plan. In both of the rural ED's I worked at, one of which was a level 3 trauma ED, there were quite a few of FP's though most had been working in that environment for awhile. We also had an FP that might or might not have been as comfortable in the main ED, and he asked to work the Fast Track and would do that regularly. The pay over on the FT side probably wasn't as good, but any hospital is going to prefer a physician working FT which would be more similar to your Urgent Care experience than a NP as long as you were willing to work for a little less. Either way, it's more than you would be making in residency, that's for sure.

Yea, the flying was fun for awhile but got old because you feel obligated to make it worthwhile for the agency that's paying for all your travel, they want to get as many shifts out of you as possible, so I'd usually do 4 shifts, all nights with the first one starting on the night that I flew in, so not much sleep that day, then I would fly out the morning after my last night shift, so not much sleep that day either. It burned me out pretty quick being sleep deprived so much, so I had to scale back and now only help them out when needed as they are short staffed on providers.

Weatherby Locums is who I work through if you want to look them up. They are fairly national and cover both private ED environments as well as Federal locations such as VA and even indian reservations, so it's worth a look. Good luck.

Honestly, moonlighting in some capacity is probably not a bad idea for you so that you can keep your clinical skills up to snuff during your new residency just in case you want to continue to practice part time at some point in the future unless you've been in practice for awhile and they are already solidly ingrained.

 

[Groove]

It is not that one cannot be sued when they work for the VA. When you are named in a suit while working for the VA, if the VA determines that your actions are within standard practice, etc., then the US government will then replace you as the defendant in the suit.

The primary area of concern is EMTALA violations and medical malpractice in which the federal hospital and the physician are protected by federal sovereign immunity. Theoretically, an emergency physician working in the ED of the VA can have civil monetary penalties levied against them by the HCFA, but I've honestly never even heard of this ever happening. It's really, really difficult to sue and win against an EP working in a federal hospital. Federal sovereign immunity protects a federal employee (physician) from being directly sued for malpractice. There are loopholes, and I'm not a lawyer, but my understanding is that it's extremely difficult.

 

[Aureliux]

I am thinking about moonlighting during residency to partialy off-set the huge pay-cut that I will be taking. To moonlight as a resident (at an urgent care for example) do you need to go through the extensive credentialing paperwork/process that one has to go through when getting a regular physician job?

Thanks

If you can find a cash based urgent care you'd be able to avoid the credentialing. You may still have to get your own malpractice insurance though depending on the group.

Another option for moonlighting to avoid credentialing and malpractice would be insurance exams.

Otherwise I agree with the rest and stick with in house moonlighting.

 

[biryani86]

Does anyone know how to find the contact person for getting shifts at the VA? Do we contact department of medicine, a specific hospitalist director, or go through HR?