Moonlighting - ER Doc after PGY1!??!?!?

[TOMFighter]

Anyone heard of this?


supposedly you can work in the ER as an ER doc after first year of residency (I'm guessing IM residency).....and get paid with full reimbursement INDEPENDENT of any residency salary.

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[sirus_virus]

Between the 100 hours IM residents have to work, and the lawyers camping out in the ER, I don't think this is something anyone would be interested in doing.

 

[Blade28]

Many residency programs don't allow moonlighting. Those that do often subscribe to rules similar to the following:

*"Internal" moonlighting (done at residency program-affiliated hospitals) count towards your 80 hours
*"External" moonlighting (done at non-residency program-affiliated hospitals) don't count towards your 80 hours

In programs where you may not be working the full 80 hours per week, often residents may have time to moonlight in their spare time - this is sometimes done in FP or ER, for example. In General Surgery, moonlighting is commonly only done during the optional lab (research) years.

Yes, you can do urgent care or work at an ER, but the going rate is around $90-100/hour. And while you can get your full medical license in many states after your PGY-1 year, many moonlighting gigs will require you to have finished at least 2-3 years of residency.

 

[Captain Fantastic]

Yeah, I've heard of it. Although I've mostly seen the IM chief residents moonlight in rural ERs. Here the chiefs are PGY-4s (i.e., didn't match into a fellowship program at the end of their residency and are filling their time as they reapply), and are only "acting" chiefs for 3-4 months out of the year so they have plenty of time to do research or moonlight, etc.

 

[8744]

Anyone heard of this?


supposedly you can work in the ER as an ER doc after first year of residency (I'm guessing IM residency).....and get paid with full reimbursement INDEPENDENT of any residency salary.

Your not quailfied to work in the ER with just an intern year, especially not alone in some little ED in the middle of nowhere. So sorry. You'd be stupid to do it and the hospital would be stupid to hire you. Now, I'm sure there are some places that are desperate for coverage and will take what they can get but maybe you don't want to start your career with a couple of lawsuits.

You can do just fine at Urgent Cares if your program lets you.

 

[bcat85]

Anyone heard of this?


supposedly you can work in the ER as an ER doc after first year of residency (I'm guessing IM residency).....and get paid with full reimbursement INDEPENDENT of any residency salary.

WHY would anyone want to do this ON TOP of a residency!?

 

[Orthodoc40]

I've often wondered about the guy who wrote Hot Lights, Cold Steel - he moonlighted his way through an ortho residency somehow. Unless that book is fictional.

 

[njbmd]

Moved to EM Residency Forum as this is a residency issue and EM residents can comment on this.

 

[Winged Scapula]

I've often wondered about the guy who wrote Hot Lights, Cold Steel - he moonlighted his way through an ortho residency somehow. Unless that book is fictional.

He trained in the 70s at Mayo. Not much trauma and less sick patients back then.

 

[roja]

Sits back

 

[SoCuteMD]

So wait? Are you telling me that I can moonlight as an ER doc after one year of IM residency? WOW! You mean...it takes those silly EM people three years to learn what internists can learn in ONE?!?!

Except...I hope no one comes in needing a central line or intubation. I hear those procedures are a bit scarce during the IM intern year...

 

[Hercules]

Except...I hope no one comes in needing a central line or intubation. I hear those procedures are a bit scarce during the IM intern year...

While I agree with the overall spirit of your post, central lines actually shouldn't be that scarce for an intern in a good IM program. Intubations on the other hand probably will be. What separates us from our IM colleagues though has more to do with our training and approach to the patient than it does with our superior procedural skills.

 

[SoCuteMD]

While I agree with the overall spirit of your post, central lines actually shouldn't be that scarce for an intern in a good IM program. Intubations on the other hand probably will be. What separates us from our IM colleagues though has more to do with our training and approach to the patient than it does with our superior procedural skills.

I did my medicine rotation at a great university program. Surgery did ALL the central lines. Even my PGY2 wasn't certified to do them on his own.

I was more making the point that an IM resident could quickly find him/herself in hot water in an ER.

 

[deleted109597]

I did my medicine rotation at a great university program. Surgery did ALL the central lines. Even my PGY2 wasn't certified to do them on his own.

I was more making the point that an IM resident could quickly find him/herself in hot water in an ER.

I will second this. As a first month intern, I had to show a third year FM resident how to do it, as they were going to start moonlighting somewhere. At our hospital, only surgery put in lines.

 

[DeLaughterDO]

Ooof...

Sounds pretty scary/sketchy to me. Both for the resident AND the patients s/he might be treating.

I'll soon be PGY3 and I'm not sure if I would feel comfortable with some things out on my own in the boonies.

MAYBE some internal moonlighting with adequate backup, though. We used to have a pretty sweet deal where we could moonlight in the ICU - don't think anyone's done it in a year or so, so I don't know if it's still on the table or not. I'm gonna check it out, though

 

[enfuegoEP]

It seems like a really bad idea to moonlight in the ED after just an intern year in IM. The opportunity for litigation is just to great. Urgent care would be OK because you can always take one look at the patient and say "I really think you need to go to the emergency department," if you have no clue whats going on with the patient. You always have that option if you need it. But you would need some large cajones to work in an ED after just one year of IM.

 

[EctopicFetus]

While I agree with the overall spirit of your post, central lines actually shouldn't be that scarce for an intern in a good IM program. Intubations on the other hand probably will be. What separates us from our IM colleagues though has more to do with our training and approach to the patient than it does with our superior procedural skills.

How about the lack of training IM has with trauma (major or minor) and yep... ill say it... Peds and yep OB. Most IM guys avoid pelvics like the plague. How about a vag bleeder? While these may be benign they may not be and this person wont have a freakin clue as to whats going on.

In the end it comes down to that individuals tolerance for risk and the hospitals desperation for a warm body with a medical license.

 

[DocFrog]

As far as whether or not moonlighting counts towards duty hours, my PD told us that osteopathic programs have to count moonlighting in their 80 hr work week, but allopathic programs do not. I have not verified this.

 

[southerndoc]

As far as whether or not moonlighting counts towards duty hours, my PD told us that osteopathic programs have to count moonlighting in their 80 hr work week, but allopathic programs do not. I have not verified this.

The RRC rules are that external moonlighting does not count toward the 80-hour rule so long as it doesn't interfere with educational duties, but internal moonlighting does.

However, some programs count external moonlighting as well. My program counted it toward your maximum work hours.

 

[Plinko]

As an EM PGY3 I've contracted to moonlight in an small ER. I met with the director of the ER and told him that I would only moonlight on shifts where there was double coverage with a board certified EM physician. If you get a difficult airway, have a crashing trauma patient who needs stabilization and transfer to a trauma center, etc. you definitely don't want to be the only one in the driver's seat with only one year of postgraduate education under your belt. Especially, as an IM resident. If you have abdominal trauma and don't know how to do a FAST or DPL and the pt isn't stable for CT, the trauma attending at the transfer facility would likely report you to the state board when you say "I think he is bleeding internally but I'm not sure." I know board eligible EM attendings fresh out of residency who still don't want to be on by themselves in an ED. If you decide to throw caution to the wind, I would definitely have a damn good attorney on retainer before you start.

As far as the hours go, I agree with the above posts that say that external hours don't apply towards the 80 hours. But I can't see any program looking favorably on it.

 

[Hercules]

How about the lack of training IM has with trauma (major or minor) and yep... ill say it... Peds and yep OB. Most IM guys avoid pelvics like the plague. How about a vag bleeder? While these may be benign they may not be and this person wont have a freakin clue as to whats going on.

In the end it comes down to that individuals tolerance for risk and the hospitals desperation for a warm body with a medical license.

I'm about to finish up my 3rd year of a (previously) 4 year EM program. I've been moonlighting single coverage in small rural EDs throughout my state since the beginning of this year, and have gotten to witness first hand what non-EM trained physicians do and don't seem to know. I've been places where the nurse had to go to the OR to get a central line for me because none of the other ED physicians at the site could do central lines and just consulted surgery. Still I don't think that procedural skill sets me apart from them as much as my knowledge base and ability to multi-task and efficiently run a department.

Again, I am not supporting second year IM residents moonlighting in emergency departments. My point was simply that it is not just our ability to tube and line a patient that defines us. As you were pointing out above, an IM resident lacks our knowledge of trauma, peds, ob (as well as orth, ENT, etc).

By the way, I do highly support EM residents moonlighting. It is a phenomenal experience that has the potential to build self-reliance and confidence that will pay dividends both when you go back to your residency and when you go out into practice after residency.