Moonlighting in psych residency...

[BestDoctorEver]

I met a psych resident who is about to complete his 3rd year in psych residency and he told me that he has been moonlighting for almost 2 years. He told me that he makes more money/year moonlighting than what he makes in his residency. I know that most residents get paid around 50k/year. Therefore, the guy is telling me he is making 50k/year moonlighting. Is that even possible for someone to make that much money moonlighting since I heard you work 60+ hours/week during residency? Can someone moonlight after completing your first year psych residency?

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[notdeadyet]

$50k can definitely be done. Depending on your locale, you can make that doing 1 weekend per month and one weeknight per week.

60+ hours would be rare for any psych residency. 50 hours is more like it. The only time you're likely to consistently pull 60 hours is when you're rotating on other services, and this happens before you're licensed (and can't moonlight).

You can moonlight after you have your license, which can happen as soon as you reach PGY-2. Velho will hire a PGY-2 is the question, and you may be limited to in-house moonlighting that year. You will have more options as a PGY-3 and PGY-4.

 

[st2205]

A lot of places don't have you work 60 hours/week, especially in 3rd year. Some places also have good opportunities, so I'd say this is possible. However, and this is just my opinion, I'd guess that most people who throw around that they "doubled" their income of "practically doubled" pro ably actually make much less than that. That's not to say that it's not as significant as the dramatics of the linguistics, as when you're making 50k, especially for the folks with dependents, nearly all of that goes to taxes and all other living expenses. So if your discretionary income is $500-$1,000 a month, then even adding 20k/year more than doubles your effective "income," or at least has that perception when you add in that kind of money without having to divide it up amongst expenses as you had to through your first 50k.

But aside from that, yes, I'm sure you can literally double your income. I'd guess that most moonlighters probably make 20-35k/yr, but I am not saying that with any data.

 

[shan564]

Agree with the above. There's nothing unusual about the situation described in the original post.

Every program is different. At my program, you do work 60+ hours/wk in your first year of residency, but you work 40 hrs/week in 3rd year.

 

[TexasPhysician]

I worked at a program that did pay $4800 to a PGY-2 for a 48 hr weekend call shift. 1 horrible weekend/month would hit the criteria of the original post. Very doable.

 

[Atom bum]

How easy is moonlighting after residency? Does this completely depend on location? Is it possibly realistic to moonlight somewhere like Chicago where there are tons of psychiatrist?

 

[Shikima]

Anything is possible for moonlighting. It also depends on your contracts too... the more saturated the area, the more difficult it is to moonlight.

 

[MacDonaldTriad]

The ACGME doesn’t allow any PGY-Is to moonlight, even if you are on your second or third PGY-I training experience. After that, the policy is up to the program. The ACGME insists that there is a policy, but that is left without any guidance as far as content. Moonlighting at your training institution does count in duty hour rules, so you really cannot do a 48 hour weekend, at least not without a 10 hour break and staying under an average of 80 hrs/wk….

 

[shan564]

The ACGME doesn’t allow any PGY-Is to moonlight, even if you are on your second or third PGY-I training experience. After that, the policy is up to the program. The ACGME insists that there is a policy, but that is left without any guidance as far as content. Moonlighting at your training institution does count in duty hour rules, so you really cannot do a 48 hour weekend, at least not without a 10 hour break and staying under an average of 80 hrs/wk….

The 80-hr week just has to be averaged over 4 weeks, so a 48-hr weekend probably wouldn't break that rule. You'd have to have the 10-hr scheduled break (but only 8 hrs of actual break) only if it's in-house call.

 

[TexasPhysician]

The ACGME doesn’t allow any PGY-Is to moonlight, even if you are on your second or third PGY-I training experience. After that, the policy is up to the program. The ACGME insists that there is a policy, but that is left without any guidance as far as content. Moonlighting at your training institution does count in duty hour rules, so you really cannot do a 48 hour weekend, at least not without a 10 hour break and staying under an average of 80 hrs/wk….

No one has mentioned pgy-1's in this thread yet.

 

[Euthymia]

I don't know if it's true, but I was told at one interview by a resident that he hadn't had a day off in over a year and made over 200k from moonlighting alone last year. I guess the numbers work out, but that sounds horrible.

 

[cookymonster]

I made over $91,000 moonlighting last year according to my tax return, so it's possible to triple your income if you have a well-paying gig and you're set on it. I've slowed down slightly this year, but I still try to work 48-72 hours a month, which is a lot, considering that the hospital is over 2 hours away.

 

[Shikima]

I don't know if it's true, but I was told at one interview by a resident that he hadn't had a day off in over a year and made over 200k from moonlighting alone last year. I guess the numbers work out, but that sounds horrible.

Likely one of two situations; Wasn't reporting the hours or that was before the hour limitation was enacted.

 

[Euthymia]

Likely one of two situations; Wasn't reporting the hours or that was before the hour limitation was enacted.

This was supposedly last year during the 3rd year of residency. Aren't the hours by 3rd year around 40 per week at a lot of places?

 

[Jester25]

I made over $91,000 moonlighting last year according to my tax return, so it's possible to triple your income if you have a well-paying gig and you're set on it. I've slowed down slightly this year, but I still try to work 48-72 hours a month, which is a lot, considering that the hospital is over 2 hours away.

wow. what setting? inpatient/ outpatient/ weekend coverage?

 

[BestDoctorEver]

I made over $91,000 moonlighting last year according to my tax return, so it's possible to triple your income if you have a well-paying gig and you're set on it. I've slowed down slightly this year, but I still try to work 48-72 hours a month, which is a lot, considering that the hospital is over 2 hours away.

Is it 91k overall or is it 91k in addition to your residency salary (or stipend)?

 

[cookymonster]

That was in addition to residency salary (so I nearly tripled my income). This was working in a state hospital system, mostly on weekends.

I went back to look at my paystubs and realized I worked an average of 79 hours a month there last year (as a PGY3/4). That was probably excessive. Definitely times I felt burned out and running on fumes. It has gotten easier as a PGY-4. I've only worked 90 duty hours this month (only taken one day of leave, to go moonlight), so it's gotten much easier to balance residency and moonlighting work.

 

[doubledeuce80]

i was able to moonlight within my department as a pgy-2, but pay was low ~$60 hr. pgy-3 opportunities were much more lucrative. i found psych er a great place to moonlight in residency, if u aren't scurred

 

[Shikima]

This was supposedly last year during the 3rd year of residency. Aren't the hours by 3rd year around 40 per week at a lot of places?

Can't say... I'd assume more like 50 hours a week with call obligations.

 

[shan564]

It's 40 hrs at my program in 3rd yr. There's no required call... just optional call shifts covered by moonlighters.

 

[WolverineDoc13]

That was in addition to residency salary (so I nearly tripled my income). This was working in a state hospital system, mostly on weekends.

I went back to look at my paystubs and realized I worked an average of 79 hours a month there last year (as a PGY3/4). That was probably excessive. Definitely times I felt burned out and running on fumes. It has gotten easier as a PGY-4. I've only worked 90 duty hours this month (only taken one day of leave, to go moonlight), so it's gotten much easier to balance residency and moonlighting work.

Assuming that 91k is pre-tax, did the hospital deduct taxes before paying you or were you left having to pay a large sum every April 15? This isn't a question for/against moonlighting; I intend to moonlight during residency, I just want to plan my finances accordingly.

 

[notdeadyet]

For planning purposes, it will vary by employer. You need to ask. I've had a mix of payroll and 1099 employment and sock away portions of the 1099 paychecks into a savings account I don't touch until April specifically for taxes.


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[trophyhusband]

For planning purposes, it will vary by employer. You need to ask. I've had a mix of payroll and 1099 employment and sock away portions of the 1099 paychecks into a savings account I don't touch until April specifically for taxes.


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You can always increase your withholding on your residency/fellowship W-4 as well to account for the extra 1099 moonlighting income (unless you're at one of the few programs that doesn't withhold because they're fighting with the IRS - UTSW and maybe Mayo are two I think I remember correctly). We're withholding an extra $600ish per paycheck from my wife's fellowship paycheck for Fed/State taxes. This will also help you not have to pay estimated taxes.

 

[notdeadyet]

Trophy- you're absolutely right, but I prefer to do it myself for a couple reasons:
- moonlighting hours can ebb and flow, making w4 deductions a SWAG in the best of circumstances
- if rather I have the money sit in a savings account and accrue interest for me, rather than the government.


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[trophyhusband]

Trophy- you're absolutely right, but I prefer to do it myself for a couple reasons:
- moonlighting hours can ebb and flow, making w4 deductions a SWAG in the best of circumstances
- if rather I have the money sit in a savings account and accrue interest for me, rather than the government.


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Couple of things:
- Correct, we're probably underpaying slightly but we won't know until the end of the year. At any rate, we're keeping the difference between the extra withholding and 40% of the income in savings.
- The problem with this is that if you're not paying estimated taxes on the income you're going to have to pay a penalty of 3% (probably not in the first year since the IRS won't know that you should have been paying estimated taxes but they will in subsequent years). So it's unlikely that the interest you accrue in your savings account is going to offset the 3% penalty.

We owed more than $1,000 in taxes this year so we technically should be paying estimated taxes but we just increased withholding instead. In the end we'll probably still be under-withheld and owe the 3% but it'll be on a lesser amount than it would have been if we had just put all of the money in savings. Just something for everyone to keep in mind.

 

[notdeadyet]

- The problem with this is that if you're not paying estimated taxes on the income you're going to have to pay a penalty of 3% (probably not in the first year since the IRS won't know that you should have been paying estimated taxes but they will in subsequent years). So it's unlikely that the interest you accrue in your savings account is going to offset the 3% penalty.

Excellent point. I should have mentioned that I'm paying the quarterly estimations based on last year's taxes from the savings account and letting the rest ride there.

 

[TexasPhysician]

You can always increase your withholding on your residency/fellowship W-4 as well to account for the extra 1099 moonlighting income (unless you're at one of the few programs that doesn't withhold because they're fighting with the IRS - UTSW and maybe Mayo are two I think I remember correctly). We're withholding an extra $600ish per paycheck from my wife's fellowship paycheck for Fed/State taxes. This will also help you not have to pay estimated taxes.

Exactly what I do. W4 = 0

 

[brodaiga]

I've been moonlighting through some locums agencies. How much are you guys getting paid per hour?

 

[TexasPhysician]

I've been moonlighting through some locums agencies. How much are you guys getting paid per hour?

Usually $100-200/hr

 

[cookymonster]

Assuming that 91k is pre-tax, did the hospital deduct taxes before paying you or were you left having to pay a large sum every April 15? This isn't a question for/against moonlighting; I intend to moonlight during residency, I just want to plan my finances accordingly.

W-2, I think with 1 deduction. Like NDY said, different places will compensate you with W2 and 1099 income.

 

[FranzLO]

Sorry to bump this thread but can anyone explain a little more about moonlighting? What types of settings are there? I see that psych ER is an option. Also, I assume it is program specific but do most programs start at PGY-3 rather than PGY-2? Being able to make more money and gain experience is very important to me, and while I obviously wouldn't pick a specialty based on moonlighting, am I right in thinking that Psych is one of the better ones for it since the residency hours tend to be less and maybe there are more opportunities? I just wonder how common it is when I hear of residents making 100-150k during years 3-4.

 

[notdeadyet]

What types of settings are there?

Just about any, but most moonlighting tends to be PES/inpatient with outpatient community a pretty distant second.

I assume it is program specific but do most programs start at PGY-3 rather than PGY-2?

Don't know that one. PGY-2 had slim pickings. Many employers want folks who are PGY-3 or higher.

am I right in thinking that Psych is one of the better ones for it since the residency hours tend to be less and maybe there are more opportunities?

Yes and yes.

I just wonder how common it is when I hear of residents making 100-150k during years 3-4.

Very uncommon but do-able. Most residents who moonlight make an extra $10-25K/year. It depends on how much of your free time you want to devote to moonlighting. You could make $150K/year with you base salary plus moonlighting for most of your free time (think, 6 out of 8 weekend days and some evening work) but you'd be pretty burned out and you wouldn't be able to fully take advantage of residency, which would likely be penny-wise and pound foolish.

 

[Leo Aquarius]

Sorry to bump this thread but can anyone explain a little more about moonlighting? What types of settings are there? I see that psych ER is an option. Also, I assume it is program specific but do most programs start at PGY-3 rather than PGY-2? Being able to make more money and gain experience is very important to me, and while I obviously wouldn't pick a specialty based on moonlighting, am I right in thinking that Psych is one of the better ones for it since the residency hours tend to be less and maybe there are more opportunities? I just wonder how common it is when I hear of residents making 100-150k during years 3-4.

Making 100K I think is very do-able. Rates in California are around $80 to $120 an hour. Fit 5 or 6 moonlighting shifts a month into your schedule and it can be done. I bring in around 100K a year working about this much.

 

[shan564]

Just about any, but most moonlighting tends to be PES/inpatient with outpatient community a pretty distant second.

Don't know that one. PGY-2 had slim pickings. Many employers want folks who are PGY-3 or higher.

Yes and yes.

Very uncommon but do-able. Most residents who moonlight make an extra $10-25K/year. It depends on how much of your free time you want to devote to moonlighting. You could make $150K/year with you base salary plus moonlighting for most of your free time (think, 6 out of 8 weekend days and some evening work) but you'd be pretty burned out and you wouldn't be able to fully take advantage of residency, which would likely be penny-wise and pound foolish.

Agree with most of the above, with a couple of addenda based on experience at my program:
We have in-house moonlighting - the options are to work 6 hours on any weeknight in the ER as well as being the overnight backup, who usually gets paid to sleep, but occasionally gets paid extra to come to work when the on-call person needs extra help. Occasional additional opportunities also arise. You can be the overnight backup as a PGY2 (which will earn you around $100 to sleep near your pager, plus the market hourly rate if you get called in - some people do it multiple times a week, some people do it once a week). As a PGY3, you can take the regular ER shifts, which will pay you about $500 pre-tax and most people do it about once a week, depending on how many people in your class want to do it. I've heard of people earning over $100k without working too hard, but that would be contingent on supply/demand. In-house moonlighting is great because you don't have to go very far (most residents live near the hospital, and most of them are already at the hospital during the day anyway), you know the system, you know the people you're working with, etc... you're essentially doing the exact same thing that you did as a PGY2 on your required ER calls, except that it's optional and you're getting paid for it.

 

[milesed]

During my 3rd-5th year in training, I spent every opportunity I had moonlighting in local CMHC's. We were allowed 1/2 day a week (on the clock) for this and were covered by the program's malpractice and were paid through the program. The centers had late hours so I could work 8 hours in 1 day, then 2-3 on others and I drove to a distant clinic 1-2 Saturdays a month as well. I doubled my residency salary this way. Others worked a local hospitals or private practices (they had to buy additional malpractice insurance that was only about $1000) and worked as much as they wanted.

It really put those who worked extra way ahead of those who did not in regards to experience and comfort level seeing difficult patients after residency. Malcolm Gladwell talks about the magic 10,000 hours practice needed to be very good at something and this work got me there faster.