Moonlighting opportunities during PM&R residency..

[carlosc1dbz]

I know that many residents use moonlighting as a way to increase their income after the first year. I was just wondering if any of you have any experience with moonlighting, and if so, what challenges did you face, as a young doctor practicing out in the real world.

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[RUOkie]

I know that many residents use moonlighting as a way to increase their income after the first year. I was just wondering if any of you have any experience with moonlighting, and if so, what challenges did you face, as a young doctor practicing out in the real world.

Back in the old days (before the 90hr work week) we used to moonlight a lot. Dictating d/c summaries at $50/each for community rehab docs, urgent care clinics etc. A lot of programs forbid moonlighting now since those hours are counted toward your 90.

 

[rysa4]

I know that many residents use moonlighting as a way to increase their income after the first year. I was just wondering if any of you have any experience with moonlighting, and if so, what challenges did you face, as a young doctor practicing out in the real world.

Many of the residents in my program, including me, used to moonlight at an ER within about an hour drive of our rehab unit. There weren't any administrative issues from our program, but one resident had a couple of patient's die during his shifts and it really affected him. ( understandably).

I used to keep up on my management techniques and knowledge on basically the top 10 emergencies you must be able to handle in an ER, and then was very clear on when to call for back up, as well as what to refer to a major medical center ER and how to get that done out of a small rural ER.

My last night there I delivered a baby, which was a pretty cool way to end my acute ER duties.

 

[carlosc1dbz]

Many of the residents in my program, including me, used to moonlight at an ER within about an hour drive of our rehab unit. There weren't any administrative issues from our program, but one resident had a couple of patient's die during his shifts and it really affected him. ( understandably).

I used to keep up on my management techniques and knowledge on basically the top 10 emergencies you must be able to handle in an ER, and then was very clear on when to call for back up, as well as what to refer to a major medical center ER and how to get that done out of a small rural ER.

My last night there I delivered a baby, which was a pretty cool way to end my acute ER duties.

Wow, that sounds like fun, minus the dying part. I need a way to pay off my loans, that's why I ask. I am still looking for the millions of dollars of scholarships that go unclaimed.

 

[MSKalltheway]

There are a few programs that allow moonlighting, but it's usually not until PGY-4 year. Offhand I remember that you can at VCU at the urgent care center, and at Kessler if you publish as first author (I believe that's a UMDNJ-NJMS wide rule)

 

[topwise]

A lot of residents at my program did disability-type H&Ps. Good money, low liability.

 

[PhysMedDoc]

Where might one find be able to find jobs where you can do disability type H&Ps?

 

[PMR2008]

I did moonlighting at a subacute facility/SNF during fellowship as a consultant and I know some residents doing the same during. Pays much better than ER or urgent care and less risk. I am not sure how much disability H&Ps pay but I am sure they are hard to setup unless through the program. PM me for details.

 

[MedBronc23]

Mayo allows moonlighting PGY-2 and beyond as long as your duty hours do not exceed 80 hours. Mayo has a program called enhanced med which contracts and licenses its residents and fellows for moonlighting at various ER and Urgent care centers around SE Minnesota. Mayo pays for your liability insurance already for residency so this is already included in the Enhanced med moonlighting program. If you moonlight outside the mayo system you would have to pay for this yourself. They also reimburse your PALS ATLS training.

Pretty great gig making $60-100+ /hour depending on site and shift. I have done mostly urgent care coverage starting this JAN of my PGY-3 year but some ER coverage.

The credentialing process paperwork licensing and contract stuff at each site takes awhile and I assume it us similar other places. It too me 6 months to get approved.

My recommendation is of your program you match to allows moonlighting than to get on the application and credentialing process sooner than later.

I think it truly is a great way to enhance your training and keep up on skills within your primary specialty or outside.

For example I have been much more comfortable suturing lacerations during sports/team coverage (mostly hockey) because I do this all the time in urgent care and ER setting. It also helps be more comfortable with acute presentations like stroke that you see later on rehab wards/unit. I have even busted out the ultrasound that the ER docs I work with use to rule out appys/ gallstones check pregnancy issues and busted out my ultrasound guided injection skills from residency to help my UC/ER patients receive what I feel is a better more accurate therapy.

Currently, only 2/21 residents moonlight. Me and one of our chiefs. It's a personal choice and time away from personal life, residency obligations (reading/research), and family. I frankly read a lot or work on research when we are slow and learn a ton when we are busy. My wife appreciates the extra money. The most hours I have ever worked a month at mayo was 60 average one week or two on inpatient. A 40-50 hour work week including home call is pretty typical for us here so moonlighting is really doable.

I think it's a excellent way for someone interested in sports and interventional physiatry to expand their primary care knowledge and procedural skills.

Very glad I didn't go to a program that didn't allow moonlighting, made me publish a paper to moonlight (IMHO stupidest rule i have ever heard as it has nothing to do with work hours) or made me wait until PGY4. Great bonus at mayo and other programs. Something to strongly consider in rank because you never know when that extra money can come in handy.

PM me if you have further questions

 

[jonnylingo]

I did the Mayo Enhancemed program. Some pros, some cons:

Pros:
Autonomy - forced to make quick decisions and stand by them
$$$ - Some ED's paid 120/hr, UC tended to pay 60-90/hr, and I ended up sleeping the night away sometimes.
Experience - Saw some interesting stuff, including death, seizures, codes, MVAs


Cons:

Autonomy - But seriously, a PMR resident as the lone doc in the ED???

$$$ - because of the opportunity for making serious coin, I felt obligated to do so, at the expense of my sanity at times. I oftentimes cursed the program for existing -- "If this didn't exist, I wouldn't have to work" I felt at times obligated in order to bring some decent bacon, but at what expense? Would I want a PMR resident working on my blue child at o-dark-thirty? No way.

Experience - Although it there are many great memories, some of the dark times/hard cases overshadow the experience. I look back an shudder at times.

Paperwork - The credentialing paperwork/process seems ENDLESS. Make sure the program pays for it. Buying my home was easier than getting credentialed at some of these places. I worked at 2 ERs and 4 Urgent Cares. An absolute friggin disaster of paperwork that later bit me when securing my job post residency. Later, I had to contact each of the 6 moonlighting facilities and get paperwork in order to get privileges at my current job.

Liability - I felt like I was dodging bullets through most ED shifts. At any moment, a blue baby may come in, may get MI, OD, or a nasty MVA. And they did. Sure, help is a phone call away or a helicopter ride away, but I was nervous as ____. For a lot of stuff, I was doing Up-To-Date medicine and hoping that worked. I was lucky I didn't kill anyone or get sued. Mayo covers you, but it would still be on record.

In the end, was it worth it? The money was great, but in the big picture, just pissin on the bonfire in terms of debt payoff.

Near the end I worked mainly at UC where liability is low, the ED is next door to refer if needed, and there may be a PA or other FP to bounce ideas off.

 

[MedBronc23]

I did the Mayo Enhancemed program. Some pros, some cons:

Pros:
Autonomy - forced to make quick decisions and stand by them
$$$ - Some ED's paid 120/hr, UC tended to pay 60-90/hr, and I ended up sleeping the night away sometimes.
Experience - Saw some interesting stuff, including death, seizures, codes, MVAs


Cons:

Autonomy - But seriously, a PMR resident as the lone doc in the ED???

$$$ - because of the opportunity for making serious coin, I felt obligated to do so, at the expense of my sanity at times. I oftentimes cursed the program for existing -- "If this didn't exist, I wouldn't have to work" I felt at times obligated in order to bring some decent bacon, but at what expense? Would I want a PMR resident working on my blue child at o-dark-thirty? No way.

Experience - Although it there are many great memories, some of the dark times/hard cases overshadow the experience. I look back an shudder at times.

Paperwork - The credentialing paperwork/process seems ENDLESS. Make sure the program pays for it. Buying my home was easier than getting credentialed at some of these places. I worked at 2 ERs and 4 Urgent Cares. An absolute friggin disaster of paperwork that later bit me when securing my job post residency. Later, I had to contact each of the 6 moonlighting facilities and get paperwork in order to get privileges at my current job.

Liability - I felt like I was dodging bullets through most ED shifts. At any moment, a blue baby may come in, may get MI, OD, or a nasty MVA. And they did. Sure, help is a phone call away or a helicopter ride away, but I was nervous as ____. For a lot of stuff, I was doing Up-To-Date medicine and hoping that worked. I was lucky I didn't kill anyone or get sued. Mayo covers you, but it would still be on record.

In the end, was it worth it? The money was great, but in the big picture, just pissin on the bonfire in terms of debt payoff.

Near the end I worked mainly at UC where liability is low, the ED is next door to refer if needed, and there may be a PA or other FP to bounce ideas off.

While I think a lot of this is true for ED coverage. The UC stuff is pretty much primary care without any death or critical care involved. I think the positives outweigh the negatives. You can also tailor to your comfort level and avoid any code browns

 

[PMR2008]

I don't understand why as a rehab resident or fellow you would want to deal with EDs and UC when you can make 200/hr working at a subacute facility with flexible hours and extremely low malpractice and litigation risk. My Malpractice for working part time at a facility in Wisconsin was $500 for the whole year. I am not sure how you would defend your self in court after only doing 1 year of IM as an intern.

 

[MedBronc23]

I don't understand why as a rehab resident or fellow you would want to deal with EDs and UC when you can make 200/hr working at a subacute facility with flexible hours and extremely low malpractice and litigation risk. My Malpractice for working part time at a facility in Wisconsin was $500 for the whole year. I am not sure how you would defend your self in court after only doing 1 year of IM as an intern.

Well some of us don't have subacute facilities right in our back door. Have to work with what is available.

Also, I'd put my intern year training up against anyone's (when it comes to primary/ urgent care issues). Plus I worked ED rotation during intern year.

Again personal comfort level is key. What might seem out of your comfort zone is very much within someone else's. just trying to help the OP know what's out there. No judgment. Just how I feel

 

[DOctorJay]

I don't understand why as a rehab resident or fellow you would want to deal with EDs and UC when you can make 200/hr working at a subacute facility with flexible hours and extremely low malpractice and litigation risk. My Malpractice for working part time at a facility in Wisconsin was $500 for the whole year. I am not sure how you would defend your self in court after only doing 1 year of IM as an intern.

If this option were available here I would have done it in a second (although now that I'm giving it some thought there may actually be an option). My anes colleagues in fellowship can take anes call here for moonlighting. We get ED or UC.

 

[Taus]

More power to you w feeling comfortable doing acute care- maybe if I kept it up as a pgy2 fresh out if internship, but I have no problem saying I'm no longer qualified to do that.

Our residents at Temple/Moss have no real restrictions on moonlighting- you just can't be clearly slacking w your real clinical/academic responsibilities. Most don't do it as pgys2, as hours are a little longer and call is 2x/month. Many 3 and 4s moonlight routinely taking call at a community rehab hospital, drug n alcohol rehab and doing disability evals (our 3s take call 1x/mo and none for 4s). Some also do discharge summary dictations for another local hospital (remotely from home). Some moonlight weekly, some very sporadically.

It's certainly been very nice to be making some significant extra $$.... but I wouldn't choose a residency based upon moonlighting opportunity.

 

[jonnylingo]

While I think a lot of this is true for ED coverage. The UC stuff is pretty much primary care without any death or critical care involved. I think the positives outweigh the negatives. You can also tailor to your comfort level and avoid any code browns

Agree, shifting from ED to UC was so nice. Actually enjoyable. Low level decision making for the most part. Fun to keep up on abx for general stuff, MSK stuff was a cinch. If things became sticky, turf to ED next door. This paid less but was still 65-90/hr.

 

[MedBronc23]

Yes it is nice. It's not a big factor. But I think incoming residents should know what's out there and that some programs really don't allow them a means to use their skills to pay the bills

And or loans

 

[lobelsteve]

In residency there were a few of us who did HS sports physicals. $10 per kid. Fill out a form, brief Ortho exam, listen to the heart, review if on meds. Depending on meds and murmur a few kids would get dinged and have to get cleared from Peds.

I made a decent living as a resident.

 

[PhysMedDoc]

I've learned that one of our local resident is doing acute sickle cell crisis management at a local VA that's paying $50/hr for 12 hour shift, less than what UC can pay, but the plus is its low liability since the patient can be sent straight to ED for any emergent issues.

Doing subacute rehab definitely is right up PM&R's alley, and this would be my first choice, with UC as my second choice, while I definitely would be stretching my comfort zone far working in an ED.

 

[Gauss]

if you're thinking MSK, spine, sports as a future career do some UC or ER. order and read xrays, see fractures, cast/splint, maybe reduce, suture, maybe some physicals, etc. So what if suabacute pays better, anyone can do that, and malpractice is usually covered by your training institution.

 

[mjakec]

At UW, we can do disability evaluations during our PGY 3&4 years. Pay is $85/pt and I see between 8-12 per day.

 

[MedBronc23]

if you're thinking MSK, spine, sports as a future career do some UC or ER. order and read xrays, see fractures, cast/splint, maybe reduce, suture, maybe some physicals, etc. So what if suabacute pays better, anyone can do that, and malpractice is usually covered by your training institution.

Truth