Moonlighting policy at your residency

[Hercules]

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Hey everyone,
We're reviewing our own moonlighting policy with the possibility of making some changes, and I thought it might be nice to have an idea of what the moonlighting policies are at other programs. I ran a search and got information on 3 or 4 programs on here, but was looking for info from more programs if possible. Here are my main questions for you guys:

What kinds of in-house opportunities do you have to moonlight?
What year are you allowed to start moonlighting?
Do you have required scores on the inservice, and if so what are they?
What percent of conference must be attended to keep moonlighting privileges?
Does your program allow moonlighting in single coverage or just double coverage EDs?

Thanks!

 

[Seaglass]

No moonlighting as a doctor as an intern. Internal moonlighting in the Fast Track as a 2. Outside moonlighting as a 3. You must have good conference attendance/be in good standing to moonlight.

 

[Seaglass]

Oh sorry, about the specifics:

70% conference attendance.
You may do single coverage as a 3, double as a 2 (but here almost noone moonlights outside as a 2).

 

[GRchief]

GRMERC/MSU--Grand Rapids

1. No in-house moonlighting
2. No moonlighting until 3rd year of post-grad training
3. Must be in good standing. Good inservice and monthly quiz scores.
4. Conference, journal club, and procedure lab attendance required (we are allowed 12 hours of "personal time" per year to use as needed to miss these). Not excused from these activities to moonlight.
5. No restrictions on location. Single-covered, double-covered, Aeromed.
6. Total hours, including moonlighting, average 80/wk or less.

 

[FoughtFyr]

What kinds of in-house opportunities do you have to moonlight?
What year are you allowed to start moonlighting?
Do you have required scores on the inservice, and if so what are they?
What percent of conference must be attended to keep moonlighting privileges?
Does your program allow moonlighting in single coverage or just double coverage EDs?

Thanks!

"In-house" moonlighting only to teach ACLS, PALS, etc at $75/hr. Possible to teach 4x monthly.

Can teach starting PGY-1, true moonlighting after licensure (PGY-2).

No in-service or attendence "requirements" but moonlighting is at the discretion of the PD I if you weren't meeting the program's requirements, moonlighting would stop.

Moonlighting is through the larger health system. It includes double and single coverage.

- H

 

[iatrosB]

I thought that the EM world frowned upon moonlighting (at least in EDs) because it gives credence to the notion that someone other than a residency trained EM doc can work there. Am I wrong?

 

[kungfufishing]

SAEM is anti moonlighting. My experience has been that moonlighting is publicly discouraged but often privately encouraged. Especially in more rural areas, where none of the options are board certified, you could often do worse than an EP in training.

 

[FoughtFyr]

I thought that the EM world frowned upon moonlighting (at least in EDs) because it gives credence to the notion that someone other than a residency trained EM doc can work there. Am I wrong?

Here is EMRA's take:
What is EMRA's position on Moonlighting during residency?

• EMRA's current policy states: EMRA firmly believes that emergency medicine is best practiced by an emergency medicine residency-trained ABEM/AOBEM board certified physician.
• EMRA recognizes that the current number of such emergency physicians is not adequate to provide full coverage 24-hours a day – 7-days a week – for all emergency departments. For this reason, EMRA supports resident moonlighting by senior EM residents with approval of the residency director under any of the following conditions: in underserved areas, in areas where nurse practitioners and/or physician assistants practice independently, i.e., fast tracks and in double coverage emergency departments.
• Some critics of this policy have argued vehemently that our policy is contradictory to our mission. However, because of workforce shortages, the EMRA membership has decided to maintain this stance.
• The EMRA Representative Council (i.e. the EMRA membership) voted on several occasions to uphold this position despite opposition from other organizations.
• There are many benefits to resident moonlighting aside from the financial aspects. By practicing independently, residents begin to hone their skills and broaden their educational experience. The vast majority of residents who moonlight view it as a positive experience and supplement to their residency training.

From: http://www.emra.org/Index.cfm?FuseAction=Page&PageID=1002155

However AAEM/RSA says:
AAEM Resident Section Position Statement on Resident Moonlighting
The Resident Section of the American Academy of Emergency Medicine believes that the independent practice of Emergency Medicine is best performed by the ABEM/AOBEM certified Emergency Medicine specialist. We believe this is the standard of care in emergency department practice, and should be advocated without reservation. Various organizations have proffered their respective opinions regarding this issue with quite diverse conclusions. We believe that patient care and the regard of our specialty suffers when any resident with a medical license regardless of his or her paucity of experience becomes licensed and actively practices independently in an emergency department. In the near future the increased number of residency-trained emergency physicians will allow even smaller and rural emergency departments to employ Emergency Medicine specialists. The honor of specialist in Emergency Medicine is currently conferred only to physicians who undergo rigorous training in Emergency Medicine and pass both written and oral certification exams. When we condone unrestricted moonlighting in an emergency department by any insufficiently trained resident, Emergency Medicine or any other specialty, we denigrate the value of our profession and ultimately aid our detractors in their effort to demonstrate our training is without added value. Therefore:

Residents should not engage in the independent practice of Emergency Medicine until three years of Emergency Medicine residency training is completed. Moonlighting in emergency departments should be limited to the educational arena where adequate backup is ensured and the resident may add to his or her experience of practice without lowering the level of patient care.

The current financial situation of residents is not lost upon this resident organization. We must ally to lobby for student loan deferment for the entire length of a residency. We must also encourage Emergency Medicine residency programs to allow for moonlighting opportunities within the confines of residency training to abate the financial incentive of extracurricular moonlighting. There have been many arguments made on both sides of this debate, however two things must remain paramount in our discussion and seem to have been lost: One is promoting the value of our specialist training, the second is attention to the level of patient care. With these things considered we must disallow ourselves the short-term gain of independent emergency department moonlighting, and we must encourage other residents to do the same.

from: http://www.aaemrsa.org/issues/moonlighting.php?topic=aaemres

In short, there are very discordant views on resident moonlighting within the profession.

- H

 

[Hercules]

I thought that the EM world frowned upon moonlighting (at least in EDs) because it gives credence to the notion that someone other than a residency trained EM doc can work there. Am I wrong?

Unfortunately its more than a notion. In underserved areas and in many states, EM trained physicians are hard to come by. Some of these spots are already being filled by FP and IM residents, and I think a senior EM resident is vastly superior to a non-trained random physician and thus better for the patients. That's the high-brow ethical defense of moonlighting for me. Realistically speaking though, I plan on moonlighting for my own benefit more than out of a desire to save my patients from untrained IM/FP residents.

The benefits of moonlighting for the EM resident are well established. The money is only part of it. I have never spoken with an attending who moonlit that thinks its a bad idea. For those of us leaving the ivory towers, moonlighting is also part of our resume and a major positive when searching for a job.

I don't want to get too far off track of the thread's stated purpose though, so thanks for everyone's replies so far and keep them coming!

 

[GeneralVeers]

In Los Angeles moonlighting is almost a requirement for residency, as the cost of living is far too high for many residents. I know a few who would be sleeping in their cars if they couldn't moonlight.

We had in-house moonlighting in urgent care, and many residents moonlight at Kaiser or private Walk-In clinics. All moonlighting activities require approval from the PD, and residents with low-inservice scores were often barred from moonlighting. We had no requirement for conference attendance.

 

[The White Coat Investor]

Discouraged but allowed at Arizona. About half the senior class would do it each year. Few did more than a shift or two a month.

 

[DrMom]

We're strongly encouraged to do moonlighting in EDs as soon as we have our license PGY 2. With my former attendings (all of my attendings were recently replaced), we could only moonlight in urgent care during PGY2, then EDs after that.

We're not permitted to miss any educational sessions to moonlight. There is no inservice exam score requirement. We can moonlight with either single or double coverage from day one. We have no in house moonlighting opportunities.

 

[waterski232002]

We can moonlight in-house as a PGY-1 (all you need is to have done 1 month of EM). No conference attendance requirements, no inservice score requirements. You can moonlight out-of-house once you pass step III.

Most of our residents don't actually moonlight out-of-house b/c we do international transports which pays $1,000 - $1,500 for 2 or 3 days overseas, respectively.... everything is paid for, all tickets are 1st class and you keep the triple miles, 5 star hotels anywhere in the desitination city, and you can opt to request 1 extra night. It's a paid vacation....

 

[GeneralVeers]

We can moonlight in-house as a PGY-1 (all you need is to have done 1 month of EM). No conference attendance requirements, no inservice score requirements. You can moonlight out-of-house once you pass step III.

Most of our residents don't actually moonlight out-of-house b/c we do international transports which pays $1,000 - $1,500 for 2 or 3 days overseas, respectively.... everything is paid for, all tickets are 1st class and you keep the triple miles, 5 star hotels anywhere in the desitination city, and you can opt to request 1 extra night. It's a paid vacation....

You guys suck.....😛

 

[ER-ER-Oh]

MSU/Sparrow Lansing MI:

We can moonlight in-house in our double coverage ED, in the "C-hall". It's staffed by a seperate attending and PA's. Because there aren't enough PA's to staff all the shifts we can fill in @ $50/hr for a 10 hr shift. We have a satellite ED, where we can also work PA shifts. You must have 6 mos. in residency and the approval of the PD, and generally have a proven record of being effecient and independent. You get reviewed occasionally, and if the feedback of the attendings is not good you can have your privileges revoked.

Once you have step-III you can moonlight in fast track independently, or work as an "attending" at one of the other rural ED's in the system, although I don't know anyone who currently does so. You need to be fairly exceptional to do this I believe.

Finally, we also teach ACLS for the fire dept and for the nursing school and medical students.

 

[EM Junkie]

Bumped for some more up to date info.....

I was told my my PD that the RRC won't allow internal moonlighting at your primary training hospital, yet it seems to be allowed by some.

Which residencies allow internal "fast-track" types of moonlighting, and how much do you get paid?

Thanks in advance!

 

[DOnut]

We were told the same thing as above that the RRC does not allow internal moonlighting, or moonlighting at any facility where you train, however I can not seem to find this anywhere. Is it true, or just something my program does. It does seem like policy changes greatly from department to department or program to program.

We are forced to go to small very rural departments to moonlight in our PGY-3 year. Most of these are single coverage.......but it pays very well.

 

[southerndoc]

Bumped for some more up to date info.....

I was told my my PD that the RRC won't allow internal moonlighting at your primary training hospital, yet it seems to be allowed by some.

Which residencies allow internal "fast-track" types of moonlighting, and how much do you get paid?

Thanks in advance!

I've never heard this. We've allowed internal moonlighting at my institution for a while now. I have done moonlighting during all four years of residency.

I doubt the RRC forbids internal moonlighting since there are specific regulations regarding internal moonlighting and work hour rules. Internal moonlighting counts toward your total hours and follows the work hour rules since it's within your own institution. My institution also applies external moonlighting toward work hour rules.

 

[AmoryBlaine]

Maybe too general a question but for residents at programs that allow/encourage moonlighting what sort of bump is this giving your yearly salary?

As a rule are we talking about beer money or rent money?

 

[kungfufishing]

I think this depends on what region of the country you are in. In the south I know 110-140/hr gigs are fairly common, in varying setups in terms of rurality, coverage and acuity.

 

[gutonc]

Maybe too general a question but for residents at programs that allow/encourage moonlighting what sort of bump is this giving your yearly salary?

As a rule are we talking about beer money or rent money?

There was a poll on the General Residency board a couple of months ago (Kimberli Cox started it if that helps you find it.) Across all specialties the range was $50-100/h but I don't remember too many EM folks chiming in. But 1 or 2 8-12 hour shifts a month, even @ $50 an hour is rent money in my mind...or beer money for your entire department.

I know of Derm folks who more than doubled their annual salary by moonlighting urgent care...when you only work 30-40h/wk it's easy to do another 2 shifts a week and not even notice the time impact.