Aug 18, 2016
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I just started a fellowship in a medicine subspecialty at a place that doesn't allow moonlighting. Also I just got good news that basically makes it extremely clear that I will need to significantly raise my income above what a fellow is currently making for pretty much the duration of my fellowship and likely for the rest of my life (I guess this is both good news and bad news in a way). Thus I want to take a chance and moonlight as a hospitalist or other medicine position (or at least am strongly considering it. The alternative seems to be uber). Yes I know there are risks and yes I know its reflects on ethics and professionalism and etc but this is a rather inflexible social situation. At this time I'm not really interested in opinions regarding whether I should do it or not or a thorough discussion of the risks and benefits. I'm also not really interested in discussing my need for extra income with the program either because I do want to maintain this wall of privacy about it.

What I am interested in is HOW people do it. You see people at my fellowship do moonlight but its very hush hush and despite asking extensively around, as soon as I bring it up, I hit a stone wall of silence. My basic research into the matter seems to be that most of the risk appears to be with employment verification, where the employing facility has to confirm that you are a working fellow (otherwise you have this block of time that is unaccounted for and needs to be explained otherwise) and so they may contact your program. But yet people ARE moonlighting without program directors knowing. How is this happening?

So there. I asked a very dirty question (I feel like a 14 year old asking an adult about how to put on a condom or how to have sex) but one I have to ask. How do people get moonlighting jobs without their programs knowing? How do they not all get caught during credentialing?
 

AdmiralChz

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Pretty vague about needing a lot of additional income, which is your call. Having twins or something more nefarious...?

I have no advice here, but in the age of the Internet don't be surprised if some your moonlighting somehow finds its way online via social media or other sites (including online hospital directories). I'd venture to say if you've been told in advance that external moonlighting is strictly forbidden (which is not at all unusual, especially at large academic centers), you run the risk of being fired on the spot if caught. Are you willing to take that risk, just to be temporarily more comfortable - really way the risk/benefit profile here.
 

Promethean

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Don't get caught.
 
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OP
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Aug 18, 2016
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Pretty vague about needing a lot of additional income, which is your call. Having twins or something more nefarious...?

I have no advice here, but in the age of the Internet don't be surprised if some your moonlighting somehow finds its way online via social media or other sites (including online hospital directories). I'd venture to say if you've been told in advance that external moonlighting is strictly forbidden (which is not at all unusual, especially at large academic centers), you run the risk of being fired on the spot if caught. Are you willing to take that risk, just to be temporarily more comfortable - really way the risk/benefit profile here.
Yes I'm willing to risk it. One is the fellowship itself doesnt add that much to my earning potential over just completing internal medicine which I have already done and I actually really already like IM a lot anyway and could do it forever. Also I actually don't think an on the spot firing will happen based on the attitude the program has given and their past behavior. I think you're much more likely going to have to simply sit and have an uncomfortable conversation about it.

Like I said I'm still weighing the risks and benefits and that's really not what I want do discuss. I'm really more interested in information on the credentialing and employment verification process and how other people who have moonlighted either without explicit permission (or a program that allows moonlighting but you simply didn't let them know about ALL the moonlighting your were doing) got through the initial application process without being caught. Heck even knowledge about how much contact a locums or other facility had with your program that DID give general permission for moonlighting would be useful. I just need information on what initial process is like.

One word for you: Locums. Find a Locums agency and get work through them. They have no business knowing what else you do for work, you're a gun for hire.

Congratulations on the baby!
So should I tell the locums I'm in a fellowship? Or not tell them? Won't they find out anyway if they do any sort of casual search?

Or are you saying that most locums companies will not care? And don't facilities that locums contract to do their own credentialing and employment verification as well?
 

michaelrack

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One word for you: Locums. Find a Locums agency and get work through them. They have no business knowing what else you do for work, you're a gun for hire.

Congratulations on the baby!
Most sites where the locums agency has you work will still want to credential you. Working through a locums agency will in no way keep you from caught.
The locums agency may, however, be able to find you work at a place that wont contact your fellowship- such as possibly a prison.
 

irJanus

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Congrats first off
Second... If the fellowship doesn't mean much, if you're happy with general medicine, then why not just approach the program about the situation, offer a solution to them (limit hours of moonlighting or something, but you drive that car) and if they balk or flat out say no, walk.
I mean, is that not the safer way? Then you don't risk a professional blackballing
 
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QofQuimica

Seriously, dude, I think you're overreacting....
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Congrats first off
Second... If the fellowship doesn't mean much, if you're happy with general medicine, then why not just approach the program about the situation, offer a solution to them (limit hours of moonlighting or something, but you drive that car) and if they balk or flat out say no, walk.
I mean, is that not the safer way? Then you don't risk a professional blackballing
Yeah, I agree.

Since you're willing to leave fellowship if your needs aren't met, OP, why not at least give the PD a chance to try to work out some kind of acceptable compromise that you can both live with? You might be pleasantly surprised to find out that they'd be willing to work with you to try to retain you. Then you could have your cake and eat it too. Or, maybe they'd tell you no, in which case you could express your regrets, give adequate notice, and go earn some real money as a FT hospitalist (which is way more than what you could earn moonlighting as a fellow). Either way, you wouldn't have to worry about all this cloak and dagger credentialing stuff coming back to bite you in the butt.
 

BobBarker

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if the moonlighting facility has a real need they will be happy to not contact your fellowship or you could always just do disability physicals.
 

NRAI2001

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Cant you just not tell them you re in fellowship and just use your prior residency for credentials and employement verification?

Alternately you could go do locums/hospitalist work during any vacation time you have? If you have a month during the year you could make 30-$50K doing hospitalist type of work? That should be more than enough to create a little nest egg for yourself?
 

ProfMD

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With regards to hospital credentialing committees, most will want a list of all the places where you have held privileges and/or trained. They will then request that each program director and/or service chief at each hospital/program sign off on your competence as a physician. I would be concerned that the hospital you are moonlighting at will contact your fellowship program or fellowship hospital.
 

caffeinemia

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Consider locums at outpatient facilities -- urgent cares, etc etc. Some are staffed by pediatricians, FM, and IM doctors. Seems to be okay.
 
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Is the forbidding of moonlighting contractually or policy based? If it is, then you can't do it. If it isn't contractually stated, then moonlighting shouldn't be forbidden and if they give you any issues with it, you would have legal recourse, as they would not be able to dictate to you how to spend your free time. The flip side would be that THEY would have legal recourse if it was contractually or policy forbidden and you defied this and did it anyway.
 

Raryn

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I mean, you could just lie when getting credentialed at the moonlighting gig. That is, not list your fellowship.

Otherwise, I don't see a way to do it. Anytime you get priveleges at a hospital they will confirm with anywhere you ever trained that you were in good standing.

Probably wouldnt drive an uber though. I mean, I'm sure it pays more than residency, but as a board certified specialist? That's just insulting.
 

AdmiralChz

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For our institution (and state) moonlighting implies you are issuing your license to provide some sort of medical care. Uber clearly does not count, but most people wouldn't be thrilled because the reimbursement will be far, far less than traditional medical moonlighting even with tips.
 
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