Moonlighting

[lockian]

So one of the things I've noticed on the interview trail so far is that some programs will emphasize that they're moonlighting friendly, and residents will talk about their moonlighting experiences, while some programs will not mention it at all.

Interestingly, these are also the residencies where the cost of living is touted as "very reasonable," and while you may get paid a little less, $45,000 a year in Nevada still takes you a helluva lot farther than your $58,000 in Hawaii or New York.

So what's the deal? Does a culture of moonlighting say anything either way about a program?

Obviously, we're in a specialty where we do get more free time, so moonlighting is unlikely to be as onerous, but I kind of like my free time, and I wonder if a "very reasonable" cost of living really means "very reasonable" but only if you do in fact moonlight.

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[DuskPhilosophy]

So one of the things I've noticed on the interview trail so far is that some programs will emphasize that they're moonlighting friendly, and residents will talk about their moonlighting experiences, while some programs will not mention it at all.

Interestingly, these are also the residencies where the cost of living is touted as "very reasonable," and while you may get paid a little less, $45,000 a year in Nevada still takes you a helluva lot farther than your $58,000 in Hawaii or New York.

So what's the deal? Does a culture of moonlighting say anything either way about a program?

Obviously, we're in a specialty where we do get more free time, so moonlighting is unlikely to be as onerous, but I kind of like my free time, and I wonder if a "very reasonable" cost of living really means "very reasonable" but only if you do in fact moonlight.

If you're talking about Nevada you'll be fine with the base salary without any moonlighting at all.

I think the emphasis on moonlighting comes from so many past applicants being concerned about it. Also if you could more than double your salary in residency isn't that something you would want to know?

 

[deleted314290]

Moonlighting, in my opinion, is a great way to improve your skills and get more experience outside of general residency. I would look at it as additional training with the perk of getting paid for it. Some programs have affiliated sites where you can moonlight while others make you go outside of the program. You can moonlight as much or as little as you want. I know residents who moonlight 2-3x a week and make great money, while others do it once a month. Moonlighting is a huge perk if the program offers it. If you are concerned about cost of living, there are calculators where you can see how much your money will get you, compare cities, etc.

 

[eli20]

If you're talking about Nevada you'll be fine with the base salary without any moonlighting at all.

I think the emphasis on moonlighting comes from so many past applicants being concerned about it. Also if you could more than double your salary in residency isn't that something you would want to know?

My experience so far is that it seems like the programs in the more expensive cities none of the residents moonlight - I personally found this a little concerning, especially at one in particular where everyone who talked about living inside the actual city was married/partnered and had 2 incomes.

 

[digitlnoize]

In general, programs don't talk about something because it's a weakness. My program is weak on moonlighting. We can't start until PGY-3 (it's PGY-2 at most places) and the two approved moonlighting sites (both state hospitals 45 minutes away) are easy gigs, but pay crap (~$65/hour) because they can. So it's not exactly advertised.

 

[notdeadyet]

My experience so far is that it seems like the programs in the more expensive cities none of the residents moonlight

This might be selection bias. Many folks might flock to more expensive cities because SOs have more career options there.

I'm in one of the most expensive cities in the country and moonlighting opportunities are plentiful.

 

[DuskPhilosophy]

My experience so far is that it seems like the programs in the more expensive cities none of the residents moonlight - I personally found this a little concerning, especially at one in particular where everyone who talked about living inside the actual city was married/partnered and had 2 incomes.

I did a sub-I at one of the residencies in the greater LA area and they were huge on moonlighting.

 

[Doctor Bagel]

I did a sub-I at one of the residencies in the greater LA area and they were huge on moonlighting.

I remember UCLA-Harbor had a lot of inhouse moonlighting. I can't remember with UCLA. With other west coast places, UW seemed to have none (or the residents I met were all disinterested in this). OHSU has one local place where you can pick up shifts that pays poorly ($68/hour), but you can also drive 50 miles to a hospital where you can work on the weekends and make at least $3k for that. Options in Colorado seemed pretty bad, too. If you're in a desirable area, there might be less need for psychiatrists and hence less need for non-board eligible folks. I also think moonlighting as PGY2 seems kind of crazy, but maybe that's a minority opinion.

 

[splik]

I remember UCLA-Harbor had a lot of inhouse moonlighting. I can't remember with UCLA. With other west coast places, UW seemed to have none (or the residents I met were all disinterested in this). OHSU has one local place where you can pick up shifts that pays poorly ($68/hour), but you can also drive 50 miles to a hospital where you can work on the weekends and make at least $3k for that. Options in Colorado seemed pretty bad, too. If you're in a desirable area, there might be less need for psychiatrists and hence less need for non-board eligible folks. I also think moonlighting as PGY2 seems kind of crazy, but maybe that's a minority opinion.

UCLA does not allow in-house moonlighting but I believe its one of the places where residents are allowed to do private practice (even if it's not allowed this certainly has happened). UW does have inhouse moonlighting now but only for PGY-4 and above (as moonlight as an attending) which pays $150/hr otherwise seattle has limited (read no) moonlighting opportunities, residents drive a little further afield or do disability evals.

 

[splik]

So what's the deal? Does a culture of moonlighting say anything either way about a program?

Moonlighting culture may say more about the institution than the program as often moonlighting policies are set at the institutional level. some places outright ban moonlighting (rare), whereas others strongly discourage it, some don't care, and some places strongly encourage it. There are some places where residents are encouraged to moonlight to make up for the meager salary offerings or because they believe it provides valuable additional experience that prepares their employees for the real world and allows them to grow without supervision and work in non-academic type settings etc.

Also it does appear that programs in less desirable locations often make more of moonlighting as a way of attract applicants and convince them they can make bank and enjoy the added bonus of the low cost of living. Whereas programs in more desirable locations don't necessarily have to make such a song and dance unless the location is so prohibitively expensive that they have to encourage their residents to moonlight in order to make ends meet.

Personally I think those programs that basically pay their residents to take call in the form of moonlighting etc have it right and it would be nice to see more of this.

 

[Doctor Bagel]

Personally I think those programs that basically pay their residents to take call in the form of moonlighting etc have it right and it would be nice to see more of this.

I would have loved internal moonlighting as a resident. We did some brief opportunities to do it to cover unexpected shortages, but it wasn't a regular thing.

 

[WingedOx]

I would have loved internal moonlighting as a resident. We did some brief opportunities to do it to cover unexpected shortages, but it wasn't a regular thing.

Not sure my hospital had the $$ to afford such a thing.

Moonlighting in my large city was... adequate. Not great as in rural areas but enough to help pay the bills.

 

[splik]

Not sure my hospital had the $$ to afford such a thing.

that's what they want you to believe.

 

[WingedOx]

that's what they want you to believe.

We were essentially the state-owned tertiary care center for the state's medicaid population (in what isn't exactly a fiscally healthy state) without many private payors. They could have found a way to make it work I'm sure, but we weren't exactly swimming in cash.

 

[Doctor Bagel]

that's what they want you to believe.

I'd also have liked to train a place where the residents had a union.

 

[Shikima]

that's what they want you to believe.

So very, very true.

 

[TexasPhysician]

I'd also have liked to train a place where the residents had a union.

Even with a union, would any have power?

 

[splik]

Even with a union, would any have power?

being part of a union gives you a seat at the table and the ability to bargain terms of contract rather than have the GME office or whatever entity negotiate the terms of your contract for you which is entirely self-serving. There is a variability in how successful unionized programs have been, but it is infinitely better than not being unionized. It can lead to all out war at time but for example Children's Hospital Oakland was ultimately successful getting what they wanted after a long battle with the administration. The University of Michigan has great benefits (including 6 months of paid sick leave for serious illness without requiring disability insurance, getting your birthday off, being paid to work holidays) as does the Cambridge Health Alliance. Some other programs like harbor-ucla have crappy benefits but they would be much worse off if they weren't unionized. some places have a particular location unionized so the salary is matched. For example at san francisco general residents are unionized because they were paid less and worse benefits than when at UCSF so their contract allows them to get the similar sorts of benefits regardless of the site their work at.

Hospital administrators don't like it when residents are trashing the hospital in the press or when people are picketing outside the hospital etc. Also nurses and other unionized staff are very supportive of residents, partly because if we get better benefits this helps them in their bargaining for their contracts.

also if the administration refuses to negotiate then you can file a complaint against them and it may lead to mediation or arbitration, so if they refuse to engage, they will be forced to.

There have been some studies that have found even if there were no medicare payments to hospitals in multiple specialties residents actually bring in money to the hospital far in excess of what they cost, particular in more senior years. This hasnt been looked at for psych residents (i suspect we are just a waste of money for the most part, certainly at my institution we are a financial black hole)

 

[SourceOfDenial]

In general, programs don't talk about something because it's a weakness. My program is weak on moonlighting. We can't start until PGY-3 (it's PGY-2 at most places) and the two approved moonlighting sites (both state hospitals 45 minutes away) are easy gigs, but pay crap (~$65/hour) because they can. So it's not exactly advertised.

It's not really much of a disadvantage. You can start pgy2 in my program, but by the time you get offered a gig, get your DEA, full license, it's near third year anyway.

Plus places that take moonlighters would rather have a resident with more experience than some one fresh out of internship.

Your program is likely being more realistic than everyone else.

 

[FlowRate]

being part of a union gives you a seat at the table and the ability to bargain terms of contract rather than have the GME office or whatever entity negotiate the terms of your contract for you which is entirely self-serving. There is a variability in how successful unionized programs have been, but it is infinitely better than not being unionized. It can lead to all out war at time but for example Children's Hospital Oakland was ultimately successful getting what they wanted after a long battle with the administration. The University of Michigan has great benefits (including 6 months of paid sick leave for serious illness without requiring disability insurance, getting your birthday off, being paid to work holidays) as does the Cambridge Health Alliance. Some other programs like harbor-ucla have crappy benefits but they would be much worse off if they weren't unionized. some places have a particular location unionized so the salary is matched. For example at san francisco general residents are unionized because they were paid less and worse benefits than when at UCSF so their contract allows them to get the similar sorts of benefits regardless of the site their work at.

Hospital administrators don't like it when residents are trashing the hospital in the press or when people are picketing outside the hospital etc. Also nurses and other unionized staff are very supportive of residents, partly because if we get better benefits this helps them in their bargaining for their contracts.

also if the administration refuses to negotiate then you can file a complaint against them and it may lead to mediation or arbitration, so if they refuse to engage, they will be forced to.

There have been some studies that have found even if there were no medicare payments to hospitals in multiple specialties residents actually bring in money to the hospital far in excess of what they cost, particular in more senior years. This hasnt been looked at for psych residents (i suspect we are just a waste of money for the most part, certainly at my institution we are a financial black hole)

The way medical training is accounted is funny, too. We cost nothing other than overhead/fixed costs, for the most part. If we see a patient and the hospital bills for that, it's positive revenue. You could argue that psych clinic could be re-purposed as a surgical center (or to attending-only 10-minute med checks) to make more money, but that would be a rather silly argument IMO.

 

[nitemagi]

I love moonlighting.