Moonlighting

[The Sports Doc]

Hello all. I want to know how residents maintain the 80 hr limit with the moonlighting

And does a resident need to moonlight in the same specialty as the residency?

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[VA Hopeful Dr]

So there's essentially 2 options. A) Only moonlight when you won't go over 80 hours. If you're not on a call month, that should be easy. B) Lie about your hours (I would not recommend this but it is done).

Its not the specialty that matters its what you're being asked to do. I had 2 moonlighting jobs - one was doing disability exams for the state, the other was weekend coverage at a psych hospital. The latter was psych not FM but I was really just there for acute issues. That's much different than coming up with long-term psychiatric treatment plans.

 

[Merely]

So there's essentially 2 options. A) Only moonlight when you won't go over 80 hours. If you're not on a call month, that should be easy. B) Lie about your hours (I would not recommend this but it is done).

Its not the specialty that matters its what you're being asked to do. I had 2 moonlighting jobs - one was doing disability exams for the state, the other was weekend coverage at a psych hospital. The latter was psych not FM but I was really just there for acute issues. That's much different than coming up with long-term psychiatric treatment plans.

You were on call at a psych hospital acting as a psychiatrist or as a medical consultant?

 

[VA Hopeful Dr]

You were on call at a psych hospital acting as a psychiatrist or as a medical consultant?

Yes.

I was the only doctor in house at that time. There was a back up available by phone (one of the staff psychiatrists), but I never needed that.

 

[Merely]

Yes.

I was the only doctor in house at that time. There was a back up available by phone (one of the staff psychiatrists), but I never needed that.

I don’t understand, you were acting as a psychiatrist as a family medicine resident? You were looking over psychiatric medication regimens and making adjustments based on your experience as a FM resident?

 

[VA Hopeful Dr]

I don’t understand, you were acting as a psychiatrist as a family medicine resident? You were looking over psychiatric medication regimens and making adjustments based on your experience as a FM resident?

I was acting as a licensed physician, which I was.

If needed, I could have adjusted medication regimens. Not sure why I would though. My purpose (and everyone else who was there on the weekends) was to address acute problems. 90% of the calls I got were informing me when they had to use a PRN med on a patient. The rest were general medical issues: elevated blood sugar, cold symptoms, that sort of thing.

 

[Merely]

I was acting as a licensed physician, which I was.

If needed, I could have adjusted medication regimens. Not sure why I would though. My purpose (and everyone else who was there on the weekends) was to address acute problems. 90% of the calls I got were informing me when they had to use a PRN med on a patient. The rest were general medical issues: elevated blood sugar, cold symptoms, that sort of thing.

You understand psych is a residency right? Not any licensed physician can do it..

 

[VA Hopeful Dr]

You understand psych is a residency right? Not any licensed physician can do it..

I think you don't understand how physician licensing works.

I am a licensed physician. My license doesn't state what type of physician I am or what my training is in. It is a license to practice medicine and surgery. Full stop. So yes, any licensed physician can do it.

Now whether or not they can do it well is another story entirely. Given that as a family doctor probably a third of my day consists of treating psychiatric illness, I feel pretty good about doing PRN coverage at a psych hospital.

 

[Merely]

I think you don't understand how physician licensing works.

I am a licensed physician. My license doesn't state what type of physician I am or what my training is in. It is a license to practice medicine and surgery. Full stop. So yes, any licensed physician can do it.

Now whether or not they can do it well is another story entirely. Given that as a family doctor probably a third of my day consists of treating psychiatric illness, I feel pretty good about doing PRN coverage at a psych hospital.

Dude you’re not a psychiatrist, you are practicing outside your scope by acting as a psychiatrist rounding on patients on an inpatient psychiatric unit..that’s like saying I’m a family doctor so now I want to cover a surgical unit or a derm clinic, etc etc..yes any doctor can technically do it but you’re practicing outside your scope and in a lawsuit you would get destroyed when a real psychiatrist gets on the stand.

 

[VA Hopeful Dr]

Dude you’re not a psychiatrist, you are practicing outside your scope by acting as a psychiatrist rounding on patients on an inpatient psychiatric unit..that’s like saying I’m a family doctor so now I want to cover a surgical unit or a derm clinic, etc etc..yes any doctor can technically do it but you’re practicing outside your scope and in a lawsuit you would get destroyed when a real psychiatrist gets on the stand and skewers your ass lol

Your reading comprehension is somewhat lacking. Who said anything about rounding? I was there in case there was a problem. In a 24 hour shift I bet I maybe saw 1-2 patients and only when called with a problem.

And no, I wasn't acting as a psychiatrist. I was acting as a family doctor. If I were sued in my state (and many others), it would be another family doctor on the stand acting as expert witness not a psychiatrist.

Edit: I think we've derailed this thread enough. If you want to continue discussing this, might be wise to either start a new thread. In the meantime, might be good to let this get back to the OPs questions.

 

[Merely]

Your reading comprehension is somewhat lacking. Who said anything about rounding? I was there in case there was a problem. In a 24 hour shift I bet I maybe saw 1-2 patients and only when called with a problem.

And no, I wasn't acting as a psychiatrist. I was acting as a family doctor. If I were sued in my state (and many others), it would be another family doctor on the stand acting as expert witness not a psychiatrist.

I mean if you’re on call just for medical complaints with a psychiatrist rounding daily then obviously that’s not an issue I misunderstood

 

[cabinbuilder]

I did different moonlighting jobs while in residency:

1. Held the pager for the oncologist when he was OOT, more of a formality for him since all his patients were managed by his staff
2. Was Clinic Director for a Plasma Center. Essentially was a chart review job, had to talk to patients who failed the lab screening.
3. Worked urgent care for a physician who was one of our attendings who owned the urgent care.

 

[The Sports Doc]

I don’t understand, you were acting as a psychiatrist as a family medicine resident? You were looking over psychiatric medication regimens and making adjustments based on your experience as a FM resident?

FM resident can do most of the things as phych

 

[MedicineZ0Z]

You understand psych is a residency right? Not any licensed physician can do it..

Tell that to psych NPs

 

[Atlas Shrugged]

Tell that to psych NPs

That’s doctor nurse practitioner to you, buddy.

 

[eimaise]

Hello all. I want to know how residents maintain the 80 hr limit with the moonlighting

And does a resident need to moonlight in the same specialty as the residency?

During my residency (med-peds), I moonlighted as a hospitalist (covering medical floors, level 2 nursery, and adult ICU) and did night shifts in urgent care seeing all kinds of things. Had to pick up shifts primarily on clinic/elective months to stay under the 80 hour requirement but occasionally did a Friday night 7p-7a hospitalist shift while on medicine wards... but still stayed under. Remember, it’s an 80 hour a week rule averaged out of over 4 weeks.

Generally you moonlight in your specialty ... ask around in your residency to see what people are up to. However, I know FM residents who did internal moonlighting in the ED and I know IM residents who moonlighted in certain radiology facilities to cover emergencies in case someone codes or has a reaction to IV contrast (not really outside the speciality I guess... but just shows there’s lots of diversity in opportunities out there).