Moonlighting

[chemist157]

I understand the Army does not permit moonlighting in residency but what is the policy as an attending?

Are there many people who still moonlight in residency, despite the policy? Would they actually dismiss you from your residency?

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[colbgw02]

It is site and boss specific once you're an attending. I have never heard of any place flat out denying it as a matter of policy. They can also "permit" it, but make the approval process an administrative nightmare.

I've never met nor heard of anyone to do this, although I'm sure it has occurred. Considering that we're paid substantially more than our civilian resident counterparts and our salary is adjusted somewhat for cost of living, I would say this decision falls firmly on the risk side of the risk:reward ratio.

 

[bogatyr]

I understand the Army does not permit moonlighting in residency but what is the policy as an attending?

Are there many people who still moonlight in residency, despite the policy? Would they actually dismiss you from your residency?

The general MEDCOM policy is that off-duty employment is a retention incentive that is granted to physicians to maintain their skills and supplement their income. You can work no more than 16 hours per week no more than 2 hour distance drive from your duty station. Every instance of off-duty employment must be approved by the local JAG office and command ahead of time. As with anything local policies can be more restrictive.

Do people break the rules? All the time. You do not want to be the one caught and have them decide to make an example out of you.

 

[Chonal Atresia]

I currently moonlight one week every other month and use official leave to do so (built up to over 60 days from 5 years of residency). This supplements my military income well raising my income from effectively around $160,000-$170,000 (including the military tax advantage) to around $280,000 per year (I'm a subspecialist moonlighting in a rural location so pay is very lucrative). This also takes into consideration not paying any state income tax (I'm a Washington state resident) which would effectively cost me $20,000 per year if I was to stay and practice as a civilian in the state where I'm currently stationed. When you are able to work like this, military medicine is not such a bad financial deal.

In addition, I generally do not work more than 45 hours per week at my military job unless I have to come in on-call, which is rare. I am still able to see around 25 patients per day and have my AHLTA notes done by 1630 and out the door.

My point is do not let everyone on this website tell you how bad military medicine is. If you play your cards right, you won't be so disgruntled.

 

[mslall]

I currently moonlight one week every other month and use official leave to do so (built up to over 60 days from 5 years of residency). This supplements my military income well raising my income from effectively around $160,000-$170,000 (including the military tax advantage) to around $280,000 per year (I'm a subspecialist moonlighting in a rural location so pay is very lucrative). This also takes into consideration not paying any state income tax (I'm a Washington state resident) which would effectively cost me $20,000 per year if I was to stay and practice as a civilian in the state where I'm currently stationed. When you are able to work like this, military medicine is not such a bad financial deal.

In addition, I generally do not work more than 45 hours per week at my military job unless I have to come in on-call, which is rare. I am still able to see around 25 patients per day and have my AHLTA notes done by 1630 and out the door.

My point is do not let everyone on this website tell you how bad military medicine is. If you play your cards right, you won't be so disgruntled.

so you take a full week and basically work as a civilian?

 

[Chonal Atresia]

That's correct. I'm not allowed to see Tricare patients b/c the DoD sees it as "double dipping." I'm covered by my locums company for malpractice and hotel, rental car, per diem and salary are all paid by the hospital. It's a pretty sweet gig and a great supplement to my military income. Using leave at the pace I'm doing would take me until 2012 to exhaust all days.

 

[chemist157]

That's correct. I'm not allowed to see Tricare patients b/c the DoD sees it as "double dipping." I'm covered by my locums company for malpractice and hotel, rental car, per diem and salary are all paid by the hospital. It's a pretty sweet gig and a great supplement to my military income. Using leave at the pace I'm doing would take me until 2012 to exhaust all days.

If you don't mind my asking, what subspecialty do you practice?

 

[jabreal00]

A doc at my MTF moonlighted like crazy while he was active duty staff. He and I are internists. He is now a civilian contractor. He did not tell the command when he was moonlighting. He was pretty outrageous about his moonlighting. While he was on call as an AD staff at the MTF he was also moonlighting at civilian hospitals. He could get away with this because we take home call and rarely have to come in. He must have made an additional 150-200K a year on top of his military salary. I was not interested in moonlighting though. I am single without any dependents. My rent is dirt cheap. The area I am in is pretty desolate and isolated so I wouldn't be able to spend the money anyways. I guess to him it was worth the risk.

 

[Chonal Atresia]

I practice ENT. A week of work in the civilian sector is worth at least $10,000-$11,000 and potentially more depending how much you have to come in on-call.

 

[mslall]

is there work out there like that for all surgical subspecialities? Urology? Ortho? or just even general surgery? Or is it, like most all things, dependent upon the area?

 

[Chonal Atresia]

There's work for all specialties. The only catch is that you may have to travel a gerat distance due to the military restrictions on locums work (no more than one week at a time). A good site to check out is locumtenens.com.

 

[Sgt Whizzo]

"The only catch is that you may have to travel a gerat distance due to the military restrictions on locums work (no more than one week at a time)."
Hey Chonal Atresia, is there a central regulation on moonlighting that you can refer us to...or is it set at an MTF level and variable. I am particularly interested in this 1 wk at a time restriction. Is it one week every 2 months like you are doing just no more than one week at a time?
Thanks for the great information.

 

[Chonal Atresia]

No, there's nothing set in stone about the week every other month. You could moonlight more often than this I guess but you would quickly run out of leave. The wording in my contract with the MTF says that I only need to be "on official leave" but it doesn't mention how often I can go. I also think that if you're gone too much it may catch the command's eye and potentially cause problems. I can also moonlight while not on official leave, but I need to be within 200 miles of the hospital. Right now there are no jobs that offer lucrative enough compensation in my specialty (my opinion) to warrant doing this. Hope this helps.

 

[Maverick10]

One of the major GMO cons presented here on SDN was the fact that GMO tours often ****** the physician's medical education b/c the majority of patients are usually young and healthy active duty personnel. I was wondering if:

1) Are GMOs allowed to moonlight?
2) If so, are there even moonlighting positions available for a physician who has only completed a transitional or categorical internship year?
3) If not in a civilian hospitals, are GMOs who are not assigned to the larger mil facilities, allowed to work at the closest big mil hospital in order to keep up skills?

 

[mslall]

One of the major GMO cons presented here on SDN was the fact that GMO tours often ****** the physician's medical education b/c the majority of patients are usually young and healthy active duty personnel. I was wondering if:

1) Are GMOs allowed to moonlight?
2) If so, are there even moonlighting positions available for a physician who has only completed a transitional or categorical internship year?
3) If not in a civilian hospitals, are GMOs who are not assigned to the larger mil facilities, allowed to work at the closest big mil hospital in order to keep up skills?

1)

2)In the civilian sector you can obtain a license after your intern year (provided you pass step 3; i know a few residents in the civilian sector who do this and a doctor who moved from denmark, only did a intern year, and now works as an ER physician), and you can generally work in ERs, particularly in rural locations. Don't see why it would be any different if your command would let you moonlight.

3)I'm pretty sure that would be a no-no, based on what chonal said about not being allowed to double-dip

 

[colbgw02]

In my experience, most hospitals will not grant privileges to someone with just a license. They require people to at least be board eligible or, more commonly, board certified.

 

[jabreal00]

^^Many civilian residents moonlight^^ My buddy moonlighted his senior of medicine.


---------------- Listening to: Beth Orton - Stars All Seem To Weep via FoxyTunes

 

[colbgw02]

^^Many civilian residents moonlight^^ My buddy moonlighted his senior of medicine.

duh. what was i thinking?

 

[a1qwerty55]

1)

2)In the civilian sector you can obtain a license after your intern year (provided you pass step 3; i know a few residents in the civilian sector who do this and a doctor who moved from denmark, only did a intern year, and now works as an ER physician), and you can generally work in ERs, particularly in rural locations. Don't see why it would be any different if your command would let you moonlight.

3)I'm pretty sure that would be a no-no, based on what chonal said about not being allowed to double-dip

I know GMO's who have moonlighted as urgent care physicians. Contrary to what many of you would like to believe, health care in the U.S. especially in rural America is a lot worse than that provided in military hospitals. Many places just want a warm body in their ER regardless of their lack of experience, or training.

 

[jabreal00]

I know GMO's who have moonlighted as urgent care physicians. Contrary to what many of you would like to believe, health care in the U.S. especially in rural America is a lot worse than that provided in military hospitals. Many places just want a warm body in their ER regardless of their lack of experience, or training.

Agreed. My MTF is in a rural area in the midwest. Things are bad at my MTF, regarding standard of care. Things are a little worse on the civilian side. This includes primary care and specialists. I often shake my head when I hear some of the tails from my patients, when they're seen on the outside.

 

[a1qwerty55]

Agreed. My MTF is in a rural area in the midwest. Things are bad at my MTF, regarding standard of care. Things are a little worse on the civilian side. This includes primary care and specialists. I often shake my head when I hear some of the tails from my patients, when they're seen on the outside.

I'm with you. I can't believe the stuff that flys in the civilian sector. If I have a doc who is incompetent, it is there for all to see in the EMR. There is no hiding out and no practicing without priviledges at a hospital. The military is acutally pretty good at identifying and at least limiting the priviledges of the dangerous docs. There really is no oversight for civilian providers as hospitals only care about the bottom line and state medical boards rarely censure docs.

 

[NavyFlightDoc]

1)

3)I'm pretty sure that would be a no-no, based on what chonal said about not being allowed to double-dip

It's not double-dipping if you're working at a military facility, because you wouldn't be getting paid any extra, unless it pays in good letters of recommendation, which many* Navy GMO's who want to enter competitive specialties obtain by spending leave/TAD at military facilities working with the staff in that specialty.

*"many" might be an overstatement of the facts. Some do.

 

[mslall]

It's not double-dipping if you're working at a military facility, because you wouldn't be getting paid any extra, unless it pays in good letters of recommendation, which many* Navy GMO's who want to enter competitive specialties obtain by spending leave/TAD at military facilities working with the staff in that specialty.

*"many" might be an overstatement of the facts. Some do.

So do they function in a role similar to a PA for that staff physician?

 

[GeoLeoX]

one thing that I have not seen mentioned (maybe I missed it?) is that when you moonlight you will be responsible (or the locum organization if you go that route) for your malpractice insurance. i know several people who get into a moonlighting position only to find that a big portion of the income has to go towards insurance.

 

[Chonal Atresia]

That's enirely untrue about malpractice. I'm covered up to $3,000,000 by the locums company. I'm sure part of their cut from my pay goes to paying insurance premiums, but I'm still bringing home on average b/t $11,000-$12,000 per week of work, sometimes more if I'm "busy" on-call.

 

[GeoLeoX]

That's enirely untrue about malpractice. I'm covered up to $3,000,000 by the locums company. I'm sure part of their cut from my pay goes to paying insurance premiums, but I'm still bringing home on average b/t $11,000-$12,000 per week of work, sometimes more if I'm "busy" on-call.

Please reread my post. I clearly say that you pay for your malpractice UNLESS you go locums.

 

[The White Coat Investor]

Please reread my post. I clearly say that you pay for your malpractice UNLESS you go locums.

Not necessarily true. Most EM jobs cover the malpractice. Easier to insure "the group" including independent contractors than for each to try to get his own policy.

 

[IgD]

T...I'm still bringing home on average b/t $11,000-$12,000 per week of work, sometimes more if I'm "busy" on-call.

I need to change specialties!

 

[Chonal Atresia]

I also occasionally moonlight for an ex-partner of mine who has managed to escape military medicine w/o the intermediary of a locums company. I am covered up to $3,000,000 through his hospital. So, no, I doubt you are ever responsible for your own malpractice. If you are, run from the job as there are many better opportunities out there.

 

[GeoLeoX]

In my specialty (pathology) almost everyone that I have know who has moonlighted in the local area (n=5) has been required to provide their own insurance. This is through at least 3 different institutions. I do know of someone who traveled to another state (to fill a position for someone going on vacation) who had malpractice coverage provided similar to the situation you describe. One of the confounders is that despite being in a large metro area there are limited opportunities. In addition the positions that are most commonly taken are for "overflow" on weekends usually, rather than to fill a vacant spot.

 

[Gastrapathy]

What I've seen has been highly variable. Most groups provide malpractice while you moonlight but you have to be careful about tail coverage.

 

[psoasminor]

http://navymedicine.med.navy.mil/files/media/directives/navmed 1610-1.pdf

this is the form that apparently navymedicine has to use.
as an internist, i would think its pretty hard to get a moonlighting job because it says your employer cant bill the FEDERAL GOVERNMENT for anything that you do, (i.e. double dipping). Not just tricare, but medicare too.
That takes out ALOT of old patients (i.e internal medicine patients).

 

[Chonal Atresia]

I have moonlighted multiple times and as an active duty physician you can see Medicare, Medicaid, Indian Health Service, etc but NOT Tricare. Specialty makes NO difference. This is the only population of patients that you are not allowed to see b/c of the so-called "double-dipping" rule.

 

[pokerslut]

I currently moonlight one week every other month and use official leave to do so (built up to over 60 days from 5 years of residency). This supplements my military income well raising my income from effectively around $160,000-$170,000 (including the military tax advantage) to around $280,000 per year (I'm a subspecialist moonlighting in a rural location so pay is very lucrative). This also takes into consideration not paying any state income tax (I'm a Washington state resident) which would effectively cost me $20,000 per year if I was to stay and practice as a civilian in the state where I'm currently stationed. When you are able to work like this, military medicine is not such a bad financial deal.

In addition, I generally do not work more than 45 hours per week at my military job unless I have to come in on-call, which is rare. I am still able to see around 25 patients per day and have my AHLTA notes done by 1630 and out the door.

My point is do not let everyone on this website tell you how bad military medicine is. If you play your cards right, you won't be so disgruntled.

Thanks for sharing sir.

I'm a third year medical student with 12 years prior service in the Army-- 6 active 6 reserves.

As I read these boards in trying to decide if I should do FAP I'm starting to think that I will be doing it for the money and retirement. Apparently a bad thing?

Based on what you wrote, I'm starting to think that I can get out of debt debt on my own just working my ass off in the civilian sector. My goal is to get my soon to be $250,000 debt paid off in 7 years. I will either do Family or Physical Medicine and Rehabilitation.

There are just so many pros and cons of either decision-- Army or Civilian.

Open ended question-- any opinions or insight for me?