potential first moonlighting gig--need advice

[bashir]

My program allows moonlighting starting PGY-3, making me eligible this July. For tax reasons my spouse would really like me to earn some extra income in 2017, but moonlighting positions are fairly scarce due in part to my residency program's large number of training sites and unfortunate prohibition of internal moonlighting.

So I'm talking to someone about a moonlighting position covering occasional weekends at a small town hospital within a reasonable drive of my city. I'll tell you what I know about it now; I'm hoping to get some guidance on what else I should find out about it, and some frank talk about whether I'm qualified for it, irrespective of whether the hospital is desperate enough to hire me.

It's 5PM Friday through 8AM Monday, covering the 14-bed inpatient unit as well as floor and ED consults in the 99 bed hospital. Pay is $3500 plus room and board. There is a primary care physician to handle patients' medical needs. Is it fair to inquire what the typical number of floor and ED consults is? What else do I need to be asking to assess this position?

I'll have 6 months of inpatient psychiatry, 3 months of C/L, and 2 years of ED call under my belt by then, and pretty much no outpatient experience. I like to think I'm a good resident (don't we all?) but at this point I have had little experience handling issues that arise after hours due to the way our program is structured (call in first two years is essentially limited to evaluating patients in the ED for admission and occasionally giving admission orders over the phone). So I'm trying to figure out whether a job like this falls in the category of "really hard and a steep learning curve, but you'll learn so much and be glad you did it" or "taking on more responsibility than you can handle and putting patients and your new permanent license at risk." I have some good faculty mentors; do people ever rely on faculty for informal supervision when moonlighting externally? I understand it would be my license on the line but I'd feel a lot more comfortable knowing I could call faculty if I needed to.

I really appreciate your frank feedback. Thanks for reading.

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[michaelrack]

Seems like fair pay as long as you don't have to go to the er too much.....find out about the #of floor consult and if most of er calls can be handled by phone

 

[Jules A]

I'm hoping to get some guidance on what else I should find out about it, and some frank talk about whether I'm qualified for it, irrespective of whether the hospital is desperate enough to hire me.

Kudos for having the insight to realize employers have little interest in whether you are qualified as long as you hold the license and for being thoughtful enough to want to provide safe, competent care.

It really shouldn't be a bad gig unless you get pounded with CL on medical floors or ED stuff which would probably be unusual. I've done weekends for years at multiple hospitals with 15-32 beds and usually enjoy it. You aren't reinventing the wheel just making sure everyone survives the weekend. Most attendings don't want you to change meds and if they do will let you know. In my area the pay varies from $3,000-$4,000 so in my opinion they have given you a nice offer especially with room and board included.

Something to ask about would be if they expect any after hours face:face. None of the jobs I have require anything more than phone consults or admit/prn orders overnight which is a good thing because I have no intention of dragging myself into the ED at 3am unless I'm the patient.

 

[st2205]

For a 14 bed unit that's a pretty good rate. The bigger variable are those consults. I'd find out about average census, which I presume they're running at near-capacity with how few beds they have. I'd ask if there are typically DCs on the weekends because that will add more work, as will doing a new admit on the bed you opened up. If they don't typically DC on weekends and run at capacity, then you'll be seeing all follow-ups which should be pretty easy, especially on the second day. I'd ask about the floor and ER consults but my guess is you likely won't get a very clear answer. More so try to clarify what the nature of the consults are and what your role is. It's a small hospital so you may not have a ton of consults, but if your role is screening for admission primarily then that should be manageable. If you're consulted for pseudoseizures, capacity, garden variety delirium or someone happens try cry out of frustration, then you may have enough consults to be annoying. I'd see if they have any numbers on how many consults come from the floor as well as the ED. Also, if the ED knows you're there do they actually do anything or do they autoconsult on anything from "feeling depressed" to "wants to talk about rehab options." Find out if there's a social worker seeing and triaging these things as well as what you may be called to the ER for.

 

[FlowRate]

I'm not sure how you'd find this out exactly, but the nurses on our unit are spoiled with having ready access to night float interns overnight, so thinking about your gig has me worried about getting paged every 2-3 hours about asinine, day-appropriate things (colace...) I'd try to find out if they understand that the moonlighter is not to be paged unless it's important. Or I guess with the PCP around, maybe that stuff gets shunted to them?

 

[Salpingo]

Are you solely responsible for admits? Rounding on the unit? Are patients often discharged over the weekend? Is it a tertiary care center?

I can't imagine with those bed numbers it's too stressful, and pay is good.

 

[Merely]

Tell them you want 4,000 cause why not

 

[Dharma]

I'm not sure how you'd find this out exactly, but the nurses on our unit are spoiled with having ready access to night float interns overnight, so thinking about your gig has me worried about getting paged every 2-3 hours about asinine, day-appropriate things (colace...) I'd try to find out if they understand that the moonlighter is not to be paged unless it's important. Or I guess with the PCP around, maybe that stuff gets shunted to them?

2-3 hours? Lucky!

 

[SourceOfDenial]

Not knowing what your evening and early morning responsibilities will be like, but it's 63 hours of moonlighting which puts you over the ACGME limit I believe, if that's a concern for you. That also breaks down to 55$ an hour. I wouldn't touch that gig for less than 5000.

Also, the friday to Monday morning gigs are logistically crappy as a resident. I hated the overnight sunday work and roll right into clinic or hospital.

For reference, the moonlighting gigs I had paid 85-130$ an hour.

 

[Merovinge]

Not knowing what your evening and early morning responsibilities will be like, but it's 63 hours of moonlighting which puts you over the ACGME limit I believe, if that's a concern for you. That also breaks down to 55$ an hour. I wouldn't touch that gig for less than 5000.

Also, the friday to Monday morning gigs are logistically crappy as a resident. I hated the overnight sunday work and roll right into clinic or hospital.

For reference, the moonlighting gigs I had paid 85-130$ an hour.

$55/hour when you can sleep and not be in the hospital for a lot of the time is pretty great, especially as a resident. This offer blows anything out of the water that people around me in a major metro get. Urology senior attendings including d0ing all emergency cases get like 5-6k to cover a place friday evening to monday am. If you can command the same salary as a psychiatrist, I'd be impressed (or you see an inhumane number of patients).

 

[st2205]

Not knowing what your evening and early morning responsibilities will be like, but it's 63 hours of moonlighting which puts you over the ACGME limit I believe, if that's a concern for you. That also breaks down to 55$ an hour. I wouldn't touch that gig for less than 5000.

Also, the friday to Monday morning gigs are logistically crappy as a resident. I hated the overnight sunday work and roll right into clinic or hospital.

For reference, the moonlighting gigs I had paid 85-130$ an hour.

This doesn't sound like in-house work. The only difference is that they're having to travel away from home to provide the coverage. The going rate around me is roughly the same for a bit more work. As long as consults are manageable, this is a job you should be in and out of within 4-5 hours, if that, and 2-3 hours on the second day. If I were doing a per hour gig, I wouldn't take less than $175, because per hour tends to be for a finite amount of work, in my experience.