Question about moonlighting

[EmmaNemma]

Can someone tell me when the earliest a post grad can moonlight? Is it at the end of the internship year when step 3 is passed? Or is it just when step 3 is passed regardless of whether the internship year has been completed.

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[gro2001]

Can someone tell me when the earliest a post grad can moonlight? Is it at the end of the internship year when step 3 is passed? Or is it just when step 3 is passed regardless of whether the internship year has been completed.

As soon as you have a full license, which varies by state (and whether you are AMG or FMG). The earliest that some states allow is after PGY-1. Some states require 2 post-graduate years, and some require 3.

http://physicianlicensing.com/resources/state-requirements/

 

[Law2Doc]

Can someone tell me when the earliest a post grad can moonlight? Is it at the end of the internship year when step 3 is passed? Or is it just when step 3 is passed regardless of whether the internship year has been completed.

As mentioned, you need a license to work as a doctor. States vary as to how much residency you need under your belt before you can be licensed. During residency, you will be working under your facility's trainee license in most states, so you may be allowed to moonlight within that same institution even during intern year, although this it's atypical since they already own your time.

In general, at a facility other than your home institution, you are going to need to pass Step 3, have completed at least a year of internship, and actually received the license (the process can take up to 6 months in some jurisdictions). So don't plan on moonlighting before your 2nd year of residency at a minimum.

Also bear in mind that under the residency duty hour rules, time spent moonlighting counts toward your 80/week average cap, so in some programs you won't have the time to spare to do much moonlighting, and in other programs the PD may be uncomfortable to allow you to do moonlighting out of fear that it limits his ability to up the hours in the face of an increase of workload. Many residency contracts explicitly prohibit moonlighting, while others require consent of the PD.

Not something you should be banking on during early residency, but some lenient programs senior residents do very well with moonlighting, particularly in the lifestyle fields.

 

[393656]

Keep in mind when it is your own liscense it is all completely on you legally and you really need to be sure you feel ready to take patients under your care completely independantly.

I see residents get anxious to moonlight and think that "all i need is my liscense" however neglect understanding they need proper experience and confidence.

I was not really comfortable with everything in my field until my last year where I was willing to bet my liscense or a law suit on my practices. Documentation and such needs to be up to par as an independant physician and all your decision making.

While its nice money, its not worth having a lawsuit or bad outcome for the rest of your career

 

[EmmaNemma]

Just curious about this. Could a resident that is licensed moonlight by working at a dispensary evaluating and prescribing medical marajuana in states where it is legal? Would this have future consequences on their ability to practice in their specialty in any way? Again just curious. Thanks.

 

[AzEMMD]

Keep in mind when it is your own liscense it is all completely on you legally and you really need to be sure you feel ready to take patients under your care completely independantly.

I see residents get anxious to moonlight and think that "all i need is my liscense" however neglect understanding they need proper experience and confidence.

I was not really comfortable with everything in my field until my last year where I was willing to bet my liscense or a law suit on my practices. Documentation and such needs to be up to par as an independant physician and all your decision making.

While its nice money, its not worth having a lawsuit or bad outcome for the rest of your career

I agree that a resident needs to be cautious, but I don't think that should stop him/her from moonlighting. There are NPs/PAs out there practicing with half the training and knowledge of a PGY2, I think a resident at that stage of training should be able to handle their own or at least know when to get help. Aside from the money, moonlighting also offers a great way to gain experience and continue growth as a resident. After all, a physician needs to practice independently at some point.

 

[393656]

I agree that a resident needs to be cautious, but I don't think that should stop him/her from moonlighting. There are NPs/PAs out there practicing with half the training and knowledge of a PGY2, I think a resident at that stage of training should be able to handle their own or at least know when to get help. Aside from the money, moonlighting also offers a great way to gain experience and continue growth as a resident. After all, a physician needs to practice independently at some point.

One big difference-NP/PA do not carry any liability or virtually no liability. Shallow pockets and there is always a doctor supervising them in the hospital setting.

I am not discouraging moonlighting as I think it provides the next needed step in progressing as a doctor-independence, decision making and legal documentation. Also confidence and authority.

However this should be after you have a strong grasp on clinical work where it is second nature (or close) to treat the majority of things in your field you would come across. If you can do that at the beginning of 2nd year than more power to you. I felt after 3 years I was capable of handling virtually anything thrown at me in a hospital/ER/inpatient psych setting. Depends on what the gig is too and how confident you are in that particular setting. If you know it all than go for it. I am just saying make sure you dont jump the gun for money because the bad outcomes can make your life miserable.

 

[393656]

Just curious about this. Could a resident that is licensed moonlight by working at a dispensary evaluating and prescribing medical marajuana in states where it is legal? Would this have future consequences on their ability to practice in their specialty in any way? Again just curious. Thanks.

Physicians to not work at dispensary's. They simply distribute marijuana after you bring in a script. They are a controlled "pharmacy" for marijuana.

 

[235750]

Physicians to not work at dispensary's. They simply distribute marijuana after you bring in a script. They are a controlled "pharmacy" for marijuana.

You can work at a "medicinal clinic" where "qualified patients" pay $100 for a consult, and then you give them a script that's good for 1 year. That's the only script you write

Sounds sketchy though

 

[EmmaNemma]

Interesting. Does this cause problems for those residents later though?

 

[bigDinLV]

Interesting. Does this cause problems for those residents later though?

I would say that depends on the legal issues related to your state.

Put that on your resume and you could always be judged for it by someone, no matter what the legality is.

 

[Law2Doc]

Interesting. Does this cause problems for those residents later though?

Absolutely. Bear in mind that medical marijuana is only legal in a couple of states, and not legal federally. And while there are some generally accepted uses of marijuana in terms of glaucoma patients or for purposes of alleviating side effects of chemotherapy, almost every other medical usage is frowned upon by the bulk of the profession, making it very controversial nationwide. If you have this in your background, it's going to be assumed that you are a recreational drug user, or have a marijuana legalization agenda, which can impact how future employers regard you. So yeah, IMHO you stay far away from this kind of stuff at the early part of your career.

 

[235750]

Interesting. Does this cause problems for those residents later though?

I just visited a clinic today today in a state where medical marijuana is legal. I saw the process first hand.

To say that it seemed like a scam is a bit of an understatement. If all the clinics in all the states are like this, I'd say that marijuana is completely 'legalized' (as in, the state doesn't care). Literally, anyone could get as script, even without lying. The doctor was not at all discriminatory.

I whole-heatedly believe in the decriminalization of cannabis, but not like this. This is completely dishonest. The people who I argued against for years (some of you on SDN), who claimed that this was just a backdoor method of legalizing weed, were right. I thought this could just be a way that those with serious medical conditions (AIDS, cancer, etc) could benefit. I was wrong. I knew a few people would take advantage, but...this is large-scale abuse.

There's only two things you need to know about these clinics: (1) the docs ONLY write scripts for marijuana. Have you ever heard of a physician that writes scripts for only one drug? I know we're in an era where specialization is taking over, but my god. (2) They had a book of breed recommendations for the particular condition you had! So, you have some pain in your extremity? Try white widow. Motion sickness? Go northern lights. Are you anxious? AK47 is the best.

I s*** you not.

Of course they have "this statement is not approved by the FDA" plastered all other it, as if that makes it better.

I got into an argument with one of the doctors who said that (for example) psychiatrists give out stimulants to kids like candy after meeting very lose criteria for ADHD, so what's the difference between that and his 'clinic'? I was too stunned to say anything, but I think he shouldn't model his practice on poor physician habits.

Anyway, yeah, I'd avoid it all together. I don't see how, after visiting one of those places, a reasonable person would think it legitimate.

 

[notdeadyet]

Uhhhh... In fairness, you went to a medicinal marijuana clinic. They exist only to give out medical marijuana prescriptions. Of course they're scams. Just like the online "physicians" that evaluate patients for anxiety and automatically prescribe them Xanax are scams. Just like the storefront "back pain/pain medicine" clinics that doll out oxy like m&ms are scams. Etc. etc.

Please don't judge how a majority of physicians view writing medical marijuana prescriptions based on how docs at a medical marijuana clinic write marijuana prescriptions.

And incidentally, the reason for this large scale abuse is because the federal government won't legalize medicinal marijuana. If it did, medical MJ would be as restricted as opioids or whatnot (probably moreso). Because the federal government won't, and California has legalized medicinal marijuana, the state has to keep largely hands off on the process to not get the federal government overly involved. The result is a poorly managed process.

This was debated in California ad nauseum. We ultimately decided that we wouldn't turn away the patient who legitimately needed their medication, even if the cost was allowing malingerers to slip through. This same decision process happens in EDs every day.

Most folks with medicinal marijuana prescriptions that I've met have gotten it from their PCP or health clinic. Judging medicinal marijuana on a whole based on visiting a clinic that exists for the sake of abuse is akin to visiting an daytime t.v. advertised ambulance chaser and walking away saying, "boy, law sucks..."

Anyway, yeah, I'd avoid it all together. I don't see how, after visiting one of those places, a reasonable person would think it legitimate.

If my only exposure to abortion providers was visiting some back-alley abortionist with a coat hanger as their billboard, I'd probably be Pro-Life too.

 

[notdeadyet]

Though I'm for appropriate use of medical marijuana (and appropriate medical use of opioids, benzos, antibiotics, etc.), I'm with Law2Doc on avoiding working for medical marijuana clinics while in residency. I'd also avoid providing those "Internet evals for Xanax" services as well. I'd also avoid becoming a televised spokesperson for snake oil weight loss supplements that cause liver damage (how'd that look on your resume, Dr. M?).

If you're going to sell out, jeeze, wait until trying the legitimate BC doctor thing for a few years after residency...

 

[Arch Guillotti]

Though I'm for appropriate use of medical marijuana (and appropriate medical use of opioids, benzos, antibiotics, etc.), I'm with Law2Doc on avoiding working for medical marijuana clinics while in residency. I'd also avoid providing those "Internet evals for Xanax" services as well. I'd also avoid becoming a televised spokesperson for snake oil weight loss supplements that cause liver damage (how'd that look on your resume, Dr. M?).

If you're going to sell out, jeeze, wait until trying the legitimate BC doctor thing for a few years after residency...

yeah you might want to wait until you are financially secure before you have action taken against your medical license.