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Question about myths and realities of Moonlighting in residency and fellowship

Discussion in 'Internal Medicine and IM Subspecialties' started by olivarynucleus, Aug 3, 2015.

  1. olivarynucleus

    olivarynucleus Membership Revoked
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    Ok, so I know most programs say residents can start moonlighting pgy2-3, but how common is moonlighting in IM residency? Originally I thought that after inter year, 2nd and 3rd year residents only work about 55 hrs a week. I looked at the frieda website, a few of them say their residents work 55 hrs a week. Now I understand this "average" isn't evenly distributed, and you can have 70-80 hr ward months with easier 40-50 hr months. So my question is, is it possible for IM residents to moonlight maybe 2 12hr shifts a month after pgy1, and are there moonlighting opportunities that are willing to work around your schedule? The frieda website also states that fellows usually work lower hours averaging about 50, are fellowship hours more regular, and since you are a licensed physician, could you work maybe as a hospitalist covering Saturdays?
     
    #1 olivarynucleus, Aug 3, 2015
    Last edited: Aug 3, 2015
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  3. gutonc

    gutonc No Meat, No Treat
    Administrator Physician PhD 10+ Year Member

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    Thing 1: Stop planning your life around the data on the FREIDA website. At best, it's a glorious fantasy...like mermaids and unicorns. At worst, it's a bald faced lie.
    Thing 2: I worry that you were surprised by the fact that an "average" wasn't equally distributed. That's pretty basic statistics.
    Thing 3: No moonlighting position will work around your hours. You need to fit it into your schedule. You can decide what that means to you when the time comes.
    Thing 4: Fellowship hours are both more, and less, regular. I worked many fewer nights and weekends as a fellow than as a resident. But I got woken up from a dead sleep in my own damn bed, and dragged into the hospital from home much more as a fellow (2-3x/month which was on the low end for my program) than as a resident (never).
    Thing 5: If you are planning your career path based on moonlighting opportunities available during your training, you deserve the misery you get.
    Thing 6: Moonlighting as PGY2 is a disaster waiting to happen.
    Thing 7: My income increased by >50% halfway through my PGY3 year until I finished fellowship due to moonlighting. You can make a fair amount of money doing it in the right circumstances. And I dropped that s*** as soon as I could because working extra hours, especially overnight, is not nearly worth the money. Not even close.
     
  4. olivarynucleus

    olivarynucleus Membership Revoked
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    Wow, I just wanted to know some ways to make some extra money. Honestly I don't want to make ~50k until I am near 36 years old, at some point ill want to buy a house and actually start my life. And no I am not basing my specialty choice entirely on moonlighting ops but it is a part of it, albeit a very small part.
     
  5. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    After pgy1 you are really BARELY trained to do anything on your own that isn't an H&P or ordering what you are told. Not really. And only in the context of the in-patient side of the hospital. Your out-patient skills will still be serioulsy sub-par for even most chronic medical illness issues. You will not find jobs working in the hospital without being BE/BC. This leaves you with the option of urgent care mostly and I'd argue that as an internal medicine trained person, you would be woefully undertrained even for an urgent care gig maybe even out until third year (depending on the person). You are also very busy during residency, get few weekends off, and I'm not convinced the money would be worth the trade off. That is the reality.

    As a fellow, I think it is good to start stretching your internist legs and you can usually find hospitalist gigs (read: nocturnist) that you will be trained for, but . . . just barely though. You will be competant, but just barely. There is defiitely a post-training learning curve. I wouldn't start moonlight in fellowship until after you've passed boards and gotten your feet wet in your own new specialty, and I might even humbly suggest no moonlighting until you hit your second year of fellowship (and you may not be able to given call schedules - fellowships are "front loaded" as a rule with the first years taking the lion's share of call).

    My honest advice is to simply not worry about moonlighting during residency. At all. Learn your craft. Enjoy the little time off you'll have.
     
    SouthernSurgeon likes this.
  6. chessknt87

    Physician 10+ Year Member

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    I've been moonlighting since PGY-1 (basically acted as an NP with an attending on site at all times). It all depends on how the shifts are set up--they can be either really independent where you are responsible for admitting sick people with no oversight to handholding the interns so their attendings can leave at a decent hour.

    You definitely need to watch for burnout though, because the money can really tempt you to take on insane hours because its probably the best money youll have ever had the opportunity to make and, in light of all the debt and joblessness you've had up until now, is a potent motivator.
     
    sso_blasted87 and Crayola227 like this.
  7. IMreshopeful

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    Moonlighting is a great plus during residency if it's available, but it should not by any means be a dealbreaker. Much more important things are at stake (whether the clinical training is good, whether you have adequate leadership support, whether they match fellowships well if you're interested, etc).

    My program does not have out-of-system moonlighting, but we do have in-system "moonlighting" wherein we get a huge Department of Medicine stipend to do extra shifts, varying from 60-70/hr, in order to provide extra support for the residents who are on service at those particular times. I started in my PGY2 year and did a bunch of moonlighting and made a good chunk of extra cash.

    A bunch of the fellows at my institution do real moonlighting and get paid upwards of 150/hr for 8-12 hour shifts in many locations, usually admitting patients and doing H&Ps in a zero-supervision environment (obviously). Typically second/third year fellows do more moonlighting than first year fellows because as JDH noted most call schedules are heavily front loaded in fellowship. It seems very manageable.

    I think it's manageable, but you need to be careful to recognize that money shouldn't be your primary priority during residency (though it's a plus). You'll make plenty of money as a qualified attending. You should spend time learning and doing well and building yourself up (whether for jobs or fellowship), and avoid burnout.
     
    sso_blasted87 likes this.

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