Resident moonlighting- is this reasonable?

[Cath Up]

Numerous attendings/mentors have encouraged me to moonlight for the experience. The money would also be nice. I think it’s a win-win.

I am setting up a new moonlighting opportunity (hopefully multiple) because the internal moonlighting that people tend to do is competitive. Pay for that is around 120/hr, inpatient. Not sure of the hours but there’s still oversight. I know setting up new opportunities is sometimes a ton of work- I don’t mind.

This opportunity covers weekend inpatient (~12-22 pts, split with a PA), hospital consults, and ED consults. Full weekend so 3 nights and 2 days. I negotiated 300/night for phone coverage and 1100/day. I know this is at least a little less than attendings typically receive. Is this reasonable for a resident? I know I’m likely making the hospital $$$ or losing them less $$$ than normal, but that’s going to be unavoidable to some extent. The most recent moonlighting rate threads for psych I could find were from >3 years ago and it looks like some were getting 125/hr around then even- want to make sure I’m not getting completely shafted.

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[surfguy84]

Fwiw I moonlighted as pgy4 (last year) and made 225/hr. 1100 is pretty low for all that work imo. Night coverage should be at least 500 too.

Residents where I am located now get 3600 for total of 28 patient encounters over the weekend with no phone call responsibilities overnight, leave when you're done rounding. For those who are quick this can work out to like 600-900/hr.

 

[splik]

So depending on location $120/hr would be okay for internal moonlighting but not for external moonlighting since you will have to pay self-employment taxes on that unless its a W2 set up (which would be unusual but its certainly possible - I did W2 external moonlighting as a resident). The internal moonlighting rates for residents in my day (circa 2015) was $150/hr and external could be over $200 but at least $160/hr. There was also a weekend moonlighting gig which was $4500 for the weekend back then. I'm sure there's so geographic variation, but these rates sound low to me unless its something you can do in the morning and then leave.

 

[psych_0]

When I was moonlighting as a PGY-3 & 4, I was paid $4800/weekend (Sat morning - Mon morning). I was required to see a census of ~18-25 patients total (for some reason they only needed to be seen one time per weekend, I never asked why), handle admissions over the weekend (usually 3-6 max for the whole weekend) & cover phone calls overnight for one of the two nights I was there. I've always been a bit of a white cloud so none of the overnights were particularly bad unless someone was constantly in/out of restraints. We also were never expected to discharge anyone because every discharge was pre-planned and no one discharged on the weekend.

Biggest downside is that I had to stay on hospital grounds, which was far-ish from home base & not close to any good food at all. Watched a lot of football & movies those weekends. The "hourly" rate worked out to $4800/48 hrs "on call" = $100/hr, but the amount of "work" I did those weekends was maybe 10 total hours. OP I'd see if you can speak with someone who is working there currently to see if you can get an idea of how labor-intensive this gig actually is day-to-day.

 

[TexasPhysician]

When I was moonlighting as a PGY-3 & 4, I was paid $4800/weekend (Sat morning - Mon morning). I was required to see a census of ~18-25 patients total (for some reason they only needed to be seen one time per weekend, I never asked why), handle admissions over the weekend (usually 3-6 max for the whole weekend) & cover phone calls overnight for one of the two nights I was there. I've always been a bit of a white cloud so none of the overnights were particularly bad unless someone was constantly in/out of restraints. We also were never expected to discharge anyone because every discharge was pre-planned and no one discharged on the weekend.

Biggest downside is that I had to stay on hospital grounds, which was far-ish from home base & not close to any good food at all. Watched a lot of football & movies those weekends. The "hourly" rate worked out to $4800/48 hrs "on call" = $100/hr, but the amount of "work" I did those weekends was maybe 10 total hours. OP I'd see if you can speak with someone who is working there currently to see if you can get an idea of how labor-intensive this gig actually is day-to-day.

It’s been a few years, but something like this was available to me as well. 5pm fri - 5pm Sun was $4800. This included in-house call, rounding on maybe 10 patients per day and probably 10-15 admissions.

 

[nexus73]

Numerous attendings/mentors have encouraged me to moonlight for the experience. The money would also be nice. I think it’s a win-win.

I am setting up a new moonlighting opportunity (hopefully multiple) because the internal moonlighting that people tend to do is competitive. Pay for that is around 120/hr, inpatient. Not sure of the hours but there’s still oversight. I know setting up new opportunities is sometimes a ton of work- I don’t mind.

This opportunity covers weekend inpatient (~12-22 pts, split with a PA), hospital consults, and ED consults. Full weekend so 3 nights and 2 days. I negotiated 300/night for phone coverage and 1100/day. I know this is at least a little less than attendings typically receive. Is this reasonable for a resident? I know I’m likely making the hospital $$$ or losing them less $$$ than normal, but that’s going to be unavoidable to some extent. The most recent moonlighting rate threads for psych I could find were from >3 years ago and it looks like some were getting 125/hr around then even- want to make sure I’m not getting completely shafted.

Total for the weekend is $3100. The rate is somewhat low if you’re seeing 11-12+ patients per day, but as a resident it may be the best option to make some money and it will be good experience. The rate isn’t bad if census is 12 and split between you and a PA and no consults.

For comparison, in 2014 I got paid $3000 per weekend to cover max 12 patients per day and no consults or ED. Unit had 24 beds and each doc took 1 night on call.

 

[Mad Jack]

I suddenly feel ripped off for what I was getting- $4,000 to cover around 17 patients in a small community hospital over the weekend with associated overnight responsibilities. Usually only 4-5 admits, minimal consults on the floors, but a decent amount of ED dispo. It paid the bills through fellowship though, couldn't complain. And it was W2 and offered 401k with a match, as well as full malpractice and tail.

 

[Cath Up]

Wow, thank you for all the feedback! It sounds there’s pretty huge variation regionally, and some of you got legitimately fair compensation for your work as residents. That’s pretty cool. I’ll try to keep looking for opportunities near me.

I do know attendings at this site make around $3500- I should have asked for just that. My plan moving forward would be to find work elsewhere in addition, and if this site is unwilling to match potentially higher pay, would just transition to a new site. But yeah, it’s definitely the best I can get right now.

 

[psych_0]

And it was W2 and offered 401k with a match, as well as full malpractice and tail.

So it was more than $4000.

 

[Mad Jack]

So it was more than $4000.

Malpractice may have added up to around $300/weekend, 401k is worthless because I already max out my primary employer, W2 taxes paying employer half are kind of a wash since I lose out on the ability to make 1099 deductions. I'd place total value at around $4500 for someone that would effectively utilize tax deductions, or around $5000 for someone that has no clue how to manage their deductions and is just doing it on the weekends. The match is worthless unless you work there at least 1000 hours per year anyway due to vesting. Still not great for the amount of work+3 overnights of call

 

[comp1]

Need at least the state to figure out if this works out. It might be reasonable in Omaha, but much less so in Palo Alto. And I'm glad the OP recognizes that setting up something like this is indeed a lot of work.

 

[ridethecliche]

It’s been a few years, but something like this was available to me as well. 5pm fri - 5pm Sun was $4800. This included in-house call, rounding on maybe 10 patients per day and probably 10-15 admissions.

10-15 admissions total or per day? I'm guessing total, eh?

 

[TexasPhysician]

10-15 admissions total or per day? I'm guessing total, eh?

Depends on the number of open beds, but it could easily be daily some weekends. I think total census was 130.

 

[Merovinge]

10-15 admissions total or per day? I'm guessing total, eh?

That's a normal number of admissions where I worked in the past for a 150ish bed hospital.

 

[Stagg737]

Depends on the number of open beds, but it could easily be daily some weekends. I think total census was 130.

As in you saw 10 patients per day + the 10-15 admissions and did the in-house call? How long ago was that?

 

[TexasPhysician]

As in you saw 10 patients per day + the 10-15 admissions and did the in-house call? How long ago was that?

10+ years ago. It wasn’t fun.

 

[BiscoDisco]

As in you saw 10 patients per day + the 10-15 admissions and did the in-house call? How long ago was that?

When I moonlighted on weekends they had me seeing (PER DAY) 10-15 new intakes, and 25-30 follow ups, 1-2 discharges I knew nothing about and the NP who covered weekly did nothing to set up the weekend discharges. I did not last long at this hospital.

 

[aspiringdoc09]

Hi...not to hijack this thread but it is about a moonlighting gig too. Has anyone worked with Amwell? They want to pay $1700/day for a 24-bed unit (8a-4p) OR $1400/day for a 16-bed unit (8a-2p) for weekend tele-rounding coverage. Telephonic coverage is $400/night from Friday 4 pm to Monday 8 am ($1200) and C/L 2-4p for $150/consult.

Does this sound reasonable for virtual coverage? I am in the New England region.

 

[BiscoDisco]

Hi...not to hijack this thread but it is about a moonlighting gig too. Has anyone worked with Amwell? They want to pay $1700/day for a 24-bed unit (8a-4p) OR $1400/day for a 16-bed unit (8a-2p) for weekend tele-rounding coverage. Telephonic coverage is $400/night from Friday 4 pm to Monday 8 am ($1200) and C/L 2-4p for $150/consult.

Does this sound reasonable for virtual coverage? I am in the New England region.

1700 for 24 patient encounters?

 

[aspiringdoc09]

1700 for 24 patient encounters?

Yes, that's the maximum number of beds for the unit. They report it may not always be a full unit but may have 1-2 admissions per day.

 

[ridethecliche]

Yes, that's the maximum number of beds for the unit. They report it may not always be a full unit but may have 1-2 admissions per day.

I'm a fellow and I get paid more for a friday night call where I might not even have to come in...

 

[surfguy84]

Yes, that's the maximum number of beds for the unit. They report it may not always be a full unit but may have 1-2 admissions per day.

This is an absolutely terrible rate.

 

[aspiringdoc09]

That's what I thought but I tried to compare it to salary reports. People don't typically talk about salaries, so it's difficult to gauge.

 

[aspiringdoc09]

I'm a fellow and I get paid more for a friday night call where I might not even have to come in...

It's all virtual. I never leave my house.

 

[Stagg737]

Hi...not to hijack this thread but it is about a moonlighting gig too. Has anyone worked with Amwell? They want to pay $1700/day for a 24-bed unit (8a-4p) OR $1400/day for a 16-bed unit (8a-2p) for weekend tele-rounding coverage. Telephonic coverage is $400/night from Friday 4 pm to Monday 8 am ($1200) and C/L 2-4p for $150/consult.

Does this sound reasonable for virtual coverage? I am in the New England region.

$1400/day for 6 hours of telepsych to see up to 16 patients isn't good but not completely awful if they're all follow-ups that you're just keeping alive. Any work more than that is straight up bad.

$1700/day for 8 hours of telepsych up to 24 patients is garbage. C/L is low, that's what one of our fellows got paid for new consults and $50 for a f/up encounter. The overnight is also terrible.

Overall this is terrible, even for telepsych. For context, if you extrapolate the better rate ($1400 for 6 hours/16 patients) to a FT position, then working 5 days a week at 46 weeks a year you'd only be making $322k. For 16 patients a day that's terrible unless you're at an academic center.

 

[surfguy84]

Thoughts on this one...

ER tele psych, providing recommendations only to the ER doc. 8-8. Average 8 consults per shift. 2200 per shift. Doesn't seem terrible to me but curious what others think.

 

[Stagg737]

Thoughts on this one...

ER tele psych, providing recommendations only to the ER doc. 8-8. Average 8 consults per shift. 2200 per shift. Doesn't seem terrible to me but curious what others think.

As an in-person ER psychiatrist, there are too many intricacies to dispo plans for me to ever do ER psych remotely. It's not just admit vs. discharge like a lot of people think and if you don't know local resources then you often do the patients a disservice unless the ER has a strong SW team. Plus, just because you're the consultant doesn't mean you don't carry liability. If it hits the fan and things go to court, you're almost certainly going to be named. While I see the utility, doing telehealth in the highest liability setting in our field is something to do at your own risk.

From a purely financial perspective, depends how you look at it? That's $183/hr or $275/patient. Not bad, but ER patients are not like other evals as you're the frontline and you can't turn these people away like outpatient offices or inpatient units can. Some patients are fast and easy CYA type consults, others are train wrecks that require a lot of time. My hours are typically in 6-8 hour shifts and when I do cover longer 10-12 hour shifts it definitely wears me down. However, I also work at a place where SW and nursing addresses the basic psych consults and I only see the more complex patients requiring higher levels of decision making, so YMMV.

 

[surfguy84]

Sorr

As an in-person ER psychiatrist, there are too many intricacies to dispo plans for me to ever do ER psych remotely. It's not just admit vs. discharge like a lot of people think and if you don't know local resources then you often do the patients a disservice unless the ER has a strong SW team. Plus, just because you're the consultant doesn't mean you don't carry liability. If it hits the fan and things go to court, you're almost certainly going to be named. While I see the utility, doing telehealth in the highest liability setting in our field is something to do at your own risk.

From a purely financial perspective, depends how you look at it? That's $183/hr or $275/patient. Not bad, but ER patients are not like other evals as you're the frontline and you can't turn these people away like outpatient offices or inpatient units can. Some patients are fast and easy CYA type consults, others are train wrecks that require a lot of time. My hours are typically in 6-8 hour shifts and when I do cover longer 10-12 hour shifts it definitely wears me down. However, I also work at a place where SW and nursing addresses the basic psych consults and I only see the more complex patients requiring higher levels of decision making, so YMMV.

Appreciate your take. My understanding is that the liability in the ER can be mitigated by well thought out reasoning and proper documentation. I did a lot of psych ER work pgy4 and the thing our attendings used to always hammer home was, you can be wrong but you cant be negligent. A well thought out plan, even if wrong, will keep almost all attorneys from even taking a case.

This mantra has been what's allowed me.yo stay comfortable doing my in person er work.

And fwiw I would be covering about 50% floor consults and the rest CSU calls. So the patients could at least be admitted for 24 hours for observation which also appears to minimize risk.