Setting up moonlighting

[Neoplastic]

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hey guys, just curious what the process is for starting a moonlighting gig. Do you typically cold call? Is there an application process? letters of rec? etc If you have a bad relationship with your PD, are you screwed?

if there is a thread that already covered this, I apologize. Using the search led to too many hits that didn't cover this question.

Thanks in advance!

 

[Winged Scapula]

Most people ask colleagues where the moonlighting gigs in town are. You could look at ads or cold call as well.

I had to fill out a routine application which was mostly demographic stuff and then provide copies of my license, DEA, and degree. I didn't have to provide LORs because they knew me as I had rotated at this hospital when I was a resident.

So it depends on whether or not they ask for references or not. Others who have moonlighted at places they didn't rotate through can provide more info about what they had to do.

 

[Blade28]

I asked other residents that had moonlighted for hospitals, LTACs, nursing homes, etc.

You'll need Step 3, a full state medical license, DEA number and BLS/ATLS. It takes a while to get your license, depending on where you live - sometimes up to 2-3 months. Then it also takes a while for you to get privileges at some hospitals.

What's your program's view on moonlighting? What field are you in? Will you be in the lab doing research?

 

[Neoplastic]

hey, thanks for your response, blade.

my program does allow moonlighting. The only problem I foresee is that I've had a rocky relationship with my program director over one specific incident. I'm curious to know whether this may be an issue. Do hospitals aggressively seek references or letters of recommendation from the program director sepcifically? It would not be a problem to get references/lor from others in my field.

 

[Winged Scapula]

They will probably ask for a letter to prove that you are allowed to moonlight, as it is not allowed in many programs. The letter is expected to be from your PD but its not usually a letter of reference, so hopefully wouldn't be a problem for you.

 

[gutonc]

Some hospitals may have internal moonlighting gigs as well. Our hospitals (Univ and VA) have 3 that I'm aware of. The upside is that you don't need accreditation or you own DEA #, only an unlimited license and approval from your PD and GME. The downside is that they don't pay quite as much as some other gigs.

1 (admitting only, no cross-cover) pays $400/night if you don't get called in and $55/hr if you do get called in ($660 total). One pays $65/hr, is both admitting and X-cover but is relatively quiet (maybe 1 admit/night). One pays $75-85/h + holiday bonus pay (~$1250 for a holiday shift) and is fairly busy (1-5 admits/night and a fair amt of X-cover) but is the most popular.

OTW, asking around is the best way to find moonlighting. LTAC/Vent Farms are always looking for warm bodies...they tend not to pay that well either but it's primarily sleeping for dollars so that makes up for it.

 

[Bobblehead]

You'll need Step 3, a full state medical license, DEA number and BLS/ATLS.

Note that while some specialities will require ATLS some will require ACLS and others will require neither. A current BLS card is a good idea to have regardless though.

Some places will require health documentation (PPD) and others board certification status.

 

[Blade28]

hey, thanks for your response, blade.

my program does allow moonlighting. The only problem I foresee is that I've had a rocky relationship with my program director over one specific incident. I'm curious to know whether this may be an issue. Do hospitals aggressively seek references or letters of recommendation from the program director sepcifically? It would not be a problem to get references/lor from others in my field.

It depends. The gigs here required a letter from my program director stating that I was a resident in good standing, could be trusted, etc.

Note that while some specialities will require ATLS some will require ACLS and others will require neither. A current BLS card is a good idea to have regardless though.

Some places will require health documentation (PPD) and others board certification status.

Sorry, I meant ACLS (the thing that comes after BLS!). I'm just so used to writing "ATLS" that it slipped out!

I haven't heard of any moonlighting places that require ATLS - that would be a pretty hardcore (read: trauma-heavy) gig!

 

[elwademd]

best to ask around from different residents in the same program, and other programs at your hospital.

personally, i covered on weekends occassionally for a hematology/oncology group which paid really well, an infectious disease specialist which paid ok, and did urgent care clinic in korea town which paid well. all three were word of mouth.

i also know residents who covered on weekends at different hospitals, others who did per diem work for kaiser permanente, and even one who covered for a doc that did boutique/concierge medicine!

so, there are plenty of different ways to moonlight out there, some with little to know paperwork (internal moonlighting), and others with a ton. again, i'd suggest asking your fellow residents, as they're the most likely to be in a similar financial situation and thus have that knowledge in hand.

 

[anonymousEM]

Before you do any moonlighting make sure you ensure that you have adequate malpractice coverage (ie does it have a tail included if you have claims-made insurance?) If you have to cover the tail (anything from the day you stop til the limit of time a patient would have to file a potential suit (consider in cases involving kids especially this can be decades) it can cost you more than you made moonlighting....

 

[swpm]

Partly related question.

Does anybody ever care about board scores, ever again? If you're applying for a job moonlighting as a resident, or looking for a job after residency, does it ever matter one bit if you scored 99% on the ITEs and written vs barely passing at the 18th percentile?

Is BC/BE as far as anyone ever looks?

 

[Winged Scapula]

Outside of fellowship applications, I have never been asked on any job applications, licensing or privileging paperwork.

 

[elwademd]

i Have Never Been Asked On Any Job Applications, Licensing Or Privileging Paperwork.

+1

 

[Puffle]

I just interviewed with a hospital for an external moonlighting gig doing weekend coverage. The rate they quoted me seemed kinda low--> only about $900 for the whole weekend. I haven't signed anything yet, and was told that the contract was "up for negotiations." I'd like to know what other people are getting paid for moonlighting in Primary Care or specifically Psychiatry. Is it generally by the hour, or the day? Also, did you just accept the offer, or did you haggle?

 

[gutonc]

I just interviewed with a hospital for an external moonlighting gig doing weekend coverage. The rate they quoted me seemed kinda low--> only about $900 for the whole weekend. I haven't signed anything yet, and was told that the contract was "up for negotiations." I'd like to know what other people are getting paid for moonlighting in Primary Care or specifically Psychiatry. Is it generally by the hour, or the day? Also, did you just accept the offer, or did you haggle?

Depends on what they're expecting from you. Is this just an on-call at home gig, answering nursing pages and maybe going in 2-3x over the w/e? Or is it an in-house all w/e thing? If it's the former, it may seem low but it's not horrible. If the latter, it's a total screw job (doesn't even come to $20/h).

If it's a home call coverage thing you could conceivably negotiate an extra fee if you have to go in for admissions or emergencies. Our pulm attendings and fellows have a deal w/ the local vent farm that pays $200/24h period to be on call for vent mgmt. Every page they get is worth another $100 and if they have to go in they get $500.

If you're going to be expected to be in-house for the whole w/e a minimum of $40-50/h isn't unreasonable, although you may not be able to get that much.

 

[Puffle]

Thanks gutonc. I think I'll try to negotiate for more, since it is on-site for the majority of the weekend. It's nice to know a some ballpark figures.

 

[gutonc]

Thanks gutonc. I think I'll try to negotiate for more, since it is on-site for the majority of the weekend. It's nice to know a some ballpark figures.

The same vent farm I mentioned above pays $50/h to sleep there at night as a hospitalist, rather than in your own bed on weeknights, $55/h for the whole w/e.

 

[dragonfly99]

I moonlight as a fellow at the VA. I was not asked for a program director letter, probably b/c I'm doing a research year. I was not asked for references. They will not care what your board scores are, just that you passed.
If they know you a little, they probably won't ask for references.
I'd go ahead and try it...at least if you need a PD letter and he creates some kind of problem you will know how bad your relationship REALLY is...it might be good to know now.
p.s. been there, done that. Don't worry too much, and try to keep good relations with other attendings, residents, etc.