Supplemental income via moonlighting

[doctorjayyy]

I’ve heard from some residents that moonlighting is relatively easy to do during rads residency and can often lead to doubling your salary. I’m sure this varies by program, but how true is this? Are rads residents really making about 100-120k during residency with the help of moonlighting? How many extra hours a week does it take to make this type of supplemental income during residency? Is it really that easy to get these extra hours or is a fight between co-residents? When can you start doing this (ie, R1, R2, R3, R4)?

Also, just curious to hear how much fellows are generally making during a rads fellowship. I heard during fellowship you can start doing external moonlighting since you’re already licensed by that point (or at least a few months into fellowship). I imagine this can bring in even more money if you’re moonlighting for multiple different groups. Can anyone share some info regarding how much this can supplement a fellow’s total income?

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[SeisK]

Moonlighting opportunities are extremely program dependent. It is true that at some programs there is enough going around that you can double your salary with “5k a month” being an above average amount that I heard many residents speak to when I was on the interview trail. While it is possible, the usual rules are as follows: the better gigs (high paying, close by / in house) go to seniors because they get first dibs; moonlighting usually starts in R2, but can in R1 in some cases; babysitting scanners is the most popular option, and also the one most frequently cited, with varying amounts of reimbursements (some residencies as little as $40/hr, some as high as $120).

Some residencies have no moonlighting to speak of at all (*cough cough* you know who you are, and trust me, it’s a big deal to applicants) while others have so much they have open spots and people making >120k/Year.

Pro tip: when you interview, don’t just ask “do you have moonlighting” or “tell me about moonlighting.” Be specific, it’s much harder to dodge a jabbing question. “Is it possible to, say, double my salary if I were gungho? What does the moonlighting entail? Is it onsite or offsite? Does it involve babysitting scanners? When can I start?“ Beware the half-hearted responses and the guy who “couldn’t hear your question.” That’s an answer.

 

[piii]

No one is doubling their salary. The highest I heard on the trail was 30K a year. This was one resident that moonlighted like every weekend and many nights. Very very very uncommon. Moonlighting is more like an extra 3-10K a year but it’s heavily program dependent. Some programs don’t even have moonlighting. Some you can only do certain years.

 

[ma3afan]

No one is doubling their salary. The highest I heard on the trail was 30K a year. This was one resident that moonlighted like every weekend and many nights. Very very very uncommon. Moonlighting is more like an extra 3-10K a year but it’s heavily program dependent. Some programs don’t even have moonlighting. Some you can only do certain years.

Inaccurate^^^

there are certainly moonlighting opportunities out there that allow you to make way more than 3-10k extra gross income above your base salary.

Source: Am resident

 

[clutch21]

Inaccurate^^^

there are certainly moonlighting opportunities out there that allow you to make way more than 3-10k extra gross income above your base salary.

Source: Am resident

Agree with this. At my program I made greater than 10k moonlighting as an R1. If motivated, an R4 at my program could easily double their salary. While that amount is probably above average, I don’t think it is an outlier.

 

[Dave1980]

For the most part it's pretty much just babysitting the scanner which is a sweet gig until fellowship when you can actually do "real" moonighting. Meaning dictating cases. No R1-4 is going to get a job dictating cases.

 

[Rad2013]

Some programs have moonlighting where you pre-dictate routine studies that came in after 5pm to be signed by attendings the next morning. This pays more than babysitting a scanner but less than solo-reads of course.

 

[guytakingboards]

One of my residency classmates says he made over $100k between residency salary and external moonlighting in his R4 year.

He, and a few other classmates, were doing moonlighting for a tiny group a few hours away. On weekends, they drove out there and got ~$2800 for a Saturday/Sunday shift. Some even got workstations and read remotely for that group in the evenings. They were doing final reads. It was actually kind of awkward when patients got transferred from that hospital to ours and we saw their names on the reports.

The rest of us did scanner-baby sitting and made $50-$70/hr. I did 4-6 2hr shifts a month and made about $1000 extra per month.

FYI: my fellowship did not allow any external moonlighting.

 

[bobjonesbob]

No one is doubling their salary. The highest I heard on the trail was 30K a year. This was one resident that moonlighted like every weekend and many nights. Very very very uncommon. Moonlighting is more like an extra 3-10K a year but it’s heavily program dependent. Some programs don’t even have moonlighting. Some you can only do certain years.

For the most part it's pretty much just babysitting the scanner which is a sweet gig until fellowship when you can actually do "real" moonighting. Meaning dictating cases. No R1-4 is going to get a job dictating cases.

Both of you are incorrect. There are definitely opportunities to double your salary and opportunities to dictate studies as a moonlighter. Brown is probably one of the more notable places that offers opportunities to do both of these. @piii Making $30k moonlighting is a lot more common than you're letting on.

 

[Dave1980]

Both of you are incorrect. There are definitely opportunities to double your salary and opportunities to dictate studies as a moonlighter. Brown is probably one of the more notable places that offers opportunities to do both of these. @piii Making $30k moonlighting is a lot more common than you're letting on.

That's why I said "for the most part". That still works even if a few programs do have more lucrative moonlighting. In general this is not the case.

 

[Cognovi]

They were doing final reads.

That is not advisable from a legal standpoint.

 

[guytakingboards]

That is not advisable from a legal standpoint.

Is that actually true? I get why people say that, but in practice does it actually make a difference if a gross miss was from a licensed, but unboarded resident vs a licensed and boarded junior attending?

 

[zero0]

That is not advisable from a legal standpoint.

I didn't even realize it was possible. How would reimbursements even work for a non BE/BC radiologist?

 

[Dave1980]

My first day as an Attending I was a little nervous singing off on cases. If an R4 thinks they are ready they are at the peak of the Dunning-Kruger curve.

 

[SirGecko]

I’m a military resident (we aren’t allowed to moonlight) so forgive the ignorance but do civilian residencies carry malpractice insurance for their trainees that covers activity outside of residency? If not who’s covering you when you moonlight? Are you buying insurance yourself?

 

[guytakingboards]

I didn't even realize it was possible. How would reimbursements even work for a non BE/BC radiologist?

In general, you have to be licensed to be able to bill for medical services. Clinicians can bill for chest/MSK interpretations. A radiologist could bill for an lap appy.

The nuance is purely in what can you get credentialied to do and what are the requirements of the payers to whom you're submitting claims. Some places require a boarded rad. Some want a CAQ'ed rad reading neuro cases. Some don't care if you're boarded or not.

I’m a military resident (we aren’t allowed to moonlight) so forgive the ignorance but do civilian residencies carry malpractice insurance for their trainees that covers activity outside of residency? If not who’s covering you when you moonlight? Are you buying insurance yourself?

Correct. Residents who moonlight externally have to setup their own malpractice insurance for those activities. Its part of the not-insubstantial costs of external moonlighting: e.g. state licensing, DEA licensing, medmal insurance, etc...

 

[zero0]

In general, you have to be licensed to be able to bill for medical services. Clinicians can bill for chest/MSK interpretations. A radiologist could bill for an lap appy.

The nuance is purely in what can you get credentialied to do and what are the requirements of the payers to whom you're submitting claims. Some places require a boarded rad. Some want a CAQ'ed rad reading neuro cases. Some don't care if you're boarded or not.



Correct. Residents who moonlight externally have to setup their own malpractice insurance for those activities. Its part of the not-insubstantial costs of external moonlighting: e.g. state licensing, DEA licensing, medmal insurance, etc...

Weird, I guess I'm just surprised there are payers out there willing to reimburse for non-BC reads. I am planning on moonlighting at some point, as I'm told private practices like hiring people who had experience doing reads in a pp setting, but I figured it was all preliminary reads that an attending signs off on later. I'll have to keep an eye on that in the future and think about liability.

 

[Tiger100]

In general, you have to be licensed to be able to bill for medical services. Clinicians can bill for chest/MSK interpretations. A radiologist could bill for an lap appy.

The nuance is purely in what can you get credentialied to do and what are the requirements of the payers to whom you're submitting claims. Some places require a boarded rad. Some want a CAQ'ed rad reading neuro cases. Some don't care if you're boarded or not.

I haven't heard of any payer/insurance which requires CAQed rad to read neuro.

FYI, Many groups have exclusive contract with the hospital and one term of their contract says that ALL their radiologists are board certified.

 

[guytakingboards]

I haven't heard of any payer/insurance which requires CAQed rad to read neuro.

FYI, Many groups have exclusive contract with the hospital and one term of their contract says that ALL their radiologists are board certified.

I don't know precisely the mechanism, but i was told it is in my group's economic interest for all of the neurorads to get CAQ. It's not a requirement. I was led to believe it's something related to a percentage of neuro reads being performed by CAQ neurorads --> then there's either a slightly higher reimbursement rate or bonuses from the hospital system based on the contract. (in which case its less to do with reimbursement and more to do with the hospital contract).

 

[maxxor]

I don't know precisely the mechanism, but i was told it is in my group's economic interest for all of the neurorads to get CAQ. It's not a requirement. I was led to believe it's something related to a percentage of neuro reads being performed by CAQ neurorads --> then there's either a slightly higher reimbursement rate or bonuses from the hospital system based on the contract. (in which case its less to do with reimbursement and more to do with the hospital contract).

There are payers who will not reimburse cardiac and coronary CTA unless the reader has either CBCCT, did ABR certifying with 3 cardiac sections, or a fellowship.

I could see this come to all boarded subspecialties.

 

[Chemdude]

Residents at my program can double their salaries working about 20 babysitting hours extra/week. Our record has been ~180k a few years back. I know that one of the current R2s made over 100k last year.

 

[Taurus]

Moonlighting is better as an attending. I can make 10k in a weekend working less than 20 hours.

 

[Taurus]

Over the last 2 years, I’ve made over 400k in moonlighting, selling vacation time, legal expert witness, etc. Unfortunately, my extracurricular activities have taken a big hit because of covid. Still doing some spotty moonlighting. I refuse to lower my rate though.

 

[emdee_inside]

What about taxes? Suppose you make 50k as a resident (base salary) and then 50k moonlighting in R4 year. Do you get taxed on 100k? How much is actual take-home money? Also if you're working like 60-70 hours a week as a resident, how much time do you spend moonlighting? 5-10 hours a week?

 

[DrOngoGablogian]

What about taxes? Suppose you make 50k as a resident (base salary) and then 50k moonlighting in R4 year. Do you get taxed on 100k? How much is actual take-home money? Also if you're working like 60-70 hours a week as a resident, how much time do you spend moonlighting? 5-10 hours a week?

Not sure if there is nuance I am missing to your question, but it is a progressive tax system. The bracket you cap out in doesn’t then apply to income made on the way up to it—the rates associated with those brackets still apply to those earnings. Again, sorry if I misunderstood your question.

 

[Rad2013]

Just a note to novices... if you do "external" moonlighting, you will likely be paid as a 1099 contractor. Taxes are not taken out. Make sure to either pay quarterly taxes or set aside money from each moonlighting paycheck to cover taxes.

 

[Chemdude]

Over the last 2 years, I’ve made over 400k in moonlighting, selling vacation time, legal expert witness, etc. Unfortunately, my extracurricular activities have taken a big hit because of covid. Still doing some spotty moonlighting. I refuse to lower my rate though.

Wow that sounds amazing. How did you come across the opportunity to become an expert witness?

 

[risus_sardonicus]

Over the last 2 years, I’ve made over 400k in moonlighting, selling vacation time, legal expert witness, etc. Unfortunately, my extracurricular activities have taken a big hit because of covid. Still doing some spotty moonlighting. I refuse to lower my rate though.

Love the #hustle. Keep grinding


Sent from my iPhone using SDN

 

[Timtom98]

One of my residency classmates says he made over $100k between residency salary and external moonlighting in his R4 year.

He, and a few other classmates, were doing moonlighting for a tiny group a few hours away. On weekends, they drove out there and got ~$2800 for a Saturday/Sunday shift. Some even got workstations and read remotely for that group in the evenings. They were doing final reads. It was actually kind of awkward when patients got transferred from that hospital to ours and we saw their names on the reports.

The rest of us did scanner-baby sitting and made $50-$70/hr. I did 4-6 2hr shifts a month and made about $1000 extra per month.

FYI: my fellowship did not allow any external moonlighting.

How did you guys find that group ?! Head Hunter or cold calling?

 

[Timtom98]

Residents at my program can double their salaries working about 20 babysitting hours extra/week. Our record has been ~180k a few years back. I know that one of the current R2s made over 100k last year.

Umm which program???? Can I apply

 

[NecrotizingFasciitis]

Hey sorry, lowly 4rth year here, what do you guys mean by “babysit the scanners”

And does it include the 80 hour work week for residents? Like if you hit 80 are you even allowed? Would you even want to?

 

[guytakingboards]

Hey sorry, lowly 4rth year here, what do you guys mean by “babysit the scanners”

And does it include the 80 hour work week for residents? Like if you hit 80 are you even allowed? Would you even want to?

Babysitting the scanner usually refers to being the physician in charge of covering contrast reactions at CT/MRI scanners for a period of time. Contrast reactions come up very infrequently with the current generation of contrast agents, so you're essentially being paid to sit in a room without any responsibility. Hence, babysitting the scanner.

Yes, per ACGME any moonlighting should be reported be for the 80hr limit.

However,
1) most radiology rotations don't come anywhere near 80 hr's per week (rarely intervention) so unless you were moonlighting a ton its a moot point
2) Residency programs often have zero knowledge of how much moonlighting you do, external or internal. So self-reporting can only hurt you or the program.

I never did contrast-coverage for more than 15 hrs any given week, usually less, so I didn't even bother logging it because i knew I'd always be under 80 hr's.

Contrast-coverage is a sweet gig if you can get it. It can be protected study time. I used it to do my chief admin duties. Some nights, I just connected to the imaging center's wifi and watched TV/netflix for a few hours.

 

[theonlytycrane]

Is there an appropriate way for m4's applying to radiology to ask about "babysitting" opportunities that may be available at the programs / areas they are applying to?

 

[zero0]

Is there an appropriate way for m4's applying to radiology to ask about "babysitting" opportunities that may be available at the programs / areas they are applying to?

Just ask about moonlighting openly. Any program that gets upset or defensive is not one you wanna be at.

 

[Cognovi]

Is there an appropriate way for m4's applying to radiology to ask about "babysitting" opportunities that may be available at the programs / areas they are applying to?

Ask the residents - how often do they personally moonlight (eg, avg hours per week or month), how much does the person in their class who moonlights most do, how much do they make, what are their responsibilities during moonlighting