To Moonlight, or Not To Moonlight

[The White Coat Investor]

I have arrived at the fateful day. I'm an EM2 in a 3 year program who just passed Step III. Now I've got to decide if I want to do any moonlighting. My options include urgent cares, babysitting a vent farm, and working in rural EDs.

My little family and I CAN live on my resident salary and I have no loans (except for one big one to Uncle Sam, if you know what I'm saying) but we'd love to have an extra 1-2K a month.

I'm philosophically opposed to moonlighting in EDs prior to residency completion....I mean...if you can work an ED without an EM residency, why do an EM residency, even if you're better than whatever they've got working that ED right now.

I do believe there is a small educational benefit to getting out there and doing it on your own.

It'll cost me some effort and some money to get licensed and credentialed.

So the question I give to the attendings out there is this, if you were in my shoes, would you moonlight or not? Would you try to get an urgent care slot, babysit the vent farm or work an ED and why?

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[roja]

I am not planning on moonlighting. I have a family and while we aren't rolling in dough (the extra money would be great), I value my free time. I intend to spend that extra time studying some, going ot the gym more, and generally being with my friends and family more. In the long run, even 1-2K a month isn't worth my time for my loved ones, or myself.

 

[DrQuinn]

I have arrived at the fateful day. I'm an EM2 in a 3 year program who just passed Step III. Now I've got to decide if I want to do any moonlighting. My options include urgent cares, babysitting a vent farm, and working in rural EDs.

My little family and I CAN live on my resident salary and I have no loans (except for one big one to Uncle Sam, if you know what I'm saying) but we'd love to have an extra 1-2K a month.

I'm philosophically opposed to moonlighting in EDs prior to residency completion....I mean...if you can work an ED without an EM residency, why do an EM residency, even if you're better than whatever they've got working that ED right now.

I do believe there is a small educational benefit to getting out there and doing it on your own.

It'll cost me some effort and some money to get licensed and credentialed.

So the question I give to the attendings out there is this, if you were in my shoes, would you moonlight or not? Would you try to get an urgent care slot, babysit the vent farm or work an ED and why?

For me it'd be more about the extra cash. My wifey and I aren't hurting at all, but it'd be nice to get to enjoy some extra bling bling before we start squirtin' out the baby Keanus. I'd go for the vent farm... and nearing the middle of my PGY-3 year considering an urgent care setting. Nearly all of my attendings tell me not to moonlight in an ED.

Q

 

[Seaglass]

I'm in a program where most all of the 3rd years moonlight in EDs and most think the experience is definitely positive. Most positions are double coverage so you have backup and all provide malpractice + tail.

 

[Snoopy]

All the residents from my program that I've talked with and who have been out on the interview trail say they've been asked whether they have moonlighted. Those asking seemed to view moonlighting as a positive and thought candidates were better prepared for a position if they had been out there on their own for at least something.

I have received my license and DEA number and plan to moonlight third year. I do not, however, plan on working in an ED in any kind of single coverage situation. We have institutional moonlighting opportunities and there are some community hospitals that have double coverage so that you would at least have someone to back you up if you had questions about a patient.

 

[bcsmith]

I'm in a program where most all of the 3rd years moonlight in EDs and most think the experience is definitely positive. Most positions are double coverage so you have backup and all provide malpractice + tail.

I wouldn't mind moonlighting for some extra tail. My wife, however....

B

 

[GiJoe]

i've heard some programs allow PGY1'ers moonlight. Anyone know of any chicago programs allow this? I heard christ is one of them

 

[Syd Barrett]

Gi Joe is right. We have a unique opportunity at Christ starting our intern year which I call quasi-moonlighting. Here's the dealio.

We have an 8 bed cardiac obs unit (ECC = emergency cardiac center) which is right next to our main ED but it is a separate unit. It is designed to be an obs unit for low risk chest pain patients waiting for stress tests in the AM....when beds are tight, the ECC gets everyone from the unresponsive nursing home gome to pediatric foot injuries. We have scheduled shifts during the day (6a - 6p). At night (6p - 6a), there is a voluntary sign-up. Pay is ~ $65 per hour.

In the ECC, it's just me, two nurses, and 1-2 techs. I get to run the show (great empowering feeling). There is an attending in the main room "overseeing the unit" who will see ALL of the patients eventually (maybe 2-3 hours after they come in). Some of the staffing is done over the phone. When s**t hits the fan, I'm the cowboy. When s**t REALLY hits the fan, I put out a call and the attending comes running in. I coded a patient in all 8 rooms last year (low risk chest pain.... my arse).

Bottomline. This opportunity provides the perfect balance between autonomy and supervision. I'm basically on my own, but Mommy and Daddy are there to comfort me if I need it.

I don't have the balls to work single coverage BY MYSELF in a busy ED and frankly I don't know how good I'll feel about that when I'm a PGY-3. Like Desperado said, what does this say about EM if we allow people to do this? Is this the case in G surg? Uhh...hi...I'm an FP resident and I just passed Step III so I'm going to take your gall bladder out. In Illinois, we can't moonlight outside the institution until we're PGY-3. Our program neither encourages or discourages outside moonlighting. Some of my fellow residents get out some, but it's so easy to moonlight in the ECC - no hassles, just sign the sheet on the bulletin board and you get paid.

As for your original question GI Joe, U of C used to allow people to moonlight in their Fast Track but I don't think this is allowed anymore. As far as I know, none of the other programs have institutional moonlighting opportunities.

Syd Barret
Bizzup on da souf side
PGY-deuce, EM
Advocate Christ Medical Center

 

[Apollyon]

ABEM is on the record as being against moonlighting, for the reason Despy gave. If we demand that ED's be staffed with EM-trained, BC/BE docs, how can we, in the same breath, advocate patients being treated by less than the aforementioned?

 

[DocWagner]

I can tell you without hesitation that moonlighting has been invaluable to me. Your decision making becomes more concise and speed becomes more honed. While I do enjoy the money (need it), I also understand the political implications. Let it be known that I always moonlight during double coverage, but I have seen some hefty acute cases. You earn your scars.

 

[bartleby]

I agree that moonlighting in a fast-track or double/triple coverage department is a great idea, money aside. There is nothing which will give you a better perspective on your last year of residency, help you in your job search, or hone your skills better. All residencies are an ivory tower to some degree, and there is no better way to really get a feel for what community practice is like. This experience has had some pretty dramatic and unforseen effects on my job search, and has probably kept me from making a mistake or two in terms of the job I'm going to take...

I would absolutely NOT recommend moonlighting in a single coverage situation as a resident. You still need to have someone to bounce patients off of when you have a question and you need to have another doc around to help you with local protocal/procedures when you're new anyplace, but especially in your first "real" job.

 

[DocWagner]

One of the more interesting things that happen is the developement of SPEED. 20-30 patients in 8 hours is moving...and as an moonlighter it can be done.
I can also tell you that some of my most medically challenging cases have been while moonlighting and it can be scary and cool at the same time. I had to intubate a 3 month old while moonlighting...not something any parent wants to do...or any moonlighter.

 

[bcrosspac]

Despite the fact that all of our emergency medicine societies (AAEM, ACEP, and SAEM) agree that emergency medicine residents moonlighting in an ER is a bad idea for reasons previously stated, a PGY3 EM resident may be more qualified that a FP or IM doc, even though they are boarded in their respective specialty. It is prudent however, to limit your employment to ED's with double coverage or at least, a reasonably low census. With that being said, I believe strongly that the experience gained is invaluable to building confidence, skill, and efficiency. Yes, the money ain't bad either. So, even though my hospital does not allow residents to moonlight in their area of specialty, I hope to be able to take advantage of whatever moonlighting opportunities that come my way.

 

[Homunculus]

ABEM is on the record as being against moonlighting, for the reason Despy gave. If we demand that ED's be staffed with EM-trained, BC/BE docs, how can we, in the same breath, advocate patients being treated by less than the aforementioned?

for $$$$ of course

interesting point. i imagine that you could argue that since other specialties moonlight, that you are better than their moonlighters and are serving the interests of your patients while pursuing your early bling bling.

i'm not in EM, but personally i'd wait. i havethe rest of my life to work and have responsibility. i'm enjoying my safety net while it lasts, lol.

--your friendly neighborhood fledgling physician caveman

 

[rh]

I can say that even if you are working in double coverage you are typically still on your own and many times you know a lot more than the doc you are working with. I moonlight in a fairly busy ED with 12 hours of Double coverage. I have done a few shifts were I have been on my own for 4-8 hours. Nights have been scary a couple of times. I agree with trying not go single. Also go someplace where you have decent backup. I hate to have to transfer patients to my friends at the U. Politics aside I think that your gain a lot of confidence in yourself and learn how move the meat. At my program moonlighting is quietly encouraged and our attendings ask us to call them in the dept. if we ever have a question. Philosophically I agree with ED should be staffed by ED physicians, but most EM2's are much better ED docs than the moonlighting neurologist or plastic surgery resident. Thats my 2 cents for whats its worth.

 

[FoughtFyr]

i've heard some programs allow PGY1'ers moonlight. Anyone know of any chicago programs allow this? I heard christ is one of them

Mayo allows, and actually advocates, EM interns "moonlighting" - teaching ACLS at $75/hr. Minimum 6 hours (paid for 7 - lunch hour). You only need to do this once or twice a month to have considerable beer money. You improve your own skills as you teach others and there are no liability issues. All EM residents are required to go through the instructor training in their orientation month, so you are out nothing but the time on your day off.

- H

 

[ERMudPhud]

I was in a 4 year program where we had tons of autonomy and rotated through county, university, and private hospitals. I never moonlighted and except for an occaisional realization that the safety net was gone I never noticed the transition from residency to attending