What states allow moonlighting after PGY-1?

[drcuma]

I'm an american citizen who attended Ross, I know WI is good for moonlighting after PGY-1, are there any other states? Does the fact that I was born and raised in US allow me to moonlight sooner?

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[Smurfette]

You need to have a permanent medical license in the state you wish to moonlight. Therefore, start by looking up states that will issue permanent licenses after completion of PGY1.

Born and raised in the US does not really play a factor here. It *may* speed up the process if you don't have to worry about visas, etc., but the main factor is completing licensing requirements, which everyone has to do regardless of where they were born and raised.

 

[NotAProgDirector]

The FSMB has the complete list compiled.

 

[Law2Doc]

Also bear in mind that while you may be licensed within a state, that doesn't mean your residency allows you to moonlight. They "own" you, and if they don't want to let you moonlight so they don't risk breaking the 80 hour/week mark, that is their contractual right. More than a few places restrict moonlighting, particularly for more junior residents, and some programs flat out forbid it. So I wouldn't choose a state simply because folks moonlight there. It depends on the specialty and the program within the specialty more than the state.

 

[JackADeli]

Also bear in mind that while you may be licensed within a state, that doesn't mean your residency allows you to moonlight....if they don't want to let you moonlight so they don't risk breaking the 80 hour/week mark, that is their contractual right...

I will leave it to AProgDir to correct if i am wrong.... But as noted, the 80hr/wk resident protection is a double edged sword. I believe the RRC/ACGME restricts your clinical work to average of 80 or less hours over 4 weeks to include time of moonlighting. So...

1. first need to be able to get appropriate licensing/credentials
2. need residency to approve
3. moonlighting hours will be restricted by what balance of hours are left after your residency. That is, if your residency duties are averaging 75 hrs/wk, you can not moonlight more then 5 hrs/wk.

The last part, #3 is critical. Moonlighting will require malpractice coverage. For your moonlighting employer to find you worthwhile/economically viable to hire [and pay malpractice, etc...] they will want a minimum number of hours per week. Do not know Not any will hire you for 5 or less hour shifts/wk.

 

[NotAProgDirector]

I will leave it to AProgDir to correct if i am wrong.... But as noted, the 80hr/wk resident protection is a double edged sword. I believe the RRC/ACGME restricts your clinical work to average of 80 or less hours over 4 weeks to include time of moonlighting. So...

1. first need to be able to get appropriate licensing/credentials
2. need residency to approve
3. moonlighting hours will be restricted by what balance of hours are left after your residency. That is, if your residency duties are averaging 75 hrs/wk, you can not moonlight more then 5 hrs/wk.

The last part, #3 is critical. Moonlighting will require malpractice coverage. For your moonlighting employer to find you worthwhile/economically viable to hire [and pay malpractice, etc...] they will want a minimum number of hours per week. Do not know Not any will hire you for 5 or less hour shifts/wk.

Totally agree. The current work hour rules are that only internal moonlighting (i.e. moonlighting in any hospital associated with your residency) counts towards hours, but the new rules for Jul 1 will include all moonlighting.

Some residencies have elective / outpatient / lighter months where there is time to moonlight. Some do not.

 

[lawj]

I will leave it to AProgDir to correct if i am wrong.... But as noted, the 80hr/wk resident protection is a double edged sword. I believe the RRC/ACGME restricts your clinical work to average of 80 or less hours over 4 weeks to include time of moonlighting. So...

1. first need to be able to get appropriate licensing/credentials
2. need residency to approve
3. moonlighting hours will be restricted by what balance of hours are left after your residency. That is, if your residency duties are averaging 75 hrs/wk, you can not moonlight more then 5 hrs/wk.

The last part, #3 is critical. Moonlighting will require malpractice coverage. For your moonlighting employer to find you worthwhile/economically viable to hire [and pay malpractice, etc...] they will want a minimum number of hours per week. Do not know Not any will hire you for 5 or less hour shifts/wk.

So if the 80 hour week is averaged over a month, and you are averaging 75 hours/week, then could you work two, 10 hour shifts/month to bring your average of the month to 80 hours?

 

[gutonc]

So if the 80 hour week is averaged over a month, and you are averaging 75 hours/week, then could you work two, 10 hour shifts/month to bring your average of the month to 80 hours?

Theoretically, yes. Realistically, no.

The minimum moonlighting shift you're likely to find is 12 hours. Moonlighting isn't set up to help you make easy money. It's there to allow programs/groups to cover crappy shifts with competent physicians willing to work for less than they'd have to pay their partners/employees for the same work. But it's only worth it for them if you will work the hours they set out for the money they offer. So if you can only work 10h at a time, when they really need 12-14h to be covered, the likelihood you'll get a gig is small. Also, don't discount how wiped out you'll be at 75 hours a week.

 

[Law2Doc]

...Also, don't discount how wiped out you'll be at 75 hours a week.

I would emphasize this point. First, you have to remember that if you are pushing 75 hours, you are going to be anxious to go home and sleep/decompress, etc. You will probably be coming to work in the dark, going home in the dark, with an overnight call or two each week during which you likely will be running around all night. You will be getting 4 weekend days off a month in most cases, and some of those will be postcall days so they won't really feel like they are off (you will go home that am, and have to come back the next day, so you still will have been in the hospital at least part of every day that week. So at the end of a 75 hour week, you will be ready to crash.

Second, when you are flirting with 75-80 hours, you won't really know if you are on pace for 75 or 80 hours or more in a given week until the last day of that week. Your program will structure signouts etc to at least on paper get you out the door by 80 hours, but in most cases what happens on paper and in practice aren't exactly identical. It's not really the kind of job where you punch a clock at the whistle each night. Inevitably there will be things that happen right before signout each day (unforseen Codes, attending calls, things you want to finish up before you leave either because you know you will get scolded about if you just sign out blind to the night person, or because you know that if you burn the night guy he's going to burn you right back the week you are on nights, etc. There's a whole "do unto others" culture at some programs that makes you stay late to safe yourself grief down the road. Or there's the attending who pops up at the end of the day and asks you for a few quick favors before you leave, which take way too long. These things can derail you and turn your 75 hours to 78+ hours in a blink.

Third, if you have a residency where you are working more than 70 hours/week regularly, your residency is likely going to forbid moonlighting for the simple reason that if things get very busy (or if they end up shortstaffed), they need the ability to ramp up your hours, and if you are already toward the maximum hours, they lose their ability to do the whole 75, 75, 75, 95 month if they need to. You are under contract with your residency, and they get first crack at your time.

Finally, you have to realize that at plenty of places although your timecards max out at 80 hours, that doesn't mean in reality you are home in bed at the end of 80 hours. Some places aren't compliant. At plenty of places you will have to read up on things and log in to check on things etc at home. You will have presentations to work on (you may be teaching med students, doing grand rounds, morning topical meetings, etc). So if you weren't wiped out due to the 75+ hours/week you were in the hospital, you will be after the additional 10 hours of "homework" you are doing each week.

So yeah, unless you are on a choice rotation/residency where your hours are 60 hours or less, moonlighting might be pretty unrealistic anyhow. And under the new rules a lot of places are going to discontinue the practice out of concern that they will lost the option of keeping you for the whole 80 hours they are entitled. I wouldn't plan my life around moonlighting opportunities.

 

[motoo]

A large part of residencies forbidding you from working elsewhere is they can monopolize your labor and pay you less than the going rate. I know certainly at my institution they say you can't moonlight outside our hospital. but for the moonlighting opportunities within the hospital, they pay like $65/hr whereas others are offering $100/hr. it's a captive labor pool for them

 

[Law2Doc]

A large part of residencies forbidding you from working elsewhere is they can monopolize your labor and pay you less than the going rate. I know certainly at my institution they say you can't moonlight outside our hospital. but for the moonlighting opportunities within the hospital, they pay like $65/hr whereas others are offering $100/hr. it's a captive labor pool for them

I guess that's possible, but honestly, under your residency contract they could really just adjust your duty hours to hit 80 hours/week if they wanted and pay you nothing per hour extra for the addition, so you don't really have grounds to complain about getting $65/hour during any of those hours that they already "own" you.

 

[DrJosephKim]

Moonlighting guidelines are also dependent on your residency program. They don't want you to be overworked when you're treating patients, so you can't exceed the hourly limits imposed by the ACGME.

 

[nitemagi]

Furthermore, recognize that you're not going to start moonlighting day 1 of PGY-2. You have to finish PGY-1, Then apply for your state license (depending on state can take up to 4+ months), Then get a DEA # (if you'll be prescribing), Then apply for a specific position and credentialed there, which usually takes up to an additional 3 months.

Some states and positions have faster turnaround times, of course, based on need/demand.

 

[Ishie1013]

So in the states where IMGs require an extra two years (like the one I'm going to), that means if I'm an IMG, I can't moonlight until I'm a PGY-4?

 

[gutonc]

So in the states where IMGs require an extra two years (like the one I'm going to), that means if I'm an IMG, I can't moonlight until I'm a PGY-4?

Correct.

 

[confuse]

What do the residents that moonlight do in terms of malpractice insurance? Do most just wing it?

 

[Law2Doc]

What do the residents that moonlight do in terms of malpractice insurance? Do most just wing it?

It's illegal to "wing it". Not an option. You have to obtain insurance yourself or through the place that hires you.

 

[Arcan57]

It's illegal to "wing it". Not an option. You have to obtain insurance yourself or through the place that hires you.

It's monumentally stupid, but I'm not sure it's illegal to go without malpractice coverage. It may have unintended future consequences. Every hospital that you credential with is going to ask about your prior malpractice insurers, I don't know what they would make of you working clinically without insurance if they noticed.

The big issue is not so much malpractice insurance or not, but whether that malpractice insurance provides a tail. If not, depending on how much you moonlit, then expect to see a fair amount of your profit disappear to buy a tail.

 

[gutonc]

It's monumentally stupid, but I'm not sure it's illegal to go without malpractice coverage. It may have unintended future consequences. Every hospital that you credential with is going to ask about your prior malpractice insurers, I don't know what they would make of you working clinically without insurance if they noticed.

This is state dependent. Some states require all physicians and medical providers to have malpractice insurance, others have other mechanisms (a bond...kind of like one-time purchase insurance) or nothing that they require.

But yes, going without it is monumentally stupid.

The big issue is not so much malpractice insurance or not, but whether that malpractice insurance provides a tail. If not, depending on how much you moonlit, then expect to see a fair amount of your profit disappear to buy a tail.

If it's an internal moonlighting gig (like the one I do), it will be the same as provided to the faculty at the institution (which has a tail). If it's outside, another hospital or UC type of gig, they may require you to buy your own...and it best have a big 'ol tail on it or you're going to be potentially sacrificing long term income (your future attending salary) for short term gain (moonlighting money.

 

[Law2Doc]

It's monumentally stupid, but I'm not sure it's illegal to go without malpractice coverage. ...

Actually since your license is given to you under the terms of state law, the state has the ability to impose requirements of practice. Frequently one condition of practice is carrying adequate insurance, as determined by that state. Thus if you don't have insurance, you are violating your license, hence breaking the law. You may want to check out your state licensing board's website to make sure you are carrying adequate insurance pursuant to your license. But yes, it would also be monumentally stupid, because a judgement would end your career, put most of your possessions at risk for years to come, etc.

 

[nitemagi]

Actually since your license is given to you under the terms of state law, the state has the ability to impose requirements of practice. Frequently one condition of practice is carrying adequate insurance, as determined by that state. Thus if you don't have insurance, you are violating your license, hence breaking the law. You may want to check out your state licensing board's website to make sure you are carrying adequate insurance pursuant to your license. But yes, it would also be monumentally stupid, because a judgement would end your career, put most of your possessions at risk for years to come, etc.

Again, I think this depends on the state. There's a trend towards "going bare" in specialties with extremely high cost of malpractice, such as OB-Gyn. Again, not recommended, but not illegal, at least in many states. Sounds like a good topic for a paper though.

Just google "going bare" + malpractice.

 

[Law2Doc]

...There's a trend towards "going bare" in specialties with extremely high cost of malpractice, such as OB-Gyn. ....

Agree that it is state dependent, but from a very cursory search of state licensing websites, it looks like the majority of states require insurance.

I would suggest that there is no such going bare "trend", just some theatrics. OBGYN is a field that has been threatening that their field will close up shop due to liability risk/medmal insurance costs for several decades now, but it hasn't happened, and won't. It's still a lucrative field, notwithstanding the very high cost of doing business due to liability. No OBGYN group is really foolish enough to put their entire net worth at high risk to save on insurance premiums -- it is yet another hollow threat from a field that feels it is disproportionately hindered, yet by all indication continues to thrive.

 

[confuse]

Sounds complicated. Let's say you get paid $100/hour to pick up a 10-hr shift in the ER at an outside hospital. Is it realistic to be expecting to bring home $500 for the shift after tax and malpractice costs?

 

[Law2Doc]

Sounds complicated. Let's say you get paid $100/hour to pick up a 10-hr shift in the ER at an outside hospital. Is it realistic to be expecting to bring home $500 for the shift after tax and malpractice costs?

Taxes will likely be a third or less, depending on your household income. If you are obtaining insurance on your own just for the ability to do a single 10 hour shift, probably not. If you are doing enough 10 hour shifts per premium period such that you spread the expenses, sure.