Should you moonlight during residency?

The opportunity to earn extra money moonlighting as a resident seems like a simple decision. But before deciding to cover extra shifts, think about the compromises you’ll need to make.

Moonlighting is on the rise, in part because of the looming primary care physician shortage. A 2016 study from the Association of Medical Colleges predicted the United States will face a deficit of 61,700 to 94,700 physicians by the year 2025. The trend means you may be able to pick up shifts in your current hospital or with an outside health care organization.

Benefits & Challenges

Benefits

Financial Gain

Extra shifts certainly mean more money, but many moonlighters also value the experience the opportunity provides.

Emergency medicine resident Rodney Fullmer, DO, moonlights externally. He says he makes less money than an attending physician, but a lot more than a resident.

According to the 2015 Survey of Temporary Physician Staffing Trends, health care facilities pay a daily rate for temporary physicians. Depending on the specialty, the rate can range from several hundred dollars to over $1,500.

Family medicine resident Julian Barkan, DO, says his program doesn’t allow residents to moonlight, but thinks it would help pay off his student loans.

“Having the ability even once a month would be a useful chunk of change,” Barkan says.

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Additional Education

Moonlighting can expose you to different areas of the hospital. For internal medicine resident Shannon Tosounian, DO, the work she does moonlighting is similar to being on call for a general medicine floor. She moonlights covering teaching or non-teaching teams at her residency hospital.

Teaching service requires holding the pagers for the general medical teams that are not on call, then signing out these services once the night float team arrives. Non-teaching service is covering the pager for patients who are admitted for conditions that would not require a teaching team and are managed by physician assistants during the day.

“It can get very busy, but I do that level of work on a resident salary anyway. When I look back on a week that I’ve picked up a few moonlighting shifts, I hardly notice that I had worked more,” Dr. Tosounian says.

Independence

Moonlighting allows residents to improve their medical management skills. The extra hours of practice can help develop greater efficiency.

“If moonlighting is thought of purely as a financial gain, it may not be worth it.  Once it’s considered as an opportunity to grow your independence and confidence as a physician, it becomes a much more pleasurable experience,” Dr. Tosounian says.

Dr. Fullmer says his program encourages moonlighting for that reason. With every shift and every patient, he becomes more confident in his decision making.

“Moonlighting gives you a unique opportunity to remove one more safety net before you graduate and become an attending physician,” Dr. Fullmer says.  “You grow as a future attending and in turn it changes how you practice as a resident.”

Challenges

Missed Opportunities

Obviously, extra shifts mean even less precious free time. If you’re already tired, the extra work may push you to exhaustion.

Also, think about the time you spend on educational programs, events at your hospital, involvement with professional and community organizations as well as relaxing with friends and family before deciding to sacrifice it.

“More time in the hospital means less time at home with my husband. It means one or two nights of missed opportunities to grab dinner with my co-residents.  But if I plan ahead, and optimize my free time, these sacrifices are pretty minimal,” says Dr. Tosounian.

Over Time

The ACGME puts a cap on the number of hours a resident can work a week. External and internal moonlighting are considered part of the 80-hour weekly limit on duty hours.

Liability Concerns

Residents who put in extra hours need to make sure they are protected from legal liability. Ensure coverage before you accept a moonlighting gig.

Picking up extra shifts at your residency hospital may be simplest because many programs provide malpractice coverage to residents. Ask your supervisor to clarify any concerns you might have about liability.