The pros and cons of moonlighting for medical trainees

Are you a medical resident or fellow?  Do you have a family to provide for?  Do you feel that your biweekly paycheck is not quite enough to justify the hard work you put in?  Luckily for you, your program offers the great benefit of “moonlighting.”  Should you take advantage?  Here are some of my thoughts on the matter.

What is moonlighting?

Like so many other things we take for granted in medicine, the term “moonlighting” actually came from rather devious origins.  According to Encyclopedia.com: Moonlighting came from the perpetration by night of violence against the persons or property of tenants who had incurred the hostility of the Land League in 19th century Ireland.  Or rather “commit crimes by night.”  Of course, these days we simply use the term to mean working a second job.  Generally speaking, there are two types of moonlighting for medical trainees:

Internal moonlighting — extra pay for extra work within your training institution.  Many training programs even highlight internal moonlighting as a benefit when interviewing applicants.

External moonlighting — extra pay for work outside of your training institution.  Often you will have to find your own malpractice insurance.

Pros

  • Moonlighting’s biggest pro is the obvious one: extra $$$.  From my personal conversations, it’s not uncommon to hear residents doubling their salary with moonlighting income.  On rarer occasions, I’ve heard of residents tripling their income.  If you are the main breadwinner in the family, that extra income can mean a big difference in lifestyle.
  • Extra clinical experience — depending on your moonlighting setup, you can gain valuable clinical experience.  In a 2008 article written for the Canadian Family Physician, Dr. Haque mentioned “more than 60 percent of the critical care procedures I performed during my year of emergency medicine training (central lines, chest tubes, intubations, and so on) were done while moonlighting.”

Cons

  • Let’s address the elephant in the room first: the quality of care issue.  Patients expect (within reason) to be treated by a board licensed physician rather than a trainee without supervision.  While legally residents can act as providers, the ethical side of this is much less clear.  For example, many residents moonlight in community emergency rooms and urgent care centers, settings in which the patient often will not have the luxury of choosing a physician given the acuity of illness.
  • All other cons such as fatigue, legal liability, hassle of finding extra malpractice insurance coverage are comparatively less important in my mind since our first responsibility as health care providers is to the patient.

Moonlighting in radiology

My experience with moonlighting is limited to the specialty of radiology; I thought I’d share a little. There are generally two types of moonlighting opportunities available to radiology residents:

Coverage for IV contrast administration. Medicare requires a physician to be on site when IV contrast is given.  When imaging centers want to scan patients late into the night/weekend but don’t want to pay a full-fledged radiologist for coverage, a resident or fellow can step up and make some extra money in the process.

Coverage for image interpretation. This is usually reserved for senior residents/fellows.  You actually get to do what radiologists are trained to do: interpret medical imaging.  Depending on the setup, you may be responsible for a preliminary read or a final read.  Typically these arrangements pay more but as you can imagine, is accompanied by a higher risk of legal liability.

The Future Proof MD perspective

I am a resident, so I sympathize with residents everywhere.  While you get paid a decent wage — the median starting salary for a PGY-1 resident is now $53,580 — you likely work much longer hours and have a lot more debt than other people who earns the same income.  Any extra income helps.

How do I get around the ethical dilemma of providing care as a doctor-in-training?  Well, to date I have yet to meet two attending physicians who have the exact same level of medical knowledge and competency.  Sure they’ve passed their board exams, but do they really remember every single piece of knowledge that’s prescribed by the Board?  It may be a common joke, but perhaps the reason why we refer to the “practice” of medicine is because you really are constantly learning.  So moonlighting, even as the primary provider, can be viewed as simply another situation where you hone your skills at lifelong learning.  Of course, you don’t know what you don’t know.  So if you ever find yourself in a situation where the patient is crashing, and you have no clue what’s happening, I hope you have good help close by.

“Future Proof, MD” is a radiology resident who blogs at Future Proof M.D.

Image credit: Shutterstock.com

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