Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The pros and cons of moonlighting for medical trainees

Future Proof, MD
Finance
April 15, 2017
98 Shares
Share
Tweet
Share

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

Prev

Your physician is the everyday champion

April 15, 2017 Kevin 2
…
Next

We made it! An open letter to my son.

April 15, 2017 Kevin 4
…

Tagged as: Residency

Post navigation

< Previous Post
Your physician is the everyday champion
Next Post >
We made it! An open letter to my son.

More by Future Proof, MD

  • Some doctors do it for the money. Here are some reasons why.

    Future Proof, MD

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • Don’t judge when trainees use dating apps in the hospital

    Austin Perlmutter, MD
  • Medical trainees need knowledge and education on health care systems and policy

    Daniel Arteaga, MD, MBA and Isobel Rosenthal, MD, MBA
  • How the COVID-19 pandemic highlights the need for social media training in medical education 

    Oscar Chen, Sera Choi, and Clara Seong
  • End medical school grades

    Adam Lieber
  • What inspires this medical student

    Jamie Katuna

More in Finance

  • Secure your future today: the essential guide to disability and life insurance for physicians and professionals

    Set for Life Insurance & The Podcast by KevinMD
  • A tiny step to reduce physician burnout

    Dennis Hursh, Esq
  • Why a business education is essential for financial stability and cutting-edge medical care

    Curtis G. Graham, MD
  • The myth of wealthy doctors: Why business education is vital for every physician

    Randall S. Fong, MD
  • Revolutionizing health care: lessons from Michael Jordan’s partnership with Nike

    Chris Grant
  • Mastering the art of transition: essential tips for leaving your medical career behind and pursuing a new path

    Amanda Hill, JD
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 14 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • CAR-T Tops Standard Care in Heavily Pretreated Lenalidomide-Refractory Myeloma
  • Artificial Intelligence Could Improve Medical Practice -- But Only if Done Right
  • Huntington's Disease Chorea Improved With Valbenazine
  • T-DXd Proves Mettle in Multiple Solid Tumors
  • Preoperative Ocular Surface Disease Algorithm Re-Introduced

Meeting Coverage

  • Preoperative Ocular Surface Disease Algorithm Re-Introduced
  • Omitting RT Safe in Many Locally Advanced Rectal Cancers
  • Novel IDH1/2 Inhibitor Shows 'Dramatic Effect' in Low-Grade Glioma
  • Nivolumab-AVD Boosts PFS in Untreated Hodgkin Lymphoma
  • New Standard in Operable EGFR-Positive Lung Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
  • Recent Posts

    • Master the ABIM Certification exam with effective strategies: insider tips for success

      Farzana Hoque, MD | Education
    • A mentor’s legacy in medicine, leadership, and embracing evidence-based care

      Arthur Lazarus, MD, MBA | Physician
    • Breaking free from restrictive covenants to combat burnout

      Raya E. Kheirbek, MD | Physician
    • Fixing the system and prioritizing patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • From medical student to intern: Discovering a deeper connection with patients

      Johnathan Yao, MD, MPH | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The pros and cons of moonlighting for medical trainees
14 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...