Medical Moonlighting for Residents: The Pros and Cons

Our recent look at physician moonlighting trends — and the role of locum tenens in providing medical moonlighting opportunities — examined moonlighting for new physicians looking to pay off debt, and mid- and senior-career physicians looking for secondary sources of income (or working other positions to help out during staff shortages, or a number of other reasons).

Medical moonlighting also extends to residents, although with a few caveats and qualifications. Although Staff Care only employs medical residents for locums work on a limited basis (learn more about that here), we also know that many residents and fellows look to our experts on career guidance decisions — here at the Locums Link Blog, as well as our New Physicians Program, which offers a wealth of advice and resources geared towards helping residents and fellows get their careers off on the right foot. So with that in mind, let's take a look at the pros, the cons, and the how-to of medical moonlighting jobs for residents.

In its most basic terms, moonlighting is a secondary job worked in addition to your main, primary job. The term relates to any kind of employment, not just medical employment; for residents, moonlighting means working as an independent physician, outside of the scope of your residency training program. There's also a difference between internal moonlighting (working in the same facility as your primary position) and external moonlighting (working outside of it).

Although medical residents "are legally allowed to provide medical care as licensed physicians and receive direct financial compensation in return for these services," as Elizabeth Kwo, MD, MBA put it in a 2012 article for Medscape, not all medical programs may allow their residents to do so.

"Many residency programs have strict policies in place for moonlighting," writes Adventures in Medicine's Holly Higgins. "For instance, many will only allow top performing third-year residents to moonlight. In almost every case, moonlighting needs to be approved by a supervisor."

Higgins also notes that, in addition to program-specific rules, the Accreditation Committee for Graduate Medical Education (ACGME) itself has capped the number of "combined educational and work hours for residents" at 80 hours per week.

"To be approved for moonlighting, most residents must obtain written consent from the residency's program director, as well as clearly define their moonlighting goals and objectives," Dr. Kwo writes in the Medscape article. "Residency programs may also withdraw moonlighting privileges if the activity interferes with the resident's patient responsibilities and performance.

"Residents can't be on call for more than 1 in 3 nights and must have a day off during the week," Dr. Kwo adds. "First-year residents (PGY-1s) and residents on a J-1 visa sponsorship aren't allowed to moonlight; however, residents on an H-1B visa are allowed to moonlight."

Some medical moonlighting opportunities also require residents to have a permanent license — but not all of them. "As a second-year family practice resident at Boston University (BU), Michael Noonan, D.O., discovered he was eligible to moonlight at the residency facility where he was based as long as he was already doing rotations there," wrote Marcia Layton Turner in the Fall 2010 edition of PracticeLink's online magazine. "To work anywhere outside BU’s hospital system, however, he needed an unrestricted, or permanent, license."

As Layton Turner's story illustrates, the process of finding medical moonlighting jobs can be somewhat difficult for residents. One of the residents she profiled had been rejected by a number of hospitals who required a board-certified physician, before finally finding a moonlighting employer willing to accept a physician without those particular credentials.

The most consistent warning about medical moonlighting for residents is malpractice insurance. You should make sure that any moonlighting jobs you work offer malpractice coverage — and not just any kind, but a sound, quality policy. You should either educate yourself to what a good malpractice coverage consists of, or work with a moonlighting agency that provides coverage to its workers, as Staff Care does for its locum tenens workers.

The sacrifice of free time is also to be considered. "Are you willing to trade time with family and friends – or pillow and blanket – for moonlighting shifts?" asked Joshua S. Coren, DO, MBA in the March 2007 edition of Family Practice Management. "Residents could also miss educational programs or events at their primary hospital."

"There’s also your long-term job search to consider, which you should be devoting a good amount of time to in your final years of residency," Higgins adds.

Granting full considerations to the caveats listed above, there's no denying the benefits of medical moonlighting for residents. "As a resident, I have plenty of medical school loans myself," wrote Dr. Kwo in the Medscape article. "Moonlighting during residency has provided a way to reduce this debt and to acquire additional medical training outside the requirements of a residency program."

"Whether you want to start chipping away at medical school debt or you’d simply like some extra cash to handle monthly expenses, moonlighting is a good option," adds Higgins. "Plus, you get valuable extra experience."

The financial benefits can be significant. In the PracticeLink article, Layton Turner told the story of Brett Yockey, MD, a third-year radiology resident who generated an additional $1,260 per month on top of his $4,000 salary, earning $105 per hour moonlighting in a neighboring town's emergency center.

And with a wife, two children, and $170,000 in student loans, that extra money isn’t just nice—it’s necessary," Layton Turner wrote.

Shelby Haque, MD CCFP(EM) writes of other benefits of medical moonlighting for residents in a 2008 article for the medical journal Canadian Family Physician. Dr. Haque's experience was in Alberta, Canada, but the story underlines realities present in the American healthcare system, as well.

"From an educational standpoint, I had a clear advantage in terms of comfort with critical care procedures and management of critically ill patients," Dr. Haque wrote. "To put it into context, more than 60% 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. When I was eventually hired, my work as a physician extender was a big selling feature on my resume.

"My moonlighting income doubled my resident salary," Dr. Haque adds. "I also saved money on child care and transportation for my kids."

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