Moonlighting in residency

[MedJosh]

Hi everyone
I was wanting to get an idea of what the moonlighting in residency is like for psychiatry residents.
What is it like where you are or what have you heard of:

At my program
Location: in the west
PGY you can start? mid PGY2
Internal or external (your own DEA)? internal usually, but a few external gigs that are passed on from graduating residents
Avg $/hr and how much can you work? $100/hr and there are residents that double their salary working 7x8hr shifts per month

At my friends program
Location: in the great lakes area
PGY you can start? mid PGY3 usually PGY4
Internal or external (your own DEA)? internal only
Avg $/hr and how much can you work? $75/hr and they are allowed to work 24 hours per month

Thanks

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[whacko]

I have a relevant question. How do you go about finding external moonlighting? I have asked previous residents but few moonlighted and the places they worked were changed to BE/BC required since they graduated.

 

[TexasPhysician]

Started PGY-2. All external. Never under $100/hr.

Finding jobs typically involved networking, luck, and asking to cover people.

 

[philosophize]

Start PGY3 year, external only, compensation varies - lowest is $100/hr (basically paid to sleep), highest is $175/hr (involves multiple admissions during an overnight in hospital shift). The external gig that most people end up in is $125/hr

 

[notdeadyet]

Location: CA
PGY you can start: Internal is PGY-2 after licensed, with approval (not always given). PGY-3 open to internal/external, with approval (almost always given for residents who are not flagged for anything).
Own DEA: Program pays for internal-only DEA. For external moonlighting, you need to pop for your own (keep in mind that it's about $700).
Avg $/hr: Highly variable. Internal is about $120. Highest external that I found was $205/hour.

I will say that this is extremely variable by program. Some places hold moonlighting very close to the vest, and some (though few) actively encourage it. For programs that allow it, the policy (written or otherwise) is usually that they can forbid you from doing so if they choose. Almost all programs I know of that permit residents to moonlight (by whatever year or metric) will reserve the right to prohibit residents who are under probation or have other kinds of flags. So the best way to maximize your chances of moonlighting is to be a solid resident.

Finding moonlighting opportunities is pretty much like finding any job in psychiatry. By that I mean that the best chances are via word of mouth (the majority of psychiatrists I know get jobs by asking around and getting referrals rather than by job adverts). So you let faculty and (especially) senior residents and recent grads know that you're looking and referrals will float in.

Reputation matters. Moonlighting is really the first time in residency that the "professionalism" word that many residents seem to dread pays dividends. I did a ton of moonlighting in residency. I was able to help out almost all residents who came to me, since the residents I worked with were mostly rock stars. There were a very small handful, though, that I wouldn't refer to places I had done moonlighting at (thankfully none of these folks never approached me).

Why? Because they weren't very good. And reputation matters. And I'm not going to set up a place where I have a good reputation with someone who is going to do sub-standard care, or be a complaint machine, or come in late/leave early, or the like. Because I don't want to be the person who dumped that on them.

Referring someone to a moonlighting gig is a little like setting a co-worker up on a date with your cousin. Your co-worker mentions that they're lonely and are looking for a relationship. You know your cousin wants one too. It's easy enough setting them up, but the fact is that you have a sense of loyalty to your cousin and if you set her up with a loser, you'll be tainted by association. And the psychiatry community in any region really is like an extended family. I work in a fair size urban area and I constantly run into people I've worked for or with.

Rambling, but just trying to make the case for understanding that "professionalisms" means something during residency and after.

 

[OldPsychDoc]

..
Rambling, but just trying to make the case for understanding that "professionalisms" means something during residency and after.

Needs to be said, and said more often.

 

[quiet pines]

CA program. Start moonlighting as PGY2. We earn about $100/hr. Internal. Can work as much as there are open shifts. Seniority gets first picks.

 

[Doctor Bagel]

Finished residency in 2014. The only moonlighting option in my city was to work at a walk in clinic. Not bad work, but the pay was I think $68/hour. It might be more now but probably now much. They also expanded the hours of their non physician employees leaving limited shifts for residents. You could do weekend shifts at hospitals one to two hours outside of town for I think ~$3500/weekend so not bad. All the hospitals in town required you to be BE for weekend work. No internal moonlighting options at that point.

 

[Doctor Bagel]

Needs to be said, and said more often.

"Professionalism" can also be an enforcer of the good old boys network. Let your buddies in on gigs because they're more "professional" not because they look or talk or act like you. One could dub this comment as unprofessional, but you are "the man" (white, male, in a position of power). NDY is also I'm guessing white, male, will likely some day be a program director based on his years of posts here. Speaking up, violating the status quo, etc. can also be viewed as unprofessional. I know you and NDY are good, hardworking people, but I've never been a fan of the professionalism rhetoric in the medical community, especially when it comes specifically for those with power in the system.

 

[st2205]

My problems with professionalism is that it's too often (more often than not) simply a euphamesim for covering for some else's laziness or lack of professionalism (typically the original party who invoked professionalism).

At least in my experience.

 

[Armadillos]

My problems with professionalism is that it's too often (more often than not) simply a euphamesim for covering for some else's laziness or lack of professionalism (typically the original party who invoked professionalism).

At least in my experience.

Really? It's the opposite for me, I've never had to pick up the slack for a colleague I consider professional, but the very rare (i.e. 1) unprofessional resident in our program causes tons of headache and trouble for the rest of us.

 

[splik]

Yes I am strongly against professionalism. I have been meaning to write a paper against "professionalism" for some years but have been discouraged from doing so. What NDY refers to is calling "doing your job" and obscuring it in some amorphous, culturally imbued, and wooly term such as "professionalism" serves no purpose. Of course you should turn up on time, not leave early, not leave people in the lurch, do your job, be responsible, help out, follow the rules, and be considerate of others. But that is true in pretty much any job. If you look at the ACGME definition of "professionalism" it includes altruism. But what counts as altruism?, and is this truly a value that the current generation of physician believes in? It's a slippery slope. Maybe we're all horrendously overpaid and shouldn't be allowed to make more than 100k because we'll be corrupted and we should feed our families with the honor of serving humanity and the warm and fuzzy feeling inside.

There is a decent literature on the fact that professionalism is quite frankly racist (not mention other -isms and -phobias). NDY is obviously in some part of the country with lots of liberal good for nothings who preach diversity and cultural competence etc, but there is significant cultural variation in what counts as "professional". The fact is black women and medicine have a hard time being "professional" if they have an opinion of their own, disagree with a superior or speak out. The very behaviors that may be regarded as "professional" and showing "leadership" in white men, are used against black women. I have seen this in my friends time and time again. In other parts of the country being obviously gay or lesbian (i.e. appearing too effeminate or butch) would be regarded as unprofessional. I have similarly had latino friends described as unprofessional for being latino, or foreigners described as unprofessional for having a slight accent. I have seen minority residents criticized as being unprofessional for not putting up with racial abuse. And these are just examples from psychiatry residency. In surgery not tolerating abuse or showing too much emotion may be regarded as unprofessional.

I know of one surgical resident who was humiliated on rounds, broke down in tears, and was sent to the PES for evaluation and believed to have problems with professionalism for crying after being humiliated in front of the whole department! (and then being psychiatricized!) I know of residents who have been regarded as being unprofessional for engaging in housestaff association/union activities ("it's unprofessional to unionize). I know of one resident who was being sexually harrased by a faculty member, complained, and was put on administrative leave for concern about professional conduct (baseless), and forced to undergo a $10 000 psychiatric evaluation! I know of a resident in surgical specialty who was admitted during a shift with an asthma attack and criticized for lack of dedication! OB/GYN residents who are pregnant are forced to work until they essentially are in active labor, because that is the culture, despite poorer healthcare outcomes and perinatal complications; yet to take maternity leave earlier would question their "professionalism".

I think we can all agree that their are certain expectations we have of workers. These, in general, are not unique to physicians or so-called professionals. We expect people to do their jobs and rightly so. But "professionalism" is a dangerous word.

On a personal note, during residency I was threatened on a number of occasions as behaving in a way that would "raise serious concerns about my professionalism". An example included having a blog that a faculty member disagreed with. Another example was not filling in my duty hours for a few weeks. Another example was raising concerns that an attending was demented and should not be practicing. I can tell you, I am exactly the same in my attitude to work (which I take what I do seriously and work hard) and no one in my current setting has ever, or would ever raise any questions of my "professionalism" because the culture is just very different.

 

[Salpingo]

This thread just got much more interesting.

I agree that professionalism is a loaded, subjective term that could be easily abused by those in position of power (since it seems only people above you can accuse you of being unprofessional).

But I still think it's a useful concept. I define it simply as putting your work above your own personal needs. It's a term rooted in religious indoctrination, with the belief that you belong to a higher calling. If you're a total anticonformist, that isn't going to sit well, but personally I like the idea of belonging to something bigger than myself. When I go to work, I'm not just representing myself, but an entire profession.

Why is it necessary to bring up in residency training? First, many people go straight through school without having a real job (which is a different thing than paid work). Second, it's never really 100% clear when we stop being students and start becoming professionals. Finally, we're entrusted with the care of other people, where there are pretty significant financial incentives to act in ways that isn't in their best interest.

That being said, its not feasible to be 100% professional 100% of the time. We've all been guilty of making some crass jokes, or tuning a patient out, or writing on SDN while on-call [AHEM]. So being cited for an moment of unprofessionalism is ridiculous. But if it's a pattern, it's a problem that will eventually catch up with you, and ultimately damage the reputation of doctors as a whole.

As it stands, we benefit from professional ideals. People sympathize with the doctor getting his face smashed in on a United Airlines flight, ignoring the fact that he's holding things up for hundreds of other people, because [to paraphrase the great McCoy] he's a doctor, dammit!

 

[notdeadyet]

What NDY refers to is calling "doing your job" and obscuring it in some amorphous, culturally imbued, and wooly term such as "professionalism" serves no purpose. Of course you should turn up on time, not leave early, not leave people in the lurch, do your job, be responsible, help out, follow the rules, and be considerate of others.

This is actually a pretty good definition of how professionalism gets used. But it's too long for a term. Give it a one or two word title, and I'd gladly swap out "professionalism" for whatever we come up with.

Personally, I don't think "professionalism" is such a bad term. The bold above is pretty much the definition of acting like a professional. I think a lot of raised hackles about the concept of "professionalism" comes from folks overthinking it, which makes sense given your demographic that makes up most doctors.

Being a professional means you are paid to do a job. That's it. So the standards of how you do it are higher than when you are shadowing, volunteering, or being a student. But drop the class view of "professionalism" as being some distinction about the "professional class." This applies for a doctor. It's also true for folks working at the animal shelter. Or for any business.

It's interesting that race keeps getting brought up. I've happily had a pretty small n of medical students, residents, or faculty I've interacted with that demonstrated issues with professionalism. But when they have, what has been overwhelmingly overrepresented has been white folks from upper middle class or (typically) above backgrounds. And another oddity is it's often folks who've never had a full-time job before residency. Go figure.

If folks want to come up with a new name for it, I'm down with that. Call "turn up on time, not leave early, not leave people in the lurch, do your job, be responsible, help out, follow the rules, and be considerate of others" whatever you want. But whatever name you come up with, folks will push back against it.

 

[notdeadyet]

I'm also of the mind that seeing "professionalism" as racist is not only throwing the baby out with the bathwater, it's giving way to much credit to the racists.

Racism, islamophobia, homophobia, and <pretty much pick your phobia/ism> exists in the medical community. And the phobics/ists will exercise their arts in any way they can. This will show up in subjective/narrative evaluations on rotations, letters of recommendations, references, referrals, and the like. It will show up in comments like "very opinionated" and "inconsiderate" and "not a team player" and the like.

This has nothing to do with "professionalism" and identifying it as such lets the phobics/ists off the hook by indicating the problem is with the terminology rather than the racism, islamophobia, and other prejudices and hate.

Most of the stuff I consider professionalism is actually fairly quantitative. How often you show up late for shift. How often you are caught sneaking out early. How often you turf work that is yours onto someone else unwittingly. Interestingly, the soft stuff like being "disrespectful" is normally to me an issue of entitlement ("my time/thoughts/ideas/etc. are more important than yours so I will interrupt you and others despite repeated independent coaching") and more often reflects folks of entitled backgrounds.

But again, very open to changing the name. And also open to having the same conversation in 3-5 years when people get tired of it then.

 

[notdeadyet]

"Professionalism" can also be an enforcer of the good old boys network. Let your buddies in on gigs because they're more "professional" not because they look or talk or act like you.

Exactly. I try hard to help others get work not because they look or talk or act like me, but because they work like me. Hard, smart, compassionately, and professionally. I don't look for people I consider my tribe. My tribe is more likely patient than doctor.

NDY is also I'm guessing white, male, will likely some day be a program director based on his years of posts here.

God help us, no.

Speaking up, violating the status quo, etc. can also be viewed as unprofessional.

Yup. But it should only be viewed as unprofessional when it's done unprofessionally.

You can "speak up" professionally and unprofessionally. As a faculty member, unless it's a patient safety issue that needs addressing immediately, I'll pull aside a resident or student to explain what was done wrong 1:1. Saying in a group setting that I don't like their interview style or felt that they treat the homeless disrespectfully is, in my opinion, unprofessional. Likewise, a resident that disagrees with many points in a grand rounds presentation can save their questions for the end and not repeatedly interrupt to share their greater wisdom. It's unprofessional.

You can "violate the status quo" professionally and unprofessionally. Not following the rules because you don't like them is not the professional way to go about it. Working to change them is. If outpatient moonlighting as a PGY-2 is forbidden, fight it, but don't try to do it on the sly and complain "it's not a fair rule" when you get caught. If a faculty member thinks sleeping with residents is legit if they're over 18, they can petition whoever it is you'd petition, not wait to get caught and complain (disclosure: this is not my particular windmill to tilt).

I've never been a fan of the professionalism rhetoric in the medical community, especially when it comes specifically for those with power in the system.

Sure, but that's because the ones in power are the ones who catch hell when employees are unprofessional. If one of my residents sleeps with their therapy patient, I suffer. If the Chair of my department does, it affects me not. Such is the way of the workplace.

Any subjectivity in the workplace can be abused as a power dynamic. If you feel a resident, faculty member, teacher, or administrator are using "professionalism" inappropriately as a power exercise: tread lightly. This doesn't highlight the problem with "professionalism," it highlight's the problem with that individual, and I guarantee you'll see it creep into any subjective process they apply. Monitor and intervene as appropriate.

 

[MedJosh]

I agree that the term "professional" is laden with interpretation of what professional is based on who is passing that judgement. I think that in many places if you are direct, blunt, upset or offend someone, hurt someones feelings, then you are not "professional". If you are not kissing butt then you are not professional. In psychiatry, patients (and colleagues!) need some direction, insight, opinions, interpretation, sometimes they need boundaries and limits, all of which give many opportunities to be seen as "unprofessional" despite being a good clinician and psychiatrist. However, not making waves, being passive aggressive, unemotional or rigid is often seen as being "professional".

 

[splik]

I'm not advocating throwing the baby out with the bathwater. I think you know I agree with the gist of what you're saying which is reputation and work ethic matter. However anything can be abused, and there is no doubt that "professionalism" has been used as a stick to beat us over the head with and many terrible things have been done in its name.

 

[Salpingo]

This is actually a pretty good definition of how professionalism gets used. But it's too long for a term. Give it a one or two word title, and I'd gladly swap out "professionalism" for whatever we come up with.

Personally, I don't think "professionalism" is such a bad term. The bold above is pretty much the definition of acting like a professional. I think a lot of raised hackles about the concept of "professionalism" comes from folks overthinking it, which makes sense given your demographic that makes up most doctors.

Being a professional means you are paid to do a job. That's it. So the standards of how you do it are higher than when you are shadowing, volunteering, or being a student. But drop the class view of "professionalism" as being some distinction about the "professional class." This applies for a doctor. It's also true for folks working at the animal shelter. Or for any business.

It's interesting that race keeps getting brought up. I've happily had a pretty small n of medical students, residents, or faculty I've interacted with that demonstrated issues with professionalism. But when they have, what has been overwhelmingly overrepresented has been white folks from upper middle class or (typically) above backgrounds. And another oddity is it's often folks who've never had a full-time job before residency. Go figure.

If folks want to come up with a new name for it, I'm down with that. Call "turn up on time, not leave early, not leave people in the lurch, do your job, be responsible, help out, follow the rules, and be considerate of others" whatever you want. But whatever name you come up with, folks will push back against it.

I think there's a difference between good work ethic (what you bolded) and professionalism. If you have a crappy waiter at a restaurant, you'll most likely think that's just a crappy person, or maybe you're at a crappy restaurant. You won't think less of waiters in general. Similarly, if a contractor is caught sending dirty messages to his client, he's a creepy guy, but it's not much of a story beyond that. But when doctors are bad at their job or do creepy things, it becomes a bigger deal, because it's an indictment on the entire profession.

I agree that the term "professional" is laden with interpretation of what professional is based on who is passing that judgement. I think that in many places if you are direct, blunt, upset or offend someone, hurt someones feelings, then you are not "professional". If you are not kissing butt then you are not professional. In psychiatry, patients (and colleagues!) need some direction, insight, opinions, interpretation, sometimes they need boundaries and limits, all of which give many opportunities to be seen as "unprofessional" despite being a good clinician and psychiatrist. However, not making waves, being passive aggressive, unemotional or rigid is often seen as being "professional".

You can be blunt BECAUSE of professionalism. The fact that you're a doctor, and not just some random person with an opinion, means something. You're speaking as a professional, not a self-ordained life coach or cult leader, but someone part of a larger organization with centuries of history behind it. That is to say, there's an underlying assumption that your bluntness is being carried out in the patients best interest because you're a friggin doctor and that means something. That assumption would change IF doctors stopped acting professionally, were unnecessarily rude or blunt without therapeutic intent.

 

[notdeadyet]

I think you know I agree with the gist of what you're saying which is reputation and work ethic matter. However anything can be abused, and there is no doubt that "professionalism" has been used as a stick to beat us over the head with and many terrible things have been done in its name.

Yes. I just think the enemy is the abuse itself, not the way it manifests. Whether it's professionalism, LORs, evals, etc., if folks in power are being abusive, manipulative, or racist, it's an issue of abuse, manipulation, or racism, not the form or term that folks hide behind.

 

[SeniorWrangler]

I've heard from colleagues that students and residents are very tired of hearing about "professionalism" and regard it as a stick that is used to beat them. If you go back to the original concept of a profession, it is a specialized occupation that's so technical that it has its own code of conduct and is largely allowed to self-regulate. Examples include doctors, lawyers, and clergy. So from this perspective, "professionalism" means behaving yourself in order to not screw things up for the rest of the people in your sweet, sweet line of work.

It shouldn't surprise anyone that the concept of professionalism is under fire, since doctors are no longer allowed to regulate themselves nearly as much. Now that any nurse or administrator can call a doctor out for being "disruptive", professionalism really is just a stick to beat the doctor with.

 

[masterofmonkeys]

Professionalism, operationally is used to mean "Doesn't make waves." Problem being, not all waves are bad.

A resident who's singled out and mistreated becomes 'unprofessional' if they speak out. The one doing the mistreating and singling out never is.

A resident who calls attention to major issues in a program is 'unprofessional'. The ones who allowed the problems to occur are not.

It's not necessarily a racist tool, but it is certainly a tool of authority to use their power indiscriminately because you did something they didn't like. Often because you are shining light on their inadequacies.

One of the challenges of such a nebulous, bull**** concept being that I can make the charge stick to anyone if I want to.

 

[Shikima]

I've heard from colleagues that students and residents are very tired of hearing about "professionalism" and regard it as a stick that is used to beat them. If you go back to the original concept of a profession, it is a specialized occupation that's so technical that it has its own code of conduct and is largely allowed to self-regulate. Examples include doctors, lawyers, and clergy. So from this perspective, "professionalism" means behaving yourself in order to not screw things up for the rest of the people in your sweet, sweet line of work.

It shouldn't surprise anyone that the concept of professionalism is under fire, since doctors are no longer allowed to regulate themselves nearly as much. Now that any nurse or administrator can call a doctor out for being "disruptive", professionalism really is just a stick to beat the doctor with.

Succinctly well said.

Goes along the lines where BC used to be optional. Mandatory MOC compliance. Slew of other issues that have been developing for years and the only way to enact these "policies" was to ensure compliance by doctors. What better way than to show them the stick?

On a side note, why aren't we fighting this hard for unethical behavior that seems to be more prevalent - just look at your state medical board and the behaviors they need to deal with. By and large, is either addictions or unethical behaviors (which is labeled unprofessional).

 

[notdeadyet]

Professionalism, operationally is used to mean "Doesn't make waves." Problem being, not all waves are bad.

If that's how professionalism is used in your workplace, the problem is your workplace (generalized you, MOM).

At my program, we encourage students, residents, and junior faculty to make waves, ask hard questions, and challenge what is "common knowledge." That's how you make future leaders of the field. But we also expect folks to show up on time, do appropriate documentation, and treat patients and start with respect. That's the professionalism part.

If anyone's program is like what MOM is describing, get what you can from it in residency, then when you graduate: seek out better workplaces. They are out there. Even in academia.

Sorry, MedJosh, I've probably derailed your thread enough.

 

[Ironspy]

Professionalism, operationally is used to mean "Doesn't make waves." Problem being, not all waves are bad.

A resident who's singled out and mistreated becomes 'unprofessional' if they speak out. The one doing the mistreating and singling out never is.

A resident who calls attention to major issues in a program is 'unprofessional'. The ones who allowed the problems to occur are not.

It's not necessarily a racist tool, but it is certainly a tool of authority to use their power indiscriminately because you did something they didn't like. Often because you are shining light on their inadequacies.

One of the challenges of such a nebulous, bull**** concept being that I can make the charge stick to anyone if I want to.

Completely agree. In my experience, every time I have been reminded/asked to be professional, it was because I was objecting to doing something that was abusive and unreasonable. YMMV

 

[OldPsychDoc]

If that's how professionalism is used in your workplace, the problem is your workplace (generalized you, MOM).

At my program, we encourage students, residents, and junior faculty to make waves, ask hard questions, and challenge what is "common knowledge." That's how you make future leaders of the field. But we also expect folks to show up on time, do appropriate documentation, and treat patients and staff with respect. That's the professionalism part.

Could not agree more. At least 95% of complaints I receive about residents fall into those categories--and can really become the things which differentiate "good residents" from "not so good..."
It seems that more and more we (programs) have to teach residents how to be employees, especially as less is expected of them as students.

 

[deleted736562]

The problem with the whole concept is that programs don't want to treat residents as professionals yet want them to behave as such. In other words, they want to have their cake and eat it too. They want to keep that abusive labor system we call "residency" and at the same time hold residents to professional standards. If residents were treated as professionals, this whole discussion would be silly. Of course everyone is expected to show up on time, do their job in the best ability, follow rules...etc. And if they don't, well, there's always the door for the bad resident to leave and a better resident to come. But this entails a complete revamp of the system which programs and hospitals are obviously averse to because they lose all the privileges they get with what we have right now. The culture is to treat residents as students, not as working professionals, as part of the abusive power system we have. So we end up with this sorta parent-child relationship between programs and residents instead of something more mature, which would necessarily entail more rights for residents.

The other issue is that the concept goes much further than what NDY is describing. I think showing up on time, doing your job to help patients is really a given. It's really imbued with finer cultural assumptions of what a work environment in residency should be which is itself deeply entangled with the one-sided power dynamic.

 

[Merely]

This is what happens when you ask a bunch of psychiatrists about moonlighting salaries...lol

 

[FlowRate]

As it stands, we benefit from professional ideals. People sympathize with the doctor getting his face smashed in on a United Airlines flight, ignoring the fact that he's holding things up for hundreds of other people, because [to paraphrase the great McCoy] he's a doctor, dammit!

And also because kicking him off the plane for some United employees was unethical and illegal... Especially given the amount of force used. There are actually pretty strong passenger protections when it comes to airlines. There's no fine print that says "we can beat you up to accommodate our employees."

If they were going to bump him, it should have been done before he boarded and would have come with decent financial compensation.

 

[tyrionlannister00]

Reputation matters. Moonlighting is really the first time in residency that the "professionalism" word that many residents seem to dread pays dividends. I did a ton of moonlighting in residency. I was able to help out almost all residents who came to me, since the residents I worked with were mostly rock stars. There were a very small handful, though, that I wouldn't refer to places I had done moonlighting at (thankfully none of these folks never approached me).

This exactly... Anyhow, I started in my third year, ranging from $80 to $150 per hour and I live in a very saturated market. I don't know how your thread got hijacked, but it's kinda funny.

 

[twospadz]

I think this thread is worth continuing. For me, currently receiving 140/hr moonlighting as a resident.

 

[TheFuture_22]

I make 160 an hour moonlighting in the South. It’s external and requires a 1099 and my own malpractice insurance.

 

[NickNaylor]

At our program, we were able to start moonlighting as PGY-3s (you can get a license and theoretically moonlight during PGY-2 if the PD approves, but our schedule in PGY-2 was so busy with a lot of overnight/weekend call it isn't feasible). I did mostly ER work which paid just over $100/hr. Initially this was external work, but we now have internal moonlighting our county hospital ED which has been pretty popular. There are plenty of other opportunities available in the area, but it all comes down to pay (some of which is quite poor, depending on the position) and interest (e.g., inpatient vs. outpatient vs. ED). We had no limitations on the number of hours you could work other than "complying" with duty hours (and since this wasn't looked at very closely, violating duty hours to moonlight, if you were so inclined, was not difficult).

 

[SourceOfDenial]

Gig 1: 150/hr inpatient work(of a different sort), organization pays my malpractice.
Gig 2: 2500/wknd rounding on consults and seeing follow ups, split with another provider and sometimes a fellow at a large academic hospital. I pay my malpractice.
Gig 3: 200/hr emergency room work, easy peasy and malpractice covered.
Gig 4: Sometimes cover an IDT meeting, 400/meeting, malpractice covered.

Residency ranged from 80-150/hr depending on work.

Residencies often say, ‘oh you can moonlight pgy2! Unless it’s internal, it rarely means you’ll be moonlighting in August of pgy2. Time to get license, credentialed, hired you’re looking at very late pgy2 or beginning of 3. No one wants someone who just started not being an intern moonlight.

 

[DisorderedDoc417]

Gig 1: 150/hr inpatient work(of a different sort), organization pays my malpractice.
Gig 2: 2500/wknd rounding on consults and seeing follow ups, split with another provider and sometimes a fellow at a large academic hospital. I pay my malpractice.
Gig 3: 200/hr emergency room work, easy peasy and malpractice covered.
Gig 4: Sometimes cover an IDT meeting, 400/meeting, malpractice covered.

Residency ranged from 80-150/hr depending on work.

Residencies often say, ‘oh you can moonlight pgy2! Unless it’s internal, it rarely means you’ll be moonlighting in August of pgy2. Time to get license, credentialed, hired you’re looking at very late pgy2 or beginning of 3. No one wants someone who just started not being an intern moonlight.

Our residency is similar. I started halfway into pgy2 because of the time it took to credential. Also wasn’t fun balancing moonlighting with internal call responsibilities... but that improved substantially into PGY3/4.