Moonlighting in second residency

[moonlightingthrowaway]

Hi everyone, I was hoping to use the amazing breadth of folks on SDN to see if there's anyone who might be able to help me out with a little quandary regarding residency programs' ability to regulate moonlighting. Apologize for the throwaway and vagueness of the description in advance.

I'm finishing up residency in specialty A and will be starting a residency in specialty B this summer, with the end goal of going to do a fellowship that combines elements of both specialties A and B. I will be taking my specialty A board exams in the first few months of residency B and already have medical licenses in a few states.

Residency B will be paying me at a base PGY level that does not take into account specialty A, and I was hoping to be able to moonlight in specialty A on the side to make up the difference (after passing my boards and surmounting the learning curve and being somewhat comfortable in specialty B. The institution allows for moonlighting as long as the PD approves it, but unfortunately after discussing it with PD recently they put the kibosh on that said they will not allow me to moonlight. I said yes sir thank you sir (no sense in picking a fight with your future PD a few months before you even start), but obviously am a little disappointed/concerned given that my costs of living will be going up, I will be needing to pay back loans, and will be making less than I did this year.

Now I obviously am not going to do anything out of the gate that is illegal/or puts me at risk for termination, but I was wondering if anybody else has been or known someone in a similar situation and can offer some advice about what programs can and cannot regulate. I haven't gotten my contract yet, but I assume that it will outline my roles and responsibilities as a resident in specialty B prior to then putting in a clause about needing PD approval for moonlighting.

Based on research that I've done, the ACGME duty hour rules only apply to in-house moonlighting- external moonlighting is specifically exempted. My question is can my new program really say I can't work- in a different state, with a separate medical license, practicing a completely different area of medicine- and if so, how is that different from them telling me I can't babysit, or work at Starbucks, or drive Uber? If I sign a contract (am also planning on discussing this with attorneys), can it really extend that far- i.e. you can't do anything extra for money at all while you're a resident with us (and I know they can /say/ that, but can they really enforce that legally)?

Thanks so much for reading this novel, and for any advice you might be able to offer.

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[AdmiralChz]

You should really check with your PD of your new residency and get approval, and check with your GME office if they have a policy about external moonlighting. My shop expressly forbids it. There are some other threads on here where people did some moonlighting "on the down low" or without telling their main program but it is extremely risky. Many programs will fire you on the spot if you are caught doing this - in their mind (and the ACGME's) you should be focusing all of your energy in leaning your new specialty.

Sure you can get lawyers involved and push for approval but trust me you do NOT want to get negative attention like this as you are starting a new residency. They might even choose to not renew your contract for the second year and beyond - there wouldn't be much you could do about this.

You can totally babysit, Starbucks or Uber but those are poorly compensated compared to being a physician (and pay much less than internal moonlighting which is why almost no one does) and all licenses will want to know where you are currently employed - you'll have to own up to it at some point.

 

[colbgw02]

Based on research that I've done, the ACGME duty hour rules only apply to in-house moonlighting- external moonlighting is specifically exempted. My question is can my new program really say I can't work- in a different state, with a separate medical license, practicing a completely different area of medicine- and if so, how is that different from them telling me I can't babysit, or work at Starbucks, or drive Uber? If I sign a contract (am also planning on discussing this with attorneys), can it really extend that far- i.e. you can't do anything extra for money at all while you're a resident with us (and I know they can /say/ that, but can they really enforce that legally)?

Thanks so much for reading this novel, and for any advice you might be able to offer.

This is a lose/lose for you.

Regarding whether they can do this, the answer is probably yes. Even as an attending, a group can prohibit engagement "in the practice of medicine except on behalf of the Employer". They can also prevent you from engaging in or being employed by "any other business or profession so as to adversely affect the performance of his or her duties" (quotes from an old employment contract of mine). Now, I'm sure there's some regional variation based on state laws, but the point is that the employers have tremendous power on this issue. Your state laws might be different, but even if they are, you've still spent thousands on lawyers and taken a long time to litigate. Good luck with that.

Which brings me to whether you want to do this. You don't. Even if you win, you're going to end up with an annoyed, resentful program director who can end your career in your second residency with relative ease.

 

[WheezyBaby]

My understanding is duty hours include both internal and external moonlighting, and your ability to moonlight in any sense is at your program's discretion.

Afaik, your program can't prevent you from moonlighting, but they could terminate you for it

 

[megawhizz]

The ACGME explicitly disallows moonlighting for 1st year residents.

It's not fair to compare working at Starbucks to working as a doctor. The PD has many reasons to restrict your moonlighting, including a concern of whether you are spending enough time at home learning how to become a good specialty B doctor (you may be "somewhat comfortable" but the faculty may disagree), risk management ("St. Elsewhere trainee doctor accused of killing patient while working at See-em-all Urgent Care"), etc.

The increase in cost of living, drop in pay and student loan issue should have factored into your decision to join Specialty B. Did you bychance discuss with the PD prior to accepting the offer?

Afaik, your program can't prevent you from moonlighting, but they could terminate you for it

+1

 

[Raryn]

Hi everyone, I was hoping to use the amazing breadth of folks on SDN to see if there's anyone who might be able to help me out with a little quandary regarding residency programs' ability to regulate moonlighting. Apologize for the throwaway and vagueness of the description in advance.

I'm finishing up residency in specialty A and will be starting a residency in specialty B this summer, with the end goal of going to do a fellowship that combines elements of both specialties A and B. I will be taking my specialty A board exams in the first few months of residency B and already have medical licenses in a few states.

Residency B will be paying me at a base PGY level that does not take into account specialty A, and I was hoping to be able to moonlight in specialty A on the side to make up the difference (after passing my boards and surmounting the learning curve and being somewhat comfortable in specialty B. The institution allows for moonlighting as long as the PD approves it, but unfortunately after discussing it with PD recently they put the kibosh on that said they will not allow me to moonlight. I said yes sir thank you sir (no sense in picking a fight with your future PD a few months before you even start), but obviously am a little disappointed/concerned given that my costs of living will be going up, I will be needing to pay back loans, and will be making less than I did this year.

Now I obviously am not going to do anything out of the gate that is illegal/or puts me at risk for termination, but I was wondering if anybody else has been or known someone in a similar situation and can offer some advice about what programs can and cannot regulate. I haven't gotten my contract yet, but I assume that it will outline my roles and responsibilities as a resident in specialty B prior to then putting in a clause about needing PD approval for moonlighting.

Based on research that I've done, the ACGME duty hour rules only apply to in-house moonlighting- external moonlighting is specifically exempted. My question is can my new program really say I can't work- in a different state, with a separate medical license, practicing a completely different area of medicine- and if so, how is that different from them telling me I can't babysit, or work at Starbucks, or drive Uber? If I sign a contract (am also planning on discussing this with attorneys), can it really extend that far- i.e. you can't do anything extra for money at all while you're a resident with us (and I know they can /say/ that, but can they really enforce that legally)?

Thanks so much for reading this novel, and for any advice you might be able to offer.

So the question ends up being complicated.

You are eligible for an unrestricted license and can legally get as many jobs as you want.

Your contract with your employer can also put restrictions on your time. You say that your residency program says that you can only moonlight with explicit permission of the PD (which is standard) and that the PD has denied you this permission. If you then pick up a second job, you will be in breach of contract. What does this mean? Well... it means they can fire you. Or put you on probation. Or delay your graduation. Or anything else they are allowed to do by the terms of the contract.

So you either need to get permission from your PD (which might happen your second year of training... or might not ever happen) or lie to them and just find a moonlighting gig somewhere (which would also probably entail lying to the moonlighting gig, since if you tell them about your residency program they're going to want a form filled out by your PD). What are the odds your residency finds out about this if you just pick up the occasional shift on your weekends off or vacation time? Probably slim. But if they *do*, you can get in trouble, up to and including firing you.

Oh, and by any reading of ACGME rules, all moonlighting, internal and external, counts towards your 80 hrs/week duty hours. No clue where you read otherwise. See the common program requirements. Two clauses of interest:

Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all inhouse clinical and educational activities, clinical work done from home, and all moonlighting.

Time spent by residents in internal and external moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour maximum weekly limit.

(Clinical work done at home counting towards hours is new this year)

 

[moonlightingthrowaway]

My apologies for the cross posting.

 

[Ismet]

Merging cross-posting threads. Please only post once.

 

[moonlightingthrowaway]

Thank you very much for the responses. I think I may have been referencing older material as you are clearly correct with respect to the external moonlighting clauses above.

I certainly agree with all of the above sentiments that this is not worth a big fight or attention drawn to me, which is why I am looking into it quietly with a throwaway on SDN and not arguing it over with my program director. I also wasn't going to be jumping into it directly at the start of the year. As I am going to be focusing on passing my A boards and then dedicating myself to catching up in B, this wouldn't be something I would be looking to do until the tail end of year 1 at the earliest, but it would be a consideration when comes time to sign year 2's contract. While some people may question my sanity for doing a second residency and having this problem in the first place, there is a small degree of comfort knowing I will have (hopefully) a board certification and unrestricted medical license in specialty A as a fallback. As such, my tolerance for an answer of "no, just because I said so" will be a little lower than it would were I needing this to become an attending.

I really appreciate the responses, and I didn't mean to be flippant in comparing working at Starbucks or driving Uber with being a physician. The concept that I've had a harder time struggling with is this mindset of "you need to dedicate all your free time to being better at your 80 hour a week job, and anything else is a distraction, though we can only officially tell you not to do things like clinical practice and can't tell you 'don't have kids,' 'don't play video games' etc". This got old during my first residency and I have limited patience for it now. After working with some amazing colleagues with families including new babies, intricate hobbies, or second jobs as professors or tutors on the side, I feel it's a poor argument against me continuing to take care of patients for an extra eight or ten hour shift every few weeks.

Incidentally, I did mention in the spirit of full disclosure to the PD that I am engaged in some research that has the potential to bleed into paid consulting work as well, and that was something they said would not be a problem, so this appears to be mainly a clinical and not necessarily financial issue.

 

[moonlightingthrowaway]

Residency B is one which requires a transition year prior to beginning, which my first residency counted toward, so I won't be starting as a first year resident. I did not explicitly discuss moonlighting during interviews, though I did mention looking for opportunities to maintain my skills in specialty A. I did look up moonlighting policies for each program prior to making my rank list, but naively assumed that obtaining approval from the PD would be as simple as demonstrating a certain degree to competency after a period of time.

 

[deleted480308]

I would show up and crush it for 9months. Become the model resident, prove you can be counted on, the one they never have to worry about....then ask for a reconsideration as your second year approaches

 

[Smurfette]

The clause does apply to internal and external moonlighting.

Also, if you apply for any jobs, they will vet you, and you'll have to disclose all jobs and places of training. They will then send forms to all those places to confirm before giving you a position, even as a moonlighter. So your new PD will find out given that s/he will be sent privileging paperwork on you.

 

[DrfluffyMD]

If your first reaidency is EM and the second one is radiology, you will need to spend a lot of time learning rads and I cannot imagine moonlight in addition to learning radiology.

 

[tyrionlannister00]

.....

 

[hallowmann]

I'd wait until your 2nd year (R3 for the program) because either way you've mentioned not really wanting to until after you take specialty A boards and catch up to specilaty B which should take at least 1/2-2/3 of your first year anyway. Those extra 8-12 or so shifts you'd have in first year don't seem worth the risk of being terminated from the residency, assuming of course you want to be in the residency.

You might find the PD more forgiving/lenient after a year of full work. If not, then you can reassess at that time whether it's worth it.

 

[moonlightingthrowaway]

Thanks very much everyone for the continued input- even for those questioning my sanity
I will say that I'm not doing EM to rads- anybody who would consider ANYTHING else after a 3 year residency that gets you 300k a year working 14 shifts a month is a psychiatric case even beyond my pathology .....there are still nights of drinking in which I kick myself for not doing EM from the beginning.