A Primer on Moonlighting

When I first started moonlighting after fellowship, it was because my hospital was small and had relatively few acute patients. I knew that my position at that hospital wouldn’t be my permanent job, so I wanted to make sure my endoscopy and acute care skills didn’t deteriorate. The extra income would be a nice boost as well, but I really wanted to get the extra experience.

I learned a ton about navigating a hospital system, getting credentials/privileges, networking, supervising mid-level providers, and managing complex patients essentially as a solo provider. I continued to moonlight while in my second job, and the experience was just as valuable with the new group.

Is moonlighting right for you? It’s a lot of work, and it’s going to take time away from your family, but there are a lot of benefits.

Here are a few important questions to consider when thinking about moonlighting:

  1. If you are currently a resident or fellow, does your training program allow it?  Many training programs don’t permit their trainees to do any moonlighting because of credentialing concerns, work hours restrictions, etc.  The work hour restrictions imposed by governing agencies have hurt moonlighting opportunities because your training programs are already hitting 70-80 hours most weeks, leaving little room to spend time moonlighting.  On the other hand, some training programs have affiliate relationships with rural or underserved hospitals and actually encourage moonlighting, especially from senior residents and fellows.  Ask your training program coordinator or some senior residents/fellows to find out what options are available.
  1. What level of supervision will you have?  If you are still in training, is an attending physician in house or at least available for you to call with questions and concerns?  You need to carefully consider your personal level of comfort with managing patients on your own.  Will you be working in a position where you can get help if you need it? 
  1. Do you have consultants available?  If you are working in an urgent care center or primary care outpatient setting, will you be able to call consultants for complex cases if needed?  If not, what are the options for transferring people to a higher level of care?  
  1. How much will you get paid?  If you’re going to be taking extra time away from your family, losing sleep, and potentially adding more stress to an already stressful job, it needs to be worth your time.  There are many ways to structure your compensation, and it usually depends on the practice you’re working with.  My first moonlighting gig paid me as a PRN employee, so I got a W-2.  My next moonlighting gig paid me as an independent contractor (1099).  In both cases, I negotiated a flat fee for a weekend (Friday night until Monday at 7AM), with higher rates for holidays.  Some moonlighting gigs pay a flat fee plus a percentage of billings/collections.  I go back and forth on whether this is worth it.  For me, I decided that I’d rather have the predictable, steady paycheck associated with a flat rate.  Call weekends tend to be feast or famine.  You could have a lot of billings one weekend and almost none the next.  If you have a really busy hospital and it’s essentially guaranteed that you’ll have high billings each weekend (based on historical averages), you could consider negotiating for a percentage of collections.  The group that you are working for probably already has a system in place for how they pay their moonlighters, so you may not have much opportunity to negotiate, but you should always ask.  
  1. Do you have to have an unrestricted license?  If you have a training/restricted license while in residency, you may not be able to practice outside of your training environment.  Just make sure that you have the proper medical license to meet the credentialing/privileging requirements with your new group.
  1. How long does it take to get licensed in that state?  Six months before I left California, I started applying for the Florida medical license so that I would already have it before I arrived.  It can take 6-12 months in some cases to get licensed in a new state, and that can hold up any moonlighting opportunities.  So, start early!  
  1. Do you really have enough time?  Seriously, do you have enough time?  Are you going to be able to handle the increase in workload?  Will you restrict your family time to the point that you never get to see your spouse or your kids?  Make sure to talk about the expectations of moonlighting with your family.  If you’re just doing it for a season to earn some extra money and knock out your student loans, it may be easier to tolerate the loss of time to meet the short-term goal.  Your spouse needs to be a partner with you in the decision.  
  1. Is it a group you’d consider working for?  Moonlighting at my first post-fellowship job is what got me my first four job offers.  You will build a reputation for yourself through your work, and you should expect that this will lead to some job offers.  So, you might as well moonlight with a group you’d consider joining eventually.  What’s the group’s reputation?  Are the doctors in that practice respected?  Do their employees speak highly of them?  Do their patients get excellent care?  This is your professional career, so take this decision seriously.  Don’t just think of this a summer job during college.  You could start out moonlighting and end up working for the group for 30 years.  Treat it like a prolonged job interview, or an apprenticeship.  Do some serious research and consider whether it’s a group you would eventually join.  

Conclusion

Moonlighting has a lot of benefits, such as gaining extra experience, making some money, and building a network.  I enjoyed moonlighting, especially in my first few years after fellowship.  I felt like it really helped me increase my confidence as a solo practitioner.  It also advanced our family’s long-term savings plans considerably, in addition to leading to some serious job offers.  It cost me some time on the weekends with my family, but my wife and I worked our schedule in such a way that we could still take time to have some fun family outings and spend time with the kids.  For me, it was totally worth it.  

It takes some work to get started, and of course it adds to your already hectic schedule, so you need to carefully consider whether moonlighting is right for you.  Hopefully these questions will give you a starting point as you think about some moonlighting options.  Good luck!

Please leave a comment below and let us know what questions you have regarding moonlighting.  If you have done moonlighting work in the past, do you have any advice for someone who is thinking about it?

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