What is Moonlighting?
What are some opportunities for physicians moonlighting in residency?
When I say moonlighting, I mean working part-time for either the facility you’re training in or potentially an outside facility and getting paid higher than you would as a resident or fellow. First, the average annual compensation for a resident is around $60,000, less at the beginning and inches up a little bit more towards your PGY-3 or later, and then fellows as well according to the American Medical Association.
How can a Resident Physician Moonlight?
It’s a little higher than that. In short, it’s not a substantial amount of money for anyone, and it’s tough for those with families to get by during residency. Although residents are dealing with lack of sleep, high stress, and just not much time, even being able to do one or two shifts a month can be a couple extra thousand dollars—which can make a significant difference if someone is struggling to get by during training.
So, how can you moonlight, and where are the opportunities found? First, you need to identify where you are in training and whether the state you’re in allows those in training to moonlight. For this information, you can consult your state’s medical board or Federation of State Medical Boards.
Usually, and I’m saying this broadly, I’m not talking about anyone’s specific state, but most states follow USMLE or Complex progress track. And then, once the resident gets to a certain level or past all that, you can apply for full licensure, allowing you to moonlight for other facilities or the facility that you’re working at. Those in their internship year usually have a training permit according to the American Board of Medical Specialties.
Moonlighting Requirements During Medical Residency
I know other states have the same thing where you’ll have a training permit while in training, and there are steps to apply for full licensure. But you need to check and see what the requirements are in your state if you are interested in doing some moonlighting. Now, the opportunities for moonlighting depend upon specialty.
Those in primary care or internal medicine who can do hospitalist work, emergency medicine, urgent care, and even fill in on the weekends in primary care potentially have more opportunities than those in surgical specialties.
Dermatology and pathology may have few jobs or moonlighting opportunities during training, but it also depends on your geographic location. If you’re in residency or fellowship, you certainly aren’t going to travel and do locum work. You’re going to need to do things locally. So, some people train in rural facilities where they don’t have those opportunities. They may have to drive a little bit to find a potential moonlight opening, but it will be up to you to determine how far is too far and then whether opportunities exist in the community that you’re in.
Identify Moonlighting Opportunities Through Direct Contact
The easiest way of finding moonlighting opportunities is to contact facilities and see if they have or are looking for people to fill in for a shift or two in your specialty. It isn’t going to be a regular thing. No one will do two moonlighting shifts a week while you’re a resident or fellow. There’s just no time for that. And even if there were, you would be so exhausted by the end of it. It would lead to complete burnout and probably some clinical errors as well.
Moonlighting with Medical Malpractice Insurance
But as I said, even one or two shifts a month can drastically affect pay. If working in ER or as a hospitalist, you could get anywhere from $125-$225 an hour, depending on your community. And multiplying that by 8, 10, or 12-hour shifts could be a significant amount of money very quickly.
A couple of other things to think about: one, anywhere that you’re moonlighting, they must provide, or at least they will provide, medical malpractice insurance. For more information about medical malpractice insurance, you can refer to resources like the American Medical Association.
And to ensure that if you practice with them, they will pay for your tail if it’s a claim-made policy. I have other blogs—you can look at them if you want more information. But a medical malpractice policy is not personally dependent; it’s job-specific if that makes sense. So, you will have medical malpractice insurance for whomever you’re working or training with. But if you were to go somewhere else, that policy doesn’t follow you. You would need a separate policy for a different employer, so make sure it is in place before you start providing care.
What you wouldn’t want to do is give a couple of shifts a month for a couple of years of training, then they make you pay for your tail, which could potentially be thousands of dollars, primarily dependent, and then how long you work for them. But that’s something you want to avoid having to deal with.
Moonlighting can be an excellent solution for making money while in residency or fellowship. But there are a bunch of hoops you have to jump through.
To Sum Up
As I said before, one, you need to identify what the licensing requirements are in your state and then what you can do with those specific licenses. Two, you need to identify potential opportunities and contact the facilities directly. You can always go online and do a job search or ask the others in your training group if they also have moonlighting opportunities. And three, ensure the malpractice policy covers you during and after your moonlighting.
Then, when you move on to your full-time job after finishing training, there are some other complications when working in outside activities, moonlighting, locums, and that type of thing. But your employment contract will dictate what you can and can’t do while employed. But maybe that’s a good blog I can make down the road.
Medical Resident Salary
Do residents get paid during residency?
The short answer is yes, residents do get paid. The average salary for a resident in the United States is around $64,000.
Likely, you will not get $64,000 in your first year of residency.
Usually, 45 to 50 is an average amount in your first year out of your internship. It can increase over time because you’ll be able to do more things as your training moves on. And then certainly, if you’re in fellowship, it will be more than that, or likely more than that, simply because you’ll be able to do more things. It will be frustrating when you break down your hourly rate as a resident.
Ways to Make More Money Outside of Residency
If you make $64,000 a year and you’re working 70 hours a week, you’re working for somewhere between 20 to $25 an hour, which is very likely less than the RNs working in the hospital or healthcare network or wherever you’re working.
Now, there are ways of making more money outside of residency, and let’s talk about that next if you have followed the proper steps, work, locums, or moonlighting during residency. It is also specialty-dependent. It will depend upon the state’s licensing requirements where you complete your residency. Most states will give a full license to a physician once they’ve at least completed their PGY-1 and they’ve completed the steps of the USMLE. In that scenario, most states will grant a license.
Residents’ Locum Tenens Position
Others will require the resident to complete a second or third-year residency before they grant a full license. But with that license, if you have taken those steps, it will allow you to do, as I said before, locums or mood lighting. If you don’t know what those are, a locum tenens position is a fill-in where a hospital or hospital network will need a particular specialty to meet the requirements.
Maybe if they’re a Level I trauma center or something like that, they would need someone in your specialty. And so, they’ll bring them in on a short-term basis. It’s not a long-term position and is usually paid as an independent contractor. And that is a way of making a decent amount of money quickly.
Earning Pay by Moonlighting During Residency
Moonlighting is more of filling in for private practice. If you’re in internal medicine and could work urgent care on the weekend, I would consider moonlighting. That certainly is not a locum. Those are two things that you could do.
Telemed certainly has significantly increased since COVID hit in the spring of 2020. And so, there are very likely Telemed opportunities. Once again, specialty-dependent, but that might be something you want to investigate. There are many Telemed companies where if you get on their panel, you can log in, and there’s just a queue of patients that need assistance. And all you need to do is log in, hit whoever is in the line, see a few patients, log off, and that’s it. That might be another opportunity to make a little bit more money.
The first statement that you’re probably thinking is, well, great. I only have a little time to do these things. Yes, that’s true. You have a huge time commitment as a resident or fellow, and doing any locums or moonlighting work will be difficult. But if you need the money, you can make four or five times your hourly rate as a resident. And it can add up quickly, even one day a week.
However, if you can find one of those Telemed jobs that allow you to log in on your own time, see as many patients as you want, and then log off, that is usually ideal. Because if someone is home at night and has an hour or two to kill, there might be a way of making some quick money.
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