This image, “juggler” is copyright (c) 2007 kosmolaut and made available under a Attribution 2.0 Generic License
[Editor: This guest post is written by Mitul K., M.D. He is a good friend and colleague of mine, and we often discuss financial matters with each other just to get another perspective since it is impossible to see all angles by onself. This article is just such an example. Because I am such a proponent of multiple moonlighting gigs, I failed to mention the disadvantages, which Mitul lays out well here]
The idea of multiple options for additional moonlighting income during training is obviously appealing. First of all, more money at a younger age has a multitude of benefits. Second, you have options, so you can pick the jobs that fit what you’re looking for at any given time. Third, you get experience in multiple settings and this gives you a better perspective of the “real world” of medicine.
Unfortunately, there are some downsides of juggling multiple moonlighting gigs during training. This is not to say that it is not worth it, but it is important to understand them when signing up for different jobs.
Scheduling Challenges with Multiple Moonlighting Gigs
Moonlighting companies, and the hospitals or practices that are paying them, expect something when hiring physicians. They expect these physicians to work shifts, and some even have stipulations built in to the contracts stating that expectation. Unfortunately, these expectations may be difficult with a trainee schedule and it can be difficult to promise to do any set number of shifts in a given time period.
Balancing residency/fellowship requirements with moonlighting obligations can be difficult. Unfortunately medicine doesn’t have time cards that enable just walking out at 5 pm and therefore can put you in a difficult position. For example, if you’re moonlighting in an ICU and a patient is crashing at 6:30 in the morning and you need to make it to conference by 7:30 am, you may end up being late or missing that conference (or the other way around and being late to your moonlighting shift). Whether that is ok is not for me to judge, but that risk must be known.
Balancing multiple moonlighting gigs also presents challenges. The schedule in training is difficult, you may not necessarily know your call schedule while requesting shifts at different moonlighting gigs. This is also a balancing act, both while making requests and once being assigned shifts. You may need to make trades to make shifts work, you may need to give up shifts. This is ok in a scenario where shifts are in demand and easy to get rid of, but many moonlighting gigs only have a handful of moonlighters and those shifts may be difficult to remove. This is before even considering personal commitments that may arise after schedules are made. The scheduling tool is excellent to stay on top of these potential conflicts by integrating seamlessly with your calendar.
The ACGME has work-hour rules in place for trainees and these can make moonlighting almost impossible. It is important to know your hours, your program’s attitude towards work hours, and how you personally deal with fatigue. You shouldn’t jeopardize good standing with your training program for moonlighting since you don't want to compromise your long term career opportunities. Unfortunately I've seen residents prioritize moonlighting over their training program and this creates animosity among other residents and a poor reputation among the residency program.
This image, “paperwork” is copyright (c) 2014 Erich Ferdinand and made available under a Attribution 2.0 Generic License
As mentioned in the beginning, the idea of multiple moonlighting gigs is very appealing, but I can tell you that the process of credentialing at multiple hospitals is painful. The number of forms to fill out, documents to obtain, and signatures needed is absolutely incredible. In addition, being credentialed at multiple hospitals presents challenges as you go to get further credentialing or state licensing, as you need to list those hospitals and a contact person when applying for credentialing. This seems like it would be easy, but I assure you that getting a hold of that person can be challenging and that may be the barrier to completing your credentialing or licensing paperwork on time.
Steep Learning Curves
Learning new electronic medical records (EMRs) can be challenging, this includes trying to use the same EMR vendor but at different hospitals. Again, this is an individual decision, but knowing how you adopt new systems is important when deciding on going through the painful credentialing processes. Some moonlighting gigs may require learning a variety of EMRs for different tasks.
Each of these challenges can be overcome and must be weighed against the potential benefits. One thing that is obvious is that earning extra money is great, but I caution doing so at the expense of your education and training. Also, you need to consider your time needed for family and loved ones.
[Editor: There are definitely many advantages to moonlighting, but as Mitul mentioned here, there are significant risks as well. Only you can be the judge of whether the benefits of moonlighting are worth the effort. Let us know about your experiences in the comments below!]