This post is meant to describe what moonlighting is for a physician and why you should do it. It is generally something that can be started during training as a resident, and can continue through fellowship and even as an attending. It will be important to check the terms of your employment to make sure it is allowed. Also, for those in training, be sure to stay within the ACGME duty hours.

What is moonlighting?

Moonlighting for a physician means fulfilling duties as an independent contractor at a healthcare facility for which the primary employer does not have somebody staffed for at the moment. The healthcare facility may include inpatient or outpatient responsibilities, and more recently includes telemedicine. These shifts may be available because the primary physician is away from the office, the hospital is expanding coverage, or because it is easier to find coverage with moonlighters than a permanent hire. There are many reasons a healthcare facility may choose to hire moonlighters, which could affect whether or not you choose to proceed. For instance, the reason a moonlighting job could be available may include:

• the primary physician is overworked and is burnt out
• a physician had just left the practice so they need urgent coverage
• nobody wants to work there

All of the above reasons could give you pause about whether you would join. It is important to get a sense of why the job is available, or at least give yourself a good exit strategy if the moonlighting job does not suit your goals.

Finally, contrary to the name 'moonlighting', not all moonlighting is done at night. Granted, the night shift is, for the vast majority people, during undesirable work hours, and so you will find the most opportunities available to cover nights. This could include being on call for a practice at night, or taking night coverage at the hospital. There are day time shifts available as well and these are often during weekends because of the undesirability of working the weekends as well. Because moonlighting is a contracted position and because it is often during undesirable working hours, the pay should be and often is higher than somebody who would be salaried to do that job.

For me, choosing to moonlight and starting early on in my training was the best thing I could have done for my career as well as my financial security.

Why should you moonlight?

1. Additional income

The most compelling reason to moonlight is of course to earn additional income. Most people get started with moonlighting while they are still in training and earning a resident salary of approximately $50k. The extra income can be used to invest for retirement or pay down massive student loans. Many moonlighting positions pay you as an independent contractor, which provides you with a 1099-MISC for the tax year. Congratulations! You are considered self-employed. There are several benefits to having 1099 income, which I will discuss in a future post.

2. Additional clinical experience

Moonlighting usually involves a level of independence that a trainee often does not experience until later on in their career. This helps with developing confidence as well as independent critical thinking. You are often tasked as the physician to perform procedures, which is useful for developing your skills. This is definitely true for me, and I felt fairly confident managing all sorts of helath conditions as a hospitalist even as a second year resident.

3. Exposure to different work environments

You potentially have the option to moonlight at various facilities and different environments. You become very adaptable to any environment, and become comfortable working anywhere from small community hospitals to large academic centers. You will probably work with different EMRs as well and become facile with any computer system.

4. Improving your CV and finding employment

When looking for jobs as an attending later on, I found that the experience of moonlighting, especially because I did it at various locations, was a trait that employers sought out. It usually indicates an individual who is willing to work hard, and is adaptable.

How do you get started with moonlighting?

Once again, make sure that your contract with your employer allows moonlighting. As a resident, since you are not board eligible or board certified yet, your only option might be internal moonlighting within your program or hospital. You require supervision from an attending physician, and as such you can only fulfill resident level positions. Check with your department, or other residency programs within the same hospital to see if there are any opportunities. If you are board eligible or board certified, then your options are wide open. I urge you to look outside of internal moonlighting, as the pay is usually substantially higher. In addition, external moonlighting provides you with the experiences I described above that internal moonlighting may not provide you with. You can either go through a moonlighting firm or find moonlighting directly with a practice. Each has its pros and cons which I will describe in another post.

I hope I have motivated you to start moonlighting! Keep following my site for more insights on moonlighting, and my own experiences with moonlighting in future posts.