Moonlighting – the rite of passage passed down from generations to generations of over-worked and under-paid residents. For those not familiar, it’s the term given to the common practice of residents picking up a second medical job to work at night while they complete their primary residency during the day – literally working through the light of the moon.
Moonlighting becomes a desire and often necessity due to the “relatively” poor salary given to resident physicians. Yes, the average individual resident salary of about $50,000 is actually more than the median family income in the U.S. Yes, residents should remember that when they complain about the income. But residents are extremely hardworking, smart, capable people. Most residents could easily have gone into a different career and likely made more money than they do during their time in residency. They are also surrounded by high income attendings. These facts are not lost, and add that to that highly capable drive, for generations there have been residents looking to make extra money even at the expense of their little time for sleep.
For myself, moonlighting is not a means to increase my lifestyle, but is used as a way to better my family life. I know I will have an income when done with residency to singularly support my family, but moonlighting allows me to replace my wife’s salary as a respiratory therapist now, so she can raise our daughter. Being a stay at home mom is a choice she wanted to make, and moonlighting allows me to support that choice while finishing residency.
So what does moonlighting look like? The opportunities are as varied as medicine itself. For anesthesia residents I’m familiar with, common opportunities we have include extra call as weekend coverage at the trauma hospital, admission duties at an orthopedic hospital, overnight help at a woman’s/delivery hospital, and coverage at a long-term acute care facility. Because of our broad anesthesia training, we are readily hired in fields of medicine, intensive care, and emergency response where our skills in critical care and airway management are highly valued. For residents in other fields, many of these opportunities, as well as shifts in the ER, are common ways to make extra money.
The obvious benefit of moonlighting is extra cash in your pocket. And often not just a little: Most moonlighting gigs pay between $50-$100 an hour on average! Many residents will more than double that $50k residency salary and a few will work multiple extra jobs to climb into 6-figures from moonlighting alone. It can literally be a cash cow that is hard to pass up when you are used to making near minimum wage.
The downside is it severely limits any free time you have. When you add in residency call, it’s not uncommon to hear residents struggle to remember the last time they had a weekend where they didn’t have to work in some capacity.
My own personal choice was to provide coverage at a long-term acute care facility. I provide late admission and emergency coverage (and often minor issues) for patients from 7pm-7am overnight. Patients range from the post-operative surgical cases needing continued rehab and nutrition optimization, to long term antibiotic administration, and all the way to critical care ventilator dependent patients. I choose this job for my moonlighting opportunity because the schedule was very flexible and the pay was higher than the other opportunities I had. Despite the drawback of having to be in-house overnight, the relatively higher pay allowed me to work 1 less shift per month comparably while still meeting my financial goals. The downside is, my nights can range from answering 1-2 calls and sleeping more than I do at home with a newborn, to being up all night taking care of and being responsible for very sick patients. And as with most moonlighting, you still have to go to residency work in the morning.
The other benefit to moonlighting is it often allows you to keep your skills up in a field that you may not frequently care for during your day job. For me, I answer a lot of floor calls moonlighting that I haven’t had to take since I was an intern on medicine rotations. While I know how to deal with many common patient issues peri-operatively, my experience moonlighting keeps me refreshed in a more broad spectrum of medicine than my anesthesia residency does during the day.
All that said, most days I can’t wait until I can quit my moonlighting job. I can’t deny the benefit financially and from a confidence standpoint as my wife decided to leave her job. I can’t deny the security knowing in a financial pinch, I can always pick up more shifts. But the truth is, I work the minimum amount I can – usually about 3 shifts per month. I already am taking call and late nights from residency. I am often already tried and low on sleep. A bad night moonlighting can literally set me back days on sleep. I seriously dislike being away from my new daughter and wife. And I don’t like the legal liability of providing coverage to over 30 patients I know very little about, who are cared for by physicians I’ve never met, whose mistakes can come forth in the middle of the night solely on my watch.
But as I finish up a quiet shift, where I simply got paid well to sleep in a different bed and answer a few phone calls, I tell myself, maybe one more month. Moonlighting is a cash cow and one I can’t wait to quit… just not today.
UPDATE: As of Jan 1 2017, I am no longer moonlighting. It wasn’t my choice – my moonlighting group was replaced by a telemedicine service! Post on the change coming soon.
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