Radiology Moonlighting: A Taboo?
Rarely do chairmen and radiology program directors in academia utter the word “moonlighting” to their radiology residents, fellows, and employed attendings. Yet, moonlighting is a mainstay for many neophyte and seasoned radiologists. Why is the subject so taboo? Academic stakeholders want to know that their residents and practicing physicians are entirely dedicated to their primary responsibilities as learners and their duties at their daily jobs. To these stakeholders, moonlighting implies that their workers are employed in other endeavors that may “interfere” with their primary roles. Concerns such as duty hours and sleepiness during the day job can arise. Even worse, these workers can be perceived to be competing with the stakeholder’s primary business.
But I would like to argue against both of these notions. First it is unusual that the worker moonlights more than he/she can handle. Of course, anything taken to an extreme can be harmful to the practitioner. Too much sugar causes tooth decay. Too much water causes hyponatremia. And, too much moonlighting can theoretically be a distraction from the day job or training. However, it turns out that this impression of moonlighting is a widely perceived misconception.
I harken back to my days as a radiology resident and fellow. As a resident, I remember reading CT scans in a quiet room in the evening next to the CT technologist workstation, preliminarily providing initial interpretations by fax in order to satisfy the demands of the ER physician and provide coverage that would otherwise would ordinarily not be available. I would also rapidly scan the plain films that were left over from the afternoon shift to make sure there were no impending disasters in the morning, occasionally detecting occult pneumothoracies, free air, pneumatosis, portal venous gas, and more. Instead of interfering with my role as a radiology resident at the time, I found the experience of moonlighting to allow me to read more quickly and accurately. It was supplemental to my day job and subsequently my career. In fact, my performance during my daytime residency position was enhanced by the extra practice of moonlighting. The ability to rapidly read films and scans quickly and accurately can only be achieved by the experience of having to do so. Moonlighting experience easily fits the bill.
Second, most moonlighting gigs are performed at a subsidiary of the primary institution or a local group that may need temporary coverage due to staffing needs. It would be certainly unusual for a moonlighter to “poach” cases from their primary residency program or his/her day job.
Discordant views of moonlighting- academics vs. private practice
Even more interesting, moonlighting is considered to be a badge of honor for the applicant of a private practice radiology to be displayed to the future employer of the moonlighter. And, concordant with this view, moonlighting is considered an asset by the typical private practice employer. In fact, when interviewing for private practice jobs, the stakeholders would specifically ask if I had done any moonlighting. For these private practice stakeholders, moonlighting implies that the trainee has the experience and wherewithal to handle the daily pressures of a bustling private radiology practice. This is a very different impression from the typical skeptical chairmen and residency directors.
Given the importance of moonlighting for a budding radiologist from both a training and future employment perspective, program directors should be actively discussing moonlighting instead of suppressing the information. Therefore, for the rest of this discussion, I am going to talk about where to find prime moonlighting experiences, what to avoid, what you need to do prior to obtaining your first moonlighting gigs.
Where do I find moonlighting opportunities?
First of all, if you are fortunate enough to have a moonlighting opportunity embedded in your residency or fellowship program that is supported by the institution, I would say this is the best situation. You don’t have to worry about “stepping on anyone’s toes” and you will likely already be insured for the task. These opportunities are the simplest and best for the trainee.
I am aware, however, that many programs do not have these opportunities on hand. So, I would first recommend you first ask either former or current residents and fellows about the opportunities in the local area. When you interview for your fellowship, make sure to get the phone number or email of the current fellows and ask them what and if they do for moonlighting. Usually the current trainees know the local environment for moonlighting the best.
Let’s say however, the current residents or fellows are not moonlighting. What else could you do? You may want to call the local groups and find out if they have any temporary staffing needs. Many times the local group may need a warm body to “babysit” a magnet or give preliminary reads in the evening. This would be your opportunity…
Lastly, if all else fails, you may want either search employment websites or to ask a locums company to help you to find moonlighting opportunities. I would reserve this option for last because the companies that use these agencies are often charged a fee that may lower your pay rate.
What moonlighting experiences should I avoid?
In the recent past, residents would finish their residency training, take and pass their oral boards, and then be board certified in radiology. No longer is this the case. This fact leads to some new technical issues with moonlighting as a fellow. In the past, I would have said by all means go ahead and give final reads as a moonlighting fellow. Instead nowadays as a typical radiology resident or fellow, I would consider reserving final reads until after you have passed your boards. Find moonlighting opportunities where you can give preliminary reads or be under the tutelage of a senior attending that is ultimately responsible for the final readings.
Why do I feel this way? Well, if you miss a finding and it goes to court, legally you may have a harder time defending your miss. If the plaintiff’s attorney asks you if you were board certified at the time of the reading of the study and you say no, they can theoretically question your judgment at the time of the interpretation.
It is also important to check that your malpractice insurance for your residency or fellowship is compatible with the moonlighting site. If not, you should either obtain the correct insurance or the site should be off limits for the prospective candidate. If you are providing final reads for a practice or you don’t have an occurrence policy, you should consider tail insurance.
Also, make sure that the time commitment to the moonlighting job is not too much. As discussed before, you certainly don’t want your moonlighting to interfere with your day job.
What do I need to do prior to moonlighting?
1. Months prior to the prospect of moonlighting, you need to start gettting the prep work done. First thing to consider, make sure you get all the necessary state licenses that you may need. It can take a lot longer than thought to get a state medical license. Have all that paperwork ready.
2. Keep your cpr and acls certifications up to date. Some moonlighting opportunities require the applicant to have satisfied this requirement.
3. Prior to accepting any offer, make sure you feel comfortable with the requirements of the job. If they need someone to overread msk MRI and you do not have experience with this, it is probably not the best situation for you. Really be thorough when you ask the employer about what is required.
4. Let your residency or fellowship program know that you are going to be moonlighting. They need to be able to record your hours worked “off campus” as part of the duty requirements of the ACGME. If you are caught moonlighting without the knowledge of many programs, there could be a potentially stiff penalty. It’s probably not worth the risk of jeopardizing your residency or fellowship.
5. Once you have actually pinpointed the moonlighting opportunity, you then need to make sure your malpractice insurance will cover employment at the opportunity. Also, you must proceed rapidly with hospital credentialing as this process can be very time consuming. Hospital credentialing also includes sending off the malpractice insurance information to the hospital medical staff office.
Moonlighting can be a fantastic experience that supplements your residency and fellowship education. It can enhance your prospects for future employment, can allow you to gain speed and confidence at your daytime job, and let you more rapidly pay down your student debts. I highly recommend moonlighting if the opportunity is available, you are so inclined, and it is allowed by your residency or fellowship program.
Good references/links to find out more about moonlighting