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 dedicate themselves entirely to their primary responsibilities as learners and their duties at their daily jobs. To these stakeholders, moonlighting implies that their workers work toward other endeavors that may “interfere” with their primary roles. Concerns such as duty hours and sleepiness during the day job can arise. Even worse, the stakeholders perceive these workers to be competing with their primary business.
Why You Should Consider Moonlighting
But I would like to argue against both of these notions. First, it is unusual that the worker moonlights more than she can handle. Of course, anything taken to an extreme can harm the practitioner. Too much sugar causes tooth decay. Too much water causes hyponatremia. And, too much moonlighting can theoretically distract from the day job or training. However, it turns out that this impression 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’s workstation. I would preliminarily provide initial interpretations by fax to satisfy the demands of the ER physician and provide coverage that would otherwise would ordinarily not be available. Also, I would rapidly scan the plain films that attendings left from the afternoon shift. We made sure no impending disasters lurked in the morning as we searched for occult pneumothoraces, 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 to allow me to read more quickly and accurately. It supplemented my day job and, subsequently, my career. My moonlighting enhanced my performance during my daytime residency position. We can only achieve skills such as rapidly and accurately reading films by having had the experience to do so. Moonlighting experience easily fits the bill.
Second, you will perform most moonlighting gigs at a subsidiary of the primary institution or a local group. Usually, these opportunities may require temporary coverage due to staffing needs. It would be undoubtedly unusual for a moonlighter to “poach” cases from their primary residency program or day job.
Discordant Views Of Moonlighting- Academics Vs. Private Practice
Even more interesting, practices consider moonlighting a badge of honor for the applicant to private practices, one he can display to his future employers. And, concordant with this view, the typical private practice employer considers moonlighting an asset. 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. The typical skeptical chairmen and residency director’s impressions of moonlighting differ from this view.
Given the importance of moonlighting for a budding radiologist from both a training and future employment perspective, program directors should actively discuss the topic instead of suppressing the information. Therefore, for the rest of this discussion, I will discuss where to find exceptional moonlighting experiences, what to avoid, what you need to do before obtaining your first 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 the institution supports, I would say this is the best situation. You don’t have to worry about “stepping on anyone’s toes.” And, your institution will likely already insure you 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 recommend you ask either former or current residents and fellows about the options in the area. When you interview for your fellowship, make sure to get the phone number or email of the current fellows. Ask them if they moonlight and what exactly they do. 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. The local group may often need a warm body to “babysit” a magnet or give preliminary reads in the evening. This moonlighting experience would be your opportunity…
Lastly, if all else fails, you may want to either search employment websites or 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 charge 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. Subsequently, they would 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, as a typical radiology resident or fellow, I would consider reserving final reads until after you have passed your boards. Find moonlighting opportunities to give preliminary reads or work for 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 more challenging 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 essential to check that your malpractice insurance for your residency or fellowship is compatible with the moonlighting site. If not, you should obtain the correct insurance, or the opportunity should be off-limits for the prospective candidate. If you provide final reads for a practice or don’t have an occurrence policy, you should consider tail insurance.
Also, make sure you do not commit too much time to the moonlighting job. As discussed before, you certainly don’t want your moonlighting to interfere with your day job.
What Do I Need To Do Before Moonlighting?
1. Months before the prospect of moonlighting, it would help if you started getting the prep work done. The 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 opportunities require the applicant to have satisfied this requirement.
3. Before accepting any offer, make sure you feel comfortable with the requirements of the job. If they need someone to overread MSK MRI and do not have experience with this, it is probably not the best situation. Be thorough when you ask the employers about what they require.
4. Let your residency or fellowship program know that you are going to be moonlighting. The program needs to record your hours worked “off-campus” as part of the duty requirements of the ACGME. If the program catches you working too many hours, the ACGME can penalize the program. It’s probably not worth the risk of jeopardizing your residency or fellowship.
5. Once you have pinpointed the opportunity, you need to make sure your malpractice insurance covers the employment 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