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Moonlighting: a good option for fellows?
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On most Saturday evenings at about 5 p.m., at the end of a week of seeing patients in clinic, performing consults and reading and preparing presentations, I trade one white coat for another.
That’s me, Ed Chao: endocrinology fellow by weekday, moonlighting internist by weekend night. Moonlighting is a time-honored tradition, continued by generations of residents and fellows needing to supplement low salaries. As I was getting ready to start fellowship, I looked for information on moonlighting possibilities. This search proved to be more challenging than I had imagined. I wanted to share some of what my research unearthed, and a bit of my own experiences, though much of this information may not apply to other regions of the country. But opportunities exist for those who do not mind giving up a portion of their free time.
 Edward C. Chao |
I chose to continue working for Kaiser Permanente. I had been a full-time internist with the San Diego group for just longer than a year and a half before starting my fellowship. As one of five medical officers on duty, I admit patients from the emergency department, from clinics and patients who transfer from other hospitals. The shifts run from either 8 a.m. to 6 p.m. or 6 p.m. to 8 a.m., with the overnight shift allowing a maximum five-hour protected window for sleep.
I can select from among five different duties. The first medical officer on duty takes all calls regarding admissions and hands over this responsibility to the fifth medical officer on duty at 3 a.m. The second medical officer on duty fields all cross-cover issues from the floors, performs consults and runs codes. The third medical officer on duty only admits patients. The first, second and third medical officer on duty works from 6 p.m. to 3 a.m., and sleeps until the shift ends at 8 a.m. The fourth and fifth medical officer on duty works from 6 p.m. until 10 p.m., sleeps five hours and steps into different roles at 3 a.m.
What I like best is that I can condense the hours into a single shift and work, at most, once a week. The pay rate is $75 an hour, but working overnight shifts is more high-yield, because these consist of 14 hours vs. 10 hours. Because my training program allows moonlighting only on weekends, this works out well. I also already know the system and get to work with colleagues I know.
The main disadvantage to moonlighting is that you do not get first choice of dates or times, and can’t lock in a shift until after the full-time employees have a week to claim those slots that tentatively bear your name. It is difficult to get a Friday night shift, because this is understandably more popular than working Saturday and breaking up the weekend. Working overnight also means some sleep deprivation, but with the help of caffeine, a solid post-shift nap of a few hours and Sarah, my understanding girlfriend, I have adapted.
Moonlighting positions are available in urgent care clinics at Kaiser, and certainly other places, where physicians see patients after hours on weeknights or during weekends. Patients are scheduled every 10 minutes, so you easily can average 12 to 14 or more patients in one four-hour shift. I worked in this setting for a few months after residency, and the pace is a bit hectic at times. Kaiser pays the same hourly rate for urgent care work as for the medical officer on duty position. Fellows at our institution can moonlight at the Veterans’ Affairs’ urgent care unit, which is actually more like an ED. We also have available the county prison system, which offers $100 per hour.
Moonlighting, I discovered, takes more forms than I had expected. It can be viewed as merely a necessary evil, but I like to think that it is more than an extra paycheck. For me, it is also an opportunity to stay connected to my internist roots. Dr. Dale Lieu, a Kaiser San Diego infectious disease specialist, told me about his days as fellow at the University of California, San Diego: “If I wasn’t on ID consults, which was every other weekend, I’d be moonlighting at Kaiser, doing medical officer on duty shifts. There’s a special pride to working as an internal medicine physician, even after you’ve finished training as a subspecialist.”
Edward C. Chao, DO, University of California, San Diego Medical Center, Division of Endocrinology and Metabolism and a member of the Endocrine Today Fellows Advisory Board.