LYCOS RETRIEVER 
Moonlighting: Residents
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Moonlighting is prevalent among housestaff. AMA statistics estimate that up to 37% of all residents moonlight, while the American Osteopathic Association believes up to 80% of residents in osteopathic programs moonlight. For internal medicine residents, educators say, the number is probably closer to 50%.
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During the months moonlighting, they averaged 20 hours/month (SD=14) moonlighting. 56% reported moonlighting due to insufficient residency income to pay educational loans, housing, and/or childcare, 40% to gain additional clinical experience, and 5% were required to moonlight by their residency program. Moonlighting accounted for an average of 12% (SD=11) of the residents’ income. Educational debt was associated with moonlighting, as 44% of residents with debt reported moonlighting compared to 29% of residents without debt (p = .024). Also, as the amount of debt increased, so did the number of months that residents moonlighted (p = .037). Residents with debt owed an average of $113,476, and their average monthly pay was $438.
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Because residency education is a full-time endeavor, moonlighting by residents in clinical activities is discouraged. If a resident decides to moonlight, he/she may do so only with a prospective written statement of permission of his/her Program Director. The Program Director and the individual resident must closely monitor moonlighting to ensure it does not interfere with the resident’s ability to achieve the goals and objectives of the educational program. If a resident is no longer performing satisfactorily in the program, the Program Director may withdraw the permission to “moonlight”. In the event permission to “moonlight” is withdrawn by the Program Director, the obligation to notify an outside employer is the responsibility of the resident who established that employment relationship and not the responsibility of the Program Director or the College of Medicine.
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It is the Program Director's responsibility to monitor resident performance in the Program to ensure that moonlighting activities are not adversely affecting patient care, learning, and/or resident fatigue. The Program Director may enlist the assistance of the Chief Resident and/or the Attending Physician(s) with whom the resident is working to help with this monitoring. If the Program Director determines that the resident's performance does not meet expectations, permission to moonlight will be withdrawn.
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That's why some programs are taking another approach and asking residents to oversee moonlighting themselves. The University of Cincinnati's department of internal medicine, for example, developed a resident peer review committee to monitor moonlighting hours more than a decade ago. The committee documents the moonlighting activities of the program's residents through self-reports to ensure that residents follow program guidelines.
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Both residents and physicians should address the potential negatives of moonlighting before jumping in. Are you willing to trade time with family and friends - or pillow and blanket - for moonlighting shifts? Residents could ... miss educational programs or events at their primary hospital. Physicians must decide whether moonlighting would take time away from marketing their practice, becoming involved with professional or community organizations, or pursuing other ventures.
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