While the term “moonlight” may conjure up romantic or poetic images, it is also a term used to describe something many doctors opt to do at one point or another during their careers.
Plainly, to moonlight (verb) is to work a second job. For doctors, this means acting in the same capacity you normally would, just in a different scenario from your primary “day job.”
Moonlighting can be useful for younger doctors who need to supplement their income during residency or fellowship training. Since the salaries of house staff are mostly paid for by federal funding, the salaries are comparatively very low, especially for trainees working in large cities. It can be very helpful to take home even a few hundred extra dollars per month to cover things like loan repayment or childcare. For more senior physicians who are looking to transition to part-time work, moonlighting can serve as a way to stay involved in your field with more control over when, where, and how long you work.
There are a few main things that you need to consider prior to looking into moonlighting possibilities. The major one is your contract within the primary position you hold, whether it be at a hospital or private practice. Most ACGME-associated training programs are very clear about if moonlighting is permitted during training. Many residencies will allow moonlighting after the first year, though some specialties (like ob/gyn for example) do not allow moonlighting at all. The main challenge for residents looking to moonlight is that they cannot engage in extra work that would push them over the limits of work hours each month (80 hours/ week, averaged over 4 weeks). Though this seems like it would be hard to do, even for one job, many a resident would disagree!
In fellowship, moonlighting is much more readily allowed and theoretically simpler to achieve, given that fellows’ hours tend to be less demanding, and they tend to be credentialed fully as an attending at their home institution. This can be particularly helpful given that many people are settling down and have families by the time they enter fellowship training.
Another very important element to consider is how you will be insured for malpractice during your work in moonlighting. This cannot be overlooked and is essential prior to applying for any given position. For many MD’s, moonlighting within their hospital system is the easiest solution to this issue, since you would theoretically already be covered by an insurance plan through the hospital. Working extra call hours or taking on home-call or telemedicine appointments can help to boost income with relative ease. You just have to be willing to sacrifice the extra hours away from home. For private practitioners, or those MD’s who are self-employed, the options for moonlighting are slightly more complicated. One solution, however, is to enroll in a Locum program.
Being a locum for a physician is essentially the equivalent of serving as a substitute teacher. As a locum, you enter into a position for a specified period of time, and once your contract is up you will move on. Many practices and hospital systems engage with a specific locum agency that arranges coverage during specific physicians’ prolonged absences. For example, a practice or department may require a locum during a medical or maternity leave, or during transition periods where a position is left vacant from a retirement and there is a gap in time while a new replacement is being hired. Usually, locums’ insurance is arranged by the agency that facilitates the locum position. For more information about the specifics of locum positions in your area, you can either identify the agencies that work within your zip code or city or reach out to specific hospitals’ hiring departments and find out how they go about the process of arranging locum coverage. This is beneficial for physicians who are undecided about the exact environment in which they would like to practice, those looking for more variety and flexibility in their schedule, or those who only need a temporary arrangement prior to onboarding at a more permanent position. It can also work as a supplement to the salary of someone like a hospitalist or nocturnist looking for flexible moonlighting positions on the side.
The other major option in terms of making money as a non-clinical physician would be moonlighting in advisory, consulting, or other more analytical positions. Physicians are necessary for the functioning of many businesses, from small to large. The marketability of a medical degree is fairly broad, considering business from cosmetics and medical devices to web-based publications and periodicals that rely on the expertise of doctors to legitimize their claims and evaluate safety of products. The law profession additionally relies on medical professionals for “expert witness” testimony and will pay handsomely for the service. This option is slightly controversial, as it can tend to place someone in a position where testimony could affect a colleague, so serious consideration is necessary prior to moonlighting in this way.
In conclusion, moonlighting is a viable and sometimes necessary option, particularly for newer MD’s who are on the lower end of the salary spectrum. It can also be instrumental in helping to figure out what exact type of practice environment and style works best for you, prior to settling down in a permanent position. For more information, refer to the specific policies of your primary employer’s contract.