When residents moonlight: Is the extra money worth it?

It’s not easy being a medical resident. Long hours at work combined with low pay—and, in recent years, the threat of COVID—can make the job grueling.

Considering these concerns, it’s no wonder that residents often take on moonlighting jobs. This practice can be complicated, and has its own nuances. Here are some things to keep in mind when considering “side gigs,” along with some tips on how to best handle the workload if you go this way.

Pay concerns

According to the widely cited Medscape Residents Salary & Debt Report 2021, average pay for a first-year resident was $57,500 (a 3% increase from 2017 to 2020). Pay does increase year-over-year, with the average salary of the 6th to 8th year being $70,300.^[]

Although women residents make slightly less on average, the pay is roughly equivalent between the sexes (unlike in other professions). Overall, 43% of residents surveyed were satisfied with their pay, with dissatisfaction stemming from lack of compensation for the number of hours worked and pay not on par with that of other medical staff.

What the AMA has to say

Not all residency programs permit moonlighting. According to the AMA, program directors need to develop guidelines for work scheduled outside of residency, including moonlighting.^[] They need to monitor this work to ensure it doesn’t impact a resident’s ability to fulfill their educational goals and objectives.

“Increased financial assistance for residents/fellows, such as subsidized child care, loan deferment, debt forgiveness, and tax credits, may help mitigate the need for moonlighting,” the policy states. “At the same time, resident/fellow physicians in good standing with their programs should be afforded the opportunity for internal and external moonlighting that complies with ACGME policy.”

Moonlighting specifics

For residents, moonlighting usually refers to working as an independent physician. This can take the form of internal (at the same institution that hosts their residency) or external moonlighting.^[]

The ACGME specifies that moonlighting mustn’t interfere with a resident’s ability to achieve their program’s goals and objectives, and mustn’t interfere with their fitness to work or compromise their patients’ safety. Total hours worked by a resident—including moonlighting—must not exceed the 80-hour weekly limit. PGY-1 residents are not permitted to moonlight.

Finding suitable moonlighting opportunities can be tricky. Locum tenens recruiting firms such as Staff Care offer only limited moonlighting opportunities to residents. Some moonlighting positions are only available to board-certified physicians, while others require physicians to have a permanent state medical license.^[]

It’s imperative that moonlighting gigs offer quality malpractice coverage. This can be offered by the agency offering the work.

Pros and cons of moonlighting

Moonlighting offers at least two clear benefits. First, extra income. Second, more experience, as the resident is introduced to different practice settings and allowed more practice with procedures. It also introduces residents to different patient populations and can increase their primary care knowledge.

Drawbacks of the moonlighting are also highlighted in an article published by the AMA.^[] These include time spent away from other obligations such as parenting—although the extra money may be necessary to pay for childcare. It also detracts from the ability to rest, relax, and recharge. Moonlighting will also increase your salary and tax burden.

Expert advice on moonlighting

In an article published in General Surgery News, Jennifer S. Tseng, MD, MPH, advised residents based on her moonlighting experiences.^[]

She noted that moonlighting is particularly appealing during research as a resident, but your personal life or work could suffer. So she recommends limiting moonlighting to two shifts a month.

“I have met many residents who used their moonlighting money, and more, and ended up poorer than before because of the desire to splurge, and besides that, they were not academically productive,” she wrote. “Use more than half of any money from moonlighting for productive purposes—paying off student loans and supporting your family—and make sure to put some away for your retirement.”