Physician Locums July 10, 2023

A Guide to Moonlighting for Physicians and Residents

Moonlighting — or working a second job in addition to a primary job — is a fact of life for many doctors and practitioners. From medical residents and new physicians to mid-career physicians and those close to retirement, physicians throughout the U.S. are moonlighting in significant numbers for a variety of reasons.

The most apparent advantage of moonlighting is financial, but that's not the only benefit. Others include the chance for physicians to add variety to their careers, gain experience in new settings, teach, volunteer, and broaden their career horizons in other, sometimes unforeseen, ways.

"When you work in a hospital, your clinical skills tend to atrophy a bit," Mary Frances Barthel, MD, hospitalist program medical director, told Today’s Hospitalist. "There’s value in maintaining a little bit of those outpatient skills even if you aren’t going to focus on that part of your career."

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Physician Moonlighting: Trends & Demographics

Although the conventional belief is that most young physicians and residents moonlight to help offset their medical school expenses, it's more often older physicians who report a secondary income, according to recent physician surveys by Medical Economics. In other words, moonlighting is acknowledged and even embraced by physicians and practitioners across all age groups.

Nearly one-third (30%) of the physicians responding to the 2021 Medical Economics Physician Report reported earning income from secondary sources. 

In 2021, the top three annual earners among moonlighting physicians were:

  • Pediatric physicians – averaging $62,000 in a secondary income 
  • Family medicine physicians – averaging $53,000 in a secondary income
  • Internal medicine physicians – averaging $46,000 in a secondary income

Other moonlighting specialists who frequently take advantage of secondary jobs include hospitalists, pediatricians, gastroenterologists, and many others.

Moonlighting for Medical Residents: What You Need to Know

Although residents "are legally allowed to provide medical care as licensed physicians and receive direct financial compensation in return for these services," as Elizabeth Kwo, MD, MBA wrote in an article for Medscape, not all medical programs allow residents to moonlight.

"Many residency programs have strict policies in place for moonlighting," writes Adventures in Medicine's Holly Higgins. "For instance, many will only allow top-performing third-year residents to moonlight. In almost every case, moonlighting needs to be approved by a supervisor."

The American Medical Association (AMA) also reports that residents are capped for the number of combined educational and work hours at 80 hours per week.

"Residents can't be on call for more than 1 in 3 nights and must have a day off during the week," Dr. Kwo added. "First-year residents (PGY-1s) and residents on a J-1 visa sponsorship aren't allowed to moonlight; however, residents on an H-1B visa are allowed to moonlight."

Moonlighting for residents, physicians, and advanced practitioners is sometimes discouraged, due to the very real concerns of overworking and burnout, which could potentially put patients and facilities at risk, as well.

"Are you willing to trade time with family and friends – or pillow and blanket – for moonlighting shifts?" asked Joshua S. Coren, DO, MBA in a 2007 article in Family Practice Management. "Weigh the pros and cons. Both residents and physicians should address the potential negatives of moonlighting before jumping in." 

He cautioned that moonlighting residents could miss out on educational programs at their primary hospital, while established physicians might find that moonlighting takes time away from marketing their practice, professional development, community involvement, or other ventures.

Locum Tenens: The Ultimate Moonlighting Option for Physicians and Residents

When used wisely, moonlighting is, for the most part, embraced as an integral part of the medical workplace, with many hospitals even encouraging their staff to moonlight within their own facilities. Called in-hospital physician moonlighting, doctors and practitioners pick up extra shifts in other departments of the facilities in which they already work. This is a fairly uncomplicated form of moonlighting, which often doesn't require seeking out extra insurance or commuting to a second location.

Some healthcare employers also hire moonlighting professionals to help with seasonal fluctuations or to fulfill specific tasks like performing disability evaluations. And for many healthcare employers, locum tenens workers are a favored method of employing moonlighting physicians in their facilities

Locum tenens assignments are a popular option for physicians seeking part-time work, but who lack the option of extra shifts at their place of permanent employment. Usually just a few weeks or months in duration, locum tenens assignments are a means for physicians to fill in at hospitals, clinics, or practices that are temporarily short-staffed, or during times of seasonal fluctuation.

The appeal of locum tenens jobs to moonlighting physicians lies in their flexibility and temporary nature. If an assignment turns out to be something other than what you expected, you can simply move on when that assignment is over. There are no long-term commitments.

For those physicians, physician assistants, and nurse practitioners seeking moonlighting opportunities outside of the facility in which they work, locum tenens assignments can offer several possibilities in a range of practice environments. Locum tenens agencies also provide professional liability insurance and assist with privileging and credentialing. 

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Ready to Start Moonlighting? Here's What to Do Next

AMN Healthcare is a leading locum tenens staffing agency offering jobs throughout the United States. CONTACT our professional recruiters by completing the form on the right of this page to learn more about locum tenens moonlighting opportunities in your area, as well as travel-based assignments. 

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