Pros and Cons: Moonlighting During Residency

scrub coats hanging from hooks

Moonlighting is pretty much a rite of passage in residency. And extra hours of practice in your field plus the nice payday might seem like a no brainer. But should you really do it?

For me, I strongly considered moonlighting during PGY-2 to bring in some extra income for my family. In the end, though, I didn't want to lose any time that I could be spending home, which is why I went with consulting instead. All this is to say that, while moonlighting can definitely be a great thing, it might not be great for you personally.

To help you decide if moonlighting in residency is right for you, I’m sharing some of the biggest pros and cons.

What does moonlighting mean for doctors?

The legal definition of moonlighting is working any kind of second job. So if you want to moonlight as a bartender or barista, be my guest. Today, though, we’re talking specifically about picking up extra shifts as an independent physician during residency. This could be internal moonlighting—working extra shifts at your residency program's home base—or it could be external moonlighting, which would be taking on a job at any other hospital.

Should I moonlight during residency?

To answer this question, you first have to ask, can you moonlight during residency?

Some residency programs don’t allow it. Others might only allow internal moonlighting. And some programs restrict moonlighting to residents in “good academic standing.” There’s a whole range of policies, so make sure to check with your program director or coordinator before you go looking for a moonlighting gig. Also, remember that moonlighting technically still counts toward the AMA’s duty-hour policy, which caps residents at an 80-hour workweek (right...).

Okay, enough with the disclaimers…here are the pros and cons as I see them.

Pros

  • Money for living expenses. Extra shifts means extra pay, and at a much higher rate than you’ll ever be paid as a doctor in training. That means you won’t have to worry quite as much about money for rent and daily expenses. You might also be able to afford some extras that can make residency just a bit more pleasant, like a cleaning service and some top-notch scrubs.
  • Investments and future protections. If you’re moonlighting a lot, you’ll likely have enough income to put toward your savings and investment accounts. You can also think about picking up a better life insurance policy or disability insurance policy, both of which can be especially important if you have a family.
  • Extra training. Moonlighting can help you grow as an early-career physician. It means more hours in the hospital, which means more opportunities to see interesting cases and do procedures you might not normally get to do (not to mention the CV boost). It can also be an opportunity to explore a specific area of medicine to see if you might want to pursue a fellowship in that area.

Cons

  • Higher loan payments. Assuming you still have student debt as a resident, it’s worth noting that loan repayments are generally income driven, meaning that they go up as your income rises. So even though you’ll be making good money moonlighting, a lot of it could get eaten up by payments on your student loans. That's not necessarily a bad thing, since you'll end up saving money on interest in the long run, but it's definitely something to be aware of. A financial advisor can help you plan around this consideration.
  • Research falling to the wayside. If you want to go into a teaching position, moonlighting might not be for you. With so little free time as it is, moonlighting could cut into your ability to do quality research during residency. That can really set you back when trying to find an academic position. If you need to make research a priority in residency for any reason, you might want to think about doing just one moonlighting shift per month, max.
  • Lifestyle factors. Learning a new hospital's layout, workflow, and EMR is a stressor not to be taken lightly during residency. Also, for those of us with families—whether it be partners, spouses, kids, needy pets, or all of the above—moonlighting can put a real strain on those relationships. Plus, most moonlighting shifts are nights. So if you cover the night shift on a Saturday, you will basically also lose your Sunday to sleeping and recuperating. To combat this con, look for shifts in the daytime or partial coverage shifts, like from 7 PM to 12 AM, for instance.

How much do residents get paid for moonlighting?

So, the awesome thing about moonlighting during residency is that you'll often take home four figures a shift. That's right...The average moonlighting gig pays between $100 and $200 an hour before taxes—way more than you make hourly as a resident. Remember, though, that taxes might not be taken out of your moonlighting paycheck, so you'll want to save a certain percentage of your pay for when March rolls around.

Hopefully this helped you figure out whether moonlighting as a resident is a good move for you personally. Whatever you decide, I also recommend considering consulting as another option for a physician side gig. It's got many of the pros that moonlighting has to offer without the major lifestyle cons. Good luck!!

Gregory Hanson, MD, MPH

Gregory Hanson, MD, MPH

Greg is a PGY-4 interventional radiology resident at Thomas Jefferson University Hospitals in Philadelphia. He graduated from UCLA with his BS in Atmospheric and Oceanic Sciences before moving across the country to New York City. While in New York, Greg obtained his Master of Public Health degree in epidemiology with an advanced certificate in applied biostatistics. He then went on to do his medical school training at Dartmouth Medical School in Hanover, New Hampshire. In June 2018, he started his post-graduate training with a surgical intern year at Jefferson before continuing there for his integrated interventional radiology residency. During his first year of diagnostic radiology, he began offering his services to various clients by any means possible and was able to make additional side income to help support his family through residency training. This is what sparked the idea for flipMD.

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