Basking in the Moonlight
While making a little extra cash through
moonlighting is a great
way to fund holiday expenses, be sure to check your contract
and insurance provisions first.
way to fund holiday expenses, be sure to check your contract
and insurance provisions first.
With the holidays just around the corner,
everyone—physicians included—is in need of a few
extra dollars to purchase those special gifts for loved ones
and friends. Increasingly, physicians of all specialties and
years of experience are considering “moonlighting”
as a way to support their income. However, there are important
legal issues and opportunities that a physician must consider
before accepting a supplemental position.
Resident moonlighting
In the most traditional sense,
moonlighting is the unsupervised practice of medicine by
residents before the completion of residency. Resident
moonlighting remains a divisive issue. On July 1, 2003, the
Accreditation Council for Graduate Medical Education (ACGME) common duty hour
standards went into effect
for all accredited residency programs. These ACGME rules
include the well-known requirement that a resident have a work
week no longer than 80 hours, averaged over a four-week period.
The ACGME policy has a
specific section devoted to moonlighting. The section on
moonlighting notes that, “Because residency education is
a full-time endeavor, the program director must ensure that
moonlighting does not interfere with the ability of the
resident to achieve the goals and objectives of the educational
program.” Importantly, the moonlighting policy only
addresses “internal” moonlighting. The ACGME policy
states, “Any hours a resident works for compensation at
the sponsoring institution or any of the sponsor’s
primary clinical sites must be considered part of the 80-hour
weekly limit on duty hours.” The ACGME policy ensures
that the same standards apply to all residents in teaching
institutions and is designed to protect residents from
potential abuse by teaching institutions. The ACGME rules do
not directly address external moonlighting for a third party,
as the organization does not have purview over residents’
activities outside of their educational program.
Types of jobs
Many physicians are entrepreneurial.
Because medicine is a big business, an entrepreneurial
physician may be able to take advantage of her knowledge and
training in non-clinical settings. This may include developing
medical billing software, creating and refining medical
devices, establishing ancillary ventures, regularly speaking to
other physicians on behalf of a company, or providing expert
testimony in a litigation context. The non-clinical
opportunities for moonlighting are plentiful if they interest
you. In addition to the intellectual stimulation you can
receive from these “part-time” ventures, these
activities might be financially lucrative.
There also is a
wide-range of opportunities for clinical moonlighting. In-house
moonlighting physicians are needed in many hospital settings to
manage general medical floors, intensive and progressive care
units, rehabilitation floors, or emergency rooms, and to assist
in the operating room. Medical admissions and as-needed or
“prn” care are typical job functions of the
in-house moonlighting physician. Outpatient moonlighting
positions include staffing private primary and specialty care
offices, academic medical clinics, and state- or county-run
health facilities. Other clinical opportunities for
moonlighting include serving as team physicians for high school
or college sports teams.
How to find jobs
Although advertisements for full or
part-time medical positions flood physicians’ e-mail
accounts, office bins, and home mailboxes, moonlighting
opportunities can be a bit more difficult to ferret out.
Specialty journals, state society newsletters, and national
professional magazines are a good starting point. Physician
recruiters are another resource for finding a job moonlighting.
Those same publications, the Internet, and even telephone
directories will assist you in finding physician recruiters in
your region. Typing in phrases like “physician
moonlighting” or “moonlighting hospitalists”
will land hits on Web pages for companies and hospitals that
offer moonlighting positions.
Word of mouth,
however, may be your best source for finding a spot
moonlighting. Contact your local primary and specialty care
offices, hospitals, clinics, and other physicians for
opportunities in your field. Ask nurses, pharmacists,
pharmaceutical representatives, friends, or family members for
potential leads. Follow the moonlighting footsteps of
graduating residents leaving your program to pursue
post-graduate employment or fellowships. If you are interested
in supplementing your income with another clinical job, be
aggressive, persistent, and think creatively about how your
skills can benefit an employer on an intermittent basis.
Legal issues
If you are still in a training program,
any internal moonlighting you provide must be approved by your
program director. If you would like to engage in external
moonlighting, make sure your opportunity is consistent with the
requirements of your sponsoring institution. Different programs
have different policies. In addition to reviewing all of the
institution’s relevant policies, your program director
should be a good resource to confirm that your moonlighting
work is in compliance with the program.
If you are already in
practice—in an institutional setting, private practice,
and/or some combination of the two—review your current
employment contract(s). The contract should address whether or
not, and on what conditions, you can moonlight. Be sure to
review your employer’s policies and procedures as well
because they might include specific provisions and restrictions
for moonlighting.
For instance, your
employment contract might state, “While employed by
Employer, any remuneration generated by Employee shall be
solely that of Employer.” Your initial reaction might be
not to give this sentence a second thought. Compensation for
any clinical services you provide in the employer’s
office should be retained by the employer, and in turn, you
will be provided your salary and potentially a bonus. However,
if you re-read the contract language, you’ll see that it
is not limited to work you do for your employer; it states
“while you are employed by employer.” Anything you
do on your own time for which you earn money is not necessarily
excluded. The term “remuneration” can also be
broadly defined and may not be limited to cash. In addition,
the provision is not limited to clinical activities. The
honorarium that a pharmaceutical company offers you for an
evening lecture could become the property of your employer.
Hence, your compensation from moonlighting may not be yours if
you have such a phrase in your contract.
Other employers might
include very specific language about what constitutes
moonlighting—clinical and non-clinical—and the
approval process necessary prior to the employee engaging in
any moonlighting. Employers often develop these policies if
they believe they were taken advantage of or not adequately
informed of an employee’s moonlighting activities.
If you are going to
provide clinical services as part of your external
moonlighting, be sure that you or your moonlighting employer
have secured appropriate professional liability coverage. The
insurance provided by your primary employer will likely not
protect you from any liability for your professional activities
while you are not working directly for that employer. If the
moonlighting employer provides claims-based professional
liability coverage, be sure you make arrangements for your
“tail” coverage once you are no longer moonlighting
for that employer.
It is also important,
and prudent, that you execute a written contract with your
moonlighting employer for both clinical and non-clinical
activities. While the contract may not be as long and detailed
as your primary employment contract, it should delineate your
and the employer’s rights and responsibilities and the
amount and frequency of your compensation. You should ensure
that the arrangement provides you with the necessary
flexibility in the event that your primary employment
responsibilities change.
Short and long-term benefits
Cash in hand is the main short-term
benefit of moonlighting. Most, if not all, moonlighting
employers will hire you as an independent contractor and will
pay a lump sum gross payment for your services. Taxes will not
be taken out of your paychecks. Make sure you consult with your
accountant about the tax benefits and responsibilities
associated with independent contractor relationships.
The long-term benefits
of moonlighting include medical and/or business experience that
may add to your educational portfolio, line items to fill your
curriculum vitae, and most importantly, a possible segway into
a future employment or entrepreneurial opportunity.
For many physicians,
clinical and non-clinical moonlighting is a lucrative means to
supplement their incomes. Your professional experience will
become more diversified and your network of professional
contacts can expand exponentially. If you have taken the
necessary legal protections before accepting an off-hours
position, you can then share the extra cash with your family
and friends during the holidays...or all year long! g
Bruce D. Armon is a partner who practices corporate
health-care law for Saul Ewing LLP. He is a frequent speaker to
physician audiences. Bruce can be reached at barmon@saul.com. Joshua S. Coren, DO, MBA is a clinical assistant professor at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine. He can be reached at corenjo@umdnj.edu
