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Is moonlighting right for you?
Extra shifts can help you fight boredom and sharpen skills, but beware of burnout
by Tammy Worth



Published in the April 2008 issue of Today's Hospitalist

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As medical director for the hospitalist program at Gundersen Lutheran Medical Center in LaCrosse, Wisc., Mary Frances Barthel, MD, supervises nine physicians and eight physician assistants. While her day job certainly keeps her busy, Dr. Barthel still finds time to moonlight in the hospital’s urgent care clinic.

The pay is good—up to $127 per hour—but Dr. Barthel says that money isn’t the primary reason she moonlights.
“The ER gives me exposure to emergency medicine and surgery. There are more surprises in the ER.”

–K.J. Rehman, MD
Charleston Area Medical Center

She instead wants to keep her clinical skills sharp.

“When you work in a hospital,” she explains, “your clinical skills tend to atrophy a bit. 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.”

Dr. Barthel’s reasons for moonlighting may not be universal. Other hospitalists, particularly those with new homes and growing families, say they moonlight for additional income.

Others who work full-time in seven-on/seven-off jobs say they fight off boredom during their weeks off by taking on an extra shift or two. But while hospitalists may moonlight for a variety of reasons, they share one thing in common: They are helping the programs where they work extra hours solve major scheduling challenges.

A seemingly endless demand
K.J. Rehman, MD, is a good example of how moonlighting hospitalists are in big demand. While the Charleston,W. Va., hospitalist typically moonlights in local emergency rooms, he finds there’s a seemingly endless demand for his services.

“Every time I come home,” Dr. Rehman says, “there are two messages on my phone and another on my e-mail” looking for someone to moonlight.

In the three-plus years he has worked as a hospitalist at Charleston Area Medical Center, Dr. Rehman has worked two or three extra shifts during his off weeks. He estimates that at least 50% of the hospitalists in his group moonlight somewhat regularly.

The money is nice, he points out, but moonlighting also helps reduce boredom. It also exposes him to other areas of practice. “When I have a whole week off, unless I am doing something important, I just get bored sitting at home,” Dr. Rehman explains. “Besides, the ER gives me exposure to emergency medicine and surgery. There are more surprises in the ER.”

Dr. Rehman says he typically nets $100 to $150 per hour for his ER work. He notes that while his contract allows him to moonlight only outside of city limits, that embargo has worked to his advantage.

He points out that he easily finds work outside of the city of Charleston. And because hospitals “on the periphery” have a more difficult time finding physicians, the hourly rate is more generous.

Income is the primary motivator for Vihn Cam, MD, a hospitalist with HealthCare Partners Medical Group, a Southern California multispecialty group, who works at Torrance Memorial Medical Center. Because he is planning to buy a new home, the extra income comes in handy.

For Dr. Cam, however, moonlighting means picking up extra hours at the hospital where he works his regular job. Because the program at Torrance Memorial is short-staffed, moonlighting is encouraged—but not required.

“Night shifts are all voluntary and will remain so as long as people volunteer for them,” says Dr. Cam. “We all help out so we all can have good lifestyles.”

Paying for the right fit
If physicians like the experience and income that comes with moonlighting, hospitalist programs have come to rely on moonlighters to quickly add manpower without having to hire someone full time.

“Moonlighters are invaluable because you can never get a perfect fit of need and personnel,” says Tyler Jung, MD, medical director of HealthCare Partners’ hospitalist program. “If you need 8.6 physicians, there is no such thing as a .6 person.”

Of the more than 60 hospitalists who work for HealthCare Partners, Dr. Jung estimates that one-third work extra shifts. He says the willingness of hospitalists to moonlight allows the program to fill hard-to-staff evening and weekend shifts.

While nearly 80% of the shifts that moonlighters work are weekends and evenings, Dr. Jung says he makes sure to give them more desirable shifts as well.

“To attract moonlighters,” he explains, “we have to give them some weekday shifts, and some of the more favorable nights are mid-week.”

Dr. Jung also notes that he pays a premium for evening and weekend shifts. Most of his day shifts pay around $80 per hour, or $800 per day. Night shifts range from $800 to $1,500, depending upon whether the physician works on-site or takes call from home.

Burnout
While hospitalists may like the extra money from moonlighting, experienced moonlighters warn that the relief of paying off medical debt can’t ward off burnout if too much is taken on.

Some of Dr. Barthel’s partners at Gundersen Lutheran who are building new homes, for example, take up to 10 extra shifts a month at the hospital or at an affiliated facility to supplement their income.

But according to Dr. Barthel, she prefers a more laidback approach to moonlighting. Though she moonlights less now than she used to, even in her heyday she worked no more than four extra shifts a month, many of which were only four to five hours long.

Dr. Barthel also recommends not committing to more than one or two shifts, at least initially, until you’re sure the work will be a good fit. She also suggests that hospitalists look for variety and not take on a position that echoes their regular job.

“A hospital can be so hectic and fast-paced that it can get very exhausting,” she notes. “Try a couple of different things. I didn’t think I would like urgent care, but I did because it is a different perspective.”

Today, Dr. Cam from HealthCare Partners works at least one moonlighting shift every two weeks. When he first started moonlighting, he recalls, he took on as many shifts as he could—and quickly fell into the trap of viewing his moonlighting income as part of his base pay.

But Dr. Cam says he soon realized he was taking on too much and scaled back. “I found myself erratic in terms of rest,” he explains. “Hospitalist work is intensive and when I do more, it gets to be kind of tight.”

Tammy Worth is a freelance health care writer based in Kansas City, Mo.


Going off the beaten path


Thinking of moonlighting? Here are a few factors to consider:

  • Contracts. Make sure you understand contract limitations before taking on extra shifts. For instance, James Wetzel, MD, director of employed physicians at Olathe Medical Center near Kansas City, Kan., said his hospital’s contracts prohibit full-time physicians from moonlighting. Exceptions can be made only by the board of trustees.

    “Our thought is,” says Dr. Wetzel, “that our full-time physicians are insured by our institution—and they should be busy enough that they do not need to moonlight outside our system.”

  • Insurance and credentials. Most physicians say that the program that they are moonlighting for covers insurance and credentialing. Make sure that’s the case before you accept a position.

  • Scheduling. While most hospitals and emergency rooms often need last-minute coverage, moonlighting physicians say they typically try to schedule their time well in advance, sometimes up to a year if their schedule permits.

  • Familiarity. Most moonlighting hospitalists who take shifts outside of their own group say that keeping up-to-date with what is going on at other hospitals is not a problem.

    “It’s just like starting any new job. It takes a few shifts to get used to the way things are done,” says K.J. Rehman, MD, a hospitalist at Charleston Area Medical Center in Charleston, W.Va. “Small hospitals have less technology, but they’re more personal. Every place is different.”
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