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Moonlighting: costs and efficiency

March 2015

Published in the March 2015 issue of Today’s Hospitalist

IN HOSPITAL MEDICINE, moonlighting is a fact of life. There are too many hospitals begging for help, and for many physicians, the extra money is just too good to pass up.

But as our cover story points out, moonlighting raises some interesting issues. Many of the physicians we talked to believe that doctors should be able to work extra shifts, even at outside hospitals. But many hospitalists argued that the issues raised by moonlighting can’t be brushed off with “What I do on my own time is no one else’s business.”

If enough of a group’s doctors are so busy moonlighting that the group has to bring in a locum physician to cover shifts, that program and hospital will pay a premium. Those extra costs are bad for everybody.

Then there’s another issue, which we examine in our coverage of the theory of constraints. According to this business-school staple, doctors are the key to maximizing the efficiency of the entire hospital. When hospitalists can’t work efficiently, the rest of the hospital slows down.

That got me wondering how much moonlighters, who may not know a hospital system or its patients well, can quickly become a drag on a group’s efficiency.

Obviously, many hospitalists moonlight regular shifts and operate just as efficiently as staff physicians. But if hospitalists just fill in shifts here and there as needed, it’s hard to see how they could operate at peak efficiency.

That may not be the chief concern of hospitals desperate to fill shifts with any moonlighter they can find, but it may be something for hospitalists to think about when considering moonlighting outside their group. As our cover story points out, one obvious solution is for hospitalists to moonlight in their own facility where they know the system “and at least some of the patients “as well as anyone.

edoyleEdward Doyle
Editor & Publisher
edoyle@todayshospitalist.com