Why doctors are moonlighting
As the economy fluctuates, residents and physicians alike are moonlighting—taking secondary jobs—in hopes of secondary opportunities. A Sermo poll shows that 54% of respondents have a side hustle, with 33% engaging in medical surveys. An explosion of salary stagnation compounded by inflation has even some older physicians who haven’t been searching for new employment in years looking for side hustles to fulfill long-term financial goals or newfound desires for additional medical exploration.
According to the same poll on Sermo, many physicians look for remote possibilities or secondary opportunities, but 46% already have a passive income source. Common reasons are making ends meet due to the increased cost of living and decreased wages, and as a way to pay down student loans. Moreover, a third (33%) say their biggest challenge is preparedness for retirement. This sentiment has become increasingly common and reeling in familiarity; it’s no longer merely a rite of passage for residents—it’s becoming the new norm at any level of professional opportunity.
What is moonlighting in medicine?
Moonlighting in medicine is when a physician has another job performing medical or non-medical-related services outside of their regularly scheduled clinical employment. It provides flexibility, additional financial gain, and alternative career opportunities.
Moonlighting can be categorized into two ways:
- Internal moonlighting is when a doctor works additional shifts at their existing hospital or medical institution. This usually covers someone else and accepted extra shifts, which typically means easier onboarding as participation already exists with credentialing and process familiarity.
- External moonlighting is when a doctor works at another location entirely, which means they have to be credentialed elsewhere with acclimation to additional processes. This avenue can allow for broader exposure and sometimes better pay.
In addition, two categories of jobs can be performed:
- Clinical jobs include hospitalists, urgent care physicians, or telemedicine, where patients seek assistance outside normal hours. This allows for hands-on experience and honing of skills, as many physicians may be doing what they love but not seeing enough patients during their full-time employment.
- Non-clinical jobs tend to be teaching engagements like medical writing, expert witnessing, or chart review for lawsuits. These allow physicians to get compensated without addressing patients and often occur during hours less likely to incur malpractice exposure.
It’s important to note this is different from PRN (“pro re nata,” also known as “as-needed”) or locum tenens situations, which are also considered temporary employment but more formalized and not necessarily side jobs requiring ongoing commitment. Moonlighting refers to having a second job alongside your primary job, and, in many cases, the main employer does not know about it. Locum tenens (locums) is filling in for a full-time employee for a specific and defined period. PRN is simply covering shifts when needed, and some are hired specifically for that purpose. As one neurologist in the USA mentions, “Some doctors might even moonlight during vacation from their full-time job.”
Who is eligible to moonlight?
For the most part, residents (with some exceptions), fellows, and attendings can all moonlight. Here are some things to pay attention to:
- Residents and fellows may be bound by ACGME or institutional GME regulations.
- Credentialing and licensing are always required for any moonlighting assignment.
- Employment contracts may have specific language regarding outside employment.
Common moonlighting positions in medicine
The most common, accessible, and productive moonlighting jobs for doctors include:
- Hospitalist coverage
- Urgent care coverage
- Telemedicine
- Chart review
- As an expert witness
- Disability reviews and insurance examinations
According to a Neurologist in the USA, “Sometimes physicians who run private practice also take on other side jobs, such as chart review, expert witness work, disability reviews, or moonlighting. All of these side jobs can diversify the work, without adding a high medical malpractice risk, and each of these side jobs involves varied amounts of administrative time, in addition to the work that is rooted in medical care or expertise.” Similarly, an Orthopedic Surgeon said, “I’m currently in fellowship and have the opportunity to moonlight and take call for general ortho trauma. I enjoy fixing fractures and see myself wanting to continue this in my practice.”
Benefits of moonlighting
Increased revenue
The most prominent reason to moonlight is increased income, as noted with 41% of physicians on Sermo selecting this benefit in a Sermo poll. With medical school tuition on the rise as well as living costs, not to mention potential family responsibilities, many physicians feel moonlighting is the solution to their financial woes, as one GP shared, “The field of health does not generate enough income to meet all the needs, so we are forced to carry out other types of activities that generate income”
Added clinical and professional experience
Along with increased financial revenue, increased exposure from moonlighting can give physicians a broader skill set and expanded opportunities for other responsibilities while working with diverse patient populations. Building reputation was the second most common survey response from physicians, and with good reason. These opportunities give physicians experience that they may not have gained otherwise, which benefits them in providing care.
Independence and satisfaction
Moonlighting takes the organizational pressure off. Many physicians like to work on their terms, their own time, in their own spaces and positions. This can re-establish the joy of work and reduce the likelihood of burnout in the future.
The challenges of moonlighting in medicine
Burnout and schedule overload
Adding moonlighting to a primary job can be exhausting. Symptoms include fatigue, poor work performance, and compassion fatigue. Safeguards must be put into place so that one’s commitment to care does not suffer.
Legal and contractual implications
Physician moonlighters must be aware of non-compete clauses, employer-stipulated policies, and hospital bylaws or rules. Physicians should determine if malpractice insurance covers moonlighting, as liability coverage may be denied.
Tax and financial implications
Physicians who moonlight typically are compensated via 1099 independent contractor payments, which complicates tax reporting. Moonlighters may need to report this income, make estimated quarterly payments, and make non-competing retirement contributions.
How to guarantee that moonlighting won’t interfere with your day job
Your day job is a priority
Your full-time job comes first. Make sure that moonlighting does not interfere with your responsibilities or care for patients.
Set boundaries
Have a schedule, have breaks, and have personal time. Downtime is essential for longevity in the field.
Schedule appropriately
Use planners and calendars so that you never overlap and can have moonlighting hours that make sense around your full-time job responsibilities.
Recognize wear and tear
If you feel tired or mentally drained, it’s time to cut back. Your health impacts how you care for others.
Be honest
Let your employer know you’re working elsewhere so that you don’t receive write-ups or face employment issues.
Work efficiently
Choose moonlighting opportunities where you are already competent or in your specialty so you can work more easily without major learning curves.
Be financially savvy
Keep careful records of income, pay taxes on income earned, plan for deductions in advance, and consider hiring a financial accountant to navigate complicated pay structure versus increased hours.
Be mindful of burnout
As one OBGYN from the USA says, “I have and still do a ton of ‘side gigs”. TBH, at first, I just turned my overworking tendencies as a doctor into my overworking tendencies for my side gig. And I burned out again. But now they help me express myself more fully and enjoy medicine more. All in all, I highly recommend it. Know your reasons for why. No side gig is going to help an unsustainable and toxic work environment.”
Re-evaluate down the line
Determine if moonlighting is still what’s best for you down the line, or if it’s equivalent to what it means to be a physician. Physicians must consider whether moonlighting now contributes to the achievement of future goals. If moonlighting merely adds to an already ongoing cash flow burden, the changes are not worth it.
Where to find moonlighting and side gig positions
Finding moonlighting opportunities does not come from a casual Google search. As a physician, before seeking these personal interests, one should assess intention, hours, and credential needs, and whether one wants to work under someone else’s umbrella or independently. The broad categories of moonlighting and side gigs come from:
- Hospital/in-house positions vs independent: being a moonlighter in-house or at a hospital may be more structured, but independence can bring better pay and flexibility.
- Job boards: visit sites like Indeed and PracticeLink.
- Referrals by physicians: peer-to-peer recommendations/work forums can give insight into reputable companies looking for help.
Sermo can also be an effective avenue for this search. Within the Sermo community, physicians can:
- Gather the advice of peers with real moonlighting experience
- Find discussions for leads on jobs vetted by other physicians
- Find polls and information to determine less-than-reputable listings
- Take advantage of paid opportunities like surveys
For those less likely to seek clinical opportunities, medical editing and medical review may be an option. One Neurologist from the USA detailed, “Medical editing and medical review are projects that physicians can take on either as full-time salaried positions or as part-time nonclinical side gigs. For physicians who enjoy writing and feel competent with this skill, medical editing or medical review can offer an opportunity to supplement income for overseeing medical accuracy and medical communication for a specific audience.” These jobs require little to no clinical management/responsibility while expanding on previously held knowledge on a flexible basis.
Others have turned to medical consulting. “Consider contacting medical review companies that provide services for attorneys to evaluate medical records for determining whether malpractice did or did not occur. All physicians should participate, and not only those physicians willing to say things that will assure them more money with depositions and court appearances,” suggested an OBGYN from the USA. This is a great opportunity for all physicians to participate, as it’s great side money and can help the legal system get to the bottom of things.
Telemedicine is another leading option. “I would view telemedicine as a way to make some extra income, but probably not enough to justify changing your work status if you need to work full-time,” suggests another physician. For someone working long hours, this is a great, simple way to earn a little extra cash.
Moonlighting while training: resident-specific considerations
Residents who want to moonlight should:
- Understand ACGME restrictions. For some states, moonlighting is not permitted, moonlighting hours are restricted, or waivers are required through one’s institution to moonlight.
- Be in it for the learning. The goal of moonlighting is to provide additional benefits to learning, not distractions. Intern years are already challenging enough with added overnight shifts on top of a daily residency schedule.
Join the conversation on Sermo
Semo makes discovering options for moonlighting and other alternative incomes effortless. Whether you’re seeking a clinical side hustle or something nonclinical that offers flexible hours, you can find real-world physician advice on Sermo. Join Sermo now to connect with over 1 million verified doctors, share your experiences, and even earn via paid medical surveys.
