Get Started Moonlighting

How to start moonlighting and bring in extra income as a physician

I have been spending ample time moonlighting recently.  As a pulmonary and critical care fellow physician and a board-certified internist, there have been ample opportunities.  These have provided me with time to reflect on the pros and cons of moonlighting. 

I will begin by sharing the information I have accumulated regarding moonlighting: getting started, maintaining, maximizing work-life balance, and determining which opportunities are right for you. 

Getting started

There are many ways to get started moonlighting.  For me, I was never given the opportunity to moonlight in residency.  I felt this was a massive disservice to my wallet, but more importantly to my education. 

A close friend and mentor of mine instilled in me that the best thing you can do as a young physician is moonlight.  His reasonings were never financially driven (at least not primarily).  He reflected that academic training allows physicians to have a safety blanket in their formative years.  This safety blanket is obviously helpful during training, but as you become a competent physician in your specialty, eventually the training wheels must come off.  Residencies and fellowships across the country boast varying degrees of “autonomy” however only by forcing yourself to practice individually can one build the confidence it takes to trust yourself and your acquired practice, whatever that may be. 

For me, my first exposure to moonlighting was through my institution’s affiliated Veterans Affairs Hospital as a nocturnist.  As a pulmonary and critical care fellow, should patients decompensate, I felt I had ample confidence in my abilities to escalate patient care, stabilize, and manage rapid responses and cardiac arrests. 

Further, this opportunity allowed me to utilize my recently acquired board certification in medicine that seems so fleeting when you immediately graduate to a fellowship.  I really felt like “if I didn’t use it, I would lose it!” 

With that said, here are some quick recommendations on getting started moonlighting:

• Ask your colleagues where they moonlight, how difficult it is to on-board (if it is a different hospital or different role than they regularly perform)
• Email/approach physician recruiters on part time opportunities.  Really make sure to ask that there is no specific regular time commitment, it should be an opportunity you self-select into
• Maintain all appropriate certifications (i.e. BLS, ACLS, PALS, DEA licensure, State licensure, etc.)  This can drastically expedite the on-boarding process when applying for moonlighting
• Keep a secure folder on your computer that houses all the identification information, training documentation, board scores, etc. needed for onboarding.  You may have to onboard at more than one location and having all these documents in one place is a lifesaver.
• Ask questions:
  • Make sure you ask about hours of employment.
  • Is there a specific minimum of shifts needed to stay in the pool of utilized physicians for the opportunity? 
  • Make sure you understand how they reimburse (1099 or W2?)
  • How does one get out of a previously accepted shift if needed? 
  • What is the average shift like (i.e. number of admissions, patient census, etc.) 
  • What is the average reimbursement per hour/shift? 
  • Is there increased pay offered for difficult to cover shifts or holidays?  All of these are questions you should feel you have a good understanding of prior to signing a contract.

Maintenance of moonlighting

Moonlighting really can be a great opportunity for the right individual.  Should you find a position that suits you best, or are currently utilizing said opportunity, then here are some considerations to maintain that supplemental income. 

First and foremost, do you enjoy yourself when you are working?  Look, I am not naïve enough to think that most moonlighting opportunities are the “dream job” but it should still support you both financially and emotionally. 

For me, we are already busy enough as physicians, especially if you were overutilized as a result of the COVID pandemic, therefore any extra work has to feel worth my time financially and simultaneously allow me to avoid undue stress/burn out while working. 

The two current moonlighting opportunities I work (Veterans health system and COVID ICU coverage) both have a lower patient census.  This allows me a slower pace then my normal routine, allows me to provide teaching and feedback to residents or mid-level providers when appropriate, and still feel appropriately reimbursed. 

Now that you are currently working in a moonlighting shift, do not shy away from continually reassessing the position. 

• Is it meeting your financial needs/expectations? 
• Is it adding more stress to your already busy physician life? 
• Are you surrounded by colleagues or coworkers you enjoy and who support you? 
• Is the work environment malignant? 

Not all of the previous wants may be appropriately met, but a majority of them should be!  Your time is incredibly valuable, treat it as such.

Work-life balance

Lastly, and probably most importantly, should be the eternal discussion of how initiation of moonlighting, or maintenance thereof, affects your happiness. 

There is ample literature and blog postings on this continuous hemostasis we call “work-life balance.”  This is clearly a moving target, and I believe one’s perception of an appropriate balance will change in regular intervals based on life experiences. 

When I initially approached fellowship, I was “full-steam-ahead” pursuing the highest reimbursement possible following completion of my residency training.  I investigated moonlighting opportunities near and far, regularly.  I was mostly trying to gauge the average worth of my skillset, aside from the annual MedScape Physician Compensation Report. 

I thought there was nothing that would alter this vision I had of myself and my potential net worth.  Then COVID-19 happened, I was overworked and underpaid.  I was given COVID ICU moonlighting opportunities but more-so out of need than want.  My work-life hemostasis was falling out of balance. 

Then my wife and I found out we pregnant. 

Arguably the single greatest news of my life, shortly followed by that all-encompassing financial anxiety that so often occurs.  I was left with the uncertainty of how to balance my current fellowship obligations, while still creating supplemental income to meet my financial goals (maxing out retirement, paying down student debt, etc.).  As such, I was left reviewing my expectations to myself, to my wife, to my career, and to my financial aspirations.  I was now able to reapproach my moonlighting opportunities with a new perspective. 

Now I would try and maximize picking and choosing shifts where I felt reimbursement was appropriate, where I did not feel overly taxed no matter how busy the shift became, and that did not occur in such regularity where I felt burnout.

Moonlighting: Take home points

Moonlighting, like so many decisions for physicians, has profound risks and benefits. 

For me finding a balance that allowed me to feel I was bringing in more income without overexerting myself mentally or physically was a journey. 

When deciding if starting this opportunity or adding more/less to your plate is right for you, consider what I have written above, discuss with your significant other where appropriate, and always prioritize your well-being. 

Stay motivated!

The Motivated M.D.

I hope you enjoyed the information on my experience moonlighting. If you have thoughts on starting moonlighting opportunities, or have had a similar experience, let me know in the comments section down below! I would love to hear from you.

Standard Disclaimer: None of the information on this website is meant as individualized financial or medical advice.  These posts may contain affiliate links.