Moonlighting FAQ

EMRA Policy on Moonlighting

Section X: Education and Professional Development - Moonlighting

Paperwork

There is a lot of paperwork associated with moonlighting, especially if you apply to multiple places or go through a recruiter. Below is a list of the documentation you might need to submit to apply / get credentialed at an institution. It is suggested that you scan and save these documents. 

  • BLS, ACLS, ATLS, PALS 
  • DEA, State controlled substance license 
  • State Medical License 
  • Med School Diploma (shrunken to 8.5 x 11) 
  • Undergraduate School Diploma 
  • NPI letter 
  • Drivers License and Social Security Card 
  • Letter of approval from Residency Director 
  • Health immunizations and titers 
  • 3 Letters of Reference 

What to ask

  • What kind of coverage (single, double, MLP) 
  • What specialties take call at the hospital? 
  • What kind of follow up is available? 
  • Do you have responsibilities outside of the ED? 
  • Are you responsible for running codes on the floor and ICU? 
  • Are you responsible for Labor and Delivery? 
  • How is documentation done (T-sheet, EMR, Dictation)? 
  • What are the main hospitals patients are transferred to? (STEMI, ICH, psych, trauma, obstetrics) 
  • How are no shows handled? 
  • What kind of lab tests are send outs? (Lipase, lactic acid, etc.) 
  • What kind of imaging is available at night? Ultrasound? CT tech in house? Nighthawk? 
  • How many floor/ICU beds are available? 
  • Is there a surgeon on call at night? 

What to take with you? 

  • Stethoscope 
  • Bougie 
  • LMA 
  • Food 
  • References (digital, hard copies) 
  • Anything else you know you can’t do a shift without (pillow, toiletries) 
  • List of Emergency Numbers (ED administrator on-call, “emergency” attending cell numbers in case you get in trouble) 

What to do on your first shift 

  • Find out where your crash cart is 
  • Check your airway kit 
  • Meet the nurses and try to size up their abilities. 
  • Let the staff know what they can pre-order for you. 
  • Find out what’s for lunch/dinner/breakfast 

The Contract 

  • Claims-made: You’ll need tail coverage. Who pays for it? 
  • Occurrence-made: Good, no tail involved 
  • Noncompete clauses are a no-no 
  • Is there a minimum number of shifts you need to work per month? 

Financial issues of moonlighting 

  • Your taxes just got more complicated 
  • Independent contractor 
  • Set aside about 1/3 of your paycheck each month 
  • Deductions: 
    • Mileage  
    • Food while moonlighting  
    • ACS, DEA licenses 
    • Medical equipment  
    • Conferences (portion not paid for by your residency) 
    • Home office?  
  • Check with your accountant 
  • Estimated taxes 
    • Unnecessary 1st year as an independent contractor  
    • But in your second year, quarterly payments 
    • 4/15,  6/15,  9/15,  1/15 
    • Penalties for paying too little 
    • Federal estimates can be based on your previous year’s income which will likely be lower 
    • State estimates need to be paid as well 
    •  
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