Moonlighting FAQ

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