Rationale and Objectives
Recent survey data have suggested that the paid extracurricular activities of radiology trainees (known as “moonlighting”) are more diverse than has been previously recognized. The purpose of this study is to examine these activities in further detail and to assess for differences between clinical duties performed at institutions affiliated with residents’ training programs (“internal moonlighting”) versus those performed at unaffiliated institutions (“external moonlighting”).
Materials and Methods
Electronic survey data were collected from trainee members of the Association of University Radiologists regarding their extracurricular clinical work, with an emphasis on their responsibilities when working in institutions that are affiliated with their training program versus work done in unaffiliated institutions. Descriptive and analytic statistics were used to examine these data.
Results
Survey respondents represented 61 unique institutions (of 173 Association of University Radiologists member-programs, a 35% institutional response rate). Trainees engage in moonlighting activities at nearly three-fourths of these programs. Although the incidence of duty hour violations appears to be low (“probably” or “definitely” occurring at three of 44, or 7%, of represented programs with moonlighting trainees), these violations go largely undocumented. Residents participating in external moonlighting were significantly more likely to provide final interpretations of diagnostic imaging studies when compared with residents moonlighting internally (odds ratio 13.84, P < .05). Of the 27 programs with residents that moonlight externally, five respondents (19%) indicated that their external moonlighting duties include the unsupervised performance of invasive procedures. There were no reports of unsupervised procedures performed by trainees moonlighting internally.
Conclusions
Many resident physicians view moonlighting as a highly desirable, or even financially necessary, component of their clinical training. Although external moonlighting may be a useful means of garnering additional experience and income, certain ethical and medicolegal implications must be considered. The moonlighting trainee should seek opportunities for extracurricular work that do not compromise patient safety or the trainee’s own long-term professional interests. Department administrators might facilitate this process by providing opportunities for internal moonlighting, while simultaneously developing competency-based systems for assessing trainee readiness for progressive clinical independence.
As many as one in three radiology trainees participate in moonlighting, which is the performance of extracurricular clinical work for additional pay . In radiology, this clinical work typically consists of supervising intravenous contrast injections, or rendering preliminary interpretations of diagnostic images, beyond standard workday hours. However, recent survey data suggest that the clinical activities of moonlighting radiology trainees may be more diverse than has been traditionally recognized. Because meaningful differences may exist between moonlighting performed internally (within a hospital or clinic affiliated with one’s training program) versus externally (within an institution that is not affiliated with one’s training program), we surveyed trainee members of the Association of University Radiologists (AUR) to establish the prevalence of internal and external moonlighting activities, determine the scope of services performed, and clarify the degree of supervision provided in each setting.
Materials and methods
This investigation was exempted from full review by the institutional review board of the University of Washington. In October 2012, a cross-sectional anonymous electronic survey was distributed to all resident members of the AUR with registered e-mail addresses via a list server; those trainees that were contacted represented 173 unique American training programs, and an additional 14 American training programs were not represented on the AUR trainee member rolls and, thus, were not contacted. The survey instrument is reproduced in the Appendix . Responses were gathered for a total of 6 weeks, with a reminder e-mail distributed after 4 weeks. Respondents were guaranteed individual confidentiality; however, institution name was requested to identify responses from the same institution. When multiple responses from a single institution were received, the answers were composited to maximize completeness without introducing redundancy. Mode responses were selected where one existed, and for questions that included “don’t know” as a possible answer, a definitive response was given precedence over an uncertain response from a same-institution colleague. If there was no mode, preference was given to the reply of the respondent with the most complete survey form.
Results
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Monitoring of Intravenous Contrast Injections
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Table 1
Monitoring of Intravenous Contrast Agent Administrations by Moonlighting Radiology Trainees
Monitoring of Intravenous Contrast Administrations_n_ (%) None 17 (38.6) Internal only 17 (38.6) External only 4 (9) Internal and external 6 (13.6) Total 44 (100)
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Interpretation of Diagnostic Images
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Table 2
Programs with Trainees that Provide Final Radiologic Interpretations While Moonlighting
Program ∗ Type Region Affiliation Interpretation Training Level A Community Midwest External Private Final PGY-5 B University Midwest External Private Final, formal preliminary PGY-4, PGY-5 C University Southeast External Private Final PGY-5, Fellow D University Northeast External Private Final PGY-5 E University Southeast External Private Final PGY-4, PGY-5, Fellow F University Midsouth External Private Final PGY-5 G i University West Internal University, VA Final PGY-5, Fellow G e University West External Private Final PGY-5, Fellow H University Midwest External Private Final PGY-5 I University Midwest External Private Final PGY-5 J University Southwest External Private Final PGY-4, PGY-5
Community, community-based, university-affiliated training program; external, performed at an institution with no affiliation to the residency program; internal, performed at an institution that is affiliated with the residency program; PGY, postgraduate year; private, private hospital or clinic; university, university-based training program; VA, hospital or clinic administered by the Department of Veterans Affairs.
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Performance of Image-Guided Procedures
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Table 3
Performance of Invasive Image-Guided Procedures by Moonlighting Radiology Trainees
Invasive Procedure Services_n_ (%) None 37 (84) Internal, unsupervised 0 Internal, supervised 2 (5) External, unsupervised 5 (11) External, supervised 0 Total 44 (100)
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Discussion
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Conclusions
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Appendix
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