As another wave of medical students crashes upon the shore of radiology residency programs during interview season, I am always amazed at the enthusiasm and inquisitiveness that each new group of applicants brings. Although these applicants ask a variety of questions during their interviews, a common theme inevitably emerges regarding the moonlighting opportunities available at our program. What should be a secondary consideration for applicants in their ranking of programs has evolved into a legitimate feature of the program that applicants take into consideration before creating their rank list, almost on par with the educational opportunities provided by a program. Given that current literature has well documented the common practice of resident moonlighting and the financial incentives associated with it, this interest should not be surprising . However, as academic radiologists, program directors, and department chairs, are we living up to our obligation of providing an exemplary residency education by acknowledging and condoning the breadth of resident moonlighting that occurs? This is a difficult and somewhat controversial question given the spectrum of moonlighting opportunities available to residents, some of which are explored in the article, “Internal versus External Moonlighting: Differences in Roles and Responsibilities” .
Radiology resident moonlighting: A common second job
This thought-provoking article brings several key facets of resident moonlighting to life, some of which academic radiologists may not entirely appreciate. Most notably, the article reinforces prior literature in documenting that resident moonlighting is commonplace in that 72% of residents actively participate in internal and/or external moonlighting . Additional research indicates that as many as 87% of department chairs have allowed internal or external moonlighting to occur at their programs . These figures support the conclusion that resident moonlighting is not only widely practiced but also accepted by the vast majority of residency programs. Also in this present article, McNeeley et al. emphasizes a prior study he conducted that found the majority of residents who moonlight (79%) do so 1–10 h/wk, and 19.4% of residents moonlight 11–20 h/wk. Thus, we must acknowledge that resident moonlighting is not only widespread but also consuming a significant portion of residents’ time, in some cases on par with a second job.
Impact of moonlighting on the radiology resident
There are limited data in the literature documenting the impact that moonlighting has on a radiology resident’s education or well being. However, one can surmise that moonlighting may be associated with increased physical and emotional stress, especially for the nearly 1 in 5 residents who spend up to 20 h/wk away from their families to moonlight.
In addition, sacrificing time that could be spent studying radiology to moonlight may hinder a resident’s education. With the recent change to the structure of the radiology-certifying examinations, residents across the country are requesting more dedicated study time during their third year to prepare for the Diagnostic Radiology Core Examination. Residents cite recently released data from the American Board of Radiology, which indicate a 13% failure rate on the examination, to bolster their claim of the need for more dedicated study time. In light of these data, would residents be better off moonlighting, or engaging in independent study, daily lectures, and supervised clinical rotations? Can they do it all?
The present article by McNeeley does an excellent job highlighting the different aspects of both internal and external moonlighting as well as suggesting benefits to expanding internal moonlighting opportunities. Specifically, expanding internal moonlighting might decrease the amount of external moonlighting, which is often unsupervised. However, although admittedly controversial, perhaps we should also consider curtailing both internal and external moonlighting opportunities. This may be an unpopular idea among residents but offers potential benefits. If the majority of residents spend 52–1040 h/y moonlighting, imagine the knowledge that could be gained devoting even a small percentage of that time to studying. Additional benefits of spending time with family and away from clinical duties would also offer a much-needed reprieve from the “daily grind.”
Numerous surveys have documented the onerous level of debt residents carry as a motivation to participate in moonlighting . Eliminating moonlighting would cut off this stream of extra money that could be used to pay off that debt or to live more comfortably. Certainly, most radiologists sympathize with the ever-increasing costs of education and the burdensome level of debt these costs place on residents. Yet, should training programs be responsible for assisting residents in repaying that debt by allowing moonlighting, especially when it may be to the detriment of the resident’s training? The primary objective of a residency program is to provide a comprehensive educational experience. Is that objective being met when moonlighting is permitted? The Accreditation Council for Graduate Medical Education (ACGME) requires that, “Moonlighting must not interfere with the ability of residents to achieve the goals and objectives of the educational programs” .
Impact of moonlighting on the residency program
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The case for rethinking our approach to resident moonlighting
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References
1. Baker S.R., Romero M.J., Patel A., et. al.: Internal and external moonlighting by radiology trainees: a survey of the extent of participation by current residents and fellows. Acad Radiol 2009; 16: pp. 1029-1033.
2. McNeeley M.F., Prabhu S.J., Monroe E.J., et. al.: The nature and scope of moonlighting by radiology trainees: a survey of the extent of participation by current residents and fellows. Acad Radiol 2013; 20: pp. 249-254.
3. McNeeley M.F., Monroe E.J., Prabhu S.J., et. al.: Internal versus external moonlighting: differences in roles and responsibilities. Acad Radiol 2014; pp. 546-553.
4. Mainiero M.B., Woodfield C.A.: Resident moonlighting in radiology. J Am Coll Radiol 2008; 5: pp. 766-769.
5. The Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://www.acgme.org/acgmeweb/Portals/0/PDFs/Common_Program_Requirements_07012011[2].pdf . Accessed January 18, 2014.