Rationale and Objectives
The practice of moonlighting by trainees is a longstanding controversy; however, the resident point of view remains distinctly underrepresented in the radiology literature. We report the resident perspective on the moonlighting practices of radiology trainees.
Methods
Survey data were collected from resident members of the Association of University Radiologists representing 84 training programs in the United States to assess their routine and extracurricular clinical responsibilities. Descriptive statistics were used to analyze these data.
Results
Moonlighting is practiced by radiology trainees at nearly three-fourths of the programs represented in this survey. Interpreting diagnostic imaging (85.5%) and monitoring contrast administrations (72.6%) are the most common duties performed. Twenty-one percent of moonlighting trainees perform procedures (excluding diagnostic fluoroscopy) in their extracurricular positions; of these, most (61.5%) are without attending supervision. Most trainees that moonlight spend 1 to 10 hours weekly doing so while averaging a 59-hour workweek at their primary jobs.
Conclusions
The clinical duties of moonlighting trainees may be more diverse than has been previously recognized. Although major discrepancies between overnight radiology trainee interpretations and attending final interpretations have been shown to be infrequent, the consequences of trainees performing procedures and monitoring adverse contrast reactions without attending supervision are unknown. The financial and professional benefits of moonlighting must be weighed against the potential for harm. Our data suggest that most moonlighting radiology trainees operate within the Accreditation Council for Graduate Medical Education–mandated 80-hour weekly work limit; the mandatory 8-hour break between shifts and 24-hour continuous duty limit may pose logistical challenges.
Resident physicians are a heavily leveraged breed. Eighty-six percent of the US medical school class of 2011 will graduate with medical student loans, with a median amount of $162,000 ; one-third will have incurred $200,000 or more in medical education debt. As interest accrues over a 25- to 30-year repayment period, the true financial burden of medical education becomes much higher. It has been shown that residents have fewer assets, greater consumer debt, and smaller retirement funds when compared to members of the general public with post-college degrees . A 2002 survey of internal medicine trainees found that 52% had insufficient funds to purchase textbooks and work-related equipment, and that nearly one-third could not afford the required fees for their board certification exam . Similarly, many radiology residents bear considerable responsibility for American Board of Radiology certification fees, licensing costs, and radiologic-pathologic course (American Institute for Radiologic Pathology) expenses, which may amount to 16% of their annual salary .
In light of these circumstances, many resident physicians may perceive an acute need for supplementary income. Indebtedness is highly associated with the pursuit of moonlighting opportunities . However, in addition to its economic benefits , some authors have emphasized the educational value of the practical experience gained through these additional responsibilities .
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Methods
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Results
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Table 1
Factors Influencing the Decision not to Moonlight
Barriers to Moonlighting_n_ % ∗ Market forces 16 72.7 Lack of interest 3 13.6 Administrative disapproval 12 54.5 Total 31 † N/A
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Table 2
Responses from Radiology Programs with Moonlighting Opportunities for Trainees
n %Department stance on moonlighting Encouraged. 25 40.3 Allowed, but not encouraged. 36 58.1 Forbidden, but happens anyway 1 1.6 Total 62 100.0Equal opportunities within a given class? Yes 51 82.3 No 11 17.7 Total 62 100.0Moonlighting at what type of facility? Inpatient 13 21.0 Outpatient 17 27.4 Hybrid 6 9.7 Both 26 41.9 Total 62 100.0Procedures while moonlighting? None 49 79.0 Unsupervised 8 12.9 Supervised 5 8.1 Total 62 100.0Hours spent moonlighting weekly? 1–10 49 79.0 11–20 12 19.4 21+ 1 1.6 Total 62 100.0Residents provide own liability insurance? No 54 87.1 Yes 7 11.3 Unsure 1 1.6 Total 62 100.0
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Discussion
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Supplementary Data
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Appendix
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