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