since the Accreditation Council for Graduate Medical Education (AC- GME) recently required moonlight- ing to count toward a resident’s total work-hour cap of 80 hours per week. In response, TMA’s Council on
“Most of our program directors just can’t see where residents would have enough time to think about moonlighting.”
Medical Education adopted a policy put forth by the physician distribu- tion committee that encourages med- ical schools and residency programs in Texas to reconsider broad limita- tions or even prohibitions on resident moonlighting. The policy goes before the TMA House of Delegates at its an- nual meeting in May. “There seems to be less support among schools because of the im- mense oversight required by program directors to make sure moonlighting counts toward the max and doesn’t interfere with patient safety,” said Dr. MacClements, assistant dean for grad- uate medical education at The Univer- sity of Texas at Austin Dell Medical School and a former family medicine residency program director and chair at UT Health Northeast in Tyler. While acknowledging those obliga-
tions, the committee doesn’t want to see the positive effects of moonlight- ing overshadowed. “It’s our respon- sibility to look at the adequacy of the physician workforce and access to care, and moonlighting can play a role. For many communities in Texas, their support is moonlighting residents,” Dr. MacClements said. Many educators say it also has di-
rect, positive effects on residents both professionally and personally, from boosting clinical exposure and self- confidence to reducing the ever-in- creasing medical school debt that im- pacts their practice decisions. Council on Medical Education Chair Rodney B. Young, MD, vouches for that, having moonlighted in his residency prior to the restrictions. He is a family physi- cian and chair of the Department of Family and Community Medicine at Texas Tech University Health Sci- ences Center (TTUHSC) in Amarillo. Drs. Young and MacClements agree that academic performance and
38 TEXAS MEDICINE April 2015
patient safety are paramount, as is compliance with ACGME rules. “But there are a lot of tangible benefits to moonlighting, and we would encour- age institutions that sponsor residency programs to rethink sweeping poli- cies” that effectively discourage the practice, Dr. Young said.
STRIKING A BALANCE In 2003, ACGME imposed stricter duty-hours requirements, limiting residents’ work-week to 80 hours. That included hours spent moonlight- ing internally, at the same location as their residency program. Residents also may moonlight externally — at a facility that is not part of the residency program — and in 2011, ACGME re- vised the duty-hours rules to include those hours, too. ACGME Senior Vice President of
Field Activities Ingrid Philibert, PhD, says the rules were not meant to dis- courage moonlighting altogether. Rather, they guard against resident exhaustion and the potential legal and patient safety risks that could result, and they ensure residents’ education comes first. “Residents are primarily there to
learn the science and art of medicine. That is their first job. This is not about banning moonlighting, but educating residents [about it]. Residents should understand moonlighting is not for ev- erybody,” she said. Dr. Philibert acknowledges the
many benefits of moonlighting, which include a workforce boost, although she says such policy reasons are “be- yond the purview of the ACGME.” Besides New York — which as a state bans moonlighting — and the mili- tary, she observes few if any residency programs completely prohibiting the practice, even though ACGME rules allow for such a ban. The only restric- tion ACGME policy explicitly imposes
— and program directors agree upon — is barring first-year residents from moonlighting. But moonlighting is not equally practiced among all specialties, Dr.
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