MOONLIGHTING RULES
• Absent a waiver, duty hours must be limited to 80 hours per week averaged over a four-week period, inclusive of all in-house activities and all moonlighting.
• Time spent in internal and external moonlighting must be counted toward the 80-hour maximum.
• Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educa- tional program.
• First-year residents may not moonlight. • Residents/fellows must not be required to moonlight. • Residents/fellows must have written permission from their program director to moonlight.
• Programs must monitor the effect of moonlighting on a resident’s or fellow’s performance in the program; adverse effects may lead to withdrawal of permission to moonlight.
• The sponsoring institution or individual ACGME-accredited program may prohibit moonlighting.
Source: Accreditation Council for Graduate Medical Education (ACGME)
view published in the June 2014 issue of Annals of Surgery surveyed existing studies on the impact of duty hours on surgical training (tma.tips/Du tyHours) and found “negative impacts on patient outcomes and performance on [board] certification examinations” and incidents of “increased patient handovers, poorer team integration, professional dissatisfaction, concern for maturation of clinical skills, and decreased time in the OR.” ACGME acknowledges the debate
surrounding the benefits of the caps, and Dr. Philibert says the organiza- tion commissioned two long-term national studies — one in surgery and one in internal medicine — to assess their impact. “There is this tension of how to get
that clinical exposure within the re- duced duty hours,” Dr. MacClements said. He is optimistic that moonlight- ing is one way to help meet those needs, as well as those of the com- munity. As long as resident educa- tion, resident well-being, and quality of care are assured, “there are many communities in Texas that will direct- ly benefit from competent residents who are able to moonlight outside of their training institutions.”
DOUBLE EXPOSURE Dr. Young provided that much-needed backup in an emergency department (ED) in rural Crosbyton, 45 miles east of Lubbock, when he moonlighted there in his last two years of fam- ily medicine residency. “These were smaller communities that might have had two to four doctors, and there are only so many nights you can be the only doctor in the ED before you get burned out. Having a supply of people to come out made it more sustainable.” The clinical exposure was a prov-
ing ground for his skills, but Dr. Young says he had to prove himself even be- fore that. The council’s proposed policy rec-
ognizes that in order to moonlight in Texas — and most states — doctors in training must obtain a full and unre-
40 TEXAS MEDICINE April 2015
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