encouragement if you’re willing to put in the work and go through the licensing.” TTUHSC Amarillo Family Medi-
“For many communities in Texas,
their support is moonlighting residents.”
cine Residency Program Director Jer- ry Kirkland, MD, says there is a very low threshold for revoking that privi- lege if abused. “And it is a privilege. We’re not going to send someone out there who’s not prepared. But I see a real confidence and seasoning that de- velops in those residents who get that clinical exposure.” Because residents tend to stay and
practice where they train, under- served areas also benefit from expo- sure to possible recruits moonlighting there, Dr. Kirkland adds. “They might say, ‘Hey, this could be a nice place to live, and the quality of life could be good.’”
SOME RESTRICTIONS NECESSARY But educators say broader restrictions are sometimes necessary, and certain parameters should be left to each pro- gram’s discretion. Moonlighting not only affects an
institution’s standing if residents vio- late the duty-hours rules, but it also impacts programs’ federal funding, says Josephine Fowler, MD, a member of TMA’s Council on Medical Educa- tion. She oversees the residency pro- grams at JPS Health Network in the Fort Worth area as vice president of academic affairs. “We tell our programs: We are not
micromanaging you. We are just help- ing them recognize when they are going over their duty hours because that’s tracked by ACGME,” she said.
“And moonlighting does not count toward our [federal] reimbursement because residents are working as in- dependent practitioners. Reimburse- ment to an institution only counts when they are in training mode, so we have to keep track.” JPS has a general institutional
policy that encompasses ACGME’s requirements and requires moonlight- ing residents to be in good academic standing and keep up on their chart-
42 TEXAS MEDICINE April 2015
ing, for example. JPS also has pro- gram-specific guidelines that are more stringent depending on the specialty. Since the requirements to docu-
ment both internal and external moonlighting took effect, Dr. Fowler has seen fewer residents moonlight. “But the biggest factor is, do they
have enough time? Most of our pro- gram directors just can’t see where residents would have enough time to think about moonlighting,” she said. “We just want residents to understand what their limits are.” Russell Wagner, MD, directs JPS’ orthopedics residency program, which restricts moonlighting to se- nior residents who typically no longer take heavy call and to specific internal arrangements that coincide with their specialty training: as a faculty member, at the hospital jail clinic, or with a lo- cal high school football team. Until their senior year, the hours
most residents work are strenuous enough without moonlighting, “and when they are off, they should be studying or taking time for their fam- ily. They have a lot to learn,” he said. While general emergency work might be good for family practice residents,
“it’s not a great learning experience for an orthopedic resident. When I was moonlighting, it was in a psychiatric hospital. I saw patients with minor emergencies and sent them to the hos- pital. But it was not a learning experi- ence. It was because I was not getting paid enough to support my family.” On the other hand, Dr. Wagner says
resident pay nowadays has improved enough for residents to modestly sup- port themselves and their families. He does not discredit the benefits that accompany moonlighting. “But some- times it’s prohibited, and sometimes it needs to be. And it should be up to the programs.”
CLEAR FOR TAKEOFF TMA leaders worry, however, that lim- iting moonlighting to internal oppor- tunities — where program directors are just a phone call away even if they
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