Moonlighting: Can imaging residents do it all?

There has been a limited amount of research on radiology resident moonlighting and the effect it has both on radiology residents and their training programs. Consequently, according to an article in the April issue of Academic Radiology, not only is more investigation into the issue needed, but it may also be necessary to closely monitor moonlighting in order to assess its impact.

In the article, the authors--led by Eric England, M.D., of the University of Cincinnati--reference another recent article in Academic Radiology in which trainee members of the Association of University Radiologists are surveyed regarding their extracurricular clinical work. The radiology trainees who responded represented 61 unique institutions, and the authors found that trainees engaged in moonlighting activities at nearly three-fourths of the programs.

Furthermore, the researchers of the second study found that 79 percent of residents who moonlight do so one to 10 hours a week; 19.4 percent moonlight 11 to 20 hours a week.

"We must acknowledge that resident moonlighting is not only widespread but also consuming a significant portion of residents' time, in some cases on par with a second job," England and his colleagues wrote.

While research is limited on the impact that moonlighting has on these residents, "one can surmise that [it] may be associated with increased physical and emotional stress, especially for the nearly one in 5 residents who spend up to 20 hours a week away from their families to moonlight," according to England and his colleagues.

Additionally, they said, time spent moonlighting could have been time spent furthering a trainee's education. Would residents "be better off moonlighting, or engaging in independent study, daily lectures, and supervised clinical rotations?" the authors asked. "Can they do it all?"

What about the effect moonlighting has on residency programs? Could moonlighting interfere with call and overnight rotations?

"Covering studies from an outside hospital [external moonlighting] while on call or covering contrast at a remote facility [internal moonlighting] while on call both have the potential to stretch a resident's abilities and negatively impact patient care," England and his colleagues said. "Should this practice be knowingly permitted? Lack of monitoring and financial incentives may make this practice more commonplace than one might think."

Duty hour violations pertaining to moonlighting are more frequent than has been reported, according to the second study's authors, leading England to wonder whether exceeding duty hour requirements could have a significant impact on residents' education, patient care and even the accreditation status of residency programs.

"As both mentors and instructors to residents, it is our primary responsibility to ensure the highest level of patient care and educational experience for our residents," England and his colleagues said. "By allowing resident moonlighting, are we realizing this high standard?"

To learn more:
- read the article in Academic Radiology by England and colleagues
- here's the second Academic Radiology article

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