Radiology residents and moonlighting: How to navigate unsteady waters

A couple of very recent studies demonstrate the continuing challenges facing residents in medical imaging-related programs--and by extension, the programs themselves.

As we have seen, radiology residents have been increasingly worried about issues like a stagnant job market--a situation that is probably exacerbated by concerns about their financial security.

Last year, for example a study led by Michael McNeeley, M.D.,found that burnout rates among radiology residents were higher than what had been measured for internal medicine residents in previous studies, and that these burnout rates were associated to a large extent with concerns about money.  Fifty-five percent of the radiology residents somewhat agreed, agreed, or strongly agreed that their financial situation represented a "serious strain."

It's not surprising, then, that many of these radiology residents turn to moonlighting--taking on extra work in addition to their regular duties--in order to pay bills and pay back medical school debt.

Another study, by McNeeley and colleagues published in the April issue of Academic Radiology looks at the differences between internal moonlighting and external moonlighting--where the residents are working extra hours outside their training institutions--and observed that external moonlighting may not be the best way to optimize patient care. 

Eric England, M.D., and colleagues, in an editorial in the same issue, pointed out that moonlighting is probably associated with increased physical and emotional stress. The practice forces residents to sacrifice time that could be spend on their education, which could negatively impact training, as well as patient care.

Considering that medical providers are responsible for ensuring both a high level of patient care and a high-quality educational experience for residents, England asks, "by allowing resident moonlighting are we realizing this high standard?

It's hard to imagine a scenario in which moonlighting is ever eliminated. It provides much needed additional income that residents use to repay their massive student loans and maintain a decent standard of living. It's also a way of reducing that stress that McNeeley found is a prime factor leading to resident burnout. In addition, many residents believe moonlighting actually enhances their education experience.

It seems, then, that since moonlighting is a fact of life, it's up to residence training programs to ensure that it's properly controlled. As McNeeley and his colleagues point out, one way in which programs can keep a better handle on their residents and the extra work they take on is to provide them with more internal moonlighting opportunities.

In the meantime, it makes sense for resident program administrators to more closely monitor moonlighting and get a sense of how it impacts their residents and--by extension--their programs so they can ensure that patient care isn't being compromised. - Mike (@FierceHealthIT)

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