Department of Medicine Moonlighting

On July 1, 2011, the changes in the Accreditation Council for Graduate Medical Education (ACGME) work hour rules go into effect.  The ACGME has called for increased supervision of physicians-in-training, tighter limits on moonlighting, and reduced work hours for first-year residents.  It is the expectation that duty hours will continue to be limited to 80 hours per week, averaged over a four week period, and inclusive of all in-house call activities and all moonlighting.  Individual programs are now responsible to monitor all moonlighting to ensure that duty hours are appropriately maintained.  The stated goal is to reduce medical errors, ensure patient safety and improve quality of care.

Moonlighting is considered by the Department of Medicine to be an optional activity which, if approved for a given resident or fellow, must be contained within the 80 hour work week, fully documented, and void of any distraction from the academic and service components of our housestaff and fellowship programs.  To be eligible for moonlighting, the applicant must:

  • Be PGY 2 or higher.
  • Residents are only permitted to moonlight within our own institution so that we may keep track of their total number work hours (both on rotation and moonlighting).  In addition, residents are only permitted to moonlight if they are performing well within their assigned rotations.
  • Beginning July 2012, scored at the 50th %tile or higher on their previous year's In-Training Exam.
  • Be limited to two shifts per week (non-consecutive days) when serving on a non-inpatient rotation. (Moonlighting is not permitted when serving on an inpatient rotation.)
  • Be approved with a written statement from the Program Director or Associate Program Director that is made part of the resident's file. (The residents' performance will be monitored for the effect of Moonlighting activities upon performance and adverse effects may lead to withdrawal of permission.)
  • Have demonstrated no concerns with variation from implied or explicit moonlighting policy.
  • Be independently licensed to practice in the State of Tennessee and, where applicable, have adequate malpractice coverage.
  • All requests for moonlighting must be approved by the DIO/Associate Dean for GME. No moonlighting is permitted until this approval has been given. Moonlighting without this approval may result in Corrective Action.”

While any moonlighting must be monitored for compliance with the aforementioned concerns, external moonlighting will come under closer scrutiny going forward.  Accordingly, the Department of Medicine has determined to require periodic validation of external moonlighting hours, i.e., a retrospective audit. Details will follow, but at a minimum, individuals, groups, or institutions with whom you contract for services may be required to provide documentation of hours you have worked within a specified time frame.

Believing that interest in moonlighting will continue or increase, the medical center has agreed to provide an increased opportunity for internal moonlighting.  For example a second shift will be added to the Scoville Service - details to follow.  Additional moonlighting shifts are under consideration at the Veterans Administration Hospital.

To be eligible for external moonlighting, in addition to the general moonlighting rules, the applicant must:

  • Be a Fellow at the PGY 4 level or higher
  • (Beginning July 2011) Contract with entities which are willing and able to provide meaningful information regarding hours spent in moonlighting activity.