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What is Moonlighting in Residency? Answers to Common Questions

Residents across the nation are using moonlighting to earn extra income, gain more experience, and broaden their networks. If you are considering moonlighting as a resident, you might have a few questions. The experts at OnCall Solutions are here with the answers.

What is Moonlighting?

In the broadest sense, moonlighting is the practice of picking up extra shifts alongside your residency. The term originated in the 1950s in reference to the fact that most extra shifts occurred after-hours. Moonlighting is traditionally associated with physicians (MDs/DOs), though moonlighting opportunities are now commonly available for physician assistants and nurse practitioners.

What are the Benefits of Moonlighting?

Extra Income

Working a few moonlighting shifts per month can easily add 50% or more to a typical resident’s annual salary.

Increased Autonomy

Moonlighting lets you step into the role of an attending physician in making decisions for patients—but with an appropriate level of support, as needed from hospital-employed physicians by phone or in-house. It is the perfect way to practice with this level of autonomy while gaining comfort in different areas of the medical field.


Moonlighting at other hospitals or institutions can provide networking opportunities that can open the door to new job opportunities once you have finished your training.

How Do I Get Moonlighting Opportunities?

Moonlighting opportunities outside your home institution are typically arranged through a 3rd party ing solution—like OnCall Solutions. These agencies work to expedite the credentialing and onboarding processes while connecting trainees with appropriate opportunities.

Most moonlighting opportunities gravitate towards general medicine with a lean towards in-patient medicine; however, there are sometimes more specialized moonlighting opportunities, including ICU care, surgery, or even outpatient coverage. OnCall Solutions can help partner you with moonlighting opportunities in your area of expertise.

What Qualifications are Needed to Get Started with Medical Moonlighting?

To obtain moonlighting credentials, residents must have a DEA license associated with an address within their state. Applicants must also have an unrestricted license to practice medicine in their state.

Residents must complete a minimum of two years of training to apply for their unrestricted medical license:

  • Allopathic trainees can apply for an unrestricted medical license in June immediately preceding their PGY-3 year
  • Osteopathic trainees can apply for an unrestricted medical license in January of their PGY-2 year.

Once you have passed these thresholds, you can begin the credentialing process for medical moonlighting.

Are There Any Restrictions on Moonlighting In Training Programs?

Outside moonlighting activities are recognized as clinical activities by the ACGME toward the 80-hour work week mandate. As you might know, the ACGME mandates that trainees can work no more than 80 duty hours per week, averaging over four weeks.

Resident moonlighters often need several letters of recommendation, one of which comes from their program director. To earn and maintain a program’s support, you must stay within your ACGME hour limitations. OnCall can help you manage your schedule to reap the benefits of moonlighting without exceeding hours.

How Am I Paid as a Moonlighter?

Some residencies offer moonlighting opportunities in-house, meaning shifts within a trainee’s hospital that need coverage. In-house moonlighting income is often included in a resident’s typical paycheck with taxes withheld.

What about moonlighting at other institutions? In these cases, your payments are managed by your ing agency. At OnCall Solutions, our physicians are all paid as 1099 self-employed physicians, meaning that no taxes are withheld on the clinician’s behalf. We recommend you consult with your accountant or tax advisor on allocating tax payments on this earned income.

All OnCall contractors get paid on or around the 15th of each month. We accommodate our physicians’ preferred payment method—whether that be by direct deposit or check.

Is Moonlighting Covered By Medical Malpractice Insurance?

Yes! All OnCall contractors are covered by a comprehensive medical liability policy—which includes tail coverage at no additional costs. We understand the importance of providing medical malpractice coverage for our moonlighters.

How Can I Get Started or Learn More About Moonlighting?

When you are ready to get started as a moonlighter, OnCall Solutions is an industry-leading medical moonlighting solution that can help. You can find free moonlighting information and resources in our blog. OnCall connects hospitals and practices with qualified moonlighters and locums. We streamline the credentialing process and find moonlighting opportunities that work for you. OnCall manages all of the groundwork while you take control of your schedule. We invite you to contact us to learn more or get started today!

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