Survey of moonlighting practices and work requirements of emergency medicine residents

We conducted an anonymous moonlighting and academic practice survey of all emergency medicine residents enrolled in accredited programs during 1997. Expanding on previous work, this survey included specific details and practice trends of moonlighting emergency medicine residents and for comparison also included academic work requirements. The typical emergency residency program requires residents to work 204 hours monthly. However, the range of required work-hours is strikingly large (120-300). Half of emergency medicine residents moonlight. The typical moonlighting resident works as a solo emergency department practitioner in multiple facilities outside of residency-affiliated institutions. Moonlighting salaries generally double a resident's annual income and are used to pay off student loans and other debt. Residents with higher student debt are more likely to moonlight. Despite the fact that most residency programs restrict moonlighting, a majority of moonlighting residents have violated an Accreditation Council for Graduate Medical Education prohibition restricting work within one period of a regular residency-scheduled shift. Half of all residents surveyed, whether involved in moonlighting practice or not, would violate a ban on the practice. Residents universally felt that moonlighting enhanced residency performance and was a positive educational experience. Use of these data may aid in the development of formal guidelines regarding emergency medicine moonlighting practice.