Moonlighting: why training programs should monitor residents' activities

Moonlighting by psychiatric residents, or employment outside the residency program, is a longstanding and widespread practice. The author contends that moonlighting detracts from residents' ability to gain full benefit from their educational program, compromises the safety of patients treated by residents who moonlight in unsupervised settings, and exposes health care institutions to risk of costly legal actions. Although moonlighting should ideally be eliminated, a workable alternative to the current system would include oversight by residency program directors of residents' extracurricular employment to assure that the assignments complement the educational program. Institutions that employ moonlighting residents would also reimburse the residency program for selecting appropriate residents to fill the positions they offer.