Resident moonlighting: toward an equitable balance

Extracurricular employment ("moonlighting") by resident physicians has been a subject of considerable controversy for many years. A review of the medical literature for the past two decades reveals substantial debate regarding the legitimacy of the practice, the establishment of some organizational policies, and the intrusion of some new legal concerns. I have summarized the findings of previous studies of the subject, including both general reviews and data-based studies. The latter suggest that escalating financial pressures, changing call schedules, and perceived shifts in career opportunities all contribute to continuation of the practice. In addition, some extracurricular jobs seem to offer valuable clinical opportunities. These factors, which have led to several fundamental dilemmas for academic medical programs, have been explicitly defined. There is still a need for a coherent, ethical, economically sensitive, and legally defensible policy on moonlighting. Using the tangible data about moonlighting and the ongoing controversies, I have synthesized some model guidelines that could be used by residency programs to place moonlighting activities on a fair and reasonable footing.