Moonlighting vs. Night float

[Newone]

Is there a difference between Moonlighting and Night float system? If so what is the differnece? Thank you.

[teratos]

Originally Posted by Newone

Is there a difference between Moonlighting and Night float system? If so what is the differnece? Thank you.

The diifference is huge. Night Float is a rotation for your residency. You do all the overnight admissions and take care of patient problems. You don't get paid extra.

Moonlighting is a job. You get paid by the hour or by the shift. You are a licensed doc (or you are moonlighting at your place of residency, so you can practice under your training license). You take care of patient problems and do admissions. G

[pstone09]

Originally Posted by teratos

The diifference is huge....

wow, he wasnt kidding. pay vs. no pay is a pretty big difference id say.

[teratos]

Originally Posted by pstone09

wow, he wasnt kidding. pay vs. no pay is a pretty big difference id say.

You are getting paid, as it is part of your residency. Moonlighting is getting paid EXTRA. G

[Picard]

I think what the OP may be asking is about programs that use the night float system (resident on night float rotation) vs using moonlighters (may or may not be residents) overnight.

Most residency programs use the "night float" system or the "qXday overnight call system" to cover in-house night time hours. The overnight call system is getting out of favor due to its tendency to violate work hours -- not just the 80-hr work week rule. Residents on overnight call may not be on for more than 30 hours straight (24-hr call + 6 hr post-call wrap up). And there must be a 10-hour away from the hospital break between any two shifts. Therefore, night float system is more popular, where residents go on "night shift rotation." However, ABIM/RRC/ACGME (can't remember which) mandates that residents do no more than 12 weeks of night float 3 years.

Some programs use moonlighters to cover night time hours. These moonlighters may be senior residents looking for extra pay, or non-residents altogether. At Kaiser Santa Clara, they use moonlighting hospitalilsts (non-residents) -- or what they called "nocternist" to cover the hospital overnight. From a teaching/training standpoint, I don't think is is a good idea, because I think there is a steep learning curve for residents who rotate through night float system.

P

[IMG2006]

Just to add another 2 cents...

The three systems can also coexist. I'm in a program where the hospital has been at over 100% capacity for many years and there are nearly 1000 beds here. As Interns (that's me) we pull traditional call q-4 with a senior resident who is on night float. My day starts at 0500-0530 and runs through the next day at noon (or so). The night float works from 1700-0700 the next day, and goes home without rounding (that's my job). We cap out after 7 admissions, at which time, the hospitalists (often moonlighters) take over. The benefits are huge, I get the call learning experience, but won't have to do it for the next three years, and there is extra money to be made for the licensed docs.There's more than enough to go around.
The difference is that the night float and I are on salary, and so if I do 0 admissions or 7, it doesn't make a difference in my pay. The moonlighters get paid by the admission, and the hospitalists are also on salary, 4-5 times my salary, but a salary none the less. The moonlighters and Hospitalists alternate between even and odd days for admissions, and we bascially end up doing the self-pay and medicaid admits. Which is fine, as I have no financial interest in the whole situation and these people are generally the ones from whom you will learn the most (ie: 55 yo ETOH abuser with 6yr Hx of chest pain, blood per rectum, uncontrolled HTN, pneumonia, and a positive cocaine screen.)