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Thread: Moonlighting in the South

  1. #1
    mua2008 is offline Junior Member 510 points
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    Moonlighting in the South

    What are the state laws for moonlighting in the southern states such as Louisiana, Alabama, Arkansas, Mississippi, Tennessee for FMG's??? I'm primarily interested in the University programs in these states.

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    Arkie, M.D.'s Avatar
    Arkie, M.D. is offline Elite Member 6139 points
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    Arkansas allows moonlighting by carib grads (and US grads) as soon as you obtain your license (PGY-2).
    Step 1 [x] Step 2 CK [x] Step 2 CS [x] Prematch [x] M.D. [x] Step 3 [x] PGY-1 [x] PGY-2 [x] PGY-3 [x] ED Attending [2015-]
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  3. #12
    Groove's Avatar
    Groove is offline Member 534 points
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    Just to re-awaken an old thread...and provide some advice... If you find yourself stuck in a Southern state or any state for that matter that does NOT allow moonlighting before 3 years PGY3 training have been completed, look into states that only have 1 or 2 yr stipulations. That's assuming that your program will allow you to moonlight during or after your PGY2 year.

    I'm in a 4yr EM program in a Southern state and am one of the first, if not the only FMG here to ever moonlight out of state during their 3rd year. I've been working shifts steadily in a (somewhat) nearby state that's fairly easy to fly to. It's about 2 1-1.5hr flights to get to my destination so it really hasn't been that difficult. Find a good staffing firm that will pay for everything, the flight, the rental car, the lodging, etc.. and does all this scheduling for you makes it very easy.

    Words of advice...

    1) Research the state before hand. The state I'm currently in and won't have a perm license for until July this year lets EM residents moonlight ED's all over the place. I assumed this was the case in other states. I picked a state that allowed me to get a license fairly quickly and easily and wasn't too far away. I found out that it is a state where residents do not commonly staff ED's so I rather luckily just happened across a situation that worked out well for both me and a desperate group that had picked up a few extra hospitals and were in dire need of coverage. Proved myself, and then developed a good relationship with them but I don't think they had used residents before... Most states that will be utilizing residents to moonlight EDs will be less desirable locations, so keep that in mind.

    2) You will take a hit on payment when you use a staffing firm that is going to end up flying you everywhere. They eat the travel costs, so don't cry about it when you're making less than your colleagues who are moonlighting nearby for $50-60 more an hour. You can easily make $120+/hr (if they're having to pay for your travel... add more if it's within driving distance and at your expense.) with the firm with lowest I've seen being $100/hr which I wasn't too interested in and didn't end up taking but in hindsight, hell...anything is better than what we're making, right? Any price most firms offer will drastically improve your financial situation, just don't let them screw you over too bad.

    3) Your specialty will dictate your comfort level. Don't overstep your comfort level. I'm serious about this. Always expect the worst and be prepared to deal with it. The staffing firm wants to staff the ED, and rarely will give you a really clear picture of what the type of environment is going to be like. I thought I was walking into a single coverage bandaid station and walked into a single coverage level 3 Trauma ED with 15 beds. During my first few shifts, I probably saw more acutely ill patients and did more procedures than I have done in 2 months at my level 1 Trauma academic institution. Chest tubes, LP's, intubations, reductions, complex lac repairs, nerve blocks. Unexpected pt presentations such as a 2yo TBI with active brain herniation on the table in front of me brought in by hysterical father who suddenly stops breathing, pupils blown, posturing, etc.. that I had to emergent intubation, double IO's, hyperventilate, mannitol, transfer to tertiary care center STAT, etc.. MI's, strokes, meningitis, torsions, fulminant respiratory failure, codes, trauma, you name it. Definitely not the first ED environment I would ever recommend a resident to moonlight in but re-affirmed the excellent training and has been a great confidence booster. However, please don't pick an environment to moonlight unless you really feel comfortable because you definitely don't want to make a mistake. If you can choose double coverage where you have a colleague as backup, do THAT. Single coverage can be a sphincter tightening experience because it's just YOU and you don't have time during some of the emergencies to "phone a friend" but just have to make a decision.

    Also, I'm not knocking other specialties, seriously... There were some FP's working at this place that seemed to be doing a really good job but I had a really s.h.1.t.t.y sign out from whom I thought was another locums fresh out of residency person where I luckily caught some bizarre and potentially extremely dangerous orders that they had standing for a mis-diagnosed pt. Fixed it, really pissed me the hell off, ended up reporting it to the ED director. The person was eventually fired by the group using the agency to staff the ED, but turns out this was an internist that had been in private practice for 9 years which surprised the hell out of me. Some of his/her management was just bizarre and it was obvious they were very uncomfortable in such an acute environment. Again, that's not knocking IM in the ED because I was very impressed by most of the hospitalists at this place. It just goes to show that there are good docs and bad ones in every specialty.

    If you are IM, pick at least a double coverage ED, or even better yet... check out all the local VA's and IHS facilities. You get a free DEA license for any government institution so that saves you a few hundred on top of your state license bill and the VA ED's tend to be much less trauma and more comfortable for other specialties to work in. Again, I'm not knocking other specialties working in the ED, just make sure it's the "right" ED environment which can be very difficult to ascertain before you get there. Try to avoid single coverage unless you have lots of specialty coverage. (Meaning...if you identify an emergency, and don't feel comfortable with a procedure, is a surgeon nearby? I moonlit 2 shifts at another ED from the bigger one and they literally had 5 beds and much smaller place. I thought I'd get some rest that night, use the call room, etc.. One of my first cases was a massive hydrohemothorax with one of the largest mediastinal shifts I've ever seen. Heart and trachea literally in his right chest. BTW, this is one of the few weekends that the gen surgeon is out of the city... You can't transport somebody like that. They need a chest tube. Luckily, I'm very comfortable with the procedure and threw one in but keep in mind that you might find yourself in these situations out in the middle of nowhere. That doesn't mean that you need to be EM/Surg to work a small ED, or feel comfortable with all the procedure skill set, but make sure somebody is around that can do it if it needs to be done.) Back to VA's, VA's will hire you to staff their ED if you are in your last year of residency so keep that in mind. If you live near an academic institution, you most likely have a VA somewhere near by so that's a big convenience factor.

    *****Even if you are in a 3yr stipulation state, ALL you need to work in the local "Federal" VA is ANY state license. Yes, that means you can apply for a license in any state with a 1 or 2 yr stipulation and work across the street at your local VA if you are a PGY3 IM/FP, etc.. resident. That's because it's a federal facility. Again, free DEA license. There are a few states that have a track record for really quick licenses, so you can be up and going in no time once your 3rd year starts.*****

    3) DO NOT under any circumstance use FCVS for your first license to moonlight. FCVS is great for storing all your medical crap for future licensing in other states but it is beyond a pain in the *** to deal with and takes MONTHS to get everything processed. That's after they've lost and found multiple documents 2 and 3 times over. I applied for 3 other states through FCVS and it took months to get the application even sent, that's excluding the 2-3 months required for processing by the state once it gets there. I applied on my own to another state and literally had my license in 3 weeks and a DEA in 10 days. FCVS is a good long term idea, especially for FMG's, but don't rely on it for all your licensing, especially your first one.

    4) I would encourage everyone, if able, to moonlight at some point. There's plenty of advantages, but a key advantage is moonlighting in an area that you might have some interest in moving to once you finish residency. There really is no better way to get a feel for a hospital system, geographic region, local people, colleagues, networking with connected people, than by doing moonlighting out of state. It really opened my eyes, so if you can, and feel comfortable, then do it. I wasn't even working that long at this place before being approached by the group about my interest in a perm position after residency, so again... great way to network and get some experience in negotiation prior to finishing residency.

    Keep in mind there are other places to moonlight other than EDs, nursing homes, urgent care, even approach the staffing firm about possibility of staffing their mid-level ED fast track if you are nervous. Most staffing firms are looking to staff EDs though. Again, like I said before, I DO NOT recommend single coverage EDs as your first gig, no matter how much they make it sound like a sleepy little place unless you have some steel balls or ovaries for the women out there. Don't be fooled into feeling more comfortable because you have "mid-level" support until Xp.m., etc.. Mid-levels are great, but most are no help during emergencies. Also keep in mind that you will be required to sign all the pt's that the mid-level saw and treated during your shift. Most of which you never saw. That's essentially like signing a resident's chart and you never saw the patient. I'm actually not sure what the legal risks are when you're dealing with a NP, and even though I sign the charts, I do not check the little T-sheet checkbox that says "evaluated pt and agree with blah blah, etc..". It might be wise to ask about this beforehand if you know a mid-level will be working, or do some research into how well you are protected. I honestly don't know. Luckily, most pt's in the fast track areas have been properly placed and our mid-levels seem competent with that acuity level.

    Overall, great experience for multiple reasons and easier to make happen than you might think. It's really not that hard to get dropped off at the nearest airport, fly somewhere, work 4-5 shifts and fly back. That's assuming you have a schedule that can facilitate that. Even using one or two of your vacation weeks would net you a tremendous amount of extra cash that you could put towards loans, cc debt, investing or just improving your standard of living.

    If you have any questions, let me know.
    Last edited by Groove; 12-22-2011 at 01:43 PM.
    devildoc8404 likes this.

  4. #13
    Matt Williamson is offline Newbie 510 points
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    Check out pushhealth [dot] com. It is like moonlighting from your phone for your personal networks. It is an invite only platform. Go to pushhealth [dot] com for more information and to request an invite.

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    juel231 is offline Junior Member 510 points
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    Moonlighting is any job you have secondary to your primary job. It doesn't have to relate to your main job.
    Quote Originally Posted by Rubicon681 View Post
    what is moonlighting?

  6. #15
    juel231 is offline Junior Member 510 points
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    Hello Rubicon681, this is your answer,
    Moonlighting is any job you have secondary to your primary job. It doesn't have to relate to your main job.

  7. #16
    rokshana is offline Member Guru 11646 points
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    Quote Originally Posted by juel231 View Post
    Hello Rubicon681, this is your answer,
    Moonlighting is any job you have secondary to your primary job. It doesn't have to relate to your main job.
    well, yes and no...most people in medicine consider moonlighting to mean a job doing medicine, but not required in residency...i mean someone can work flipping' burgers at the mcdonald's but no one will consider that to be moonlighting...
    Endocrinology, Diabetes and Metabolism Attending
    ABIM certified IM
    ValueMD-the place "where nothing makes sense, but everything is related-fellow vmd'r gabon

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