Walking In Your Shoes: Moonlighting Part #2- ED + Hospitalist E10

By John Stillson MD

The Rural ED

After doing several clinic moonlighting shifts I decided that I would like to do some work in a rural emergency department (ED). This is something that I've always wanted to do particularly in residency. I know that this will allow me to not only increase my moonlighting pay but it will provide me with learning opportunities and force me to gain some independence in my medical decision-making. This is both exciting and scary at the same time. I laid the groundwork for this by reaching out to multiple rural ED staffing companies early on so that I could get credentialed and have opportunities for scheduling in the future once I decided I was ready. This process can take several months to complete so if this is something you were thinking about I'd recommend doing it as soon as possible. You can always delay scheduling your first shift but you should have the credentialing completed early. One of the staffing companies said that given I am still only part way through my second year of residency they would likely not be able to give me any shifts at their EDs until I gain some more experience or progress in my program further. However, one of the other companies said that they would have opportunities for me at their smaller EDs as long as I was comfortable and signed off on by the emergency department medical director at the hospital.

Credentialing

The last step of the credentialing process was my interview with the medical director. He asked me some basic questions to get a feel for my knowledge and comfort level with doing emergent procedures. This went well and he said that I could schedule shifts going forward. The staffing company has a scheduler who I'm able to reach out to directly. I was able to look at my schedule and see my availability going forward. Once I told her my availability, she worked to get me scheduled for my first shift. The hospital where I plan to do my first ED moonlighting has 15 inpatient beds and five beds in the ED. They typically see 10 to 20 patients during 24 hours. I decided to go big and do a 24-hour shift for my first ED Moonlighting shift. Due to this being a small hospital and my availability being on the weekends, this meant that I would round on the hospital patients on the weekend in addition to my emergency department duties.

Getting Started

At the time of my first shift, I was doing a rural elective. This meant I had to wake up very early in the morning to drive the two hours to the hospital so that I could get there around 6:00 AM. This gave me plenty of time to become comfortable and familiar with the facility before my shift starting at 7:00 AM. When I arrived there were no patients in the emergency department and the provider who was on overnight signed out that I did not have to round on any of the patients in the hospital. Unfortunately, several hours into my shift I was called by one of the hospitalist NPs who proceeded to tell me that I did need to round on all six patients in the hospital and then gave me a sign-out over the phone.

EMR Challenges

This would normally not be a problem however I had never used the EMR that is used at this hospital, and it was causing quite a few problems. As all of us know EMR challenges are extremely frustrating and end up taking way more time than patient care. It didn't help that I was doing my first shift on the weekend so there were no other physicians around to help me troubleshoot the EMR difficulties. What should have been 2 hours of work turned into 4+ hours of work. My hospital patients included COPD exacerbation, likely ACL tear waiting for an MRI during the week, and a patient with possible intussusception after bariatric surgery awaiting transfer.

Despite the patients being relatively straightforward I think that the hospitalist element of this first shift was the most stressful part due to the problems I encountered with the EMR. During my 24 hours in the ED I saw 8 patients: one required transfer, one periorbital laceration repair, two pediatric patients, and others not requiring serious intervention. Fortunately, I was able to get a fair amount of sleep overnight in the call room that was adjacent to the emergency department. I think that with each shift it will become easier to sleep as I become more comfortable. Feels good to get paid to sleep. Overall, this first shift was successful and motivated me to schedule several more shifts in the coming months.

This is Tod and I want to be your guide to starting a micro-corporation during residency—just like John is doing. It's an ideal option for earning 1099 moonlighting income—or any side work you are doing. While you can receive this income as a sole proprietor, starting a micro-corporation during residency allows you to gain experience in operating and managing it while it's still small. This will make it much easier to scale up when you start funneling larger earnings through it as an attending physician, regardless of how you job stack. For a complete breakdown of how a micro-corporation allows you to retain more moonlighting and side income—even paying no taxes—check out my blog post here.

I invite you to download my free e-book on 20 reasons every resident should start a micro-corporation during residency—and start embracing the power that you have earned with your medical license! A micro-corporation is a simple $5000 capstone to your $250,000-$500,000 investment in your medical career.

Tod