Proposal for a Fair and Transparent Moonlighting System
by Bo Liu, MD
Moonlighting can be a great source of additional income for resident physicians. In my specialty of radiology, 78% of training programs offer some form of moonlighting opportunity for residents. Among US medical students applying to radiology, 32% considered moonlighting as a factor in ranking programs (ranked 3.5/5 in importance). Today, I want to propose to you a fair and transparent system of managing moonlighting shifts among residents.
The Problem
While the exact moonlighting arrangements vary by institution, my personal experience has been that moonlighting is driven primarily by senior residents at many institutions. As moonlighting may have a significant impact on a resident’s income, there is potential for interpersonal conflict regarding the fairness or perceived fairness of shift assignments. Left unchecked, such conflicts can lead to significant disruption in resident morale and breakdown of interpersonal relationships.
The Solution
In order to address these concerns, all residents met to discuss by what method shifts should be assigned. A consensus was arrived at, and the following system was adopted:
Assignment of moonlighting hours:
- R4 resident (PGY-5) — 50% of total hours
- R3 resident (PGY-4) — 30% of total hours
- R2 resident (PGY-3) — 20% of total hours
With the help of a tech-savvy friend, I devised a semi-automated shift scheduler based on Microsoft Excel. This was later ported to Google Sheets for easy online sharing. The scheduler relied on 3 components (images of each below):
- Facility Schedule. All moonlighting shifts at each facility are recorded.
2. Resident availability. All resident availability is recorded.
3. Shift scheduler. Incorporates the shift times and resident availability data in one spreadsheet.
The shift assignment process takes 5 steps:
- After the shift times are made available, fourth-year residents select their shifts, up to a combined 50% of total hours available.
- Third-year residents select their shifts, up to a combined 30% of total hours.
- Second-year residents select their shifts, up to a combined 20% of total hours.
- If any shifts are still available, it becomes a first come first served situation where any resident can select any available shifts.
- If there are shifts left uncovered, they are assigned based on the resident availability spreadsheet.
The Results
We have been using this shift assignment system since July 2016. It has effectively eliminated the complaints of unfairness in moonlighting shift assignments. After two months of use, we were able to eliminate Step 5. As it turns out, there were typically no uncovered shifts by the end of Step 4.
While this particular system was designed with the needs of a specific set of radiology residents in mind, I believe the process can be easily adopted in other residency programs as well. The key is to make sure everyone participates in the process and to revisit the process periodically for changes/improvements.
Dr. Bo Liu is a resident physician and personal finance enthusiast. He is the founder & editor of the medical finance blog Future Proof MD.
