title: Internal versus external moonlighting by radiology trainees: differences in roles and responsibilities.
abstract: OBJECTIVE
  Recent survey data have suggested that the paid extracurricular activities of radiology trainees (known as "moonlighting") are more diverse than has been previously recognized. The purpose of this study is to examine these activities in further detail and to assess for differences between clinical duties performed at institutions affiliated with residents' training programs ("internal moonlighting") versus those performed at unaffiliated institutions ("external moonlighting").
  
  
  METHODS
  Electronic survey data were collected from trainee members of the Association of University Radiologists regarding their extracurricular clinical work, with an emphasis on their responsibilities when working in institutions that are affiliated with their training program versus work done in unaffiliated institutions. Descriptive and analytic statistics were used to examine these data.
  
  
  RESULTS
  Survey respondents represented 61 unique institutions (of 173 Association of University Radiologists member-programs, a 35% institutional response rate). Trainees engage in moonlighting activities at nearly three-fourths of these programs. Although the incidence of duty hour violations appears to be low ("probably" or "definitely" occurring at three of 44, or 7%, of represented programs with moonlighting trainees), these violations go largely undocumented. Residents participating in external moonlighting were significantly more likely to provide final interpretations of diagnostic imaging studies when compared with residents moonlighting internally (odds ratio 13.84, P < .05). Of the 27 programs with residents that moonlight externally, five respondents (19%) indicated that their external moonlighting duties include the unsupervised performance of invasive procedures. There were no reports of unsupervised procedures performed by trainees moonlighting internally.
  
  
  CONCLUSIONS
  Many resident physicians view moonlighting as a highly desirable, or even financially necessary, component of their clinical training. Although external moonlighting may be a useful means of garnering additional experience and income, certain ethical and medicolegal implications must be considered. The moonlighting trainee should seek opportunities for extracurricular work that do not compromise patient safety or the trainee's own long-term professional interests. Department administrators might facilitate this process by providing opportunities for internal moonlighting, while simultaneously developing competency-based systems for assessing trainee readiness for progressive clinical independence.
authors.affiliation: Department of Radiology, University of Washington Medical Center, 1959 Pacific Ave NE, Box 357115, Seattle, WA 98195. Electronic address: mcneeley@hotmail.com.
authors.forename: Michael F
authors.initials: MF
authors.lastname: McNeeley
authors.affiliation: Department of Radiology, University of Washington Medical Center, 1959 Pacific Ave NE, Box 357115, Seattle, WA 98195.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Monroe
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Somnath J
authors.initials: SJ
authors.lastname: Prabhu
authors.affiliation: Department of Radiology, Seattle Children's Hospital, Seattle, WA.
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Iyer
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D007587:Job Description; D010819:Physician's Role; D011871:Radiology / Q000193:education* / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States; D016526:Workload / Q000706:statistics & numerical data*
keywords: Radiology education; graduate medical education; moonlighting; patient safety; resident finances; trainee supervision