Before there was the physician side hustle, there was moonlighting.
Resident moonlighting is a polarizing subject. Residents see moonlighting as a great way to make some extra money. Residency programs view moonlighting as a potential distraction at best and a potential 80-hour workweek at worst. The amount of resistance I received from program directors when I conducted my moonlighting and debt survey was surprising.
My Experience with Resident Moonlighting
Why I did moonlighting as a resident
I moonlighted during my senior year in residency. My wife and I were DINKs (Double Income, No Kids) so our lifestyle and spending easily matched our income after we got organized. What changed was my wife was pregnant with our first child and we were planning on having her take maternity leave and possibly stay home full-time. I was starting my one-year fellowship in pediatric anesthesiology, so I had another year of training.
What this meant was a loss of my wife’s income and a slight increase in mine. The sum total of this change was a shortfall of $700/month for the year that I would be in fellowship to maintain our resident lifestyle. ($8,400 for the year.)
What I did for moonlighting as a resident
I worked for an organ procurement company. The company had a coordinator who would be onsite and had a very full job. They would send off labs, help place the donated organs with a recipient, and coordinate getting the anesthesiologists, surgeons, scrub techs, and other support staff to the hospital for the organ harvest.
It was a great job for an anesthesiology resident working as a 1099 employee. I would get a call from the coordinator in charge of the case to see if I was available to provide anesthesia for an organ harvest. If I was available, then I received the flight time for departure. We flew out of a private airstrip that was next to a large airport. The money was great, there was a “cool factor” for commuting to work on a private airplane, and I was helping others receive their organ transplant
This was my first foray into moonlighting and I learned a ton. If I had to boil it down to five things, it would be this:
The 5 Things I Learned from Resident Moonlighting
1. It is work.
You still have to work to earn extra money, no matter how “easy it is”. The real work started when I got to the hospital where the organ harvest would occur. I had to procure medications, check the anesthesia machine, and check the OR to make sure I had my set up. All the “normal” stuff I would do. I then had to meet with the coordinator and triple-check the patient identification with the paperwork.
I was then working with the surgical team in the operating room to make sure the patient’s hemodynamics were stable and the organs were well perfused. Sometimes I had multiple medications on pumps running and infusion blood. I wasn’t sitting on a seat, watching the monitors. It was work and could be stressful. And sometimes this work was done in the middle of the night.
2. It takes time.
I would sometimes receive a phone call from the coordinator at all times of the day. Most of the organ harvests were done late at night or early in the morning on the weekends. This was perfect for a resident, especially if you had a weekend off from call responsibilities. But I was giving up time with my wife, time to study for the boards, and times to relax.
Sometimes I would show up at the airport only to be put on hold for a couple of hours. It reminded me of my paramedic days before medical school where long times of waiting were punctuated by work. Once I took the 10 seater (I think it had about 10 seats) aircraft to my destination, it was time to get to work. I had to procure medications, double-check the paperwork, and prepare the operating room. I would do the case, then get back in the airplane and return with the donated organ to be transplanted.
3. To be successful, you have to add value to your customer.
The coordinators had a list of possible anesthesiology residents and fellows they could use. They would start at the top of the list and work their way down. If they called or paged a resident, and they did not get a response they worked their way down the list. These are the same coordinators who had a whole host of other duties to be doing.
Most residents who put their name on the list either would not pick up the call / return the pager (because they were not on call) or, if they were not available, they would just say “sorry I can’t work”. This would then require the coordinator to go to the next person on the list.
The way to get higher on the list was to say “yes” to the cases, so I approached it a little differently.
- I ALWAYS picked up the phone. I put all the coordinator’s names in my cell phone so that when they called, day or night, I answered the call with their name.
- I told every single one of them that I would either do the case, or I would find someone who could. I knew every residents’ rotation and call schedule (because I was Chief Resident), so if I could not do it, I had a ready list of people who could. Word quickly got around the coordinators that if they called Steiny, it would get done. This got me to the top of the list with the first right of refusal. I earned this because I was willing to provide more value than the other residents. It also meant that I did more organ harvests than anyone else in my residency. I didn’t make the rules, but I made sure I played by them.
4. You need to run a moonlighting gig like a business.
I kept records of all my expenses (including the mileage for the commute to/from my “home office” to the airport or the hospital) so that I could create a Profit and Loss Statement each month. (If I was going to continue to moonlight, then I would have opened a separate checking account, obtained a Taxpayer Identification Number, and perhaps a Professional Association in Texas.)
I had to manage my own estimated taxes because this moonlighting gig was paying me as a 1099 employee. It was a good lesson on how taxes worked and how to minimize taxes.
5. Side Hustles should be a Money (+)
There should be more to side hustles besides just the money. Don’t get me wrong. I was moonlighting because I had a looming cash flow shortfall. What I didn’t expect was what I call the “Money (+)” or earning money plus something else. You have to make the side hustle bigger than just money. It can be about helping others, or learning a new skill, or even having a new experience.
My Money (+) was helping people with their organ transplants. It was pretty cool to be on a team that would procure the organ, then bring it back to town for transplantation.
Another Money (+) was being able to fly in small commuter planes. Most of the planes we flew on were dual prop airplanes and sometimes we would fly on jet airplanes if we had a long-distance or we were recovering a heart for transplant.
It was my first time in this aviation world and it was my Money (+). I was at least smart enough to enjoy the moment when it was happening. It is not often you are commuting home from work, eating dinner in a personal jet airplane while watching the sunset over the horizon. I also happened to be sitting next to a cooler with a heart that was headed to its new home and would truly change someone’s life.
Life was good.
If you are thinking about moonlighting as a resident (or an attending), then check out the second edition of my finance book, which should be released in 2021.
Do you have a money (+) story? Let others know below.