CHAPTER 3

Every little bit helps!

Residency is an apprenticeship model that artificially pays below-market rates in exchange for your training. It is designed to cost the hospital very little, and teach you to become a fully licensed whatever-ologist. It is not a get-rich quick scheme, and your take-home pay, especially combined with an expensive city, a spouse with loans, or kids. In fact, at times you may feel truly poor.

Fortunately, there is a bit of a silver lining. There are plenty of opportunities for you to make some extra money during your residency! Just remember that your main goal is to become a great doctor, and you should try not to let your side hustles get in the way of that. Here are some great options for socking away some extra cash.

Moonlighting

This is by far the most significant potential for extra income during residency. Moonlighting (as in you work all day, then you work at night for more money) consists of any clinical work that you do outside of your residency training. In almost all circumstances, you have to be fully licensed to practice medicine in order to do any extra clinical work. Depending on where you live, this likely will be after at least one or two full years of training (sorry, interns!).

There are two different types of moonlighting: supervised and unsupervised. Supervised moonlighting is any scenario in which you still have an attending as the physician-of-record. This might include any of the following:
Working extra shifts in the ED
Taking a mid-level provider shift
Working on a related service such as the ICU
Working in an observation unit
Working in an urgent care

Generally,supervised moonlighting work will not pay as well as unsupervised, but it is less responsibility. You don’t have the stress of acting as the final decision maker when you aren’t yet fully trained. Your wages will seem great in comparison to what you are making as a resident, but will likely be less than half of what you’d make as an attending. Depending on the rules of your residency, it is certainly possible to double your annual income with these types of shifts, but it will add 3-5 days of work to an already stressful residency schedule, and you’ll need to remain in compliance with ACGME duty hour regulations.

Unsupervised moonlighting work is a scenario where you are working as the de facto attending-of-record, despite still being a resident. This type of moonlighting is only legal if you have a full and unrestricted medical license. Some programs will not allow you to perform unsupervised moonlighting, as it is challenging and potentially risky. You will be taking full responsibility for your patients, including disposition decisions and procedures. It can be a wonderful learning opportunity, but you will do it alone. A major benefit is the money- you will make close to the hourly amount of an attending. However, you are alone. You are not done with your training, yet you are making the same decisions as a fully trained attending. You may run up against situations you don’t know how to deal with, or even get sued for malpractice. We’re not saying that you can’t do it (if it’s allowed), but this type of moonlighting is not for the faint of heart.

Getting Your License

In order to pursue any type of moonlighting, you will need to get your full medical license. The instructions and cost vary from state to state, but here is the general breakdown of what steps you’ll need to take, along with the price range for each.

License Fee: Varies from $75-$1,300. Good for 1-3 years.
Federal DEA number: Required to prescribe any restricted substances. Current cost= $731.
State restricted drug license: Requires in many states; cost varies but can be a few hundred dollars every few years.
Final Step Exam: Required before obtaining your full license, one time cost of nearly $900.
Other minor fees: Getting copies of your diploma from your medical school, getting your federal physician masterfile verification, $20-50.

This adds up to about $2,000-$2,500, so obtaining your full license is definitely an investment. We’d recommend having a specific plan and opportunity lined up for moonlighting, as there is no good reason to obtain your full license during residency unless you plan to make this money back on extra clinical work.

Nonclinical Side Hustles

We have plenty of great ideas for nonclinical side hustles that won’t cost nearly as much to get started, if moonlighting sounds like too much of a hassle and expense. But to read those, you’ll have to check out Chapter 3 of our book, Advanced Wallet Life Support: How to Resuscitate Your Finances (And Your Sanity) During Medical Training.

Remember, your ultimate goal is to become the best doctor you can, which is a great investment in itself. No side job that gets in the way of this goal is worth it. A good rule is that unless it nets you at least $50/hour and grants you a skill or accomplishment you can add to your CV, a side job isn’t worth taking. Make sure you take time for yourself, your own wellness and sanity, and for those you love.