GME Policy on Moonlighting

I. PURPOSE

To provide a framework for approval and conditions for participation in moonlighting activities by Residents and Fellows in Graduate Medical Education programs sponsored by New York Medical College (“NYMC” or the “College”).

II. POLICY

During residency and fellowship training, the Resident's or Fellow’s primary responsibility is the acquisition of competencies associated with their specialty.  Because of this focus, moonlighting is generally discouraged. Residents and Fellows may only participate in moonlighting activities in accordance with NYMC and program policies.

III. SCOPE

This policy applies to all ACGME- or CODA-accredited or recognized programs sponsored by NYMC.

IV. DEFINITIONS 

Resident refers to any person enrolled in a residency program accredited by the ACGME or CODA and sponsored by NYMC.

Fellow refers to any person enrolled in a fellowship program accredited by the ACGME and sponsored by NYMC. 

ACGME is the Accreditation Council for Graduate Medical Education.

CODA is the Commission on Dental Accreditation.

DIO is the Designated Institutional Official. 

GMEC is the New York Medical College Graduate Medical Education Committee.

Hospital refers to the hospital or other clinical site employing residents or fellows.  

Moonlighting is voluntary, compensated, medically related work performed beyond a resident’s or fellow’s clinical experience and education hours and additional to the work required for successful completion of the program.  The work may be clinical or nonclinical work performed in the role of a physician or dentist.

External moonlighting is voluntary, compensated, medically related work performed outside the site of the Resident’s or Fellow’s program, including the primary clinical site and any participating sites. 

Internal moonlighting is voluntary, compensated, medically related work performed within the site of the Resident’s or Fellow’s program, including the primary clinical site and any participating sites.

Good Academic Standing indicates that a Resident or Fellow is demonstrating expected competencies for their level of training, as determined by the program director, is not currently on remediation or probation, and has not been subject to disciplinary action during their time in the program.

V. PROCEDURES

A. Residents and Fellows may not be compelled to engage in moonlighting for any reason.  

B. Each program must have a program-specific moonlighting policy that must be reviewed and updated as needed at least every two years.

1. Programs may prohibit moonlighting.
2. PGY-1 Residents and Residents and Fellows on J-1 visas may not moonlight.
3. Residents and Fellows may request prospective approval to participate in a moonlighting assignment.  Such requests must be made in writing or on the form provided by the program according to the program policy.
4. Approval or disapproval of moonlighting requests are at the sole discretion of the program director.  
5. The Program Director may approve a moonlighting request if all the following conditions are met:

a. The responsibilities of the moonlighting assignment are clearly delineated in writing;
b. The Resident or Fellow is in Good Academic Standing;
c. The Resident or Fellow is fully licensed for unsupervised, independent medical practice in the state where the moonlighting will occur.  Documentation of the medical license must be provided to the program; and
d. The Resident or Fellow has procured professional liability (malpractice) insurance (including "tail" coverage).  Documentation of the professional liability coverage must be provided to the program.

6. Permission to moonlight may be withdrawn by the Program Director in writing at any time.

C. Moonlighting assignments may not be used to satisfy any program requirements and may not be counted for elective or other rotation credit.

D. Moonlighting hours must be logged according to program policies and must be included in ACGME, state, institutional, and program clinical and educational work hour limitations.

1. A Resident or Fellow approved for a moonlighting assignment must submit the planned moonlighting schedule to the program in advance and promptly alert the program to any changes in the planned moonlighting schedule.
2. Resident and Fellow moonlighting requests will not be prioritized for a program’s clinical scheduling over other Resident or Fellow scheduling requests, as per program policies and protocols.

E. A Resident’s or Fellow’s performance in the training program will be monitored by the program director for the effect of moonlighting on the Resident’s or Fellow’s ability to participate in program activities, on their level of fatigue, and on their ability to provide safe patient care. Adverse effects will lead to withdrawal of permission to engage in moonlighting. Monitoring is based on review of completed evaluations, faculty feedback, and Clinical Competency Committee assessments.

F. The NYMC GMEC may vote to disallow a program from permitting moonlighting for a specified period of time due to concerns of program adherence to clinical and educational work hours requirements, adherence to ACGME or CODA requirements, or other significant concerns regarding program quality or the clinical learning environment.

G. The NYMC GMEC may vote to disallow all sponsored programs from permitting moonlighting.

VI. EFFECTIVE DATE

This policy is effective immediately.

VII. POLICY MANAGEMENT

Executive Stakeholder: Dean of the School of Medicine
Oversight Office: Office of Graduate Medical Education