Malpractice insurance for moonlighting residents

Report non-compliance

Residents can report non-compliance with residency work hours to the Department of Graduate Medical Education or ACGME.

Contact Ann Dohn, GME Director, at 723-5948 if you have any questions about duty hours or outside commitments.

External Moonlighting

• Residents are not required to engage in “moonlighting.”
• All Residents engaged in external moonlighting must be licensed for unsupervised medical practice in California or the state in which the moonlighting occurs.
• Stanford’s malpractice insurance will not cover Residents for moonlighting activities.
• Residents must obtain written acknowledgement that their Program Director is aware and approves of any moonlighting activities before any moonlighting activity is undertaken.
• A copy of the written acknowledgement will be kept in the Resident’s file.
• The Program Director has the discretion to decline to approve moonlighting activities if he/she believes that such activities will interfere with the Resident’ s training progress or for other legitimate reasons.
• All external moonlighting must be logged into MedHubas work hours.

Internal Moonlighting

Internal moonlighting Residents are not expected to respond to pages/telephone calls from patients who are seen/operated on at outside hospitals where they do not rotate.

• Moonlighting is not permitted for: 
  • trainees under a J-1 visa 
  • active military trainees.
  • PGY-1 residents

Follow this process to request moonlighting duty hour entry in Medhub:

1. Log in to https://stanford.medhub.com
2. Select “Moonlighting Request Forms” on the left of the home page
   1. Pending requests are listed
3. Select “Submit New Moonlighting Request”
4. The following parameters are approved for all house staff
   1. Location: SHC
   2. Description: any additional details you can add to justify request
   3. Type: Internal
   4. Start date: today (date of submission)
   5. End date: End of your training period in 2023 for example 5/31/23
   6. Max weekly hours: 20
   7. Files: none required
5. Select “Submit”
   1. Trainee can now see pending request in list
6. Program director will get notification of request – approval or revision requested
   1. PDs see this tutorial on approval in Medhub https://community.medhub.com/community/tutorial_standalone.mh?tutorialID=120
   2. Trainee can revise and resubmit in pending list
7. GME office will approve
8. Be sure to select “Moonlighting” dropdown option when entering these duty hours. 

Where to Get Liability Coverage for Moonlighting

Many top-rated medical liability insurance companies also write moonlighting malpractice insurance, with rates varying by state and specialty. However, for residents the good news is that most carriers consider them as "new to practice," which gets them a discount -- often 50% off the normal rate for a first-year claims-made policy.

In fact, if a resident chooses to stay with the same liability insurance carrier after residency, many of the carriers will waive the tail payments from the moonlighting policy (in effect turning it into an "occurrence" policy) and still give a new-to-practice discount the first year out of residency. (For more information on the different types of malpractice coverage, see "Your Malpractice Adviser: You Think You're Covered, but You're Not")

If you're a resident who chooses not to stay with the same carrier, then you may be able to get a tail policy payable over 2 years in quarterly installments. This varies from carrier to carrier, so be sure to ask ahead of time whether the option to make tail payments via installments is available.

Claims-made insurance policies are generally written for 1 year and can be cancelled at any time. Most carriers will not charge a cancellation penalty, but confirm this in advance. For some residents, trying to balance the hours of residency and moonlighting may be too demanding, so it's good to know that you won't be penalized if you decide to cancel the policy'.

Not Just for Younger Doctors

Older physicians should also purchase moonlighting liability insurance for work outside their normal practice (eg, a family physician who works weekends in an urgent care center). In this case, the doctor isn't eligible for the new-to-practice discount but can qualify for a part-time discount (nonsurgical only). These physicians can add the moonlighting to their existing policy as a rider, although many choose to purchase a separate, part-time policy to keep the potential liability exposure of the sideline work off their main policy.

When choosing either an occurrence or a claims-made policy, there are several important factors to consider. For example, as mentioned earlier, some institutions only offer claims-made policies. To ensure that you're getting the best guidance and advice on 'the best policy for your moonlighting situation, check with a licensed and experienced liability consultant.

Moonlighting is a privilege for residents, and a potential godsend for older doctors who are still in debt. Therefore, understanding ways to protect against exhaustion, unnecessarily stressful circumstances, or medical liability is important to ensure your well-being.

Residents should check with their program directors about residency-specific guidelines on moonlighting, because every program is different. Group practices may also have restrictions on how much their partners or salaried doctors can earn outside of the group setting, so they would be wise to ask about this before taking on extra hours.

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