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Proposal for a Fair and Transparent Moonlighting System

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Moonlighting can be a great source of additional income for resident physicians. In my specialty of radiology, 78% of training programs offer some form of moonlighting opportunity for residents. Among US medical students applying to radiology, 32% considered moonlighting as a factor in ranking programs (ranked 3.5/5 in importance). Today, I want to propose to you a fair and transparent system of managing moonlighting shifts among residents.

Assignment of moonlighting hours:

  • R4 resident (PGY-5) — 50% of total hours
  • R3 resident (PGY-4) — 30% of total hours
  • R2 resident (PGY-3) — 20% of total hours

With the help of a tech-savvy friend, I devised a semi-automated shift scheduler based on Microsoft Excel. This was later ported to Google Sheets for easy online sharing. The scheduler relied on 3 components (images of each below):

  1. Facility Schedule. All moonlighting shifts at each facility are recorded.

2. Resident availability. All resident availability is recorded.

3. Shift scheduler. Incorporates the shift times and resident availability data in one spreadsheet.

The shift assignment process takes 5 steps:

  1. After the shift times are made available, fourth-year residents select their shifts, up to a combined 50% of total hours available.
  2. Third-year residents select their shifts, up to a combined 30% of total hours.
  3. Second-year residents select their shifts, up to a combined 20% of total hours.
  4. If any shifts are still available, it becomes a first come first served situation where any resident can select any available shifts.
  5. If there are shifts left uncovered, they are assigned based on the resident availability spreadsheet.

While this particular system was designed with the needs of a specific set of radiology residents in mind, I believe the process can be easily adopted in other residency programs as well. The key is to make sure everyone participates in the process and to revisit the process periodically for changes/improvements.

Dr. Bo Liu is a resident physician and personal finance enthusiast. He is the founder & editor of the medical finance blog Future Proof MD.

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