Characterizing Moonlighting During Pulmonary and Critical Care Medicine Fellowship

Abstract

Rationale Moonlighting is defined as optional extra work for extra compensation. Moonlighting (ML) during medical training is likely variable among residency and fellowship types and programs. To our knowledge, there have been no studies of ML in Pulmonary and Critical Care Medicine or Critical Care Medicine (PCCM/CCM) trainees therefore we sought to understand the types of moonlighting being performed by current PCCM/CCM fellows, as well as their motivations, and the perceived educational and burnout impacts related to ML. Methods Fourteen academic, university-based PCCM fellowship programs distributed geographically across the United States (U.S.) were recruited to participate in an online survey. Eight of these programs also had CCM fellows, which were included. Due to delays from the COVID-19 pandemic, two programs were unable to participate so twelve programs ultimately continued in the study. Using an iterative process of editing among the authors, focus groups with clinician educators, and cognitive interviewing among fellows, a survey was created that focused on characterizing ML practices. Descriptive statistics were generated to characterize results. Results A total of 258 current PCCM/CCM fellows were recruited and 144 fellows completed the survey (response rate: 59%), from twelve U.S. programs across the U.S. (East: 2;South: 3;Midwest: 4;West: 3). Respondents were predominantly in PCCM fellowships (87%). The majority of all respondents were second-year fellows or higher (72%). More than half of respondents (54%) had participated in ML while in fellowship, predominantly providing critical care (82%). A minority of respondents had no interest in ML (9%). Among those that did moonlight, it frequently occurred at a different hospital from their training hospital (53% of respondents). The most common motivations were financial (97%), gaining extra clinical experience (72%), and practicing with more autonomy (56%). A majority agreed or strongly agreed that ML increased their confidence as a physician (89%), and helped establish professional identity (62%). However, a majority also reported that ML worsened sleep hygiene (70%) and reduced time or energy spent on personal activities (56%). Despite this, 100% stated they would do it again or recommend ML to a colleague. Conclusion Moonlighting among trainees in academic PCCM/CCM fellowship programs is a common activity. Fellows generally find ML a positive experience. Although motivated primarily by extra compensation, they note ML offers additional educational value to their training. Moonlighting might also contribute to symptoms of burnout. More research is needed to understand the impact of moonlighting on PCCM/CCM fellows.