UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

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Internal Medicine residents may elect to moonlight, both internally and externally, as long as the following requirements are met.
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Department of Medicine  

ASSOCIATE CHAIR for EDUCATION MEMORANDUM

September 30, 2005   Policy on Moonlighting     I.                    PURPOSE:   To specify the conditions under which residents in the Internal Medicine Residency Program may work outside of the residency training program or moonlight.   II.                BACKGROUND:   The Residency Program in Internal Medicine is a full time educational endeavor. Actual work hours are now carefully regulated with the ACGME requirements on duty hours, effective July 1, 2003. By these ACGME requirements, θ       Duty hours must be limited to 80 hours/week averaged over a 4 week period, θ       Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4 week period, inclusive of call θ       Adequate time for rest and personal activities must be provided; this should consist of a 10 hour time period between all daily duty periods and after in-house call. θ       Continuous on site duty including in house call must not exceed 24 consecutive hours; residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics and maintain continuity of medical care.   Actual duty hours worked by internal medicine residents at UCSF vary depending upon the rotation, the hospital, level of training. The current system for monitoring duty hours has residents self reporting their hours while on their rotations. From this data, certain rotations such as inpatient ward rotations generally are reported as having duty hours close to the maximum allowed by the ACGME rules. Other rotations including ambulatory block rotations and electives never have had reported duty hour violations.   There are 2 forms of moonlighting; internal and external moonlighting.   θ       Internal moonlighting is defined as extra work for extra pay performed at a site that participates in the residents training program. This activity must be supervised by faculty and is not to exceed the level of clinical activity currently approved for the trainee. While performing internal moonlighting services, residents are not to perform as independent practitioners. Internal moonlighting hours must be tracked and recorded in the DOM duty hour tracking system and when combined with the normal duty hours, must not violate the DOM duty hour rules. θ       External moonlighting is defined as work for pay performed at a site that does not participate in the residents training program. External moonlighting hours must be documented (including days, hours, location, and brief description of type of service(s) provided in order to comply with Medicare reimbursement requirements for GME. For external moonlighting, the trainee is not covered under the Universitys professional liability insurance program as the activity is outside the scope of University employment. The trainee is responsible for his/her own professional liability coverage (either independently or through the entity for which the trainee is moonlighting), DEA licensure, Medicare (or other governmental) provider number and billing training, and licensure requirements by the California Medical Board and any other requirements for clinical privileging at the employment site.   It would be the preference of the Program that residents did not have to work outside of their residency or moonlight but it is also readily recognized that many residents have significant economic issues. With this in mind, the Internal Medicine Residency Program does allow residents to moonlight both internally and externally but does have certain conditions and requirements that must be met.     III.             POLICY AND PROCEDURES:   Internal Medicine residents may elect to moonlight, both internally and externally, as long as the following requirements are met. It is not required that residents moonlight.   1. A resident must obtain written permission from the Program Director if he/she wishes to moonlight. The resident should use the internal and/or external moonlighting form depending upon the type of moonlighting he/she wishes to do; both forms are available on the UCSF Department of Medicine website. 2. A resident wishing to moonlight must ensure that moonlighting activities are not adversely affecting his/her ability to achieve the goals and objectives of the educational program as well as does not cause fatigue so as to interfere with patient care or learning. 3. A resident must not moonlight when he/she is working on a ward rotation. 4. If excessive fatigue is noted by the residents supervisors and confirmed by the Program Director and moonlighting is felt to be a contributing factor to the fatigue, permission for moonlighting will be withdrawn. 5. A resident who is moonlighting must track and report those days and hours as well as include a brief description of the clinical activity on a monthly basis to the Program Director or designee. a. If the moonlighting is internal, the resident must enter the hours into the residency duty hour tracking system. These hours, when summed with the residents regular duty hours, must be compliant with the DOM duty hour rules. b. If the moonlighting is external, the duty must be reported monthly on the External Moonlighting reporting form.   Violations of the Moonlighting Policy can lead to Departmental disciplinary action.     IV.              SCOPE:   The Department of Medicine training programs comply with the ACGME common program requirements, the Internal Medicine Residency Review Committee program requirements for residency education in Internal Medicine as well as the policies of the UCSF Graduate Medical Education office. This policy applies to all residents during their rotations at any of the 4 teaching sites (Moffitt/Long Hospital, San Francisco General Hospital, San Francisco Veterans Affairs Medical Center and Mt Zion Hospital and Clinics) or other affiliated rotations.   V.                 REFERENCES:. 1.      ACGME Program Requirements, both Common Program Requirements and Requirements for Residency Education in Internal Medicine 2.      UCSF GME Moonlighting Policy (September 2004) 3.      If there are any questions regarding this policy, the Associate Chair for Education can be contacted at [email protected] or 502-5366

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