Moonlighting: The Good, the Bad, & the Ugly

I've been really lousy at blogging these past few months and moonlighting has been part of the reason (general laziness has been the other part). Although I think we're really lucky to have the opportunity to moonlight as residents (at least in Alberta), it can take a bit of a toll.

What's moonlighting? It's voluntarily picking up extra call shifts, for extra pay.

i.e. bringing this upon yourself

Residents in Alberta are allowed to moonlight halfway through PGY-2, once they've passed the LMCC MCCQE Part II and have purchased a physician extender license. I started in February and have been keeping pretty busy since.

The Good

The pay. Without a doubt the paycheque is the primary motivation for residents to work extra shifts. A few shifts a month can double your income, which goes a long way to paying off medical school debt. From funding pricey exams to enabling one's partner to be a stay-at-home parent, extender pay has helped many a resident out of a tight corner.

The learning. Not a call shift has gone by where I haven't learned something new. On extenders I've: administered Narcan; dilantin- and dex-loaded for a seizure; managed a dying patient; dealt with a humeral fracture; consulted on an ischemic limb; seen not one but two self-inflicted orbital stabbings -- all experiences that are a far cry from my outpatient oncology day job.

The responsibility. Even though backup is always a phone call away, extender call forces residents to make independent decisions. In smaller hospitals, the resident extender may be the only physician in-house. While that initially terrified me, I can already see that it's made me calmer and more comfortable in dealing with stressful situations.

The variety. From psych to ICU to medicine to surgery there are all kinds of moonlighting shifts available. Residents are for the most part free to dapple in whichever areas they're deemed qualified (i.e. have done rotation(s) in), which helps residents in more specialized programs keep up their general medical skills.

The people. I spend my days in the cancer centre, which although wonderful in many ways is (literally) isolated from the rest of the hospital -- and from the rest of the residents. On most extender shifts I'll cross paths with resident friends from other specialities, which is always nice.

another pro: when it's slow, you get to study (okay...maybe not a real pro)

The Bad

Acclimatizing. You'd think it'd get easier to pick up and switch specialties once that's been the routine every four weeks for three years...but it doesn't. Starting off covering nights and weekends in surgical subspecialties that I'd never rotated through led to a fair number of sleepless shifts. Getting familiar with a new hospital with different charting, staff, and unit protocols is always a little tricky; even more so when you only find yourself there once every couple of weeks. You end up covering wards where you don't know the patients, often having not received proper handover.

The Ugly

No post-call days! Ugh. I think I'm okay at hiding the glazed-eye zombie-ness (fortunately my day job isn't too taxing), but having to get through a ten-hour day with that I-just-want-to-go-home-and-shower grogginess will always suck.

Overall it's pretty clear to me that the good that comes of moonlighting easily overshadows the bad and ugly. It's an awesome opportunity that, if you're like me, might take a little nudge to get into, but will definitely pay off in more than monetary ways.