How much should I expect to get paid at this moonlighting job?

[MindWizard]

Pgy2 in a big Midwestern city. I'm going to be moonlighting at a therapy clinic. There's about 20 therapists there but I'll be their first and only prescriber. I predict almost all of the cases will be prescribing or switching antidepressants, maybe a few mood stabilizers. I imagine most billing codes will be 90792, for which I believe insurance pays $140-$160. I don't think I'll get paid hourly, I think I'll be splitting % with the owner for each encounter.

Can anyone recommend what I should expect to get paid/ask to be paid?

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[Celexa]

If you're their first and only prescriber, who is covering the patients when you're away? If you're a pgy2 have you even done much outpatient yet? Where did you get that estimate of the patients' acuity from, the non-prescriber therapists (who in my experience have absolutely no conception of what makes a person a simple or difficult med management case, aside from the personality disorders that are tough on everyone they interact with)? This sounds like a terrible idea from the jump... Go find a better paying ED or inpatient gig.

 

[calvnandhobbs68]

If you're their first and only prescriber, who is covering the patients when you're away? If you're a pgy2 have you even done much outpatient yet? Where did you get that estimate of the patients' acuity from, the non-prescriber therapists (who in my experience have absolutely no conception of what makes a person a simple or difficult med management case, aside from the personality disorders that are tough on everyone they interact with)? This sounds like a terrible idea from the jump... Go find a better paying ED or inpatient gig.

Yeah this...does not sound like a good idea. Especially if you're the only doc there. Agree with Celexa, how much outpatient have you even done yet? If a lawsuit comes up, how easy is it going to be for a lawyer to tear you a new one by cross-examining you about how much outpatient training you had before this gig?

The people who did moonlighting in a clinic did so in PGY-3 usually in one of the clinics they were already assigned for their outpatient rotations on the evenings/weekends. I did moonlighting in a suboxone clinic but this was with a couple other doctors already there and I was basically getting paid an hourly rate to see mostly stable maintenance suboxone patients or pretty simple outpatient inductions, but had an addiction medicine attending to bounce questions off of.

If you're gonna be the first person ever prescribing meds there, I guarantee there's gonna be allll kinds of issues they haven't even thought of yet. I agree they probably have a terrible idea of how complex (or needy) their patient population may be from a med standpoint. You're going to have to get paneled with insurance companies independently (which is going to be a huge pain in the ass because they likely will not panel you as a psychiatrist since you aren't board eligible yet). If they don't have someone who has experience paneling physicians for insurance companies (which they probably don't given this setup)...expect this to take forever. Like 6 months. They may not even have any idea what their insurance company pays for E+M codes because regular run of the mill therapists (not neuropsychologists/psychologists who do actual testing) use like 2-3 CPT codes. You're going to have to get E-prescribe capabilities set-up. You're gonna have to figure out how staff is going to relay questions that (inevitably) come up when you're not in clinic and how to respond to these. You're going to have to figure out what happens when you're on vacation, cause you're never really on vacation unless you have coverage in outpatient PP....you'd most likely have to cover yourself by responding to messages that come up on vacation. You need to buy your own malpractice insurance. Along with stuff I'm not even thinking about right now.

By the way, you'd have to be very careful NOT doing any moonlighting related work during normal residency hours or else your program might crack down on you. Your residency program director is also going to have to sign off on said moonlighting and I doubt they'll be thrilled when they hear of this setup.

 

[TexasPhysician]

I’m a huge proponent of moonlighting, but this is a terrible set-up. It could take them 6-12 months to find out that they can’t panel you. The 90792 number thus means nothing. You aren’t ready to open your own practice as a PGY2 which is what this is.

If you are going to moonlight outpatient, you should do so under another physician. This will allow you to bill under insurance and learn outpatient skills from them. Patients are their problem on vacation, hard rotations, etc.

 

[MindWizard]

Good points, thank you, you've given me a lot to think about. To answer your questions, yes, the head therapist was the one that gave me the estimate of patient complexity.

The clinic has a business manager who I will be meeting with this week. They told me they have experience getting doctors paneled with insurance companies, and that it might take a month or so to get set up. They also gave me the option of doing cash payments instead of going through insurance companies.

Despite me being the only prescriber, they tell me that they have an EMR with e prescribing capabilities.

As far as vacation goes, I don't really see how that would be too much of a concern. I will only be working one shift a week, so if I want to go on vacation, they just won't schedule any patients for me. Is there another angle here I'm not considering?

My PD knows about the arrangement and is supportive of me moonlighting if I want to.

One concern I do have is that since they're a therapy clinic, they likely won't have lab values for patients, so I wouldn't know my patients kidney or liver functions before starting a medication.

Thanks for the input

 

[Celexa]

Good points, thank you, you've given me a lot to think about. To answer your questions, yes, the head therapist was the one that gave me the estimate of patient complexity.

The clinic has a business manager who I will be meeting with this week. They told me they have experience getting doctors paneled with insurance companies, and that it might take a month or so to get set up. They also gave me the option of doing cash payments instead of going through insurance companies.

Despite me being the only prescriber, they tell me that they have an EMR with e prescribing capabilities.

As far as vacation goes, I don't really see how that would be too much of a concern. I will only be working one shift a week, so if I want to go on vacation, they just won't schedule any patients for me. Is there another angle here I'm not considering?

My PD knows about the arrangement and is supportive of me moonlighting if I want to.

One concern I do have is that since they're a therapy clinic, they likely won't have lab values for patients, so I wouldn't know my patients kidney or liver functions before starting a medication.

Thanks for the input

Oh lord. You really haven't done any outpatient.

There are no 'shifts' in outpatient. You are responsible for responding to patient calls in a reasonable period of time. And there are so many things patients call about. You can't only be available to respond to calls once a week, or just vanish for two weeks without a coverage plan.

This is a bad idea. Don't do it. I'm shocked your PD is OK with it. They really really shouldnt be.

 

[calvnandhobbs68]

A month is a very…optimistic timeframe to get credentialed with insurance. 3 months is relatively quick.

How much experience could they have if they don’t have a doctor on staff there currently? I suppose this is possible though they could have prior experience.

I don’t know how they’re going to get over the hurdle that you won’t be able to be credentialed independently easily if you’re not board eligible. Have they actually had a resident moonlighting before there?

You are responsible for obtaining and tracking labs. You are correct they won’t know these values…because it’s your responsibility.

As Celexa noted, you are responsible for calls outside hours as well in outpatient.

Also sorry to break it to you but I doubt you’re gonna get many patients paying cash to see a resident.

 

[TexasPhysician]

Good points, thank you, you've given me a lot to think about. To answer your questions, yes, the head therapist was the one that gave me the estimate of patient complexity.

The clinic has a business manager who I will be meeting with this week. They told me they have experience getting doctors paneled with insurance companies, and that it might take a month or so to get set up. They also gave me the option of doing cash payments instead of going through insurance companies.

Despite me being the only prescriber, they tell me that they have an EMR with e prescribing capabilities.

As far as vacation goes, I don't really see how that would be too much of a concern. I will only be working one shift a week, so if I want to go on vacation, they just won't schedule any patients for me. Is there another angle here I'm not considering?

My PD knows about the arrangement and is supportive of me moonlighting if I want to.

One concern I do have is that since they're a therapy clinic, they likely won't have lab values for patients, so I wouldn't know my patients kidney or liver functions before starting a medication.

Thanks for the input

It sounds wonderful, but you aren’t experienced enough to catch all of the lies/problems.

They aren’t credentialing you in 1 month. They may have experience credentialing board eligible psychiatrists, but they don’t have experience with PGY-2’s. I know because it doesn’t happen. Insurances won’t accept you at all.

The counselors have no idea about the med complexities. They aren’t trained to know that.

You are responsible for setting up, ordering, and interpreting lab results. Depending on the clinic you may need CLIA paperwork done for drug screens, etc.

You are responsible for the patients outside of your working shift.

Who is managing complications on days you aren’t there?

 

[docksan]

The biggest thing you're missing is that you're a pgy2..
This is a bad arrangement.

 

[MindWizard]

I have some outpatient experience at a resident clinic that ran pretty smoothly, but not a lot. So again, I appreciate the advice.

I was told that my responsibilities would be for 6 hours, one shift a week. I would do evals and prescribe medications.

I haven't really though about the responsibilities outside of those 6 hours. But now that I'm thinking about it, I'm comfortable taking calls from patients outside of those hours, and comfortable giving advice about complications. I feel like that isn't too hard to handle, especially when having the default line of "if you're feeling bad, go to the hospital."

I was not aware that credentialing a PGY2 would be different than a PGY3, thanks for the heads up, I will be sure to ask the office manager about it.

In regards to labs, my initial thought was to request that patients come with basic labs performed before the initial appointment, but perhaps this is too much to ask the patients?

Again, I appreciate the input. I'm starting to think that this might be more than I can handle, and am leaning towards declining the offer in favor of an ED or inpatient unit...

 

[Orgone]

Good points, thank you, you've given me a lot to think about. To answer your questions, yes, the head therapist was the one that gave me the estimate of patient complexity.

The clinic has a business manager who I will be meeting with this week. They told me they have experience getting doctors paneled with insurance companies, and that it might take a month or so to get set up. They also gave me the option of doing cash payments instead of going through insurance companies.

Despite me being the only prescriber, they tell me that they have an EMR with e prescribing capabilities.

As far as vacation goes, I don't really see how that would be too much of a concern. I will only be working one shift a week, so if I want to go on vacation, they just won't schedule any patients for me. Is there another angle here I'm not considering?

My PD knows about the arrangement and is supportive of me moonlighting if I want to.

One concern I do have is that since they're a therapy clinic, they likely won't have lab values for patients, so I wouldn't know my patients kidney or liver functions before starting a medication.

Thanks for the input

There is so much going wrong here that I'm asking myself if this isn't a troll job.

If you are not a crafty troll ... stop. Cancel your meeting with this "business manager". Your questions and statements show a complete lack of awareness of what you are getting yourself into. Maybe (and that's a big maybe) something like this could be entertained 4th year if you have a light schedule.

I would be astonished if your PD is truly aware of what you are planning. If so I would seriously question their judgement and/or ethics.

I appreciate a "jump in and try for it" mentality as much as anyone. But please note that every response you've gotten, from experienced psychiatrists, is some variation of "WTF?".

If you are desperate for cash, and are in a "big Midwestern city", there should be numerous other more appropriate moonlighting opportunities in a more structure environment, e.g. weekend inpt coverage where there is a separate back-up attending or medical director to help you with the inevitable floundering.

 

[docksan]

Again, I appreciate the input. I'm starting to think that this might be more than I can handle, and am leaning towards declining the offer in favor of an ED or inpatient unit...

Every PGY2 has experience in outpatient clinic in preparation for pgy3, for the most part.

It's not that you can't handle this, it's that the arrangement may be more than you're anticipating it will be.

Who will manage the patients when you're not there?
Are you responsible for crises? Who screens those?
Who takes call?
Who provides the insurance?
Are you just doing intakes? If so, how responsible are you for initial diagnostic impression and medication initiation as the patient evolves in the practice?

You assume full liability and responsibility as a moonlighting physician, you need to keep that in mind. Without a full year of outpatient under your belt, do you really feel comfortable with REMS, Xw, PDMP, and other monitoring needs with these patients, and being potentially responsible for everything beyond that first meeting?

Personally, I would ask myself why this practice wants you to be the sole prescriber for an outpatient panel as a resident. That's a huge red flag in and of itself.

 

[calvnandhobbs68]

I have some outpatient experience at a resident clinic that ran pretty smoothly, but not a lot. So again, I appreciate the advice.

I was told that my responsibilities would be for 6 hours, one shift a week. I would do evals and prescribe medications.

I haven't really though about the responsibilities outside of those 6 hours. But now that I'm thinking about it, I'm comfortable taking calls from patients outside of those hours, and comfortable giving advice about complications. I feel like that isn't too hard to handle, especially when having the default line of "if you're feeling bad, go to the hospital."

I was not aware that credentialing a PGY2 would be different than a PGY3, thanks for the heads up, I will be sure to ask the office manager about it.

In regards to labs, my initial thought was to request that patients come with basic labs performed before the initial appointment, but perhaps this is too much to ask the patients?

Again, I appreciate the input. I'm starting to think that this might be more than I can handle, and am leaning towards declining the offer in favor of an ED or inpatient unit...

Ugh dude you don’t get how credentialling works.

It’s not that the difference is between PGY-2 vs 3. It’s that you aren’t board eligible and haven’t completed a residency program. There’s a difference between being eligible for a full medical license (which I assume you must have gotten if you’re even entertaining this? You have to take Step 3 for this) and being eligible to be paneled for private insurance companies. There is very little chance private insurers will credential you independently if you have not completed a residency program. This is why people who haven’t completed a residency program can’t go do what you’re proposing to do in most states…insurers will never credential them.

 

[comp1]

I've never seen PGY2's doing general outpatient moonlighting. Second (and third, fourth, etc) the above that this is not a good idea. Inpatient is so much better for resident moonlighting. There are nurses and pharmacists checking your work in detail and you aren't expected to change much. If not that, then maybe something like a methadone clinic where policies and procedures are firm and detailed. General outpatient...just no.

 

[MindWizard]

I'm not trolling... I dont have a lot of experience and I'm looking for advice. The practice owner gave us a lecture a while ago and asked if someone might be interested in moonlighting for him. Many of his team's patients need psychiatric care and he was hoping to have someone come to his clinic once a week to evaluate patients and start them on appropriate medications. That way, their patients don't need to wait weeks or month to see a psychiatrist. He has not had any moonlighters in the past. I was approached with this offer and it sounded interesting because I like the idea of getting some exposure to therapy, and he said he would be open to doing some training with me if I wanted.

I'm not exactly strapped for cash, but I would like to make some money, hence the interest in moonlighting. At this point an ED moonlighting position sounds better, but I'm still going to ask my questions about this, because this is an opportunity to learn. I'm not sure why I'm encountering some hostility for asking questions, but thank you to those of you who are giving me answers.

I have gone an bought a malpractice policy for myself. And yes, I have my full license.

I assume that most moonlighters (pgy3s and 4s) are credentialed by insurance companies, right? They also haven't completed a residency program, why would it be easier for them?

Thanks

 

[Celexa]

You say you've done a resident clinic, but it clearly wasn't a clinic where you were responsible for the full spectrum of outpatient work if it didn't even occur to you to ask how patient calls would be covered. So... Either you're in a pgy2 situation with training wheels, or maybe the person speculating you're a troll is right.

Ordering labs on patients you haven't seen and assessed is a liability nightmare. You're establishing a patient physician relationship without an evaluation. Or are you intending to have the pts pcp order them? How would you enforce that? If someone shows up without them, will you terminate the visit? Also you do understand that return visits are generally not coded as 90792, right? What about if the patient needs an ekg?

Circle of life of psychiatry residency: as an inpatient resident you think you know what's what and how hard can outpatient be. Get to outpatient and realize how very much more complicated it is than inpatient.

I don't want to trigger another round of mid-level vs physician here but there's a reason general outpatient is the very worst place for midlevels in psychiatry. It's the same reason it's not a good place for a pgy2 without supervision.

 

[Orgone]

I'm not trolling... I dont have a lot of experience and I'm looking for advice. The practice owner gave us a lecture a while ago and asked if someone might be interested in moonlighting for him. Many of his team's patients need psychiatric care and he was hoping to have someone come to his clinic once a week to evaluate patients and start them on appropriate medications. That way, their patients don't need to wait weeks or month to see a psychiatrist. He has not had any moonlighters in the past. I was approached with this offer and it sounded interesting because I like the idea of getting some exposure to therapy, and he said he would be open to doing some training with me if I wanted.

I'm not exactly strapped for cash, but I would like to make some money, hence the interest in moonlighting. At this point an ED moonlighting position sounds better, but I'm still going to ask my questions about this, because this is an opportunity to learn. I'm not sure why I'm encountering some hostility for asking questions, but thank you to those of you who are giving me answers.

I have gone an bought a malpractice policy for myself. And yes, I have my full license.

I assume that most moonlighters (pgy3s and 4s) are credentialed by insurance companies, right? They also haven't completed a residency program, why would it be easier for them?

Thanks

Hopefully the replies come off more as tough love than hostility. Brutal honesty is needed sometimes. Based on your follow up replies you now seem to me less likely to be a troll. But I reserve the right to alter my opinion should further evidence arise

Starting off in an ED setting would be much better, but even then it's hopefully in a system you are familiar with, or know other residents who have done moonlighting there. ED can certainly be a big liability and headache also if you don't fully know the ropes.

I started moonlighting in outpatient the 2nd half of 3rd year and continued through the end of residency. I also covered a detox unit on the weekends. I'm not sure I would have wanted to start outpatient earlier. And even then, it was at a clinic that had a long history of residents from my program working there. They had full coverage for the times I was not seeing patients. And there was a dedicated medical director who had been one of my senior residents as an intern, so I knew that I had a friendly resource available for when problems came up (preview: they always do!).

 

[SpinDktr]

I have gone an bought a malpractice policy for myself. And yes, I have my full license.

I assume that most moonlighters (pgy3s and 4s) are credentialed by insurance companies, right? They also haven't completed a residency program, why would it be easier for them?

Thanks

1. Insurance companies are willing to take your money. That doesn't mean they can or will cover you; seems risky.
2. Moonlighters (pgy3 and 4) are not usually credentialed like it seems you are thinking. They still need to work under an attending or supervising doctor. Pgy5, fellows, or "board eligible" physicians can be paneled, and I did this when working as a fellow. However, I was supported by an actual clinic and could order labs, or refer to other physicians and specialists. I did this 3 days a week for 3 hours each evening, and could respond promptly or arrange coverage if needed. Our program did not allow moonlighting until 4th year, but I know of some programs that would allow it in the 3rd year. I have never heard of a program allowing it in 2nd year.

The reason people are assuming trolling is that you are new, and that you are asking questions that do have answers in other posts on this site, as well as others. If you are really interested, do some research and come back with questions that show you have put some effort into this other than just talking to the practice owner.

 

[TexasPhysician]

Insurances in the states I’ve worked are not individually credentialing a PGY2, 3, or 4 at all. When I did moonlighting in an outpatient clinic, I had direct oversight from the experienced psychiatrist that owned it. He signed off on all of my notes and was credentialed himself to be able to bill insurance. I was expected to order labs, meds, and coordinate with the billers on proper coding. He was also there to deal with issues when I wasn’t.

Without a supervising board eligible physician overseeing you and being credentialed him/herself, the odds of you being able to bill insurance legally are 0% unless there is a new loophole that I have yet to find.

 

[Stagg737]

Holy bologna this thread...

I haven't really though about the responsibilities outside of those 6 hours. But now that I'm thinking about it, I'm comfortable taking calls from patients outside of those hours, and comfortable giving advice about complications.

How are you going to know when you're getting calls if you're only at the clinic once a week? Are you going to access EMR remotely every day? Provide your clinic your cell number? What happens when you're "off" and a patient has a crisis or when you get 2-3 patients in one day who need to be seen back in 2-4 weeks? Are you going to increase your hours to see them or say "sorry, I don't have space?" Many of these aren't often issues as other psychiatrists cover each other but you'll be flying solo, so there's going to be a much higher burden on you.

I feel like that isn't too hard to handle, especially when having the default line of "if you're feeling bad, go to the hospital."

And what happens if the patient is suicidal, can't get a hold of you for several days, and doesn't go to the hospital. If they make an attempt, do you think it will fly in court that the above is your general policy? What about the patients who are calling you 3-4x per week? Not trying to sound condescending, but are you actually aware of how complex and long these calls can be? It seems like you're very naive about the complexities and intricacies of outpatient work.

Personally, I would ask myself why this practice wants you to be the sole prescriber for an outpatient panel as a resident. That's a huge red flag in and of itself.

DING! DING! DING!

This needs to be the first thing you ask them. Why isn't there an attending psychiatrist working there? For a therapist group this large, they must be capable of hiring an attending, so why are they starting with a PGY-2? My guess is that they either don't want to pay for an attending or they haven't been able to find one willing to work there. Both of which are also red flags. I wouldn't let residents even consider a position like this until they had a full attending on staff, and personally this sounds like something I would also avoid as an attending.

I'm not sure why I'm encountering some hostility for asking questions, but thank you to those of you who are giving me answers.

I don't think we're trying to be hostile. I think a lot of us are genuinely baffled that A) you're considering taking this position with limited experience when it sounds like you really don't know what you're getting into. B) that the hiring group is either so oblivious or seedy that they'd be trying to hire you for this position. and C) that somehow your PD seems okay with this.

Moonlighting can be great, and you will have to take on a certain level of liability yourself no matter what. However, this position is setting you up for failure both as a clinician and in a legal/liability sense. Do NOT take this position unless they can hire a full-time attending or have an affiliation with a psychiatry clinic that can provide full-time coverage when you're not there. You can get the same experience with far less liability in an urgent care/emergent setting or even doing inpatient consults where you see and evaluate patients but don't have the ongoing liability of them being "yours" afterwards.

 

[MindWizard]

Thanks for more advice. It's precisely because I don't have much experience that I didn't know what red flags to look for. Oddly enough, my co residents seemed to think like it was a fine situation as well, so I'm glad I posted here.

Back in my resident clinic, the seniors took all the call, I actually forgot about it entirely since I never took any.

 

[docksan]

Your co-residents are probably the last folks with the self awareness necessary to give you moonlighting advice.

 

[calvnandhobbs68]

I'm not exactly strapped for cash, but I would like to make some money, hence the interest in moonlighting. At this point I assume that most moonlighters (pgy3s and 4s) are credentialed by insurance companies, right? They also haven't completed a residency program, why would it be easier for them?

Yeah, like @TexasPhysician noted above, they are not individually credentialed. What's happening there is that these residents are working in a clinic that is billing under a different NPI. They are not doing solo practice. In the examples I mentioned, those residents were just moonlighting in their assigned outpatient clinic after hours, so I think they were still even just using their training licenses and doing indirect supervision for those patients during their supervision time, the clinics would just use this to expand hours for patients.
The suboxone clinic I did moonlighting at was when I was a fellow, so was board eligible already, and during that time STILL had difficulty with private insurers. Many of those patients were initially private pay who were seeing the addiction medicine attending and switched to me because they were stable but, cause it's suboxone, had to come back every month. I was also a fellow. So a very different situation.

 

[Candidate2017]

As far as vacation goes, I don't really see how that would be too much of a concern. I will only be working one shift a week, so if I want to go on vacation, they just won't schedule any patients for me. Is there another angle here I'm not considering?

My PD knows about the arrangement and is supportive of me moonlighting if I want to.

What the heck?

Your program is failing at it's job to protect its residents (and its ACGME status). There is no way a resident should be allowed to moonlight in a place without an attending boss. Please name and shame. Also, what terrible psychiatry program makes senior residents take clinic call for their juniors?

My other thought is your extremely low awareness of your limitations, and how psychiatry/medicine actually works, is on par with that of an NP. It's basically, "Tee hee, I'll be the sole "prescriber" for some therapists, learn some therapy from social workers, sprinkle some SSRIs and "just" mood stabilizers, increase access to "prescribers", I'll have patients get labs prior to the eval, vacay is no biggie because they won't schedule patients during my vacay, if anything happens they can go see the hospital doctor, I've "done" some outpatient so no biggie, tee hee yaaaay!"

Why would anyone who is 2 years away from earning the equivalent of a Honda Civic every month risk it all to be a "prescriber" for a few dollars for a bunch of social workers? There is so much lack of knowledge and inconsistency here for a PGY2. Didn't an NP recently get banned from this forum?

 

[Merovinge]

What the heck?

Your program is failing at it's job to protect its residents (and its ACGME status). There is no way a resident should be allowed to moonlight in a place without an attending boss. Please name and shame. Also, what terrible psychiatry program makes senior residents take clinic call for their juniors?

My other thought is your extremely low awareness of your limitations, and how psychiatry/medicine actually works, is on par with that of an NP. It's basically, "Tee hee, I'll be the sole "prescriber" for some therapists, learn some therapy from social workers, sprinkle some SSRIs and "just" mood stabilizers, increase access to "prescribers", I'll have patients get labs prior to the eval, vacay is no biggie because they won't schedule patients during my vacay, if anything happens they can go see the hospital doctor, I've "done" some outpatient so no biggie, tee hee yaaaay!"

Why would anyone who is 2 years away from earning the equivalent of a Honda Civic every month risk it all to be a "prescriber" for a few dollars for a bunch of social workers? There is so much lack of knowledge and inconsistency here for a PGY2. Didn't an NP recently get banned from this forum?

I hate how true your post is and I would feel much better if OP was a troll or an NP. I get the uneasy feeling this an actual PGY2 but probably from a less than stellar program, which is actually much more disconcerting.

 

[MindWizard]

Again, not trolling. Maybe there's just a bad overlap of blind spots between myself and the clinic owner. The owner of the clinic hasn't had a moonlighter before, so perhaps they weren't aware of how difficult it would be for me.

I clearly have my own blindspots, thanks for helping point them out. Maybe next time try and do it with a little more civility.

 

[Stagg737]

I hate how true your post is and I would feel much better if OP was a troll or an NP. I get the uneasy feeling this an actual PGY2 but probably from a less than stellar program, which is actually much more disconcerting.

I'm less concerned with the naivety of the resident, as much of what we're talking about isn't evident until you get to PGY-3 year, and far more concerned that there is a PD who knows of this set up and is supportive of it. Wtf

 

[ObsequiousAplomb]

Again, not trolling. Maybe there's just a bad overlap of blind spots between myself and the clinic owner. The owner of the clinic hasn't had a moonlighter before, so perhaps they weren't aware of how difficult it would be for me.

I clearly have my own blindspots, thanks for helping point them out. Maybe next time try and do it with a little more civility.

Again, people really are being civil here. I know it's uncomfortable having people point out personal foibles, but nobody here is being mean to you about it. They're expressing their honest surprise about the situation in a candid manor. I know this sounds condescending, but you'll understand it better during pgy-3 when you get some real psychotherapy experience.

 

[docksan]

Again, not trolling. Maybe there's just a bad overlap of blind spots between myself and the clinic owner. The owner of the clinic hasn't had a moonlighter before, so perhaps they weren't aware of how difficult it would be for me.

I clearly have my own blindspots, thanks for helping point them out. Maybe next time try and do it with a little more civility.

What they want you to do is the equivalent of asking an NP to come in and cover a brand new practice straight out of school with no practical experience in managing outpatient panels. What you fail to see here is that the responsibility of your decision is all on your shoulders as the sole prescriber, moonlight or not, and your lack of experience in this particular area coupled with your not understanding the depth of your limitations is a dangerous ingredient to add to the mix.

I'm like 80% confident zero thought was given by the owner how difficult things would be for you and thought "oh snap an MD who wants to work under contract and has done intakes and prescribing stuff this'll help our practice tremendously". If we're being generous, they may have even considered that your status as a specialist makes you highly valued and they're gambling you'll stay on after residency.

At this level in training, it's just not a safe bet and you're better off on an inpatient gig so you can focus on the real outpatient work in pgy3. Maybe it's an option later? For now, certainly not a good idea and there's just too many red flags to get your feet wet safely.

 

[nexus73]

If you want to moonlight, find a weekend inpatient unit, or a hospital that pays to carry the on-call pager overnight. Or do social security disability exams. DON'T start an outpatient job as a PGY2 with a bunch of therapists. And PLEASE PLEASE stop calling yourself a "prescriber", you're a physician/doctor etc. Prescriber is a b*ll**** term to belittle what you do as just giving the meds.

 

[Merovinge]

I'm less concerned with the naivety of the resident, as much of what we're talking about isn't evident until you get to PGY-3 year, and far more concerned that there is a PD who knows of this set up and is supportive of it. Wtf

Sorry my "less than stellar program" was trying to be civil about the insanity of a PD supporting this. It gives me the impression the PD is taking some easy $$ and spending their time doing something else rather than really understanding what is actually happening here which is a crime to medical education. Makes me want to write a second thank you letter to my PD...

 

[the5thelement]

"My PD knows about the arrangement and is supportive of me moonlighting if I want to."
This is the most fishy out of all this.