Description of University at Buffalo Graduate Medical Education’s (UB GME) moonlighting requirements, including eligibility, resident/fellow responsibilities, program director responsibilities, and applicable requirements.
The following definitions are from the ACGME Glossary of Terms.
Moonlighting: Voluntary, compensated, medically related work performed beyond a resident’s or fellow’s clinical experience and education hours and additional to the work required for successful completion of the program.
External Moonlighting: Voluntary, compensated, medically related work performed outside the site of the resident’s or fellow’s program, including the primary clinical site and any participating sites.
Internal Moonlighting: Voluntary, compensated, medically related work performed within the site of the resident’s or fellow’s program, including the primary clinical site and any participating sites.
Internal Moonlight is further defined by UB GME as clinical duties within a residency program, or for a subspecialty fellow within the subspecialty program, or within the core specialty program previously completed by the fellow.
This policy: applies to residents/fellows in UB-sponsored, ACGME- and CODA-accredited training programs; is compliant with ACGME and New York State Department of Health (NYS DOH) requirements and regulations; is published on the UB GME website; and is available for review by residents/fellows at all times.
- The UB GMEC and the UB-sponsored GME programs are responsible for ensuring a high-quality learning environment for residents/fellows, notably by ensuring a proper balance between education and service within the work hours standards set by the ACGME and NYS DOH. During training, the resident’s/fellow’s primary responsibility is the acquisition of competencies associated with their specialty.
- Moonlighting must not interfere with the ability of the resident/fellow to achieve the goals and objectives of the ACGME- or CODA-accredited educational program, and must not interfere with the resident’s fitness for work nor compromise patient safety.
- Moonlighting is strictly prohibited during scheduled work hours.
- The University at Buffalo and its residency/fellowship training programs are not responsible for supervision of residents/fellows while performing external moonlighting activities (see Internal Moonlighting section, below, for supervision information regarding internal moonlighting).
- Program Directors may choose to prohibit moonlighting by all residents/fellows in the program.
- Obtain the advance written approval of the Program Director prior to engaging in any Moonlighting activities.
- Abide by all applicable work hour requirements and regulations (See Clinical and Educational Work Hours Policy)
- Log work hours in the Residency Management System (RMS) as instructed by the Program Director
- Obtain and maintain professional liability insurance coverage while engaging in any external moonlighting activities ( external moonlighting duties are not covered under the professional liability insurance arrangements for residency/fellowship program activities)
- Obtain and maintain a license as a physician or other health professional for unsupervised practice in the state where external moonlighting occurs while engaging in any external moonlighting activities
Failure to adhere to this policy may result in the dismissal of the resident/fellow from the program, in accordance with UB GME’s Academic Action and Misconduct policies.
- Ensure that residents/fellows are not required to engage in moonlighting
- Monitor the effect(s) of moonlighting on resident performance
- Permission for a resident/fellow to moonlight may be withdrawn if adverse effects are noted
- Provide, and maintain in the resident’s/fellow’s file, advance written approval for the resident/fellow to moonlight in accordance with this policy
- Ensure that resident/fellow schedules, inclusive hours engaged in moonlighting, are compliant with all relevant work hour requirements and regulations (See Clinical and Educational Work Hours Policy)
The impact of moonlighting activities on individual and aggregate resident performance should be assessed by the program’s Clinical Competency Committee (CCC) and Program Evaluation Committee (PEC), respectively.
UB GME programs may develop program-specific policies which govern Internal Moonlighting and these program-specific policies may be more restrictive than this institutional policy.
Without compromising the goals of resident training and education, a program director may allow a resident to engage in Internal Moonlighting if all the following conditions are met:
- Participation in Internal Moonlighting is entirely voluntary on the part of the resident or fellow; no trainee can be required to participate in Internal Moonlighting.
- Internal Moonlighting may only occur in clinical settings in which the resident has previously satisfactorily performed assigned duties in the program.
- While performing Internal Moonlighting, the resident must be under the same level of supervision as other residents assigned to those clinical duties would receive. That supervision must be consistent with the level of supervision mandated by the ACGME specialty-specific program requirements for an intermediate or advanced resident in that clinical setting.
- The resident is in good standing within their program.
- Internal Moonlighting is not used as a form of remediation for any resident deficiency in clinical skills.
- Advance approval by the program director is required for assignment of any resident to any Internal Moonlighting.
- Internal Moonlighting must not replace any clinical experience that is integral to the resident’s training program.
- Internal Moonlighting must not interfere with the resident’s/fellow’s ability to achieve the goals and objectives of the residency program.
- Internal Moonlighting must not place the resident in jeopardy of violating any accrediting body requirements or NYS DOH regulations.
- All hours that a resident spends in Internal Moonlighting must be reported as work hours in the RMS and on any Institutional or ACGME survey.
As Internal Moonlighting occurs in the context of the program with the same level of supervision as regular assigned programmatic duties and at active training sites (i.e., Program Level Agreement), these additional duties are covered by each resident’s existing medical malpractice coverage. Furthermore, as Internal Moonlighting entails no activities outside of the scope of the resident’s assigned clinical duties and is under the supervision of a licensed physician with the same level of supervision as regularly assigned programmatic duties, full New York State medical licensure is not required.
ACGME Institutional Requirements effective 7/1/2022 (IV.K.1.- IV.K.1.d)):
- Moonlighting: The Sponsoring Institution must maintain a policy on moonlighting that includes the following:
- residents/fellows must not be required to engage in moonlighting; (Core)
- residents/fellows must have written permission from their program director to moonlight; (Core)
- an ACGME-accredited program will monitor the effect of moonlighting activities on a resident’s/fellow’s performance in the program, including that adverse effects may lead to withdrawal of permission to moonlight; and, (Core)
- the Sponsoring Institution or individual ACGME-accredited programs may prohibit moonlighting by residents/fellows. (Core)
ACGME Common Program Requirements (Residency) effective 7/1/2022 (VI.F.5.- VI.F.5.c)):
- Moonlighting
- Moonlighting must not interfere with the ability of the resident to achieve the goals and objectives of the educational program, and must not interfere with the resident’s fitness for work nor compromise patient safety. (Core)
- Time spent by residents in internal and external moonlighting (as defined in the ACGME Glossary of Terms) must be counted toward the 80-hour maximum weekly limit. (Core)
- PGY-1 residents are not permitted to moonlight. (Core)
Established: 1996
Reviewed by GMEC: 07/96; 11/01; 02/02; 05/02; 09/03; 01/08; 01/10; 01/13; 06/17; 03/18; 10/21; 05/22; 1/25