Many physicians use “moonlighting”—taking on extra clinical work outside of primary employment— to accelerate debt repayment, save for a down payment or boost their retirement savings. Some opt to take on the extra work while they’re still a resident, a decision that comes with its own benefits and challenges.
Residency is notorious for its grueling combination of low salary, long hours and high-stakes training. Many residents feel that they get paid a fraction of what their skills command in the open market—while contending with student loan debt—so the financial rewards of moonlighting can be attractive. However, residents face strictly regulated work hours, licensure limitations and the sheer exhaustion of their primary training programs.
The decision to moonlight is a question of whether the extra income is worth the extra fatigue, and whether it’s possible to balance a side job without jeopardizing your standing in your program. Here’s what residents should know before taking on extra work:
Who is eligible for moonlighting as a resident?
Before pursuing moonlighting opportunities, you need to determine if you are permitted to moonlight. First, check your contract. Some programs have a blanket ban on moonlighting regardless of your year or academic standing.
Eligibility varies significantly by specialty, postgraduate year (PGY) level, state licensure laws and the specific policies of your residency program.
The Accreditation Council for Graduate Medical Education (ACGME) has rules surrounding moonlighting. In practice, most residency programs prohibit PGY-1 residents from moonlighting, even though the ACGME leaves the decision to individual programs. The rationale is that the first year of training requires full focus on developing core competencies without the distraction or fatigue of outside work.
For PGY-2s and above, moonlighting is permitted with caveats. Typically you must:
- Be in good academic standing with your program
- Have the approval of your program director
- Hold the appropriate license for independent clinical practice in your state (which many residents don’t obtain until their second or third year, depending on state laws)
- Adhere to the 80-hour work week limit (moonlighting hours count toward this cap)
Residents who are eligible can take on two types of clinical work: internal or external moonlighting.
Internal moonlighting occurs within your residency institution. It might involve covering extra shifts, such as supervised ICU or night coverage, or picking up cross-coverage duties depending on specialty and PGY level. These are often easier to get approved because you are already credentialed and using a familiar electronic medical record (EMR) system.
External moonlighting involves working at an outside hospital or clinic. While often more lucrative, it requires separate credentialing, malpractice insurance (if not provided) and a full medical license.
Why do residents seek moonlighting opportunities?
Physicians often have a heavy workload, as highlighted by one otolaryngologist on Sermo. “It’s hard for me to get a good work life balance…and that seems to be the case for most doctors,” they write.
Still, some practitioners decide that the advantages of taking on even more outweigh the downsides. In a poll of the greater Sermo community, members most commonly (41%) cited extra income as the main benefit of having a side hustle, followed by improved skill set (21%). A community discussion reveals that some Sermo members moonlight on average three to four times per month, while others take on extra shifts more frequently.
For residents in particular, their motivations usually boil down to financial necessity and professional curiosity.
High debt and low income
As a resident you have an MD or DO behind your name, but your earnings may still be lower than your level of training and responsibility would suggest. In the U.S., residents often carry massive student loan debt—in many cases exceeding $200,000—while the average first-year salary is about $60,000. Moonlighting can help residents cover their cost of living, especially in expensive urban centers.
Supplemental income can reduce reliance on consumer debt (like credit cards) to pay for unexpected expenses. It allows residents to begin saving, investing or paying off loans, which one oncologist on Sermo highlights as an advantage: “Financial health maybe is the biggest challenge for many professionals in any area.”
Skill diversification
Side gigs can build skills you might not sharpen in your primary program. For example, a gig in a rural ER might force you to be more independent than you are in your academic medical center.
Low-risk career exploration
Moonlighting provides a controlled way to try out other specialties or practice settings. For instance, if an internal medicine resident is considering a hospitalist fellowship, picking up shifts as a nocturnist can confirm if that lifestyle suits them. Through moonlighting, you can explore urgent care, telemedicine or other paths before committing post-residency.
Pros of moonlighting during residency
Deciding to moonlight is a balancing act. You are weighing financial relief against physical and mental exhaustion. Here is a breakdown of the positive aspects:
Increased earnings without delaying training
The most obvious benefit is the paycheck. Residents can significantly boost their annual income by working a few extra shifts a month. This liquidity can help fund weddings, down payments or childcare. The average salary for moonlighting physicians in the U.S. is $105 per hour, according to ZipRecruiter data. “Paid a lot of bills with that money,” a pain medicine doctor on Sermo recalls of their experience moonlighting during residency. “Paid for my wife’s princess wedding completely,” an OBGYN and Sermo member adds.
Real-world clinical responsibility in a controlled setting
Program-approved moonlighting under ACGME rules does not eliminate supervision, but it often places residents in care settings that differ from their primary training environment. Depending on institutional policy, residents may function with graduated autonomy while still having an attending physician available, either on site or on call. These roles frequently involve independent triage, cross-coverage and decision-making for common acute issues—experiences that may be less emphasized in subspecialty-heavy or academic rotations. “I thought moonlighting was the most valuable learning experience that I had during residency,” an internist on Sermo notes.
Opportunity to explore different scopes of services/settings
If you have trained exclusively in a quaternary academic center, you might not know what community medicine looks like. Moonlighting exposes you to different patient populations, resources and hospital cultures. One family medicine doctor on Sermo shared that they moonlighted at an urgent care facility, an emergency room and a private practice throughout their time as a resident.
Flexible, short-term work options
Unlike your residency schedule, which is set in stone, moonlighting is usually voluntary. You can work as much or as little as you want (within ACGME limits). If you have a light rotation, you can pick up shifts; if you’re in the ICU, you can pause.
Improved marketability post-residency
Having documented independent clinical experience through approved moonlighting on your CV before you graduate looks excellent to recruiters. It shows you are capable of independent practice and proactive.
Cons of moonlighting during residency
While moonlighting can benefit residents, the extra work has potential negatives.
Risk of burnout and fatigue
Residency is exhausting. Burnout is a real threat to patient safety and your own mental health, as noted in one 2022 study published on ScienceDirect. Among 347 residents surveyed in the study, 42.4% reported feeling burnt out with high emotional exhaustion. Adding extra work hours through moonlighting cuts into sleep, relaxation and study time.
Potential conflicts with residency program
If your moonlighting affects your performance in your primary program—if you are late, tired or unprepared—your program director can revoke your moonlighting privileges. Your primary duty is your main training.
Risk of malpractice early in your career
When you moonlight externally, you are often working independently. If a negative outcome occurs, you are the physician of record. That’s why residents need malpractice insurance for moonlighting. While your residency covers you for your training duties, it generally does not cover external moonlighting. You must ensure adequate malpractice coverage is provided. If coverage is claims-made, confirm whether tail coverage is included.
Where to find moonlighting opportunities as a resident
So, you’ve decided the pros outweigh the cons. Here’s where to find moonlighting gigs:
- Internal hospital postings: ask your chief residents or program coordinator about internal shifts. Hospitals often list these on internal boards or email them out to staff.
- Affiliated teaching hospitals: many residency programs rotate through multiple hospitals (e.g., the VA or a community hospital). These affiliates often prefer hiring residents they already know from rotations. “…during fellowship I continued to moonlight at the affiliate and therefore I was forced to keep up my IM skills, which was good,” one gastroenterologist shares of their time moonlighting at an affiliate.
- Staffing and locum agencies: staffing and locum agencies exist specifically to fill temporary spots. While some require you to be board-certified, others place senior residents in urgent cares or rural ERs.
- Peer networks: ask your seniors. Outgoing PGY-3s often pass down moonlighting gigs to trusted juniors.
- Sermo: as a medical social media community, Sermo is a powerful tool for networking. You can connect with peers in your specialty or region to ask about local opportunities and get the details on which facilities are resident-friendly.
6 moonlighting opportunities for residents
Not all side gigs are created equal. Here are the most common clinical options well-suited for residents.
Internal moonlighting (hospital shifts)
This is the safest and most commonly approved option. It involves picking up extra shifts within your home institution. You might cover ICU nights, handle floor cross-coverage, or manage admissions. Some advantages to internal moonlighting: you know the EMR, you know the nurses and malpractice is usually covered by your GME office.
External hospitalist/nocturnist shifts
You can work shifts at a different hospital as a hospitalist or nocturnist. This work is typically limited to senior residents (PGY-3+) who hold a full state license, and requires explicit PD approval and malpractice coverage.
Rural emergency departments
Some rural hospitals rely on senior residents to staff their emergency departments (EDs) under a defined scope. These roles can be high-demand environments with limited supervision, and are generally not suitable for early trainees.
Locum tenens work
Locum tenens (filling in temporarily) can be lucrative. Eligibility depends heavily on your residency program’s rules. While you typically cannot work locums in the early stages, some programs allow it in the final six months to a year. It is a very common option for those who have completed residency but aren’t ready to sign a permanent contract.
Ambulatory and outpatient care
Urgent care moonlighting tends to be high volume, but generally lower acuity, and is ideal for family medicine or emergency medicine residents. Working in an ED Fast Track unit involves managing the lower-acuity side of an emergency department (sutures, colds, sprains).
Telemedicine and remote consults
You can take on additional work via virtual urgent care or tele-triage/advice lines. Often this allows you to work from home, making it physically less demanding than a hospital shift. However, eligibility varies widely and telemedicine roles may still require attending physician oversight.
Event EMS
Concerts, sports games and festivals require medical coverage. It’s often low-acuity work (dehydration, minor injuries) with a fun atmosphere.
Non-clinical side jobs for residents
If you are burned out on patient care but still need money, you can choose side jobs that aren’t clinical in lieu of moonlighting. For example, as a tutor, you can help medical students prep for the USMLE Step 1. Or you can consider medical writing for health tech companies or consulting, providing for startups. For a deeper dive into these options, check out Sermo’s article on resident side gigs.
Sermo paid medical surveys as a means to reach your goals
If you have 15 minutes between rounds but not 12 hours for a shift, you can still complete paid medical surveys. On Sermo, physicians can earn supplemental income by sharing their expert opinions on new treatments, drug developments and healthcare trends. It’s flexible, low-stress, and can be done from your phone.
This extra income can be especially valuable to residents, helping you to cover daily expenses or save for professional goals like board exam prep. It’s a way to monetize your knowledge without the liability or exhaustion of an extra clinical shift.
Make the most of your medical expertise
Moonlighting can serve as a financial lifeline and a way to gain valuable non-clinical experience. It can be a viable route as a resident, provided you have program approval and self-awareness regarding burnout.
Whether you are looking to pick up an extra ICU shift, start tutoring, or just vent about the challenges of residency, you can connect with people in the same situation. The Sermo community has more than 1.5 million healthcare professionals, including residents. You can sign up for free to swap advice on the best moonlighting gigs and start earning extra money through paid medical surveys.
