What the work involves
Moonlighting is additional work outside your primary role or training responsibilities. Internal and external arrangements may have different approval, insurance and clinical requirements. Ask which arrangement is actually being offered.
Who the work may fit
For attending physicians, review outside-work terms and conflicts. For residents and fellows, ask your program whether the work is allowed and what approval, licensing and supervision it requires. A nearby hospital asking for help does not establish that you are eligible.
Questions before you say yes
- Does my employer or training program approve this exact work?
- Do my license and privileges cover the duties?
- Who is clinically available if I need help?
- Who provides coverage for this assignment, and what is excluded?
- How are additional hours tracked alongside my primary responsibilities?
Your first step
Get the duties and schedule in writing, then take them to whoever must approve outside work. In ACGME-accredited training, moonlighting counts within the clinical and educational work-hour limit.
What can go wrong
Treating an extra shift as separate from fatigue and training responsibilities. Check your current program requirements; this guide is not clearance to moonlight.
How to get started, step by step
Turn the idea into a specific next action. These are preparation steps, not approval to perform a role.
- Separate attending outside work from resident or fellow moonlighting; they do not have identical approval requirements.
- Get the actual duties and schedule in writing, then seek the required employer or program approval for that exact work.
- Confirm licensure, privileges, malpractice coverage, supervision and an escalation contact. Do not use proximity to your home hospital as proof of eligibility.
- Add all relevant clinical work to one schedule, including preparation and recovery time. ACGME says moonlighting is included in its clinical and educational work-hour limit.
Where to look and who to ask
Use search terms and contacts that fit this work. Check the actual source and current requirements; these suggestions are not verified openings or Saile inventory.
- Start with your current organization’s approved extra-shift process or your training program’s permitted moonlighting process.
- Search physician career resources for moonlighting, additional shifts, part-time and your specialty. Check whether the post is for attendings or trainees.
- Ask a clinical hiring team which qualifications and approvals it requires. An invitation to help does not replace clearance.
JAMA Career Center — professional search resource, not an opening endorsement
Scheduling and payment realities
Ask about nights, weekends, post-call duties and shift cancellation. A nearby extra shift still competes with sleep and your main responsibilities. For trainees, check current program rules before taking the offer, not after.
Keep gross pay and taxes separate
For federal employment taxes, the IRS considers control and the relationship, not only the contract label. Self-employed individuals generally pay income and self-employment tax and may need estimated payments. Keep payment and expense records and ask a tax professional about your actual arrangement; this guide does not calculate take-home pay.
IRS: Independent contractor or employee
IRS: Self-employed individuals tax center
Before you say yes: a final checklist
Do not let an unanswered question become an assumed term.
- Scope fits my expertise and any required authorizations.
- Time, deliverables, payment unit and expenses are written.
- Outside-work approval, conflicts and confidential-data handling are checked.
- Coverage, escalation or review responsibilities are clear.
- Starting and ending the engagement each have a written process.
Work types to compare
Telemedicine
Compare visit type, patient states, schedule and clinical support.
Locum tenens
Compare assignment duties, onboarding, travel and written terms.
Per diem / PRN
Compare minimum commitments, offered shifts and cancellation rules.
Consulting / project work
Compare eligibility, deliverables, conflicts and review deadlines.
Frequently asked questions
How much does this work pay?
This guide does not quote a market rate or promise earnings. Compare a verified written offer, including all required work and expenses.
Does Saile have this work available now?
Check the Saile app for current openings. This educational guide does not claim that a particular role or project is available.
Can I do this alongside my main job?
Check outside-work approval, conflicts, confidentiality and scheduling obligations before accepting.
What should I get in writing?
The work, deliverables, schedule, payment terms, coverage responsibilities, cancellation terms and the steps required before starting.
What should I do next?
Get the duties and schedule in writing, then take them to whoever must approve outside work. In ACGME-accredited training, moonlighting counts within the clinical and educational work-hour limit.