General requirements 

The following requirements must be completed in full prior to requesting moonlighting shifts: 

  • Eligible residents must be PGY-2 or above (PGY-3 for CUH Hospital Medicine) in good academic and professional standing with the residency program.
  • Approval from UTSW GME office and Program Director is required to be documented and approved in MedHub prior to registering for shifts.
    • This needs to be renewed every academic year!
  • Independent credentialing and hiring for moonlighting is required for each clinical site. This approval is separate from the MedHub approval.
    • This is a lengthy process, you are being hired and credentialed for a new role independent of residency. 
  • Employment authorization status must allow for moonlighting privileges.
    • H-1B visa holders may moonlight at the sponsoring institution only (e.g., if you have an H-1B visa sponsored by UTSW, you can only moonlight at UTSW hospitals like CUH). 
    • J-1 visa holders unfortunately cannot moonlight at all. 
  • You are required to maintain the conditions mentioned below under “Requirements to maintain Moonlighting privileges.”

 

Requirements to maintain moonlighting privileges

You are required to maintain the following conditions to keep your moonlighting privileges. Failure to fulfill any of the following conditions will result in the revocation of your moonlighting privileges for 3 months after the first incident and indefinitely after second incident. 

Scheduling 

  • You are not allowed to moonlight during call rotations.
  • Moonlighting must not compromise your residency training and scheduled rotations.
  • You cannot break the 80 hour per week work limit.
  • You are required to have at least 14 hours free of clinical work and education after 24+4 hours of in-house call.
  • You are required to take a minimum of one day off in a week.
  • You must have at least 8 hours off between shifts in a 24 hour period.
  • You cannot sign up for more than 8 shifts per month.
  • There is no coverage allowed for moonlighting (or part of) shifts without prior approval.
  • You are also not allowed to request coverage for scheduled shifts and professional liabilities to allow you to moonlight.
  • Do not sign up for the shift if you are unsure about your availability. All shift changes must be requested at least 2 weeks in advance (with exception of medical emergencies) Cancellation of shifts for non-medical emergencies may result in revocation of moonlighting privileges.

Logging Duty Hours 

All residents are required to log all moonlighting hours as duty hours in MedHub. This counts towards the 80-hour work limit. This is an ACGME requirement and failure to do so accurately will result in revocation of moonlighting privileges.

 

Process to start moonlighting

1. Submit a MedHub request for moonlighting

Submit a request in Medhub for moonlighting. Please list in MedHub location sites as "Parkland Hospital Medicine, CUH Hospital Medicine, CUH Teaching Team Cross-Cover, CUH BMT, and CUH Lung Transplant” to ensure you are approved for all available sites. MedHub will ask you for a number “max weekly hours”, this refers to the number of hours you plan to moonlight, not the total weekly hours you are working. Your moonlighting hours count towards the total max 80 hours/weekly. GME has been approving 24 hours/week. 

Once you submit your request, it needs to be approved by Dr. Kazi and then by UTSW GME. You will receive an email by MedHub when your request is approved. Once you receive a medhub approval email, follow the link and take a screenshot of your approval in medhub to send to each site coordinator. Follow the next steps based on your site(s) of interest. 

 

2. Parkland Hospitalist shifts

  • PGY-2 and above.
  • Residents signing up for Parkland Hospitalist shifts for the first time:
    • Once your MedHub request is approved, please email the screenshot of your MedHub approval to Barbara Dillard () in our Education Office and ask her to send a program approval letter to Parkland GME and Parkland HR so they start creating a moonlighting position for you. After your MedHub request is approved, please allow 10 business days for Parkland GME/HR to work on their side of the process; if after 10 business days you haven't heard back from Parkland, email Laura Navarro () and Elizabeth Ponce () from Parkland GME to ask for an update. Sometimes there are no moonlighting positions available and it can take months for one to open up. 
    • When the GME/HR process is complete, you can sign up for shifts contacting Mary McGraw () from Hospital Medicine.
    • Shifts have typically been 12 hours overnight cross-covering 80-100 patients, $100/hr (before taxes). Confirm the final details of your shifts with Parkland team.
  • Residents who are already hired and credentialed at Parkland and just renewed their MedHub approval: 
    • You do not need to be "hired" again, but you do need forward Ms. Dillard your MedHub approval screenshot and ask her to send an updated approval letter to Parkland GME before working any shifts. 
  • Med/Peds Residents: The process is the same but instead of emailing Ms. Dillard, please ask Blair Solis to send the program approval letter to Parkland GME. As UTSW employees, the Parkland hiring process will be longer than that for your Parkland-employed colleagues. 
  • Communication from Parkland HR/GME will go to your Parkland email address. If you do not have a Parkland email address, let Parkland GME team know. 

 

3. CUH Hospitalist shifts

  • PGY-3 and above.
  • Residents signing up for CUH Hospitalist shifts for the first time:
    • If you want to moonlight at CUH for Hospitalist Medicine and your Medhub request is approved, please forward your MedHub approval screenshot to  and ask to start the CUH credentialing and hiring process. CC Dr. Abey Thomas () and Kalita Rose ().
    • Once your CUH credentialing process is complete, contact Kalita Rose to ask her about the “ML hiring” process. Once that is complete, you will get regular emails with a calendar link to sign up for shifts. You cannot sign up for shifts before finishing the hiring process. 
  • Residents who are already hired and credentialed at CUH and just renewed their MedHub approval: 
    • Please forward your updated MedHub approval to Kalita Rose so you can start signing up for shifts once again. 
  • Shift types at CUH Hospitalist:
    • APP cross-cover + admitter: 7 PM – 7 AM. Cross-cover ~40-50 patients and 2 admissions. $100/hr (before taxes).
    • Please confirm the final details of your shifts with CUH team.
 
4. CUH Wards Teaching Cross cover
(AY 2023-2024)
  • PGY-2 and above 
  • See process for CUH Hospitalist shifts above for credentialing process. 
  • Shifts: every 3rd day from 3 - 7 PM
    • Compensation $100/hr
    • Cross cover all wards and geriatrics teams that sign-out before 7 PM
    • Expectations: receive in-person signout from teaching teams and handoff to night intern at 7 PM
    • Start shift at 3 PM in the Resident Lounge on 3rd floor. If you change locations, contact the teaching teams + night intern to let them know where you are.

 

5. CUH Lung Transplant Daylighting

  • PGY-2 and above
  • Residents signing up for lung transplant daylighting shifts for the first time:
    Please email your MedHub approval screenshot to Erika Louis () to sign up for shifts.
  • You'll need to go through the CUH credentialing and hiring process if you haven't done so already
  • Shifts: Saturdays and Sundays, 7 AM - 7 PM
    • Compensation: $1200/shift before tax
    • Patients: ICU level patients on the lung transplant service
    • Cap: 10 patients, typical census is 5-7 patients
    • Expectations: Primary team (first call, notes, orders, admissions, transfer, etc).
  • Workflow:
    • 7 AM report to work room on 10 Blue for sign out; room number is 10.117 (Conference room 10 Blue)
    • Rounds with attending typically 9-11 AM
    • There is a lung transplant floor APP team in the same work room for help with logistics questions during the day
    • Transplant ICU admissions will be assigned to you and are staffed with the lung transplant ICU attending. No floor admissions will be assigned.
    • 7 PM sign out to overnight team.
    • Please review the Lung Transplant Rotation Guide (2023) 

 

6. CUH Lung Transplant - Overnight Cross-Cover

  • PGY-2 and above
  • Residents signing up for lung transplant moonlighting shifts for the first time: Please email your MedHub approval screenshot to Erika Louis () to sign up for shifts. 
  • You'll need to go through the CUH credentialing and hiring process if you haven't done so already.
  • Shifts: 7 PM - 7 AM
    • Compensation: ​$1400 /shift before tax
    • Patients: ICU and floor level patients on the lung transplant service
    • Census: typically ~32 patients on average (ICU 5-8 pts, floor 24 pts)
    • Back up: transplant faculty by phone and MICU attending for immediate help
  • ECMO Workflow
    • Low threshold to call overnight attending
    • If urgent in-person help needed, place CVICU Anesthesia team consult and page
      • CVICU Anesthesia has 24/7 coverage with 2 APPs and in-house attending
    • RN will notify CVTS if surgical issues are present
  • Work room on 10 Blue for sign out; room number is 10.117 (Conference room 10 Blue)
  • Additional Notes:
    • Post-pulmonary thrombectomy (PTE) patients are admitted to pulmonary hypertension team (not lung transplant team). Lung transplant team may be involved if patient is on VV ECMO.

 

 

Entering hours in MedHub

Enter your hours as you normally would.  Using the drop-down box, change the shift category from “standard hours” to Internal Moonlighting.

Please contact Caroline Abe if questions.