Moonlighting Policy

I. Purpose of policy

The purpose of this policy is the expectation that the Graduate Medical Education (GME) Office maintain a policy regarding professional activities outside the educational program per Accreditation Council for Graduate Medical Education (ACGME) Institutional Requirements.

II. Policy scope

This policy applies to all ACGME-accredited residency and fellowship programs at Dartmouth-Hitchcock (D-H).

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.

IV. Policy statement

  • Dartmouth-Hitchcock Medical Center neither encourages nor discourages moonlighting. Residents are specifically not required to moonlight.
  • Individual ACGME-accredited programs may prohibit moonlighting by residents.
  • All residents participating in moonlighting must first complete a Moonlighting Request form and obtain approval and signature by their Program Director and the Director of GME prior to undertaking such activity. Moonlighting Request forms are available on the GME Intranet site.
  • Internal moonlighting is defined as any moonlighting that occurs within D-H (Mary Hitchcock Memorial Hospital (MHMH) or the Veterans Administrative Medical Center (VAMC)).
  • External moonlighting is defined as any moonlighting that occurs outside of D-H (MHMH or the VAMC).
  • A resident must have the following to participate in either internal or external moonlighting:
    • An unrestricted, permanent license to practice medicine in each state where he/she moonlights. A permanent license is different from a training license and residents are not legally allowed to moonlight under a training license.
    • A federal DEA number (DEA #). A federal DEA # is different from a training DEA # and residents are not legally allowed to moonlight under a training DEA #.
  • Residents who moonlight within D-H (internal moonlighting) will be covered for medical malpractice under the Dartmouth-Hitchcock Professional Liability Insurance Policy so long as they are acting within the level of their training and within the scope of their employment, and are appropriately credentialed by the institution.
  • Residents moonlighting outside of D-H (external moonlighting) are not covered by the Dartmouth-Hitchcock Professional Liability Insurance Policy and must make certain that the outside employer provides adequate professional liability coverage. It is the resident’s responsibility to determine what level of coverage is “adequate.”
  • All approvals for moonlighting:
    • Shall remain in force for the current academic year unless terminated by the Program Director.
    • Shall automatically expire on June 30 of a given academic year.
  • Renewal requests for the next academic year must be processed and approved before undertaking additional moonlighting activities.
  • Program Director Responsibilities
    • Prospective written approval from the Program Director and the Director of GME is required for all moonlighting activities.
    • The Program must maintain a copy of the completed Moonlighting Request form as part of the resident’s personnel file.
    • The Program Director is ultimately responsible for assuring that moonlighting activities do not interfere with the ability of the resident to meet the goals, objectives, assigned duties, and responsibilities of the educational program. They are expected to monitor all moonlighting activities in their program on an ongoing basis.
    • The Program Director may withdraw permission to moonlight if, at any time, moonlighting activities are seen as producing adverse effects on the resident’s performance in the program.
  • Resident Responsibilities
    • All residents participating in moonlighting must first complete a Moonlighting Request form and obtain approval and signature by their Program Director and the Director of GME prior to undertaking such activity.
    • It is the sole responsibility of the resident to:
      • Apply for and obtain a permanent license to practice medicine to support any moonlighting activities.
      • Apply for and obtain their own Federal DEA # to support any moonlighting activities.
  • Duty Hour reporting
    • All moonlighting activities, internal and external, must be reported by the resident as duty hours within the Residency Management System (RMS) using the appropriate task identifier:
      • Moonlighting-D-H/VAMC, or;
      • Moonlighting-Non D-H/VAMC.
  • All moonlighting (internal and external) must be counted toward the 80-hour weekly limit on-duty hours.
  • Post-Graduate Year 1 (PGY-1) residents may not moonlight.
  • Residents employed under a J-1 visa are strictly prohibited by law from participating in moonlighting activities. Residents employed under an H1-B visa may be able to moonlight under specific, very limited circumstances.
  • Violation of these moonlighting rules and procedures by the resident may lead to disciplinary action.
  • GME Office Responsibilities
    • The GME Office must maintain a copy of the completed Moonlighting Request form as part of the resident’s personnel file.

D-H Policy ID: 11310