Optional Extra Shifts Within a Training Program Policy

I. Purpose of policy

From time to time, Program Directors of Graduate Medical Education (“GME”) training programs at Mary Hitchcock Memorial Hospital (referred to herein as “Dartmouth-Hitchcock) may identify additional shifts that are determined to be within the scope of the GME training program – but not a required part of the program – for which extra payment may be offered. As outlined below, these “Extra Shifts” must be specifically designated as such by the Program Director. “Extra Shifts” are intended to address occasional, often unanticipated need for expanded Resident involvement in certain clinical activities. This may occur for a variety of reasons, including for example, covering for a colleague on an extended medical leave or responding to a surge of clinical volume.

It should be noted that Residents may be required to cover unplanned shifts or parts of shifts as part of their program responsibilities without any additional stipend—for example, routine service on “backup call” is a requirement of many programs and thus not associated with extra pay.

II. Policy scope

This policy applies to Residents, Fellows, Faculty, Program Directors, Program Coordinators, and Graduate Medical Education (GME) staff at D-H.

III. Definitions

Extra Shifts: Optional work within the scope of the training program, as specifically designated by the Program Director, for which additional payment is made to the Resident. Extra Shifts do not include required, unexpected or unplanned work or shifts within the training program that are considered part of the required program activities; such work is not eligible for additional pay.

Resident: Any physician in an ACGME-accredited graduate medical education program including Residents and Fellows.

IV. Policy statement

Dartmouth-Hitchcock neither encourages nor discourages Residents to take on optional Extra Shifts. Resident participation is strictly voluntary.

When approved by the applicable Program Director and the Director of GME, Residents may engage in optional, extra shifts within their training program for which they will be paid, unless prohibited based on visa status*. Requests will be handled in the Residency Management System.

Program Directors must ensure that Extra Shifts meet the criteria set forth below.


  • PGY-1 residents may not take Extra Shifts.
  • Extra Shifts involve activities that are within the scope of the training program, meaning responsibilities as are normally assigned to Residents at the same level of training (or a more junior level).
  • All clinical activities undertaken during Extra Shifts are supervised by the attending staff, consistent with other program activities, as appropriate to the level of training and the nature of the activities; Residents do not function as “physician of record.”
  • Extra Shifts must occur at a clinical site where Residents in the program have standard program-related activities, either at the “home” institution site(s) and/or educational affiliates.
  • An activity must be deemed by the Program Director as appropriate for Extra Shifts and the Program Director must specifically designate the activity as such. (Optional, extra-paid work that is not designated as “Extra Shifts” is considered “moonlighting” and is subject to the requirements set forth in the GME Moonlighting Policy, which places additional obligations on the Resident including the requirement for full licensure).
  • Because Extra Shifts are activities designated by the Program Director as part of the training program, there are not additional licensing or malpractice insurance requirements.
  • Extra Shifts must be logged as work hours and must not cause the Resident to exceed the work hour limits established by ACGME (i.e. when including any Extra Shifts, the Resident must not exceed 80 hours/week and must receive 1 day off in 7).
  • Residents subject to formal remediation or disciplinary actions are not eligible to participate in Extra Shift work.
  • When designating an activity as an “Extra Shift” opportunity, the Program Director must specify any specific eligibility requirements for Residents, e.g., a minimum level of training (year in program) or prerequisite rotation/experience.

Examples of Extra Shifts Within the Scope of the Training Program

  • During an 8:00 a.m. – 6:00 p.m. weekday elective rotation, a Resident takes extra weekend shifts on an inpatient service where Residents at that PGY level typically rotate.
  • A Resident works during a vacation block at an affiliate institution where Residents from that program have a standard rotation, with the same responsibilities and supervision.
  • A Resident takes on a monthly weekend clinic session at an ambulatory care site where Residents from the program have rotations.
  • A Resident in a research year works clinical shifts that mirror rotation assignments during the clinical years of training.


  • The standard hourly rate for Extra Shifts will be set by the GME Office with input from Human Resources. This rate may be adjusted from time to time.
  • Current pay levels are located in MedHub: Resources/Documents > Optional Extra Shifts Within a Training Program > Optional Extra Shifts Pay FY(applicable year)
  • The funding source is the Department in which the training program offering the optional Extra Shifts is based.

Program Director Responsibilities

  • The Program Director must approve a Resident request to work Extra Shifts in the Residency Management System.
  • The Program Director is required to monitor all “Extra Shift” activities within their training program on an ongoing basis.
  • The Program Director is responsible for ensuring that Extra Shift activities do not interfere with the ability of the Resident to meet the goals, objectives, assigned duties, and responsibilities of the training program.
  • The Program Director will withdraw permission for Extra Shift work if the Program Director determines in their reasonable discretion that Extra Shift activities are or are likely seen as producing adverse effects on the resident’s performance in the program.

*Residents who are in the U.S. on a visa (i.e. non-citizens and non-permanent residents) must speak with the GME Business and Reporting Specialist before taking on Extra Shifts as they may be subject to restrictions or additional requirements associated with their visa status. 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.

V. References

ACGME Program Requirements. (2020). Retrieved from ACGME.org: Common Program Requirements (acgme.org)

Additional procedures and job aids related to this policy can be found in MedHub and PolicyTech.

D-H Policy ID: 25613