MOONLIGHTING OPPORTUNITIES & RESPONSIBILITIES

Following is a list of the job description and pay for all moonlighter positions that are paid by the House Staff Office. If there are any questions about this please speak to Dr. Ward or the chief resident.

General Rules for all Moonlighters:

  • By ACGME regulation, moonlighting is counted in duty hours. Therefore, moonlighters may not moonlight if it will result in a violation of the duty hours regulations.
  • Moonlighting while on back up call or on your post-backup day is not permitted.
  • Prompt arrival at the designated time is expected. Moonlighting assignments carry the same degree of responsibility as regular rotation assignments.
  • General guidelines regarding the moonlighter’s duties are outlined below. Some flexibility will be required in order to equitably distribute the workload. Common sense should prevail when determining the activities of the moonlighter on any specific day. If for any reason the moonlighter and other members of the team cannot reach consensus on what constitutes a reasonable approach, they should consult with the chief resident.
  • The common sense “rules” regarding what is appropriate to check out to another resident apply to moonlighters as well.
  • Moonlighters should participate in any scheduled sign in and check out rounds.
  • Moonlighters should not leave before the post-call resident has completed their work.
  • Moonlighters will be paid at the rates noted below. Extra pay will only be granted under extraordinary circumstances (such as those requiring the moonlighter to stay beyond a reasonable period of time). Dr. Ward will make the final determination regarding extra pay, and any questions regarding this issue should be directed to him.

Private Pediatric Inpatient

Number of moonlighters: 1

Schedule: every Saturday and Sunday

Arrival time: 7:00am

Pay: $300/shift

Prerequisites: Any PL2 or PL3 resident

Duties: The day call resident will divide patients up evenly amongst private pediatric inpatient residents and the moonlighter. The moonlighter is responsible for contacting each of the private pediatricians after rounding on the patients.

TCH Level 2 Nursery and AltMD

Number of moonlighters: 1-2

Schedule: every Saturday and Sunday (AltMD variable)

Arrival time: no later than 7:00am (AltMD 5p-8a & 8a-8a)

Pay: Level 2 $250 each/shift; AltMD - 5p-8a $750, 8a-8a $1200

Prerequisites: TCH Lev 2 Nurseryor TCH NICU Level 3

Duties: Rounds may start as early as 8:00am, and the attending will usually round in the order of which resident has their patients seen first (with post-call resident always going first). As always, the moonlighters should not leave before the post-call resident is done with their work.

The residents routinely assigned to TCH Level 2 should divide up the patients to be seen in an equitable fashion. The moonlighters should see all of the patients normally cared for by the residents who are off for the day. If one or more of the moonlighters are seeing a disproportionately low number of patients compared to the other residents, they should be assigned an additional number of the least complex patients of the other residents.

AltMD moonlighters are responsible for all level 2 admissions to the resident teams during their shift. They are not reponsible for writing daily progress notes, but should be available for patient hand off in the morning.

TCH NICU Level 3

Number of moonlighters: 1-2

Schedule: every Saturday and Sunday

Arrival Time: no later than 7:00am

Pay: $350/shift

Prerequisites: TCH NICU Level 3

Duties: The moonlighters should see the patients normally cared for by the residents who are off for the day. Including the moonlighters, NICU Team A and NICU Team B, should each have 2 residents. When there is a 3-person NICU Team A or Team B and one person is off (leaving 2 residents remaining on the team), no moonlighter will be assigned to the team.

As always, the moonlighters should not leave before the post-call resident is done with their work and should also assist the post-call resident with any work needed.

BT Newborn Nursery-supervisor

Number of moonlighters: 1

Schedule: every Saturday

Arrival Time: 7:00 am

Pay: $350/shift

Prerequisites: BT newborn supervisoror TCH Level 2 or TCH NICU Level 3

Duties: Examine and complete admission in EPIC on all babies in 3G who are born by noon on the day you are moonlighting. Complete a Ballard exam, admission orders set (found under Admissions med rec –sign new orders order setneo), and Admission H&P in EPIC (H&P Notes smart text template neo nursery H&P).

Additional duties include:

  1. Help the interns:
  • If you finish in 3G before the interns have finished their work, help examine the remainder of the babies in 3A and 3B and complete their admission/ progress notes/ discharges in EPIC. You should do one of three things:
  1. If the baby is new (i.e. has not been examined by a physician previously), complete the exam.
  2. If initial exam has been completed, but the baby is not being discharged that day, write a daily progress note (go to Notes new noteProgress note and free text/type a short SOAP note.)
  3. If the baby & mom are ready for discharge, complete Discharge Summary (using smart text template Neo newborn d/c note) and discharge orders (DischargeMed Rec discharge orders). Make appropriate early follow up and 2 week follow up appts, by placing an order “schedule appointment” and type in the comments box where and when the follow ups should be. Make sure the baby has had a hearing screen, NBS, and T/D Bili prior to discharge.
  • Answer any questions the interns might have about physical exam findings or discharge planning.
  • Round with the interns on their patients and make sure all babies were seen, all questions answered.
  1. Complete the beeper doc checkout sheet with labs to follow-up on for beeper doc on call and what to do with specific values.
  1. Take checkout paper to beeper doc (281-952-3643) and enjoy the rest of your weekend!

For more detailed instructions, please refer to the orientation handout entitled “Moonlighting in the Normal Newborn Nursery” (available in the Neo Chief’s office at Ben Taub and on the residents’ web site [

The Neo Chief may be paged (281-952-3642) with any questions.

BT Level 2

Number of moonlighters: 1

Schedule: every Saturday and Sunday

Arrival Time: no later than 7:15 am

Pay: $175/shift

Prerequisites: BT Level 2

Duties:

  1. Some attendings like to round as a team so please be ready to round with them by 8:15 am. You can page the BT Neo chief (281-952-3642) to find out what time the attending will round. The Neo Chief will email you with a time that the attending would like to round.
  1. The moonlighter is responsible for the patients of those residents who are off during that day. You can find the list of residents who are off and the patients you need to see by looking at the “Daily Level 2 assignment” list posted on the board of the Residents room. You will be able to copy and paste the resident note from the previous day (like a pre-printed note) and make the appropriate changes. In EPIC go to progress notes to see old note, copy this. Then go to Notes new note, to create your note for the day.
  1. The post-call intern and sometimes the post-call Level 2 third year resident round first. After you finish rounds and complete work on the patients you saw, please update the “BEEPBEEP” list (found in the R: drive, BT Level 2 nursery folder) and then check out to the day cover person on call (281-952-3643) or the Beeper doc (281-952-3643).
  1. If you are done early you are expected to help the post-call person; once that person is done you may leave.

Page the Neo Chief 281-952-3642 with any questions.

Page 1 of 3

G:\Housstaff\Ward\Reference Documents\Moonlighter Responsiblities 2010-05-24.doc

Last Saved 12/3/2010 2:34 PM