Moonlighting means taking on paid clinical work in addition to your residency. Opportunities can be internal at your training site or external through another hospital, clinic, or urgent care. Rates commonly range near or above one hundred dollars per hour, but all moonlighting must still fit within ACGME work hour rules. Expect tradeoffs around time, taxes, malpractice coverage, and program policies.
What is Moonlighting?
Moonlighting is a second, separate clinical job performed outside your core residency duties. It can occur at night or during the day, depending on coverage needs. Importantly, moonlighting refers to practicing as an independent physician, not a nonclinical side job.
Two Ways to Moonlight
- Internal moonlighting: Extra shifts at your own institution under your training license and program’s malpractice coverage.
- External moonlighting: Shifts at other facilities, often via locum tenens. These typically require an unrestricted state license, your own malpractice policy, and site privileges.
Because licensure, credentialing, and coverage are simpler, many residents find internal moonlighting easier to arrange than external roles.
The Benefits of Moonlighting as a Resident
Earn extra income: Average resident pay in 2024 was about seventy thousand dollars, up from sixty seven thousand dollars in 2023. Hourly moonlighting rates can exceed one hundred dollars and vary widely by specialty and region.
Test practice settings: Try community hospitals, urgent care, or clinics to learn what feels right before you sign your first attending contract.
Network and strengthen your CV: Meet physicians and administrators outside your program and keep clinical skills sharp during research-heavy blocks.
Related: How to Make Money in Medical School: 7 Ideas for Medical Students
Downsides and Risks
Time and fatigue: ACGME limits clinical and educational work to no more than 80 hours per week averaged over four weeks, inclusive of all moonlighting and work done from home. You must also have at least one day free of duties in seven and appropriate rest between shifts. Moonlighting that would push you over these limits is not allowed.
Taxes and student loans:External moonlighting is usually paid on a 1099 basis. Set aside taxes quarterly and remember that higher income can increase payments on income-driven repayment plans.
Malpractice insurance: Internal moonlighting is often covered by your program’s policy. External roles may require you to buy coverage and to understand whether it is occurrence or claims-made with a need for tail coverage when you leave.
Program rules: Programs differ. Some prohibit PGY-1 moonlighting, require prior approval, cap hours, or limit internal options to residents in good standing. Always check your agreement and get written approval.
To learn more, read How Much Does Medical Malpractice Insurance Cost?
Typical Moonlighting Pay in 2025
National data sources show moonlighting physicians earning around one hundred dollars per hour on average, with wide variation by specialty and market. Community datasets report average locums rates near two hundred dollars per hour across specialties. Internal medicine examples around one hundred thirty dollars per hour are common in 2025 writeups.
Your actual rate depends on specialty, geography, shift type, and urgency of need.
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How to Find Moonlighting Opportunities
Start internally
Ask your chief residents, GME office, or hospital staffing office about internal shifts. These are simplest from a licensing and malpractice standpoint.
Look externally if needed
Use reputable locum tenens agencies and physician job boards. When comparing offers, confirm license requirements, malpractice type, credentialing timelines, and whether the work counts toward your program’s limits.
Screen roles with this checklist
- License status and hospital privileges
- Malpractice coverage type and tail provisions
- Pay rate, shift details, and cancellation terms
- Documentation systems and onboarding time
- Compliance with your program’s moonlighting policy and ACGME limits
Tips for Moonlighting During Residency
- Start with one or two shifts per month to gauge stamina and schedule impact.
- Protect your training by prioritizing program requirements and education.
- Budget for taxes if paid as an independent contractor.
- Build an emergency fund so you can select a reasonable waiting period if you later buy your own malpractice tail or disability coverage.
- Practice self-care and maintain rest days to avoid burnout.
Key Takeaways
Moonlighting can meaningfully boost income, expand your network, and expose you to different practice settings. In 2025, common hourly rates can exceed one hundred dollars, particularly in high-demand specialties and locations. The tradeoffs include time pressure, tax complexity, and malpractice coverage details. Above all, ACGME work hour rules and your program’s policy govern what is permissible. If you proceed, align shifts with your education, secure proper coverage, and be disciplined about rest and finances.
Read About: Want to Become a Part-Time Doctor? Here’s How
Yes. All moonlighting counts toward the 80 hour weekly maximum averaged over four weeks, including work done from home.
Average resident pay was about seventy thousand dollars in 2024. Moonlighting often pays over one hundred dollars per hour, with large variation by specialty and site.
Usually yes. Plan for quarterly taxes and confirm whether the site provides malpractice coverage and what type.
Occurrence policies generally avoid the need for tail coverage when you leave. Claims-made policies require tail coverage unless a free tail applies under the carrier’s rules.
Policies vary by program and specialty. Many programs restrict PGY-1 moonlighting. Always check your contract and obtain written approval.
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