Fellows and Moonlighting

Subspecialty residents and fellows, like attendings, as long as they are clinically active, are covered by UNC Liability Insurance Trust Fund offered through Medicine through UNC P & A.

UNC fellows and attendings are covered while carrying out clinical duties anywhere within the physical parameter of UNC (hospital-campus). This would include ‘moonlighting’ in areas such as Emergency Medicine. In the past, many of our fellows have moonlighted at UNC Urgent Care. However, with the discontinuation of this clinic, Dr. Pamela Clanton directs our Hospitalist program, where fellows can moonlight as an alternative. Contact information includes Carolyn F. Crank of General-Internal Medicine, phone 6-2276 (ext. 269), fax 6-2274. Fellows interested in moonlighting in EM are asked to contact the program director, Dr. Judith E. Tintinalli, at 3-3045 or judith_tintinalli@med.unc.edu.

If we have contracted services with another institution, such as Wake and Fayetteville VA for our attendings, they are covered by UNC. Additionally, fellows are covered for any contracted services constituting part of or an extension of their current training program with us. However, if a fellow chooses to moonlight in an area outside of UNC and one for which we do not contract educational services (s/he wants to earn extra money to provide services elsewhere not required by us), such as at Central Prison or in a private practice, the fellow must make sure that s/he is covered by this facility. In the case of Central Prison and private practices, generally they provide liability insurance coverage for an outside physician who works for them. This applies to attendings as well. Most attendings and fellows do not feel the need, therefore, to carry personal insurance in this respect since they are covered by UNC.

When a fellow moonlights in a non-UNC, non-contracted venue, it is thus very important that s/he is covered either by the outside agency or individually because if a malpractice suit ever arose, it would be between the litigant and the agency providing the liability coverage.

Our Office of Graduate Medical Education (OGME) asks that the fellowship coordinator provide documentation of each fellow’s “acknowledgement of moonlighting activities.” This includes a ‘description of activity’ and ‘site of activity’ with the following requirements met for moonlighting at UNC:

• The fellow has a permanent (full) NC medical license. This license must be renewed yearly on the fellow’s birthday with no lapse at a cost of $175 per year. The NC Board of Medical Examiners address is 1203 Front Street, Raleigh, NC 27609 or POB 26808, Raleigh, NC 27611; phone 919-326-1100 or 800-253-9653; fax 919-326-1130 or 919-326-1131; email info@ncmedboard.org, web site www.docboard.org/nc. The ‘certificate of registration’ refers to the NCMB license, of which there is also a smaller wallet size. The site for renewal of licensure is www.ncmedboard.org/seal.htm. Due to a large volume of forms to process, the Board cites email as the preferred method of correspondence. A copy of the fellow’s current NCMB license must accompany the GME moonlighting request form. In addition, as of 7-12-12, GME requires that you attach a copy of your personal DEA certificate or, if you do not have your own, attestation from the institution stating that you are allowed to use their DEA number.
• The fellow has adequate liability coverage. (This means not only UNC but any other outside source of liability coverage, which the fellowship coordinator must verify with the fellow and/or outside source.) Confirmation of current liability coverage must accompany the GME moonlighting request form for non-UNC agencies. This confirmation must be from the risk management office. GME also requires that a copy of your employee work agreement be included.
• The fellow has appropriate training skills to carry out assigned duties. (The skills for which s/he is credentialed for clinical privileges and comparable background experience in training relate to and are commensurate with the duties required for moonlighting.) For our fellows who are BE/

BC in internal medicine, this would involve medical evaluations of admitted patients. A comparable description must be indicated on the moonlighting request form.

• The total hours worked, including moonlighting, do not exceed RRC (Residency Review Commission) requirements. (The moonlighting hours must not interfere with a fellow’s training with us and his/her optimal performance, also dependent on his/her schedule with us such as endoscopic rotation, etc.) Thus, fellows must include average # of hours per week moonlighting, in addition to average # of regular program hours per week.
• GME request forms must be submitted on a yearly basis for continuous updates. THE FORM MUST BE ORIGINAL AND NOT A FAX.
• In addition to the site of moonlighting activity requested on the form, other ongoing sites must be listed. In the case of Central Regional Hospital and Dorothea Dix (two separate entities), if a fellow is to moonlight in both places, two separate request forms would need to be submitted.
• Per updated moonlighting request form and accompanying policy on 6/15/11, OGME now requires a) that shifts be indicated on the form (if shifts are not notated, the form will be returned) and b) a copy of the employment contract between the facility or a representative of the facility (e.g., ‘Moonlighting Solutions’) and the physician must be included. If the physician is at UNC, a copy of the interinstitutional agreement is needed. Requests not on the updated 6/15/11 form will not be considered.

The moonlighting form must be completed by the fellow, signed by the Program Director, signed by the Chair of the Department of Medicine (Marschall S. Runge, M.D.,Ph.D.), submitted to the OGME, and approved by the GME Executive Committee at its mid-monthly meeting before the fellow can begin to moonlight. These meetings are held the third Wednesday of each month, and completed forms need to be submitted to OGME at least a week in advance. For example, if a fellow decides on March 23 s/he wants to moonlight, the start date on the form would need to indicate April 22, the day after Wednesday April 21, when the GME EC meets. (Assuming that moonlighting is approved, the fellow would then be able to moonlight beginning April 22.) The completed form itself would need to be submitted to OGME no later than Wednesday April 14, a week prior to the GME EC monthly meeting.

This policy pertains to fellows within GME and not to medical staff fellows. (Requirements apply to medical staff fellows – this is arranged between the fellow and the site of moonlighting activity; however, GME fellows must comply per GME protocol by submitting a request form and be approved to moonlight during the time they are appointed to housestaff.) Thus, a medical staff fellow coming into the GME program in July needs to have moonlighting approval in place by the July start date so that continuity of care is not interrupted. This means that fellows should submit requests 2-3 months prior to the July start date.

The fellowship coordinator makes sure the form gets signed and submitted to OGME. OGME will then notify the coordinator once the fellow is able to begin moonlighting. The GME moonlighting (professional activity) policy is attached for your review, in addition to a moonlighting request form.

Locations

If a fellow is interested in moonlighting at Central Prison Hospital, shifts are available for Sunday – Saturday 7:00 p.m. to 7:00 a.m. and Saturday, Sunday and holidays from 7:00 a.m. to 7:00 p.m. Help is generally needed on Fridays, Saturdays, Sundays, and holidays. The regular rate is $70 per hour; the holiday rate is $96.25 per hour. If interested, please fax your cv to Glenn R. Schweinsberg, gschwein@neshold.com, of NES International, Inc., and NES Government Services, Inc., http://www.neshold.com. Fax includes 1-757-420-6616. Phone numbers include 1-800-181-1813 x 203; 1-800-637-3627 x 203; 1-757-420-7985 x 203. The person to contact directly at Central Prison is Mary Gearhart of the Managed Care Division at 919-733-0800.

Dorothea Dix pays $90 per hour. Contact person is Dr. Scott Mann (scott.mann@dhhs.nc.gov) at Dorothea Dix Hospital, 3601 MSC Center, 5E Medicine Division, McBryde Building, Raleigh NC 27699-3601, phone 919-733-0742. Contact individuals at Dorothea Dix also include Gail Lewis at 919-733-0742 (gail.lewis@ncmail.net) and Delores Foster (Dolly) at 919-733-0740 (dolores.foster@ncmail.net). Mosella Jamerson is the Human Resources Director.

 

NOTE: Fellows need continuation of ACLS certification to moonlight at Dix.

Dr. Mann will need a letter of approval from the program coordinator for medical staff fellows not presenting with formal approval from OGME.

Because of delayed payments between the Comptroller’s Office at Dix and the circuitous manner in which payment is received first at the UNC Budget Office, then UNC Payroll, then Medicine Payroll, as of 5/9/10, administrative officials at Dix have agreed to put moonlighting fellows on their state payroll system (Beacon) so that payments can be made directly to the fellow. This should make the process less cumbersome and more expedient. The payroll specialist there is Debbie S. Thomas. Her email address is Debbie.S.Thomas@dhhs.nc.gov.

Marvellena L. Grantham (Marvellena.Grantham@ncmail.net) serves as the credentialing coordinator for WakeMed Health & Hospitals (phone 919-350-8114; fax 919-350-7472).

Dr. Stephen Oxley serves a Clinical Director at Central Regional Hospital (phone 919-764-7300, fax 919-764-7338). CRH is located at 300 Veazey Road, Butner, NC 27509. Contact individuals include Kelly Breedlove (kelly.breedlove@ncmail.net) and Vicki Bryant (vicki.bryant@ncmail.net), phone 919-764-7230, fax 919-764-7250. Judy Leonard (judy.leonard@dhhs.nc.gov) serves as administrative assistant to the Director of Medical Services: phone 919-764-2330; fax 919-764-2374.

The Department of Veterans Affairs VA Medical Center is located at 508 Fulton Street, Durham, NC 27705. Contact individuals include Deborah Zakrzewski, medical staff coordinator, or Melinda Orr, credentialing specialist, at 919-286-0411, ext. 7100.

Durham Regional Hospital located at 3643 North Roxboro Road, Durham, NC 27704. Contact person is JoAnn White, at 919-470-8490 (office), 919-470-8555 (direct number), 919-470-8469 (fax), email joann.whittle@duke.edu. The going rate is $1,500 per shift ($125 p/hr).

 

NOTE: Fellows need to apply for an individual DEA number in order to moonlight at DRH.

In August of this year, Fayetteville VA Medical Center began soliciting positions for capable hospitalists/fellows who have their basic specialty training. The proposed rate is $175 per hour, and the shifts are 12 hours, although they can be modified. Please note that Fayetteville VA is one of our ACGME participating sites so that any moonlighting done there by our GME residents is internal and must count toward the 80-hour limit, with these hours recorded in E-Value. Professional liability insurance from the VA would also be needed. Those interested in this moonlighting opportunity should contact Dr. Michael Rynne, email Michael.Rynne2@va.gov, cell 910-322-5894.

Some of our fellows have contacted Moonlighting Solutions, a company that recruits for multiple hospitals in the state. The contact person there is Mandy McCoy, mandy.mccoy@moonlightingsolutions.com.

Additionally, in the past Annington Hospital in Reidsville, NC, has needed a locus tenens physician for weekend GI coverage, which includes rounding on current patients, consults, on-call coverage and emergent procedures. Contact person is Marlene Yates, Director of Medical Staff Development, 336-634-4588, marlene.yates@mosescone.com. They ask for only third-year/senior fellows for this position.

We discourage moonlighting activities for at least six months until the subspecialty resident is familiar with our fellowship program and can manage moonlighting responsibilities in addition to those duties expected by us. Often research fellows moonlight initially because they are not on clinical service and can accommodate moonlighting hours into their schedules.

NOTE: Fellows on J-1 visas are not permitted to moonlight. Since this visa is intended for visiting student trainees, trainees must focus on clinic and research time required of the training program in which they are enrolled; thus, no external or professional activities are allowed.