Many radiology residents believe moonlighting is highly desirable and financially necessary during clinical training, and department administrators should consider offering internal moonlighting opportunities to avoid ethical issues, according to an article published in the April issue of Academic Radiology.

Recent research has indicated that moonlighting, the paid extracurricular activities of radiology residents, is more diverse than ever before. Lead author Michael F. McNeeley, MD, of the University of Washington Medical Center in Seattle, and colleagues recognized that potential meaningful differences exist between internal moonlighting at a resident’s affiliated clinic or hospital and external moonlighting at an unaffiliated institution. The authors aimed to establish the prevalence of internal and external moonlighting, identify the scope of activities performed, and investigate the degree of supervision offered in each setting.

McNeeley and colleagues distributed an electronic survey to trainee members of the Association of University Radiologists to understand their extracurricular clinical work and responsibilities in internal and external situations. During the six-week study period, 87 responses were received and represented 61 (37 percent) of distinct training programs. Seventy-two percent of the involved institutions said that trainees pursue moonlighting.

Incidence of duty hour violations was low at 7 percent, yet all violations went undocumented. With an odds ratio of 13.84, residents in external moonlighting were significantly more likely than those who participated in internal moonlighting to offer final interpretations of diagnostic imaging studies. Within the 27 percent of residents who moonlight externally, five residents said their duties included unsupervised performance of invasive procedures.

“Our data suggest that the scope of clinical responsibility depends heavily upon whether the work is performed while moonlighting internally versus externally,” wrote the authors. “The medicolegal, ethical, and financial implications of unsupervised trainee practice are beyond the scope of this study. However, the authors do suggest that the assumption of increased clinical autonomy by a radiology trainee would be best navigated under the aegis of his or her best-positioned advocates—the program director and the department chair—to minimize the risk for suboptimal patient care or self-inflicted vocational harm,” they concluded.