I was very surprised when I read Dr. Silman and Dr. Chen’s article, “Don’t Get Caught in a Moonlighting Trap” [June 2015], particularly the comment, “A single-coverage practice setting is probably not the best place for a first-time moonlighter.” The problem with working in a single-coverage practice is that residents have not completed the minimal training to be an emergency medicine specialist. They do not meet the minimal requirement for the job. Yes, I know that a good third-year resident may be better in the ED than a family doc or even some board-certified emergency physicians, but that is irrelevant. Solo moonlighting is a clear statement that you should be allowed to practice before completing a residency, ie, that further training may be nice but is not essential.

This is really the equivalent of an indefensible ethical statement: “I have had enough training to not endanger my patients.” If you doubt this, pray that you do not make a mistake (we all make mistakes) during your moonlighting. Your ATLS, ACLS, BLS, and PALS merit badges will not be enough. The malpractice attorneys are not stupid, and they will eat you alive over this.

Residents need to be honest. The reason to moonlight is to make money. Do it in a protected double-coverage environment. Get your solo experience after your training—and even then almost all ED groups require a period of double coverage before allowing new graduates to work alone.

—Mark Hauswald, MD, FACEP
Telluride, Colorado