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Working during CCFP-EM fellowship

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I am considering getting my independent license and working in some walk-in clinics or smaller ERs 1-2 shifts a month to supplement my income during my upcoming PGY3 year in EM. Has anyone else done this? Is this insane to think about?

Any thoughts are appreciated!

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I dont have any expertise in this area but am very interested in this scenario as I am hoping to go the same route as you.

 

My understanding is that during many 5 year Royal College residencies residents get a chance to moonlight if they get approval from their program director which is decided by whether they are in good academic standing. So I am not sure how that would work in a PGY3 1 year program where the PD doesnt really know how you will be doing if you start off already with additional work.

 

Anecdotally I have heard the PGY3 is a heavy year with lots of new material. I guess you can see if you need to have program director permission and of course there is no reason you cant try it for a couple of months and if it is too heavy of a load then you can just stop doing it.

 

Hopefully someone with expertise in this area will say their two cents.

 

 

I am considering getting my independent license and working in some walk-in clinics or smaller ERs 1-2 shifts a month to supplement my income during my upcoming PGY3 year in EM. Has anyone else done this? Is this insane to think about?

Any thoughts are appreciated!

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Its definitely doable with the 2+1.

 

It wont be considered moonlighting but actual ER shifts as an attending physician. The only problem is that you wouldn't be able to do it in your hospital of residency ( so I understand).

 

If you can squeeze in 1-2 shifts a month , it'll be an excellent way to make some extra cash!

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It's definitely doable, having a few friends having gone that route and having done just that. And it's true that it won't be considered moonlighting, since you have your CCFP. Some asked to do shifts in centres where the emerg was staffed by 2 ER docs during that particular shift (say friday evenings, where normally 2 staff are on duty, 1 position was assumed by the resident, in case back up was necessary).

 

In cardiology, which is pretty demanding time wise, moonlighting is extremely popular. Almost everybody moonlights either in internal med and/or cardiology in my program. I believe it's a great learning opportunity, and you get to build your autonomy and skills. I imagine the same thing is to be said with R3 emerg.

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Thanks everyone. Makes sense that you likely wouldn't be able to work in that same hospital....don't think that I'd even want to. I'd rather present the illusion of being a knowledgeable MD at one place (ha ha) and a learner at another.

 

I spoke with a smaller hospital in a nearby community. The chief said that I could start by doing Saturday or Sunday day shifts (10-4 or 6) in the less acute area, with another doc working acute side...can you say $$$$$??!!! Not gonna lie, after 12 years of university, I am looking forward to making some better money!

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How common is moonlighting in other fields? There is relatively long list of fields at particular schools that are listed as moonlighting possible but I have no idea how often it is actually done - ha, even radiology at Ottawa is on the list, although it seems strange to me that you could some how fit that in.

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How common is moonlighting in other fields? There is relatively long list of fields at particular schools that are listed as moonlighting possible but I have no idea how often it is actually done - ha, even radiology at Ottawa is on the list, although it seems strange to me that you could some how fit that in.

 

same question for surgery? anyone has any clue how it would work? is it even possible?

 

Internal Med Royal College Exam are passed PGY-4, whereas radiology, surgery, anaesthesiology... are all passed PGY-5. If I understand well, in order to moonlight you have to be certified from the Royal College...

 

Would the Principle of Surgery examination (usually passed in PGY-2) considered a valid exam that would allow a PGY-5 surgery resident to moonlight if he is insane enough?

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How common is moonlighting in other fields? There is relatively long list of fields at particular schools that are listed as moonlighting possible but I have no idea how often it is actually done - ha, even radiology at Ottawa is on the list, although it seems strange to me that you could some how fit that in.

 

also, what list are you talking about?

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Would the Principle of Surgery examination (usually passed in PGY-2) considered a valid exam that would allow a PGY-5 surgery resident to moonlight if he is insane enough?

 

Not as a surgeon. It's more like the radiology physics exam (I think they have that right?) vs. the General IM exam.

 

I don't know any surgery residents who moonlight at my center.

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same question for surgery? anyone has any clue how it would work? is it even possible?

 

Internal Med Royal College Exam are passed PGY-4, whereas radiology, surgery, anaesthesiology... are all passed PGY-5. If I understand well, in order to moonlight you have to be certified from the Royal College...

 

Would the Principle of Surgery examination (usually passed in PGY-2) considered a valid exam that would allow a PGY-5 surgery resident to moonlight if he is insane enough?

 

I don't think the POS (now called the "Surgical Foundations" exam... so much less apropos...) has anything to do with moonlighting. When I was in residency, some of the other surgical residents did moonlight as house officers in internal medicine for the less-academic hospital in the same city (no internal medicine residents on call already). It was typically 3rd or 4th year, other than the one who had prior independent experience because of being a GP/FP and so was doing it as an R1, and all only with approval from their program director. It was also only occasionally, during less intense rotations. The house officer position was a lot like being paid extra to be a resident for another service (in this case, internal), so it only required that you be past that level in your own clinical training.

 

Even so, I think that's already phased out now that hospital has enough internal med residents to do that job instead.

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We should clarify some stuff:

 

There are two ways to work for most cash as a resident from my understanding.

 

1. Moonlighting - This is the traditional sense where you are working as an independent practitioner without supervision. That used to be possible for many residents when you could get a GP license. Once you have LMCC 1 and 2 done, you apply for your GP license and you can work as a GP. Now, with CCFP having replaced GP, the only way to do this is to have a fully independent license to practice that you obtained prior to your current residency.

 

For example, if you were a CCFP family doc, and then you decided after a couple years to go back and retrain as a pathologist. Moonlighting means you are still a path resident, but you work on the side (walk in's, locums etc.) as a family doc, because you still have your CCFP and CPSO independent practice license for family med. You are working under your independent license.

 

YOU are the most responsible physician.

 

2. Restricted Registration - This means that the CPSO grants you a license to work OUTSIDE the bounds of your regular education license. The difference here is that you are not independent. You still have to be under a fully independently licensed supervising physician who supervises you. Imagine this is like being a resident for hire. Additionally, you need to be in a program registered with the restricted registration program (not all are), and you have to meet certain criteria to get a restricted registration license (good standing, PGY X etc.).

 

YOUR SUPERVISOR is the most responsible physician.

 

ADDITIONALLY, the areas in which you can work as a restricted registration license holders depend on your residency program. They are limited. For example, a psych resident may only be able to work in psych care. They cannot get a license to work in Gen surg, medicine, rads etc. Similarly, the gen surg resident can't work on the psych unit.

 

The idea of the license was to help provide some coverage in areas that were short, by adding "extra" residents, who work for money, not education, in their off time. Now that we have lots of residents, and physicians LOOKING for work, it's not that applicable anymore and fewer people are doing it.

 

The website is here: http://www.restrictedregistrationontario.ca/index.html

 

If anyone has a different understanding feel free to point things out.

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also, what list are you talking about?

 

well I am extremely new to this but I think this is where information exists:

 

http://www.restrictedregistrationontario.ca/index.html

 

is the general program I believe. On the home page down a bit you see what schools seem to allow you what and when.

 

In my case for instance radiology is listed under Ottawa. When I click on it is says that in theory I could do locums 6 months into my 4th year if my program director agrees etc, etc at a community hospital. Actually sounds interesting because it could be a way to help figure out what community vs academic radiology is like, and be a form of practise. Exactly what a locum is however I am not sure (in terms of specific duration etc) :)

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We should clarify some stuff:

 

There are two ways to work for most cash as a resident from my understanding.

 

1. Moonlighting - (...) YOU are the most responsible physician.

 

2. Restricted Registration - (...) YOUR SUPERVISOR is the most responsible physician.

 

(...)

 

The website is here: http://www.restrictedregistrationontario.ca/index.html

 

If anyone has a different understanding feel free to point things out.

 

Good clarification, thanks. I didn't know that distinction.

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What is the current renumeration for working under the restricted registration license? If I am in pathology, can I do extra CTU call shifts during R3/4 since I have had 18 months of training and done CTU in PGY1? I am assuming I make more than the current $116 stipend in Ontario. How much would 1 call shift get you?

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Hah. Well in St John's, one of the hospitals is chronically in need of resident locum coverage. The pay is (I think) about $45/hour for 15-hour shifts. The trick is that PGME and the College will not allow it unless you did the relevant rotation within the preceding 12 months. That will be difficult for someone to demonstrate outside of IM residents. 

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5 hours ago, md2018plz said:

What is the current renumeration for working under the restricted registration license? If I am in pathology, can I do extra CTU call shifts during R3/4 since I have had 18 months of training and done CTU in PGY1? I am assuming I make more than the current $116 stipend in Ontario. How much would 1 call shift get you?

At least in Ontario, they would never let you do this.

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1 hour ago, goleafsgochris said:

At least in Ontario, they would never let you do this.

I confirm this! They only let Internal Medicine PGY3s in good standing to get restricted registration license. You are paid to do extra calls (1000 $ I believe at UofT for senior CTU call). Only a few people that I know of opt for extra call under restricted license, as 1 out of 4 calls could get quite intense, taking extra calls for money seem to be out of question for a lot of people struggling to spend time with their loved ones & family. 

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To clarify, anyone at PGY2 or above at MUN can potentially moonlight, usually for resident call shifts that end up unfilled for whatever reason. There's also the option of covering St Clare's ICU weekends (first call from home with staff intensivist backup). 

The new restriction is that you need to have completed a rotation in whatever service the locum is for within the last 12 months. So if it's March and you last did an ICU rotation in February, you're not able to moonlight for ICU. 

Of course anyone in the final year of training can do staff locums around the province. 

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After watching those CCFP-EM folks as an FRCPC-EM resident, I can't imagine working.

The CCFP-EM year is intense and super short. You gotta be a knowledge sponge. I would focus on learning as much as possible and forget working. This way, after those months are up you can hit the ground running in the ED. I imagine you would probably thank yourself for doing so once you are finished the program. 

Edited by rogerroger

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On 3/13/2018 at 0:15 AM, A-Stark said:

To clarify, anyone at PGY2 or above at MUN can potentially moonlight, usually for resident call shifts that end up unfilled for whatever reason. There's also the option of covering St Clare's ICU weekends (first call from home with staff intensivist backup). 

The new restriction is that you need to have completed a rotation in whatever service the locum is for within the last 12 months. So if it's March and you last did an ICU rotation in February, you're not able to moonlight for ICU. 

Of course anyone in the final year of training can do staff locums around the province. 

ha, that would be nice if our 5th years could do that - honestly not from the money point of view but more that you truly would see what it was like as junior staff.  Unfortunately that doesn't happen in Ontario.

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On 3/12/2018 at 7:31 PM, Lactic Folly said:

What internal medicine department would let you do that?

I mean some let M3's take solo call and then PGY-1 off service to take call already. But I agree with you, I'm just curious.

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On 3/14/2018 at 6:49 PM, rogerroger said:

After watching those CCFP-EM folks as an FRCPC-EM resident, I can't imagine working.

The CCFP-EM year is intense and super short. You gotta be a knowledge sponge. I would focus on learning as much as possible and forget working. This way, after those months are up you can hit the ground running in the ED. I imagine you would probably thank yourself for doing so once you are finished the program. 

I second this. CCFP-EM year was painful. Totally not worth trying to work at the same time. My PD discouraged us from doing it. 

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11 hours ago, The Bunny said:

I second this. CCFP-EM year was painful. Totally not worth trying to work at the same time. My PD discouraged us from doing it. 

At my center (rural secondary hospital) we have the CCFP-EMs come through for a month of anesthesia sometimes. I have seen at least one of them pick up an occasional ER locum shift. 

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