Permission for resident moonlighting among emergency medicine programs

Study objectives: Emergency medicine residency programs differ on their granting of permission for residents to moonlight. We seek to determine whether the following factors might have an influence on the decision to allow resident moonlighting: program format, program age, presence of an emergency medicine fellowship, presence of other emergency medicine programs in the state, and whether the program is based in a rural or heavily populated state. Methods: Using the Graduate Medical Education Companion Directory by the American Medical Association primarily and the Emergency Medicine Residency Program Database by the Emergency Medicine Residents Association secondarily, we determined the number of programs that allowed moonlighting versus programs that did not allow moonlighting for program format (postgraduate year [PGY] 1 to 4, PGY 2 to 4, PGY 1 to 3), program age (0 to 10 years old, 11 to 20 years old, >20 years old), presence of an emergency medicine fellowship versus nonfellowship in the program, solitary emergency medicine program in the state versus nonsolitary programs, and rural state emergency medicine programs (New Mexico, Nebraska, Oregon, Colorado, Arizona, Maine, Arkansas, Ioly populated state emergency medicine programs (New Jersey, Rhode Island, Massachusetts, Connecticut, Missouri, New York, Delaware, Florida, Ohio, Pennsylvania). Afterward, we determined the 95% confidence interval (CI) for the results. Results: One hundred twenty-six of 132 emergency medicine residency programs responded to the database question on whether resident moonlighting is allowed. Five of the 6 nonresponders were new programs that have not accepted their first class yet. In terms of program format, 7 PGY 1-4 (44%, 95% CI 7% to 81%), 5 PGY 2-4 (33%, 95% CI 0% to 77%), and 64 PGY 1-3 (67%, 95% CI 54% to 80%) responded yes, whereas 9 PGY 1-4 (56%, 95% CI 23% to 89%), 10 PGY 2-4 (67%, 95% CI 36% to 98%), and 31 PGY 1-3 (33%, 95% CI 16% to 50%) responded no. In terms of program age, 27 programs 1 to 10 years old (69%, 95% CI 50% to 88%), 17 programs 11 to 20 years old (50%, 95% CI 26% to 74%), and 32 programs 21 years and older (63%, 95% CI 46% to 80%) responded yes versus 12 programs 1 to 10 years old (31%, 95% CI 2% to 60%), 17 programs 11 to 20 years old (50%, 95% CI 26% to 74%), and 21 programs older than 20 years (37%, 95% CI 16% to 53%). In programs with fellowships, 42 indicated yes (58%, 95% CI 43% to 73%), whereas 31 indicated no (42%, 95% CI 24% to 60%). For programs without fellowship, 33 indicated yes (59%, 95% CI 42% to 76%), whereas 41 indicated no (41%, 95% CI 19% to 63%). For state solitary programs, 9 indicated yes (56%, 95% CI 23% to 89%) and 7 indicated no (44%, 95% CI 7% to 81%). When there was a presence of another emergency medicine program in the state, 67 programs indicated yes (61%, 95% CI 49% to 73%), whereas 43 programs indicated no (39%, 95% CI 24% to 54%). For programs in rural states, 8 indicated yes (73%, 95% CI 36% to 100%), whereas 3 indicated no (27%, 95% CI 0% to 83%). For programs in heavily populated states, 33 indicated yes (63%, 95% CI 45% to 79%) and 20 indicated no (38%, 95% CI 16% to 54%). Conclusion: The program format, program age, presence of a fellowship in the program, presence of other programs in the state, and the ruralness of the program seem not to be major factors in whether an emergency medicine residency allows resident moonlighting.