MOONLIGHTING BY PEDIATRIC RESIDENTS Richard J. Pan, William L. Cull, Ethan Alexander Jewett, Holly J. Mulvey. Dept of Pediatrics, UC Davis, Sacramento, CA; Div of Health Policy Research; Div of GME and Pediatric Workforce, American Academy of Pediatrics, Elk Grove Village, IL.

BACKGROUND: Concerns about resident fatigue and medical errors have led the ACGME to impose stricter resident workhour standards. Currently, little is known about pediatric residents? moonlighting.

OBJECTIVE: To determine 1.) how much moonlighting is done by PL-3 residents, 2.) if educational debt is associated with moonlighting, and 3.) if moonlighting leads to greater fatigue.

DESIGN/METHODS: A national random sample of 500 PL-3 pediatric residents completing training in 2002 was surveyed by mail with 323 residents (65%) responding. The survey collected information about residents? frequency of moonlighting, reasons for moonlighting, residency policies on moonlighting, and educational debt.

RESULTS: In the last 12 months, 41% of residents moonlighted at least once and 18% moonlighted 6 or more months. During the months moonlighting, they averaged 20 hours/month (SD=14) moonlighting. 56% reported moonlighting due to insufficient residency income to pay educational loans, housing, and/or childcare, 40% to gain additional clinical experience, and 5% were required to moonlight by their residency program. Moonlighting accounted for an average of 12% (SD=11) of the residents? income. Educational debt was associated with moonlighting, as 44% of residents with debt reported moonlighting compared to 29% of residents without debt (p = .024). Also, as the amount of debt increased, so did the number of months that residents moonlighted (p = .037). Residents with debt owed an average of $113,476, and their average monthly pay was $438. Almost all (95%) residents who moonlighted reported that their residency program director was aware of their moonlighting, and only 24% of all respondents reported that moonlighting was not permitted by their program. Moonlighting residents were not significantly more likely than non-moonlighting residents to fall asleep during an educational conference (82.4% vs. 82%, p = .934) or to fall asleep while driving (34% vs. 32%, p = .770) as a result of fatigue from work. Still, nearly half (47%) reported that they felt federal law should regulate moonlighting hours.

CONCLUSIONS: Efforts are underway to limit resident duty hours including potentially resident moonlighting. Our results suggest that moonlighting is important for many pediatric residents both financially and educationally. Given the substantial educational debt that most residents face, proposals to regulate moonlighting also need to address residents? financial situation.