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Efficacy, Education, Administration, Informatics

E1068. A Proposal for a Fair and Transparent Moonlighting System

Liu B1,  Flores M1,  Fursevich D1,  Derrick E1,  Ho T.2 1. Florida Hospital, Orlando, FL; 2. No Institutional Affiliation

Address correspondence to B. Liu (

Objective: The purpose of this exhibit is to describe the moonlighting shift assignment system used at our institution to ensure a fair and transparent process for all residents involved.

Materials and Methods: Our residency program provides internal moonlighting for second- to fourth-year radiology residents in good academic standing. All residents eligible for internal moonlighting met to discuss what proportion of shifts should be assigned to each class of residents. We agreed on a 50-30-20% split of hours among fourth-, third-, and second-year residents, respectively. Subsequently, a semiautomated shift scheduler based on Microsoft Excel was designed to assign shifts based on resident availability. Furthermore, participants agreed to meet periodically to review the performance of the program and resolve any conflicts that arise.

Results: The final moonlighting assignment system relied on three components: shift times, where all moonlighting shifts at each facility are recorded; resident availability, where all resident availability is recorded; and shift scheduler, which incorporates the shift times and resident availability data in one spreadsheet. The shift assignment process takes five steps. After the shift times are made available, fourth-year residents select their shifts, up to a combined 50% of total hours available. Third-year residents select their shifts, up to a combined 30% of total hours. Second-year residents select their shifts, up to a combined 20% of total hours. If any shifts are still available, it becomes a first come–first serve situation where any resident can select any available shifts. If there are still shifts left uncovered, they will be assigned based on the resident availability spreadsheet.

Conclusion: Moonlighting is an important component of radiology education. According to the 2016 American Alliance of Academic Chief Residents in Radiology survey, 84% of residency programs offering some form of moonlighting and 40% of U.S. medical student applicants considered moonlighting (rated 3.6/5 in importance). While exact moonlighting arrangements vary by institution, our personal experiences indicate that moonlighting is driven primarily by senior residents at many institutions. As moonlighting may have significant impact on a resident’s income, there is potential for interpersonal conflict regarding the fairness or perceived fairness of shift assignments. We believe our system offers a fair and transparent method of assigning moonlighting shifts and lead to improved morale and resident cohesion.