Newsletters

POSTED: January 18th, 2019
POSTED IN: Career Planning, EM Pulse - The Official Newsletter of MOCEP, Resident Resources, September/October 2018,

Written by: Kevin Baumgartner MD , Resident Physician, Emergency Medicine
Washington University in St. Louis / Barnes-Jewish Hospital

35 year-old man with left leg swelling. Lives in a facility, usually bedbound. No other DVT risk factors, but the immobility and calf swelling make me want a Duplex. 

OK, Duplex is negative, no signs of cellulitis, stable vitals, no trauma. I think he can go with close PMD follow-up. I just need to check with the att…

Oh, wait.

I am the attending.

Sound familiar to you? That was my internal monologue after I saw my first patient on my first ever shift as an independent attending. Of course, as you might guess from the fact that I’m writing the Resident Corner column, I’m still in training. But thanks to the miracle of moonlighting, I can do both at once!

Moonlighting is terrifying but comforting. Terrifying, in that I’m forced to make my own decisions and can’t fall back on “what my attending wants.” Comforting, in that I get the chance to practice walking on my own while I still have a supportive environment to fall back on back in my home program. If I’m unsure about a case or feel like I could have managed a patient better, I can come back and debrief with my attendings and co-resident and take the opportunity to practice the relevant skills in a supervised, backstopped environment. 

I’ve also appreciated the help and support of the “real” attendings at my moonlighting jobs. What with all the time pressures of modern EM practice, I know it can’t be easy to have a wet-behind-the-ears resident asking for “an extra pair of eyes.” But whenever I’ve needed a second opinion on an EKG, help with a difficult consult or house supervisor, or a second pair of hands on an abdomen, my grown-up colleagues have been happy to help. It’s been great to experience that camaraderie and encouragement.

Moonlighting has helped me become more confident in my clinical work at my main residency site as well. I’ve learned to really think: what would I do with this patient if I had the final word? Do we really need to involve that consultant? Can I discharge this person with close primary care follow-up instead of punting upstairs?

But I’ve also faced real-world problems. I now cringe when I hear the words “sepsis criteria.” I get weekly emails about how to boost patient satisfaction. The academic environment has sheltered me from some of these financial and organizational challenges, and now I have to learn how to work with new expectations and new systems. I suppose it’s a good thing to get used to.

Overall, I’m happy my program allows external moonlighting, and I encourage any residents reading this to take advantage of this opportunity if they can. And for all the “real attendings” out there: thanks for taking a second look at the EKG for me, lending a hand with that intubation, and letting me know which antibiotics the surgeons like. I appreciate the help, and although I don’t know if I’ll be able to pay it back, I’ll certainly try to pay it forward.