An unrealistic option

We were pleased to see the question “Should residents be allowed to moonlight?” addressed in Canadian Family Physician.1,2 This issue has been of great importance to residents and has emerged repeatedly as an item for discussion in the Section of Residents (SOR) of the College of Family Physicians of Canada (CFPC). This body is the primary representational forum for family medicine residents in Canada within the CFPC. All family medicine residents are members of the SOR.

Many training, licensing, and logistical issues in postgraduate medical education are fundamentally different for family medicine residents. What works for Royal College residents might not work for family medicine residents. We urge policy planners, postgraduate deans, and medical licensing bodies to consider these differences in all facets of planning.

Although Drs Verma and Meterissan have provided insightful arguments both for and against moonlighting, neither debater has acknowledged the issues that are specific to family medicine residents. We thought it worthwhile to share some of the issues related to moonlighting that have been raised by family medicine residents.

Moonlighting is essentially unavailable to family medicine residents within the 2 years of training toward Certification with the CFPC. Residents are permitted to apply for a restricted licence, or moonlighting licence, after they can confirm that they have passed the Medical Council of Canada Qualifying Examination Part II. For most family medicine residents, this examination is done in late October during the second year of training. Results are usually available in the second week of December. Realistically, family medicine residents with an interest in moonlighting could expect to arrange the necessary licensing and insurance in time to have 5 months left to moonlight. During those 5 months, family medicine residents contend with the CFPC Certification Examination and the pressures of completing innumerable other projects that have been crammed into these final months. Afterward, the new graduate would have to apply for yet another licence and new malpractice insurance. The costs are substantial and the paperwork inordinate. For most, it just isn’t worth it.

The debate surrounding moonlighting might be more important to Royal College residents and family medicine residents in enhanced skills third-year programs. But given some of the logistical issues discussed above, the overwhelming opinion of family medicine residents has been that this really isn’t a realistic option for the vast majority of family medicine trainees. This has been the central message from the SOR as well. We agree that family medicine training is too short and packed with too many additional projects, research, and examinations to realistically expect that residents will substantially benefit from additional moonlighting experience within a 2-year program. For Royal College trainees, the situation might well be different.

Although the question “Should residents be allowed to moonlight?” is an interesting one, it is virtually inapplicable to most family medicine residents.

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