You Pay A Price to Gain A Prize

November 4, 2022   |   PA

“Time is our most valuable asset, yet we tend to waste it, kill it, and spend it rather than invest it.” Jim Rohn

My PA career started in 1970, within ten years that the title began to resonate in healthcare. More than 80% of PAs were gainfully employed in a full-time job with an additional part-time, per diem or moonlighting job. We engaged in this additional employment because of low salaries – institutions and physicians were considering where PAs would fit, both in their hospitals and in private practices. We sought out additional employment opportunities to pay off college debt, plan for the future and all the needs inherent in it, such as homes, cars, marriage and children’s education.

When I write about moonlighting or additional employment outside of your primary employment, what am I considering? There is a plethora of opportunities in urgent care, emergency medicine, hospitalist, as well as surgery and others. Many of these positions are for weekends, evenings and night shifts (which is the actual definition of moonlighting). These responsibilities are surgical call, per diem, part-time, Locum Tenums, and for a very few, because of state laws, independent practice. This additional employment can supplement the professional’s lifestyle by reducing educational debt, purchasing that first house, along with a nice motor vehicle. I personally used this additional income for my children’s education, family vacations, and to provide for greater financial stability.

Many professionals, including NPs, physical therapists, radiological technologists and residents, think of this as a win-win opportunity. The reality is that with most things in life, there is a price to pay. What is the cost of adding additional hours to your work week?

  • strained marriages and relationships
  • failure in parenting
  • failure to be present as a role model
  • inability to maintain a proper diet which can result in obesity, pre-diabetes, diabetes, and hypertension and chronic fatigue
  • motor vehicle accidents
  • medical errors
  • less than acceptable performance in your primary employment
  • failure to excel in your side gig
  • sleep deprivation
  • tremors which are observed by team members and patients
  • poor concentration and patient relationships(communication)
  • varicosities from prolonged standing at the OR table
  • decreased health
  • inattentiveness and sleepiness
  • greater exposure to malpractice
  • lack of confidence in the malpractice insurance of your additional employment
  • lack of malpractice coverage from your primary employment

There is a very real possibility of losing more than you gain, as everyone will pay a price to gain a prize.

Perhaps I am more conversant on this than many of you, my colleagues, because this was my lifestyle for more than 30 of my 47-year career. I worked an average of between 60 to 100 hours weekly. I recall one week where I exceeded that number and fell asleep while speaking to a patient. Fortunately, the patient was also a friend. I am neither boasting nor proud of this fact –  sleep deprivation can make you just as dangerous to yourself, the public and your patients as a drunk driver. I became obese, diabetic, fatigued in the OR during a lengthy case while sitting. I developed varicosities of my lower extremities that were somewhat like the Lincoln Tunnel in NYC. I contributed less than my best to my family, my primary employer, my additional employers, and my patients; in addition, I was paying much more in taxes. I ruefully can expand this list at the risk of making you think that I am biased. I propose the following question –  would I live the same lifestyle again, if I had a second chance? I can only respond with an emphatic “NO.”

What can I pass on to all of you practicing PAs that may augment your thinking and give you guidance? How can I lend you my experience to assist you in your own extra employment opportunities? How can I encourage you to sustain your health, your reputation, your relationships, your sanity? I shall endeavor to offer you my guidelines because I do possess a Ph.D. in experience.

How to work a full-time job and make additional income, while balancing your primary job, your family and your social life:

  • Consider how much extra income is needed for big tag items without being greedy.
  • Love yourself and your family by taking no more than six extra shifts per month.
  • Allow for some weekend days to engage in family time, outings, sports, and your family’s spiritual life.
  • Share your schedule with your primary physician or supervisor so that there is honest transparency; demonstrate that you are putting their practice needs first.
  • Share your schedule with your part-time or per diem employer, allowing them to observe that you are still providing them with your best skills.
  • Develop an exercise schedule and a healthy diet. Get 7-9 hours of sleep daily.
  • Spouses and significant others can attend a short communication course which considers your change in lifestyle and demonstrates mutual understanding.
  • Take at least two family vacations per year.
  • Develop a hobby.
  • Continue to educate yourself in your specialty.
  • Join your specialty organizations as well as your state and national association.
  • Invest and save your additional income for future expenses.
  • Review your vulnerability to litigation with the inherent realization that additional jobs require additional malpractice insurance outside of that which you currently possess.
  • Sit down with an attorney and review your policy dates, specific coverages, gaps in insurance , vulnerability due to the search aspect of a litigation when a plaintiff’s attorney will argue that your malpractice incident is directly related to additional working hours, fatigue, and the accusation that you are a novice in that specialty.
  • Do you have tail insurance, particularly for moonlighting, per diem and part time work?
  • Resolve to check your policy at least one month prior to the end of your contract year.
  • Consider if your physician or employer is in danger of being bought-out or absorbed by a health care system which will totally change your insurance.
  • Do you own, and are you confident that, your malpractice carrier is stable, not in danger of bankruptcy due to additional claim settlements?
  • The final question in this vein – would you be far better off to finally invest in your secure future with a personal liability insurance policy that has your name only on the face of the policy?

There is only one question to ask yourself after reading this article: “Are you confident after reading and hopefully gaining this knowledge, that you do not have an Achilles’ Heel that can prematurely conclude your practice?”

Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor

Photo by Karolina Grabowska


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