Moonlighting

Moonlighting must comply with ACGME guidelines and the GME Moonlighting Policy, including:

1. Residents and fellows must receive approval from their program director to moonlight. Only those in good clinical, research, professional, and academic standing will be given permission.
2. Program Directors will do monthly reviews of duty hours, moonlighting hours, and performance to ensure moonlighting is not having any negative effects on resident and fellow education, research, or well-being.
3. All shifts are voluntary and NOT an expectation of residency or fellowship training. Shift coverage is completely optional and NOT mandatory.
4. All shifts have to be reported as work hours in MedHub. Per ACGME rules, no resident or fellow is allowed to violate duty hour regulations for ANY reason. These work hour regulations include no more than 80 hours/week with an average of one day in seven is free of patient care.
5. Residents and fellows cannot moonlight in roles that are part of their regular training programs.
6. Moonlighting cannot be done as a PGY-1 resident.
7. Moonlighting cannot be done in the active military.
8. Moonlighting cannot be done if on remediation or probation.
9. Internal moonlighting cannot be done on vacation or leave.
10. Moonlighting cannot be used for jeopardy.
11. Shifts cannot be longer than 24 hours.
12. Moonlighting limit: 24 hours/week, max of 79 hours/month.

• Two types of moonlighting proposals will be reviewed:
  • Residents and Fellows: Internal moonlighting at SHC in a supervised capacity
  • Fellows only: Internal moonlighting at SHC as an attending (for fellows moonlighting in their board-eligible area and not in the scope of their fellowship)
• Approved moonlighting proposals are effective from July 1, 2025 to June 30, 2026.
• Requests are valid for a maximum of one academic year and must be renewed annually.
• Please submit your proposal here by Friday, May 30:
  https://app.smartsheet.com/b/form/d378c552b99b4b47b324d8a2f32edf1c
• We will review proposals twice/year – due: May 30, 2025, then October 1 and April 1 thereafter.
• After the GME Moonlighting Subcommittee reviews them, they will be reviewed for approval at the Graduate Medical Education Committee (GMEC).  Then, we will let the moonlight proposal submitters know the decision of the review.

• External moonlighting has to abide by the ACGME and Stanford GME rules listed above.
• All Residents engaged in external moonlighting must be licensed for unsupervised medical practice in California or the state in which the moonlighting occurs.
• Stanford’s malpractice insurance will not cover Residents for moonlighting activities.
• Residents must obtain written acknowledgement that their Program Director is aware and approves of any moonlighting activities before any moonlighting activity is undertaken.
• A copy of the written acknowledgement will be kept in the resident’s/fellow’s file.
• The Program Director has the discretion to decline to approve moonlighting activities if he/she believes that such activities will interfere with the resident’s/fellow’s training progress or for other legitimate reasons.
• All external moonlighting must be logged into MedHub as work hours.
• SMCH provides oversight of all SMCH based moonlighting as a separate entity and is considered external moonlighting.
• SHC and SMCH have mirrored moonlighting policies and rules.

• Approved moonlighting requests are effective for the entire current academic year from July 1st (or request date) to the following June 30th. 

Residents who want to moonlight:

1. Complete the “2025-2026 Resident/Fellow Moonlighting Attestation Form” in Smartsheet.
   https://app.smartsheet.com/b/form/86732fa861cd4367804df35d1caf0ff2
2. When both resident and PD attestations are complete, submit a moonlighting request in Medhub, following the instructions below. 
3. Residents/Fellows must log ACGME duty hours when moonlighting.
    

Fellows who want to moonlight:

1. All fellows who want to moonlight (either internally or externally) need to complete the “2025-2026 Resident/Fellow Moonlighting Attestation Form” in Smartsheet.
   https://app.smartsheet.com/b/form/86732fa861cd4367804df35d1caf0ff2
2. Fellows who want to moonlight as attendings:
   1. Need Clinical Scholar appointment from the Office of Academic Affairs (OAA) – please work with your Dept Faculty Affairs Team to get this approved.
      https://med.stanford.edu/academicaffairshandbook/chapter-9/role-definitions/clinical-scholar-role.html
   2. Need credentialing from SHC Medical Staff Office for SHC – this takes a minimum of 120 days, so plan ahead for upcoming training periods as required.
      https://stanfordhealthcare.org/health-care-professionals/medical-staff/credentialing-and-privileging.html
3. When both resident and PD attestations are complete, submit a moonlighting request in Medhub, following the instructions below. 
4. Fellows must log duty hours when moonlighting.
    

Program Directors:

• PDs need to complete the “2025-2026 Program Director Moonlighting Approval Form” to submit a list of residents/fellows in your program who are approved to moonlight (for both internal and external moonlighting)
  https://app.smartsheet.com/b/form/66786d589c47488d821a9e376cf35f96

Follow this process to request moonlighting duty hour entry in Medhub:

1. Log in to https://stanford.medhub.com
2. Select “Moonlighting Request Forms” on the left of the home page
   1. Pending requests are listed
3. Select “Submit New Moonlighting Request”
4. Complete details of request
   1. Location: SHC
   2. Description: any additional details you can add to justify request
   3. Type: Internal/External/Both
   4. Start date: today (date of submission)
   5. End date: End of your training period for the current year for example 6/30/26
   6. Max weekly hours: 24
   7. Files: none required
5. Select “Submit”
   1. Trainee can now see pending request in list
6. Program director will get notification of request – approval or revision requested
   1. PDs see this tutorial on approval in Medhub https://community.medhub.com/community/tutorial_standalone.mh?tutorialID=120
   2. Trainee can revise and resubmit in pending list
7. GME office will approve
8. Be sure to select “Moonlighting” dropdown option when entering these duty hours.