ATOs/Moonlighting

The Basics

One of the perks of completing intern year is the ability to make some extra $$$ if you want. This process is formally called Additional Training Opportunities, or ATOs. 

There are three main things to know before you sign up:

  • First your paperwork has to be completed and approved before you work any shift. (Everyone has to re-do the paperwork each year.)

  • Second, you have to follow duty hours in any ATO shift you sign up for (please see below for details). Failure to do so may result in loss of privileges.If you have any questions about whether you can work an ATO shift from a duty hours perspective, please ask one of the chiefs or Jess Angerman BEFORE signing up!

  • Third, once you have signed up for an ATO shift you own that shift and are responsible for it. If you cannot work the shift you are responsible for finding a replacement.

Please note: Unfortunately those on a J1 visa can't work ATOs.

How to submit your ATO paperwork:

  1. To get started, please read the policy here (also summarized below).

  2. Obtain a copy of your limited medical license either from New Innovations (My profile --> My Personnel Record --> State License --> click the radial button for the appropriate year --> view) or from the GME office. This copy should be attached to the ATO form. Note the expiration date of your limited medical license must match that of the ATO approval form.

  3. Fill out either the ATO or Moonlighting approval form (links at the bottom of this page). Use July 1 as the start date for your next PL year.

    - If you have a limited license then you do the ATO form.

    - If you are fully licensed, then you can apply to moonlight and use that form. If you apply to moonlight outside of the BCH, then you must complete a CRICO form.

  4. If you are a BCH-based resident, fill out only the part of the form that says BCH PL-. If a BMC-based resident fill out the part of the form that says BMC PL-.

  5. Write in the following locations to be approved as an ATO-er/moonlighter:

    - ED, MICU, ICP, 7N NICU, CHPCC, GP, Cardiology, Oncology, MSICU. This will give you "access" to all sites you might be interested in.

  6. Email the form to Allyson Traphagen. She will review it, have Dr. Sectish sign it and enter your name into a database of residents approved to ATO. She will then notify you via email of your acceptance. She will also include, in this email, the names of the scheduling coordinators in the areas of interest to you.

  7. For the BCH ED specifically:

    - Coordinated by Jackie Wellington. If you are interested in the ED (which you marked on your form), Jackie will contact you (no need to email Jackie) then with that she needs (data form and CV). She will then put you on the -dl for ED supplementary shifts.

    - Once you are fully approved, find a shift you are interested in. Check this against your duty hours. We can't approve call swaps and we can't move daytime electives or clinics to accommodate ATOing. Bid for the shift by the due date that Jackie gives.

  8. For non-ED sites, those rotations own their own ATO’s and will send out emails to get residents on the distribution lists.

LEAD/MED PEDS RESIDENTS:  For anyone in the LEAD track interested in ATOs we need you to identify yourselves so you can get put on the BCH payroll.  This takes some time, so the earlier the better. 

NON BCH RESIDENTS: We have to notify HR so you will need to meet with HR to get on BCH payroll prior to the start of your ATO approval, so apply early, too.

BCRP ATO and Duty Hour Rules:

Duty hour restrictions were put in place by the Accreditation Council of Graduate Medical Education (ACGME) to ensure resident well-being and patient safety. The ACGME requires that all programs monitor resident duty hours and ensure compliance with duty hour requirements.

In signing up for ATOs, residents are responsible for ensuring that they do not violate duty hours by taking on these additional clinical responsibilities. Relevant duty hour requirements are detailed here:

  • The following rules will not be violated for ANY rotation per ACGME guidelines.

    • Residents cannot work more than 80 hours/week averaged over a 4-week rotation and cannot be on call more than an average of every 3rd day over that 4-week period, inclusive of all in-house call activities, extra training opportunities and all moonlighting.

    • PGY2+ residents cannot work continuously for more than 24 hours (with an additional 4 hours allowed for transition of care).

    • Residents must have 8 hours off after a shift of  < 24 hours and 14 hours off after a shift of > 24 hours

  • The following rule will not be violated for any rotation. They may be enforced on a case-by-case basis if significant concern from program leadership for a resident’s ability to fulfill primary clinical responsibilities safely.

  • After completing an ATO shift, residents must log the entire ATO shift worked in the same way that they would log a scheduled clinical shift that is part of their residency responsibilities.

  • If a resident has any question as to whether an ATO is compliant with Duty Hour restrictions, they should reach out to the BCRP Administration (Jess Angerman) or the Chief Residents prior to signing up.

Consequences of ATOs in Violation of Duty Hour Restrictions

All ATOs will be entered into Lightning Bolt. A representative of either the BCRP administration or one of the Chief Residents will audit resident ATOs at least monthly. Any resident found to have signed up for an ATO that does not comply with duty hour restrictions will face the following consequences:

·         A first time violation will result in suspension of the violating resident’s ATO privileges for one month

·         A second violation will result in suspension of the violating resident’s ATO privileges for six months

·         A third violation will result in indefinite suspension of the violating resident’s ATO privileges

These consequences will be imposed even if the violation is discovered prior the resident completing the scheduled ATO shift, as it negatively impacts the service requesting the ATO if the resident is forced to back out of a shift they had agreed to cover.

Department-Specific Contact People:

Jackie Wellington -- ED

Melissa (Mellie) Traore and Jamin Alexander -- 11S MICU

Adrianna Caraglia -- 7S MSICU

Eli Sprecher -- CHPCC

Most other ATO opportunities will be distributed by the chiefs

Please email your chiefs or Rose-Marie Bussey if you have any questions!

Documents:

ATO Approval Form (Limited License)

Moonlighting Approval Form (Full License)

CRICO Moonlighting Waiver (Full License)