 Okay friends, welcome back to the channel. Today I'm going to be taking you on a week of moonlighting as a physician. Moonlighting, what's that you say? We'll get into it more into this video, but it's an effective strategy that I've been using to make some extra money in residency as a physician. But today I'm going to be taking you on a moonlighting night shift from 7pm to 7am as a nighttime medicine physician. So it's time for us to grab all my stuff, coffee, chargers, and get ready to head to the hospital. Hey friends, so today is going to be night three of three for this week of moonlighting. So before we talk about the rest of the video, let's actually talk about what moonlighting is. Now moonlighting is basically a fancy phrase for working overtime and covering open shifts as a doctor. With the recent COVID surge, hospitals like my own are spread really thin and they're staffing and there's often some open slots, especially at night time. So now as a senior resident, I have the ability to sign up for some shifts and make some extra cash. And you would be asking how much do you make? Well for tonight shift I'll be working 12 hours overnight and making $100 per hour or about $1200 before tax. And so when everything is said and done, that's right under $1000, definitely not bad. Now while the money is attractive, what do you actually do during these shifts? And it really depends on the role that I'll be covering for it. Today I'll be working as a nighttime hospitalist, which means that I'll be covering some of the medicine patients while the day team comes home. And since I know nothing about these patients at all, that means tonight can be either really busy or extra chill depending on the panel of patients I'm given and how stable they are. Now since I've made it to the hospital with some time to spare, it's time to grab some caffeine, diet, mount, and do being my personal choice and start to look at my patients for the day. Okay guys, so made it to work. Like I mentioned, this is my third moonlighting shift this week. Just had a lighter week. And so essentially what it works is right now it's 703. There are about 30 times seven, about 200 to 300 medicine patients in the hospital really at any time. Making this video is the time of another COVID surge, so numbers even higher. And essentially you meet people at night to be able to cover these patients. So there are people who are scheduled and paid and there are people who are signing their shifts like I'm doing today. And so at 703 essentially what happens is from 7 to 730, I'm just waiting for patients to get assigned to me from some of the nighttime staff that works here every night. There's going to look at how many people there are and they're going to split it evenly amongst us. So I just can't show you my screen for hypothermic violations. I don't want to show you any patient information. But I slowly start to see a list growing of my names. Right now I have 10 as of a minute ago. I upload it. Let's see what we got. Okay, so we're still at 10. But usually I end up in the night with about 35 to 40 patients. It may seem like a lot. Don't get called on most of them. Most of them sleep. Most of them are medicine patients, observation patients. Do you have some sick ones or like cancer patients? People who are like post a heart attack post a really bad infection or just came from ICU recently. And so once I get my entire list, I'm going to look at each of them and see if there's anything I need to do tonight. All up on labs, check on the patient, call family, send them for imaging, do other studies and things of that sort. And while I'm waiting, usually in the midst of this from like seven to seven thirty, I'm just kind of planning the stuff that I could do to be productive at nighttime. So working on my academic stuff, working on videos, stuff, etc. And then the other thing about moonlighting is that I have to admit two patients tonight. And so the simple way that that works out is there is going to be kind of a chat system through our phones and through our EMR, our medical record system, where essentially somebody gives the patients information, there's seven of us, and then a week, whatever's next in line, we'll just take that patient, see them in the emergency room, admit them, write the note. And then you're in charge of those two patients for the night in addition to everyone you're following. This just helps offload everyone else who is seeing patients tonight, that there are seven more people who could see patients for them in just in case they get busy. So two patients, admissions, not very hard, takes like 40 minutes to admit a patient, maybe an hour if they're complicated, plus cross cover stuff. So tonight could be busy, tonight could be not so bad. I'm going to try to be productive the first few hours and then I'll try to get some sleep if possible. So catch you guys soon. And as a quick update, so it was only 7.08, so not that long, but I already have only patients have 41 tonight. So I'm hoping that that doesn't mean that we're gonna be too busy, usually 40 means that they were understaffed. But fingers crossed, everyone's sleeping. So since I already have my first patient of the day, it's only 7.27, we're gonna go ahead and go see this person, it's coming in with the domino pain. Big differential, usually I can put in the orders, especially because this patient is asymptomatic COVID, sometimes it's just not easier to see them upstairs. But because I don't exactly know everything about them, I'm gonna go downstairs. But the nice thing is that within the last 20 minutes, since we last talked, we've already put in a majority of Asian P and pretty much will be done with this patient at least 750. And then obviously monitoring them over the rest of the night. So let's go see. Now the first admission was pretty straightforward. Here we have a gentleman who presents with nausea, vomiting, and abdominal pain. Now a lot of things can cause these symptoms, but thankfully he's had multiple admissions for this. So I lucked out because I can use his past workup to come up with the two most likely causes for him. The number one cause is that he has poorly controlled diabetes and doesn't take his medications consistently. And this leads him to having high sugars and complications such as neuropathy, which also have complications such as gastroparesis. So where essentially your stomach doesn't move food forward very well. Now in addition to having gastroparesis in the setting of poorly controlled diabetes, he's also a consistent marijuana user. And no, I'm not judging, but it does increase his chances for a syndrome called cyclic vomiting syndrome. This is a condition where chronic marijuana users can notice themselves intermittently having nausea and vomiting and then notice improvement as soon as they start abstaining from it, as well as give him fluids overnight since he hasn't been able to keep anything down. Hi, friends. So it is 820. I have not seen that patient written HMP and put in all their orders, kind of caught up. Remember, I only have one more admission I can take tonight. In fact, that is 820 is good. And now I can finally actually start things on my to-do list. The first thing is to actually catch up on some of the reportings. So as a physician, I have to report when I work, how long I work, and I get behind. So we're going to work on those right now. Hey guys, so it is about nine o'clock. So far I've seen one patient cross-covered on 34 heads right now. And it's been a pretty productive evening because I've already applied for my first board exam that I have to take as a trauma medicine physician, which is a whopping $1,400. And also paid for my Texas license, which is also a whopping $800. I just dropped two grand on moonlighting. So hopefully that has been lighting money makes me a little bit less in the red. But hopefully the night so far continues to go well. I just kind of sit in front of this computer, make sure that all the labs and everything that I've come back are normal for the team in the morning. So whether patients are nice and comfy and go to sleep, probably going to go downstairs and grab some food in a second or make work or something. But right now I'm pretty broke. So but this is kind of how one of these moonlighting nights go. Oh, and in addition to everything else I've paid for, I realize I broke my status scope. As you guys can see, there's like cracks in this thing. So all the air leaves and I can't hear anything. So I'm having to use the nurses for any patients I've been called for. But that's my night. So a lot of money has been wasted or spent $200 set of scope, licensing exam, and the license application, and it's only making about half of that tonight. So not complaining, but hopefully we get some rest because we have some work to do tomorrow. Anything happens tonight. I will go ahead and catch back up with you guys later. Hopefully you guys are enjoying the video. See you later. All right, guys. So I wish I had more content to actually talk about what's going on. It is 10.30 and after admitting that patients have just had a few messages. So obviously I won't show you the screen. But the cool thing about our EMR is almost they can like message us as if there was a text message. Imagine Facebook Messenger for EMR. So I don't always have to get paid, which I hate. But I think since the start of the night, one, two, three, four, five, six, seven, eight, eight questions from nurses from the 40 patients that I've had. A lot of them are very simple. And so I've been sitting here and pretty much finished my to-do list for the day. So I don't know, I probably will go grab something to eat and then if something comes up, I'll let you know. But otherwise, we're gonna try to get some sleep. And just like that, that's a quick and easy admission for sure. Now the rest of the night so far has been me responding to quick pages and messages from nurses. Now often I get called on problems such as pain, difficulty sleeping, pain, and more pain. But on these shifts, I also get some emergent calls such as the patient is bleeding, not breathing well, or has an arrhythmia, please come to bedside. Now this latter category requires that I go see the patient, the former category. However, I can often fix the problem based on just the notes and putting in orders from my personal workspace. But thankfully today has been an overall quiet night so far. So after getting my personal to-do list done for the night, I decided to go ahead and lay down around midnight. And just like that, my pager goes off. But when I look at the time, it's actually 2 a.m. So it means I've actually had a nice two hour nap, but it's time for my next admission. Now admission number two, this is a super nice patient who comes with worsening swelling in their legs as well as complaints of shortness of breath. Oh, and when you look at their labs, their kidney numbers actually also look worse. Now this is by far as a medicine physician my favorite problem to solve, volume overload. Because there's really only three organs that can cause true volume overload, the heart, the liver, and the kidney. Now this patient likely has either a kidney problem or a heart problem, or possibly both. But thankfully the answer for both is diuresis with my favorite medication, lasix, or otherwise known as furocemyde. But thankfully after just one dose of diuresis, this patient was resting comfortably in the ED, so once again, pretty straightforward admission. And now I'm done for my two admins for the night. So now it's about 3 a.m. and since most of the patients are asleep, to this point on, I likely don't get paged by a nurse unless it's an emergency. So I try my best to get some sleep, but usually find myself spending an extra hour or two on my phone until I can finally catch some quick z's. Now while tonight's moonlighting shift seems very relaxed and very easy, because honestly it was, there are shifts that I have where I'm sending somebody to the ICU, where I'm getting an admin from the emergency room, as well as getting called by a nurse to come to bedside for somebody else who may need the ICU. So once again these shifts are really a coin toss in terms of how busy you are, as well as the panel of patients that you get. But thankfully tonight the admissions were early and simple, as well as the cross covers wasn't that bad. And when you look at it, it's 7 a.m. and it's time for me to go. But before I head out, I make sure that if anything happened for any patient overnight that I leave a note for their day team so they can be updated, but now it's time to head out. So yeah moonlighting, not bad, and a great way to supplement your income and save a lot more money and residency. But I hope you guys enjoyed today's video and learned something, and if you did consider hitting that like and subscribe button, but I'll see you guys in the next shift. Take care my friends.