Anesthesiology Residents' Medical School Debt Influence on Moonlighting Activities, Work Environment Choice, and Debt Repayment Programs

Steiner, Jeffrey W.; Pop, Radu B.; You, Jing; Hoang, Stephen Q.; Whitten, Charles W.; Barden, Catherine B.; Szmuk, Peter

doi:10.1213/ane.0b013e318248f61d

Cited by 40 publications

(14 citation statements)

References 11 publications

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“…In this survey, 72.5% of nurses agreed that more money was a factor and 81.8% agreed that weekly agency pay was a reason, thus supporting the general findings of labour economists and among medical residents that one of the main reasons for moonlighting is economic or financial (6, 12, 14, 16, 36). …”

Section: Discussionsupporting

confidence: 73%

“…Much of the research on moonlighting has been done in high-income countries (8–11), and by labour economists, drawing on the economic theory of labour supply that views moonlighting activity primarily as a source of income (7, 9, 12, 13). A few studies that have examined moonlighting among medical doctors (14–16) suggest that doctors also do moonlighting in order to interact with fellow professionals in a health practice site, get approval from peers, or to enhance their knowledge and skills, thus supporting the sociological theories related to professions (7). Organisational theories of moonlighting suggest that although moonlighting provides workers with additional income, training, and other benefits, it could also change their perceptions, decisions, and behaviours at their primary jobs (9, 17).…”

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confidence: 99%

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Factors influencing agency nursing and moonlighting among nurses in South Africa

Rispel

Blaauw

Chirwa

et al. 2014

Global Health Action

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BackgroundIn South Africa, nurses are the largest category of the health care providers. Their optimal performance is critical for the successful implementation of impending health sector reforms.ObjectiveThis paper examines the occurrence of agency nursing, moonlighting, and overtime among nurses in South Africa, and the factors influencing moonlighting.DesignThis cross-sectional survey was a one-stage cluster random sample of 80 hospitals in four South African provinces, selected with stratification from the public and private health sectors. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information, the questionnaire elicited information on the frequency of agency nursing, moonlighting, and overtime, and the nurses’ reasons for doing moonlighting. Survey data were weighted and analysed using STATA version 12.ResultsThe majority of survey participants (n=3,784) were South African (98.0%), female (92.7%), and employed in government (52.8%). Their mean age was 41.5 years (SD 10.4). The occurrence of moonlighting among nurses in the 12 months preceding the survey was 28.0% [95% CI: 24.2–32.1], the frequency of agency nursing was 37.8% [95% CI: 32.4–43.6], while 56.0% of nurses did overtime [95% CI: 51.4–60.4]. In the multiple logistic regression analysis, predictors of moonlighting were province, sector of primary employment, unit of work, category of nurse, and having children. The odds of moonlighting was 1.51 [95% CI: 1.03–2.21] times higher for private sector nurses than for public nurses, while the odds ratio for auxiliary nurses was 0.61 [95% CI: 0.47–0.79] compared to professional nurses. The odds of moonlighting was 1.49 [95% CI: 1.18–1.89] for nurses with children, compared to those without.ConclusionsAgency nursing, moonlighting, and overtime are common among South African nurses, but have received insufficient policy attention. These issues need to be addressed as part of the implementation of comprehensive health workforce strategies.

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Section: Discussionsupporting

confidence: 73%

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confidence: 99%

Factors influencing agency nursing and moonlighting among nurses in South Africa

Rispel

Blaauw

Chirwa

et al. 2014

Global Health Action

View full text Add to dashboard Cite

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“…Alternatively, an accessible link to CaRMS provincial salaries and benefits for postgraduate training may be provided ( https://www.carms.ca/match/r-1-main-residency-match/salary /#1511459027032-06ec5e41-5301). Opportunities such as moonlighting, a practice permitted by the RCPSC, support trainees dealing with financial hardship, reduce emotional exhaustion, and improve quality of life [ 26 , 29 ]. It is important to note that while moonlighting is permitted by the RCPSC, there is a regional variation in regulatory policies and eligibility for moonlighting depending on the provincial regulatory body and program [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Cross-Sectional Analysis of Canadian Anesthesiology Residency Program Website Content

Toor¹,

Wooding²,

Masud³

et al. 2022

Cureus

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“…A small segment reported seeking grant funding and philanthropic support to enable their LM practice (“I am currently writing up a research grant to help offset costs” and “so far it’s all been ‘gratis’ on my part”). While admirable from the perspective of social responsibility, such methods of payments are not feasible for most practitioners, who also may have high rates of burnout and have usually entered the workforce with considerable personal debt from student loans [ 34 , 35 , 36 , 37 , 38 , 39 ], with physicians averaging more than USD 200,000 owed [ 34 , 35 ]. It is unreasonable to expect practitioners who are engaged in evidence-based and effective therapies that align with national guidelines for management of chronic diseases such as obesity, cardiovascular disease, and diabetes to finance their efforts through philanthropy alone.…”

Section: Discussionmentioning

confidence: 99%

Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners

Freeman

Grega

Friedman

et al. 2021

IJERPH

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Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of n = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier (n = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models.

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Anesthesiology Residents' Medical School Debt Influence on Moonlighting Activities, Work Environment Choice, and Debt Repayment Programs

Cited by 40 publications

References 11 publications

Factors influencing agency nursing and moonlighting among nurses in South Africa

Factors influencing agency nursing and moonlighting among nurses in South Africa

Cross-Sectional Analysis of Canadian Anesthesiology Residency Program Website Content

Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners

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