By Stacey Ritzen, WCI Contributor
Protecting yourself and your livelihood with medical liability insurance is a part of the job no one likes to think about. But for physicians who moonlight, things can get even more tricky. While you probably have medical malpractice insurance that covers your primary job, that doesn’t necessarily mean that you’re protected from any work you might do on the side, including a moonlighting stint.
It only takes one lost or settled malpractice lawsuit to trigger a financial catastrophe from which you may never recover (though, to be fair, that outcome is awfully rare). If you’re thinking about moonlighting, it’s crucial to consider malpractice insurance before going any further.
What Is a Moonlighting Physician?
As you may have gathered from the context, a physician who moonlights is essentially performing a secondary or side job in addition to their full-time, salaried position. The term “moonlighting” is not exclusive to medicine, as any professional who works outside of their primary role is considered to be moonlighting or “freelancing.”
There are several reasons why physicians moonlight. Residents may earn money working as an independent physician outside of their residency training program since it's a good way for newer and less experienced physicians to earn extra money and to help sharpen their skill sets. On the other hand, for more established physicians, moonlighting may provide opportunities to start a side business or simply boost income.
Is Moonlighting Worth It?
While moonlighting may put some extra dollars in your pocket or diversify your skills, there are some obvious drawbacks to consider. Working too many hours across multiple jobs can lead to physician burnout pretty quickly. Plus, you'd be spending time away from family or shirking home responsibilities. Working as an independent contractor in any field can also complicate things come tax time, and you may get hit with an unexpected bill if you're working on a 1099 and aren't taking the appropriate precautions (i.e. making quarterly estimated payments). It can also be risky to you personally and your specialty to moonlight before your training is complete. You're not fully trained, and you may not know what you don't know. Plus, why would anyone value your training if you can do the job before you're even done? As such, many experts will recommend that physicians limit the amount of time they spend moonlighting.
But moonlighting also is a good way to make a significant amount of extra money, which could help you pay down your student loans or save for a home.
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Do I Need Moonlighting Malpractice Insurance?
Medical malpractice insurance policies tend to be pretty specific to a physician’s line of work, and they are fairly limited in the scope of what they’ll cover. In most cases, your policy will likely only cover the work you perform for your primary employer that falls within your job description. In other words, you can’t count on malpractice insurance to cover you if the work you’re doing on the side leads to a complaint or if it falls under a policy exclusion. However, ask the insurance company. It often will cover you for very minor things, like covering a ski clinic three days a year or being the medical support at a 5K road race.
If you plan to consistently moonlight, make sure there is a specific malpractice insurance policy in place to cover that. Most frequently, the employer will provide it themselves. If you have to purchase a separate policy, make sure it pencils out. If you don't work much, it's entirely possible to spend more on malpractice coverage than you will ever make in the job. There are a few things to know, however. Many “moonlighting policies” are only for part-time work, and they may only cover 20 hours or less per week. You’ll also want to make sure that the policy provides similar coverage to your primary coverage, especially if you're doing similar work.
As mentioned, the secondary employer usually covers the malpractice insurance. But before getting started, it’s important to differentiate whether the insurance offered is occurrence-based or claims-based. Occurence-based insurance covers the individual for a lifetime for incidents that occur when the policy is in effect. So, if you’re sued in 2025 for an alleged malpractice incident that took place in 2023, you’ll still be protected from litigation.
Meanwhile, claims-based insurance only covers the individual during the period that the policy is active. Taking that same example: if you’re sued for that 2023 incident in 2025 but the policy ended in 2024, you would legally be on the hook for that lawsuit. The way around avoiding surprise claims-based lawsuits is to purchase a tail insurance policy that covers you beyond the policy end date. However, this could eventually become costly, so you’ll want to evaluate whether moonlighting is even worth it in the first place. Most docs ask the employer to cover the tail, especially when moonlighting.
If the employer doesn’t offer moonlighting malpractice insurance, it may be on the physician to work with a surplus lines company, which consists of specialized insurers that cover risks not available within the broad insurance market. This is more likely to occur when a physician moonlights outside their primary specialty. In these instances, the insurance company will likely also require proof of training to provide coverage.
But before branching out or purchasing additional insurance, it’s also a good idea to review your employer’s contract to see if there are any terms or conditions that could prevent you from picking up extra work on the side. Many employers require employees to obtain approval before moonlighting, or they can even withhold compensation if the physician uses offices, facilities, or equipment that belongs to their full-time employer.
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Where Should I Buy Moonlighting Malpractice Insurance?
Malpractice insurance is generally the most expensive insurance a physician will ever buy. But the good news is that many carriers offer moonlighting or part-time malpractice policies at discounted rates, so shopping for additional coverage shouldn’t break the bank.
Many insurance providers offer free quotes online within a matter of minutes. But if this all seems overwhelming and you’re unsure where to begin, The White Coat Investor curates a regularly updated list of insurance agents for all your needs as a medical professional—from disability and life insurance to malpractice. It's a great place to start looking.
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