Can an internist moonlight, and what does moonlighting pay?

Yes, when three permissions line up, and the pay is real but thinner than the locums headlines. Moonlighting is contract work before it is extra income: your employment agreement or training program has to allow outside work, the facility's malpractice coverage has to reach the moonlighting shifts or you have to buy your own, and the work has to sit outside your primary job's noncompete. On rates, AMN Healthcare lists locum tenens internal medicine work at $140 to $151 an hour in October 2026, and its hospitalist listings, where most attending moonlighting lands, run $179 to $200 an hour. A resident covering in house nights and an attending selling two off weeks a year are running the same play at different prices: found income, taxed at your top rate, that either accelerates the waterfall or evaporates into lifestyle.

Part of the internal medicine hub.

The permission stack comes first

For residents and fellows, the program decides, and the governing rules are written down. A PGY-1 resident may not moonlight at all. Past PGY-1, moonlighting requires the program director's written permission before the first shift, and the program or the institution may prohibit it entirely. Every moonlighting hour counts toward the 80 hour weekly limit, internal and external alike, not only the in house hours. The work also requires a full license in most states, which is why moonlighting usually opens in the second or third year of internal medicine training rather than the first. A prohibition discovered after you have worked the shifts is a professionalism problem, not a scheduling problem. Get the approval in writing.

For attendings, the contract decides. Read three clauses before you take a single outside shift. The outside activities or prior consent clause, which may require written permission for any compensated clinical work elsewhere. The noncompete, which may bar the exact nearby facilities where moonlighting shifts exist. And the malpractice clause, because your employer's coverage almost never follows you to another facility's patients. Moonlighting shifts usually require you to carry your own coverage for that work or to be covered under the moonlighting facility's policy, stated in the moonlighting agreement itself. If neither is true, you are practicing uninsured for that shift, whatever your day job carries.

What the hours pay, and what the tax takes

The rate bands are published. AMN Healthcare's locum tenens internal medicine listings, the outpatient and coverage work residents and fellows most often pick up, post at $140 to $151 an hour in October 2026. Its hospitalist listings post at $179 to $200 an hour. Internal extra shifts at your own hospital, priced by your group, are usually the richest moonlighting of all per hour of friction, because credentialing and coverage are already in place; the extra shifts question in this bank works that comparison against investing.

Moonlighting income arrives as 1099 income with nothing withheld, so it owes income tax at your marginal rate plus self employment tax: 12.4 percent for Social Security up to the 2026 wage base of $184,500 across all your earnings, and 2.9 percent for Medicare on everything. An employed hospitalist already past the wage base on salary owes only the Medicare parts on moonlighting income, which makes attending moonlighting meaningfully cheaper in tax than resident moonlighting. Set the withholding share aside the day each check lands, the same separate account discipline the locums taxes question works in full, and pay the quarterly estimate if the amounts grow. Moonlighting also opens a solo 401(k) on the self employment income if you have none, with the standing warning that the $24,500 elective deferral for 2026 is one limit per person across your 401(k) and 403(b) plans, and a 403(b) at your day job is aggregated with a plan of a business you own for the overall additions limit.

Give the money a job before you earn it

Moonlighting income is the most psychologically fragile money a physician earns, because it arrives as a windfall for hours that already hurt. The version that builds wealth names the target before the first shift: the consumer debt line cleared, the reserve finished to its employment type level, the loan balance outside a forgiveness track retired, the taxable account opened. The version that does not names nothing, and the money becomes upgraded consumption at the exact moment exhaustion argues for it. Set an annual cap in shifts as well as a target in dollars: the off weeks of a block schedule are the recovery that keeps the primary job, and your license, intact. Moonlighting that costs the main job was the most expensive income of your career.