Moonlighting by cardiology fellows can be illuminating or detrimental, depending on the job and the fatigue level, observed the author of a column for early career cardiologists.

John T. Saxon, MD, of the University of Mississippi School of Medicine in Jackson and a regular columnist in the Journal of the American College of Cardiology, focused on moonlighting in the Jan. 20 issue. Many cardiology fellows face debt from their education as well as other factors such as home ownership. The opportunity to make on average $100 an hour in supplementary salary can help ease the burden.

On the plus side, early career physicians can apply the skills learned in internal medicine if they moonlight as internists. Some cardiology programs offer fellows the opportunity for moonlighting in cardiac intensive care units or during off hours. If an attending physician remains available as a backup or provides next-day feedback, the experience can be educational as well as lucrative, Saxon proposed.

But unsupervised cardiology moonlighting by fellows is rife with risk “and should be discouraged,” he wrote.

The added loss of sleep is a potential danger as well. Fellowship training requires early career physicians to work in a real-world cauldron that includes grueling hours and intense training. He sees this as enhancing the educational experience. Moonlighting may interfere with that benefit if the fellow is overly fatigued.

Providing in-house moonlighting opportunities may combine the benefits of income, education and oversight. But increasing fellowship salaries, loan forgiveness and subsidies also would help financially strapped fellows, he noted.

In an accompanying comment, Blase Carabello, MD, of Beth Israel Hospital in New York City, described his moonlighting experiences as career enhancing with lifelong lessons. They broadened his exposure to different healthcare settings and patients.

“Although recent duty hour regulations and attention to sleep requirements have added sanity to our profession, sleep deprivation in the practice of some fields of cardiology and in some settings is inevitable,” Carabello wrote. “It is better to know how to deal with it and to recognize one’s limitations rather than to not be exposed to it.”