Extracurricular medical practice (moonlighting) refers to voluntary, compensated, medically-related work, not related with training requirements, performed outside or within the institution where the House Officer is in training or at any of its related participating sites. House officers are not required to engage in moonlighting, either internally or externally, but are allowed to moonlight provided such practice does not interfere with the ability of the House Officer to achieve the goals and objectives of the educational program, and does not interfere with the House Officer's fitness for work nor compromise patient safety The University of Michigan malpractice insurance does not extend to extracurricular medical practice outside the University of Michigan Health System. Any extracurricular medical practice which requires that the House Officer assume continuing responsibility for patients is not permitted, as it may interfere with their responsibilities at the University of Michigan Health System.

Most often, House Officers moonlight at hospitals or health centers unaffiliated with the University of Michigan Health System. The services provided by House Officers to patient(s) at the University of Michigan as part of their GME program are reimbursed to the institution as direct GME payments, and the House Officer may therefore not receive extra remuneration for caring for patients in this situation. This policy not only affects the University of Michigan services connected to that particular GME program, but also services at other institutions that have signed affiliation agreements with that particular GME program. However, services provided by House Officers that are not related to their ACGME-approved program, including those within the University of Michigan Health system, are eligible for moonlighting payments. For example, a University of Michigan surgery resident could be permitted to moonlight at the St. Joseph's Hospital emergency room, as that is not part of their training program. A University of Michigan pathology resident could likewise moonlight in a University of Michigan ICU. These services are permissible, provided that services performed can be separately identified from those services that are required as part of the House Officer's approved GME program. Internal moonlighting opportunities are to be coordinated by an individual identified by the Department who is not a House Officer or a part of the operation of the educational programs within the Department.

The individual Program Directors are required to approve and monitor House Officers' moonlighting activities on a yearly basis. House Officers, in turn, are required to notify their Program Director of all moonlighting activity prior to commencement as well as follow the institutional and program moonlighting policy. The Program Directors will provide all program House Officers with the moonlighting policy and the "Moonlighting Request Form", to be completed. This information is in turn submitted to the GME Office, as the ACGME requires that participating institutions maintain documentation of a House Officer's extracurricular medical practice. It is the Program Director's responsibility to determine if any moonlighting activities are in compliance with the institutional guidelines, and if not, take corrective action to remedy the infraction. Any House Officer found to be misrepresenting or underreporting moonlighting activity will be banned from additional moonlighting for the duration of their training, and the HOA and the GME Office will be notified. Additional disciplinary action can be taken at the discretion of the Program Director, following the guidelines explained elsewhere.

The purposes of this policy are to (a) protect patient safety, and (b) ensure that the training of House Officers within their University of Michigan GME program is not compromised. It is not meant to facilitate a de facto policy banning moonlighting by House Officers within a particular GME program. To this end, a House Officer in good standing who wishes to moonlight should be permitted to do so, provided the moonlighting position meets the conditions outlined above. Program Directors who feel that a particular House Officer should not be permitted to moonlight must provide concrete reasons for why that House Officer should not do so, as well as objective criteria by which the resident can improve their standing, i.e. performance reviews, incident reports, scores on in-service exams, etc. Vague statements, such as "moonlighting will impair your training here" are not valid criteria to use in denying the House Officer's request.