Careful

If your state permits it, you have the appropriate malpractice, your program permits moonlighting, AND it doesn't take away from your residency education then I have no problem with it.

The dilemma is: Are not most cases being done during your residency work week? Unless you have a day off during the week when cases are done or they are being done on off weekends or in offices during time you are not working as a resident then I do not see how this is possible. Even if you do have a day off during the week, is a case that day OK to bill for but the next day a case with the same attending when you are working as a resident not OK? It's a slippery slope. My recommendation is that you are either a doctor in training or you are not and blurring the line usually leads to trouble. In addition, you would need to be on the insurance plans. How would you like a Medicare audit as a resident? Especially when they pay for the cost of your residency and may interpret any billing as fraud. Worse if you bill out of network and do not bill the balance for deductibles and co pays you are commiting fraud. Get caught and see how hard it will be to get access to these plans when you graduate. How about this scenario, you assist on a case and perhaps you would have done a different procedure than the attending or the follow up is different then yours? Now you get sued what do you do? And as a resident are you not admitting that you are still learning and perhaps your opinions are inexperienced and those of a doctor in training? Finally, your discounted malpractice rates you get as a new attending would kick in while you are practicing as a resident. This means when you do graduate your rates will be factored in as an attending in year 3. Some states will require you be considered a attending rahter than a resident when charging association dues.

Factor in those costs and risks with the minimal cases and income it may not be worth it.

Moonlighting by MDs has been drastically cut. Hospital liability companies are frowning upon it or not permitting it. This is for both the hospital with the training program and the hospital where the resident moonlights. A few rural hospitals have no choice but you can see the medicolegal nightmare this creates. In addition even if permitted this coverage is typically done in off times for the resident. An ER would have better opportunities than doing elective surgical cases.

Last comment. It's not just surgery. I know of residents doing hospital consults and house calls. An attending and the resident enter into some fee splitting arrangement. Same issues exist and fee splitting is unethical. In addition some of these stellar attendings even bill under their name. My advice, stay away from these deals. Why blow all of your hard work over a gray area?