A physician on your team mentions, almost in passing, that they’ve been picking up weekend shifts at an urgent care clinic. They assure you it’s no big deal — just a few hours here and there. But a week later, you start noticing schedule gaps. Their inbox response time has slowed. And when you look around, you realize you have no written agreement in place, no insurance verification on file, and no process for approving or tracking any of this. 

That scenario plays out more often than most administrators expect. And it’s rarely the result of bad intent on the physician’s part. It’s the result of a policy gap — a situation the practice never structured around. 

The problem is usually the process, not the provider 

Moonlighting is common in ambulatory medicine. Physicians, nurse practitioners, and other advanced practice providers (APPs) take on urgent care shifts, telemedicine coverage, consulting roles, and teaching appointments for a range of legitimate reasons: supplementing income, staying engaged with a different patient population, maintaining procedural volume, or simply filling time during lower-volume periods in their schedule. 

The practice-level risk isn’t that moonlighting happens. The risk is that it happens without structure: 

• No one reviewed whether the outside work conflicts with existing non-compete or exclusivity clauses. 
• The provider is treating patients elsewhere under coverage that may not meet your standards — or isn’t carrying separate malpractice at all. 
• Fatigue from overnight or weekend shifts is showing up in clinic the next morning. 
• The provider is using scheduling goodwill or informal flexibility to accommodate outside work in ways that quietly create access problems for your patients. 
• Confidential patient information, or even just the practice’s name, is being used in an outside context without authorization. 

None of these problems require bad faith to occur. They just require the absence of a clear agreement. 

What a moonlighting agreement should do 

A well-constructed moonlighting agreement creates shared understanding. It tells the provider exactly what the practice expects, what protections need to be in place, and what the review and approval process looks like before outside work begins. 

The core elements a moonlighting agreement should cover: 

• Scope of permitted activities. What kinds of outside work are allowed (clinical, telemedicine, consulting, teaching) and whether any categories require additional review. 
• Licensure and compliance. Confirmation that the provider holds an active, unrestricted license in each state where they’ll work, and that all applicable laws, payer rules, and facility policies apply. 
• Professional liability coverage. A clear statement that the provider must carry separate malpractice coverage for outside activities, with defined minimum limits and proof-of-insurance requirements. Your practice’s policy does not cover work done elsewhere. 
• Duty to disclose and prior approval. A requirement that the provider disclose any outside engagement in writing before it begins — including the nature of the work, the site or organization, and the schedule — and that approval is formally granted by the practice. 
• No interference with primary duties. An explicit commitment that patient care responsibilities, scheduling obligations, call coverage, and performance standards at the practice take priority. 
• Non-solicitation and confidentiality. A reminder that existing confidentiality obligations, patient non-solicitation restrictions, and HIPAA protections continue to apply during any outside work. 
• Termination and revocation rights. The practice’s right to revoke moonlighting approval if performance, access, or compliance concerns arise. 

 Note: Non-compete enforceability, patient notification requirements, telemedicine rules, and controlled-substance prescribing authority vary by state. Review any moonlighting agreement with qualified legal counsel before finalizing it for use. 

Who should use this, and when 

This template is most directly useful for: 

• Practice administrators and operations leaders who need a structured starting point and don’t want to build one from scratch. 
• HR leads or physician relations staff who manage provider agreements and need to add a moonlighting component. 
• Practices that don’t currently have a moonlighting policy and have had at least one situation (or near-miss) where the lack of one created a problem. 
• Groups in active recruitment mode, where early-career physicians or APPs may specifically ask about moonlighting flexibility before accepting an offer. 

The right time to establish this policy is before a request comes in, not after. Once a provider has already started outside work, the conversation about documentation and limits is harder to have. When the policy is in place from day one of employment, it’s simply part of how the practice operates. 

Getting started 

A clear moonlighting agreement strengthens culture and reduces operational risk while supporting clinicians’ professional growth. The goal isn’t to restrict what your providers do outside of work. It’s to make sure that when outside work happens, your patients, practice, and providers are all protected by a clear, shared agreement.

Download MGMA’s Moonlighting Agreement Template and work through it with your legal counsel. Adapt the language, build the approval form, and put the tracking process in place.