Claiming that the situation was poorly controlled and could put patients at risk, the ministry circulated a new rule, asking doctors to get permission from their employer before they can accept work at another facility.

Doctors who take a second job without permission can face monetary punishment or have the incident held against them on their next job evaluation, the bureau said.

The moonlighting situation has posed a risk to hospital management and patients' safety because doctors in China are all registered resident staff of hospitals and some local doctors are now so busy moonlighting on second job that they do not spend enough time working at their own hospital, creating staff shortage, especially in times of emergency, said Song Guofan, the health bureau's spokesman.

The ministry is also worried that the moonlighting doctors can not spend adequate time on after-operation care for patients either, which may pose a risk to patients safety in case the facility that hosts moonlighting doctors are not capable of handling the matter properly.

Besides, the income from moonlighting could easily evade the overseeing of tax authority, officials said.

The ministry stressed that cooperation are legal and encouraged if the practice meet certain regulations, in which hospital sends suitable staff to its counterpart and the receiver should carefully check doctor's qualification.

In the past, many local surgeons earned a healthy second living from moonlighting in small local or neighboring cities' hospitals, where medical staff generally lack the level of skill found in Shanghai.

Moonlighting of doctors can go astray when some small negligible hospitals go after profits and receive patients whom they do not have their own professionals to treat, insiders revealed.

Local doctors, however, feel they should be able to make their own decisions about extra work as long as it doesn't interfere with their regular hospital hours.

"I was invited to work at other hospitals due to my own reputation and skill. The money other hospitals give me is much more than my salary," said an orthopedic surgeon from a well-known local hospital, who asked not to be identified. Top surgeons in the city only earn about 4,000 to 5,000 yuan (US$482.68 to 603.35) a month.

Hospital officials admitted that it was difficult to stop doctor's moonlighting.

(eastday.com January 2, 2003)