G-1 RESIDENT AGREEMENT

 

General Provisions

The Abbott Northwestern Hospital Internal Medicine Residency Program provides a graduate medical education program to offer participating Residents an opportunity to specialize in the area of Internal Medicine.

The Abbott Northwestern Hospital Internal Medicine Residency Program hereby offers the Resident an opportunity to participate in the Internal Medicine Program.  The Program is designed to teach particular skills and meet the specific requirements set forth in the Essentials of Accredited Residencies in Graduate Medical Education (the “Essentials”) for internal medicine.

Program

The specific educational content of the Abbott Northwestern Hospital Internal Medicine Residency Program is sufficient to comply with the requirements of the Essentials.  The schedule of specified assignments and the call schedule shall be routinely provided to the Resident during the academic year by the Program Coordinator.  The academic courses, schedule of specific assignments and call schedule are subject to periodic modification and adjustment by the Program Director.

Appointment and Term

The G-1 year in the Abbott Northwestern (ANW) Hospital program in internal medicine begins June 24 (with a five to six day paid orientation prior to June 24) and runs trough June 23 of the following year. 

Should the Resident require extensive time away from the Program for any reason, including illness, the Program Director shall evaluate the academic impact of any such prolonged absence.  If the Program Director believes that the total length of absence adversely impacts the Resident’s educational development, the Program Director may recommend that specified portions of the Program or the entire Program year be repeated by the Resident.  Or, in the event repetition is not feasible, the Program Director will recommend dismissal of the Resident to the Graduate Internal Medicine Education Committee (GIMEC).  If dismissal is recommended, the Resident may grieve this action in accordance with the Grievance Procedures for Training Programs (GPTP).

It is the expectation that the Internal Medicine Program will provide the Residency with ACGME approved training to the completion of the program.  In the unlikely event of reduction of resident numbers or closure of the Internal Medicine Program, every effort will be made by the institution to assist the Resident in finding a satisfactory program for the continuation of his or her training.

Academic, Licensure and Certification Requirements

The Resident must be a graduate of an institution accredited by the Liaison Committee of Medical Education or otherwise must meet the eligibility requirement of the Essentials.

The Resident must obtain a Residency Permit to practice medicine from the Minnesota Board of Medical Practice for the first year of residency training for US graduates and for the first and second year of residency training for International graduates.  When the Resident becomes eligible for licensure he/she must obtain a license to practice medicine from the Minnesota Board of Medical Practice prior to the commencement of any Program year after the qualifying year(s) of the Resident’s participation in graduate medical education.

The Resident must at all times maintain in effect and verify, upon request, all legally required permits, licenses and other relevant documents, including proof of citizenship, naturalization or current and valid visas authorizing the Resident to work in the United States.

The Resident must, at all times during the terms of this Agreement, maintain in effect, Advanced Cardiac Life Support (ACLS) Certification.

Obligations of the Resident

The Resident agrees to:

• Develop a personal program of self-study and professional growth with guidance from the Program teaching staff.
• Develop the skills set forth in the ACGME Essentials.  This includes developing proficiency in the ACGME competencies of patient care, medical knowledge, practice based learning, interpersonal and communication skills, professionalism, and system based practice.
• Participate in safe, effective and compassionate patient care under the supervision of the Program teaching staff.
• Participate fully in the educational activities of the Program and assume responsibility for participation in the teaching of more junior physicians and Medical Students.
• Obtain a pre-placement health assessment by Allina Occupational Health.  This includes tuberculin skin testing and necessary immunizations or documented lab tests proving immunity to Measles, Mumps, Rubella, and Varicella, and is found to be fit for duty.
• Comply with all Abbott Northwestern Hospital and Program rules, regulations, practices, procedures and policies.
• Adhere to the call schedule and schedule of assignments in a prompt and timely fashion.
• Apply cost containment measures in the provision of patient care.
• Maintain a neat, well-groomed appearance.  This includes wearing the Abbott Northwestern Hospital identification tag so that the name and photo areas are clearly visible.
• Comply with all federal, state, and local laws, regulations and ordinances, including nondiscrimination and sexual harassment provisions.
• Advise the Program promptly of any change in the Resident’s mailing address and/or phone number.
• If the Resident chooses to withdraw from the Program in good standing, he or she will notify the Program Director by March 1st of the current academic year.

Stipend

Stipend on June 16, 2010, is $48,863.  Applicable state, federal and FICA taxes are withheld according to law.

Paid time off is 22 days for G-1 residents for the period from June 24 to June 23 of the following year (this includes vacation, sick and personal days).  All PTO days are granted per academic year and are on a “use it or lose it” basis, i.e., there will be no carryover or payout for any PTO time not used in a particular academic year.

Benefits and Perquisites

Abbott Northwestern Hospital’s benefit program offers a wide range of choices designed to meet the varied needs of employees.  The specific plan provisions are outlined in the “summary plan descriptions" which are available in Human Resources.  The following information applies to medical, dental, life and long term disability insurances:

• Coverage begins the first of the month following employment.  Abbott Northwestern Hospital provides each eligible employee with a benefit allowance that may be used toward the cost of elected insurances.  Premiums are deducted on a pretax basis; therefore, changes can only be made during the annual open enrollment period or at the time of a qualifying family status event.  Forms must be received within 45 days of such changes, but deductions begin on the effective date of coverage.  If a Resident terminates, coverage ends on the last date of the month.
• When the Resident is working in an official capacity, Abbott Northwestern Hospital provides liability protection.  This includes coverage for incidents that take place during the time of Resident’s employment that may arise after the period of the Resident’s employment (i.e., “tail” coverage). 
• Abbott Northwestern Hospital shall provide pregnancy-related disability leave to Residents in accordance with applicable law. 
• Residents are eligible for family leave benefits in accordance with applicable law.
• The services of the Employee Assistance Program are available to all residents.  This program is to help employees resolve problems before they affect job performance.  The program is confidential with no charge for short-term counseling.  Confidentiality would be compromised only in the most extreme cases of immediate risk to patient safety and in instances of legal necessity.  Assistance is available to Residents in dealing with personal or work-related problems.  Referrals can be voluntary or mandatory.
• Abbott Northwestern Hospital will provide noon meals.  On-call meals and sleeping quarters will be provided to the Resident on nights and weekends when the Resident is on-call and required to stay on Abbott Northwestern Hospital grounds.
• White lab coats and scrubs are provided.
• Free parking is provided at Abbott Northwestern Hospital. 

Professional Activities Beyond the Scope of This Agreement

The Program is required by the ACGME to know of all resident moonlighting, whether at ANW or at an outside site. This is to ensure that moonlighting does not negatively impact a resident’s education. In order to moonlight, residents must have the written permission of the Program Director. Three moonlighting positions are available to residents in the second and third year.  The program strongly discourages moonlighting outside of the three available moonlighting positions at ANW (see separate detailed descriptions of these opportunities in the policies). Residents on a J-1 visa are prohibited from moonlighting due to visa restrictions.  Moonlighting must not interfere with resident rotations, and limits on number of consults, etc, cannot be created.  If a resident is unable to perform full duties the post-moonlighting day, the Program Director must be notified.  Moonlighting outside of the organization is not covered by Allina’s malpractice insurance.  If a resident engages in compensated professional activities outside Allina, the Resident hereby agrees to indemnify and hold Allina Hospitals & Clinics harmless from and against any and all liability resulting from such activities.

Evaluation, Counseling and Advancement

Evaluation and counseling shall be done by the Program Director with the advice of the Program teaching staff.  The following procedure applies:

• Evaluation of the Resident shall take place at the completion of each rotation.  The Program Director shall maintain written evaluations in the Resident’s program file.
• After the first six months of a program year, at which time evaluation is intensive, Residents will be requested to discuss their performance and the program at least twice a year.  Any problems identified with Resident or program performance will be reported to the GIMEC.
• The Program Director shall discuss the Resident’s Program advancement and renewal of this Agreement with the Resident by March 1st of the Program year. 
• Program advancement and appointment renewal are not assured or guaranteed to the Resident, but instead contingent upon the Resident’s satisfactory demonstration of progressive advancement in scholarship and continued professional growth.  The Resident must also satisfactorily meet the Program obligations set forth in Obligations of Resident hereof.

Procedures for Disciplinary Action/Grievance Procedures for Training Program

Graduate Internal Medicine Education Committee (GIMEC)

• The (GIMEC) evaluates the performance and educational accomplishments of members of the housestaff as well as conducting the institutional review of the residency program.
• A Resident may grieve an action taken against him or her through the GIMEC.  A request must be made to the Program Director of Graduate Medical Education in order to have the Committee hear the grievance.
• Residents may also request assistance from the GIMEC in instances where a formal action has not been taken but a problem exits that cannot be worked out with the Program Director.

Periodic Written Evaluations With Less Than Satisfactory Overall

• All teaching relationships with Residents will be accompanied by conversations with the resident advisee or Program Director on a regular basis.  Problem areas will be documented.
• The Program Director will discuss written periodic evaluations with the Residents.
• Any less than satisfactory evaluation will be brought to the attention of the Program Director by the attending physician/advisor.  The Program Director will inquire whether any similar evaluations of the Resident have been submitted following any other rotations.
• The Program Director will discuss the matter with the Resident and provide him/her with an opportunity to respond to the evaluation.  Subsequent evaluations may be scheduled to look for the correction of any deficiency.  This review will be documented and signed by the Program Director.
• If at any point in the process, the Resident would like to present his/her point of view personally and privately, he/she may address himself/herself directly to the Program Director.  If he/she subsequently desires a further hearing, he/she may, with the knowledge of the Program Director, address himself/herself to the GIMEC.

Probation

• Probation is an opportunity period for a Resident to bring his/her performance to a satisfactory level with the aid of more intensive counseling and monitoring.
• If the gravity or the frequency of less than satisfactory evaluations or other problems result in the assignment of Probation by the GIMEC, the Resident will be offered the opportunity to appeal to the GIMEC.  The Resident must make a request in writing to the Program Director should the Resident wish to appeal to the GIMEC.

Pursuant to such appearance before the GIMEC the following procedures will be followed:

• The Resident will be given written notice of the precise circumstances at least two weeks in advance of his/her appearance.  The Resident will be given an opportunity to appear before the GIMEC to present additional information, take issue with the Department’s decision, and/or call witnesses in support of his/her position.  He or she will be also given the opportunity to bring a representative of choice who may aid and counsel the Resident.   Since the GIMEC meets to investigate facts, and does not conduct an adversarial hearing, there is no cross-examination, and an attorney may not directly participate in questioning.
• Probation requires a majority vote of the GIMEC.
• The reasons for probation will be specified (i.e., the Resident’s specific actions or deficiencies that led to the recommendation of probation).  The conditions of probation (what the Resident will be expected to do differently), and the specific measures taken by the Program to help the Resident achieve these goals will be detailed.  A copy of this statement will be presented to the Resident.
• The length of probation will be specified, together with the various options that can occur following the completion of the probationary period: A period of probation will usually be from 1 to 3 months, but may occasionally be for the duration of an academic year.
• If the GIMEC upholds the Resident’s appeal, then probation will be immediately terminated.  All documentation of probationary action will be removed from the Resident’s file.

Options After Probation

At the end of probation, the following may occur:

• Termination of Probation with a statement in the house officer’s record that the conditions of probation were satisfactorily resolved and the issues are not longer considered to be a serious problem.
• Continuation of Probation for an additional specified period of time, and a redefining of the problems and procedures to be followed below:

Premature dismissal - Temporary suspension:

• If the GIMEC believes that the retention of a Resident would jeopardize patient care or welfare, or that the Resident would jeopardize patient care or welfare, or that the Resident should not be permitted to continue with his/her responsibilities for some other reason, the Resident can be temporarily suspended at once.  The Resident may then appeal, at his/her discretion, to the GIMEC, pursuant to the above procedures.  Such a temporary suspension may also follow a probationary period during which the Resident has failed to bring up his/her performance to satisfactory standards.
• The decision to discharge a Resident in the middle of the year must be agreed by a majority vote of at least 2/3 of the members of the GIMEC.  The minutes of the GIMEC will serve as a means of the action undertaken.
• Under usual circumstances, the decision to prematurely dismiss a Resident will be taken after the Resident had been on probation.  Under unusual circumstances, the Program Director may feel that an abrupt decision necessitating premature dismissal of a Resident should be carried out without awaiting the normal probation process.  Under these circumstances, the Resident should be assigned a role which removes him or her from any responsibility for direct patient care, until the case can be heard by the GIMEC.  The Resident will thus be considered to be temporarily suspended, pending completion of the grievance procedure.
• The recommendation of the Program Director not to renew the Appointment of a Resident must take place no later than March 1st (or eight months after the start of the program) of the Academic Year.  Failure to inform the Resident of such a recommendation by that date must be treated as a premature dismissal.
• In the event that the GIMEC considers termination of an appointment in the middle of the year or non-renewal of the year-to-year contract, it shall insure that the above procedures include a notice and an opportunity to refute charges, take place prior to and during any decision-making meeting or meetings.

Withholding of Approval to Take Internal Medicine Boards

The withholding of approval to take internal medicine boards could result from the nature and/or frequency of the Resident having received less than satisfactory regular period evaluations.

The Resident must be afforded an opportunity to grieve this action to the GIMEC.

Resident Grievance

Grievances of the Resident must be presented to the Program Director.  If not resolved to the satisfaction of the Resident, he/she must have the opportunity to present the matter to the GIMEC.

In instances where the grievance(s) is/are not satisfactorily resolved, the Resident must be informed by the Program Director of his right to present the issue(s) to the GIMEC.  In the case where the matter remains unresolved, the GIMEC will present the conflict to the Chief of Staff.  The judgment of the GIMEC will be reviewed by the Chief of Staff before determining if further action is necessary.

Time Frame for Presenting Grievances to the GIMEC

Grievances may be brought to the GIMEC at any time.  However, delays of more than two weeks after an action is taken may interfere with the ability to remedy certain adverse actions.

Nondiscrimination

Allina (ANW) will not discriminate against any employee or applicant for employment on the basis of any legally protected classification such as race, color, creed, religion, national origin, gender sexual orientation, disability, age, marital or family status, covered veteran status or status with regard to public assistance.

This commitment applies to all employment practices including, but not limited to hiring, promotion, demotion, transfer, recruitment, advertising, selection, layoff, corrective action, termination, recreational activities, rates of pay or other forms of compensation and selection for training. 

Residency Closure/Reduction

If the Abbott Northwestern Internal Medicine Residency Program (ANW) reduces the size of its residency program, affected residents will be notified as soon as possible; ANW will make every effort within budgetary constraints to allow existing residents to complete their education.  In the unlikely event that existing residents are displaced by a program closure or reduction, ANW will make every effort to assist the residents in locating another resident program where they can continue their education.

Miscellaneous

This Agreement may be modified only by the mutual written agreement of the Parties hereto.

This Agreement constitutes the entire Agreement between the Parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether oral or written, between the Parties with respect to the subject matter of this Agreement.

The Resident hereby authorizes and consents to the release of information by the Program Director, or other physicians involved with Program evaluation of the Resident to other hospitals, teaching programs, medical associations, medical staffs, certification boards or other entities or persons seeking to evaluate the Resident’s professional qualifications, and hereby releases such respondent from any and all liability, cost and expense related thereof provided the release of information is done in good faith and without malice.  The Resident shall indemnify and hold harmless Abbott Northwestern Hospital, the Program Director of Medical Education, and all other physicians and Abbott Northwestern Hospital employees and personnel for any damages, expenses and attorney’s fees arising from any claims brought by the resident in relation to the release of information performed in accordance with this Agreement