Letter of Offer to Residents of the University of Florida College of Medicine
Dear Dr. “Last name”:
The College of Medicine, University of Florida (hereinafter “the University”) is pleased to offer you a position as a resident or fellow at the program level PGY 1 in the graduate medical education program, Pediatrics, in the Department of Pediatrics.
This contract describes various aspects of the graduate medical education programs for residents and fellows at the University. Trainees in such programs (residents and fellows) are hereinafter referred to as “residents.” The University reserves the right to make changes without notice in the future to any aspect of these programs.
During your residency you will be required to exhibit the qualifications and talents for the specialty to which you have been accepted for graduate medical education training. For each specialty, you must possess and demonstrate critical thinking skills, sound judgment, emotional stability and maturity, empathy for others, physical and mental stamina, and the ability to learn and function in a variety of settings. You must also be able to perform the essential functions of the specialty and meet the academic standards of the curriculum.
This contract is contingent upon the completeness and accuracy of the appointment documents prepared and submitted by you. Falsification of any of the appointment documents or failure to meet eligibility requirements constitute for non-appointment or termination. This contract, in conjunction with University rules, policies and procedures, governs the relationship between the University and you. This contract constitutes the entire agreement between the parties and supersedes any and all prior and contemporaneous oral or written agreements or understandings between the parties.
The position of resident involves a combination of supervised, progressively more complex and independent patient evaluation, management functions and formal educational activities. Among a resident’s responsibilities in a training program of the University are the following:
- To meet the qualifications for resident eligibility outlined in the Essentials of Accredited Residencies in Graduate Medical Education in the AMA Graduate Medical Education Directory or the Specialty Guidelines of the American Dental Association’s Council on Dental Accreditation;
- To develop a personal program of self study and professional growth with guidance from the teaching staff;
- To provide safe, effective, and compassionate patient care, commensurate with the resident’s level of advancement, responsibility, and competence, under the general supervision of appropriately privileged attending teaching staff;
- To participate fully in the educational and scholarly activities of their program and, as required, assume responsibility for teaching and supervising other residents and students;
- To participate in institutional orientation and educational programs and other activities involving the clinical staff;
- To submit to the program director confidential written evaluations of the faculty and the educational experiences;
- To participate on institutional committees and councils to which the resident is appointed or invited, especially those that relate to their education and/or patient care;
- To adhere to established practices, procedures, and policies of the University and of those applicable from affiliated institutions.
- Licensure: All residents are required to comply with state licensure requirements for physicians in training. Residents must hold before the start date of training either a valid unrestricted Florida medical or dental license or be registered with the Florida Board of Medicine/Board of Dentistry for a Training License or Dental Residency Permit. All residents will be required to obtain a National Provider Identifier (NPI) number. Failure to meet applicable eligibility requirements without delay and obtain and maintain a training license/permit or a valid unrestricted Florida license may result in one or more of the following:
- delay or revocation of appointment
- preclude advancement to the next program level
- preclude continuation in the program
- disciplinary action for non-academic deficiency An unrestricted Florida license is not required of residents; however, should a resident obtain an unrestricted medical license in Florida, it is solely his/her responsibility to maintain active status with the Medical / Dental Board, including timely renewal and payment of all associated fees.
- Confidentiality: all residents have an obligation to conduct themselves in accordance with the Confidentiality policies of the University and its primary teaching hospitals, including Veterans Affairs Medical Center. Failure to follow these policies may be cause for immediate dismissal.
- Background Checks: Your acceptance and continued participation as a resident in the graduate medical education program is contingent upon the results of a criminal background check.
- OIG/GSA Checks: Your acceptance and continued participation as a resident in the graduate medical education program is contingent upon your eligibility to participate in Medicare, Medicaid, Tricare or other Federal health care programs. A check will be performed of the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) list of excluded individuals and the U.S. General Service Administration (“GSA”) excluded parties’ list system as part of your appointment process. If your name appears on the OIG or GSA excluded party lists or if you are at any time excluded from participation in Medicare, Medicaid, Tricare or other Federal health care programs or are convicted of a criminal offense related to the provision of health care items or services, your participation as a resident in the graduate medical education program may be terminated immediately.
- Case Documentation: documentation of clinical experiences, cases and/or procedures is mandated by the Residency Review Committees. Residents who do not maintain accurate case documentation may not advance to the next level of training or be allowed to complete their program until compliance is achieved.
- To develop competencies in:
- Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
- Medical knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care
- Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals
- Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
- To comply with duty hours assignments consistent with patient safety, educational requirements and personal development as outlined in departmental and institutional policies.
Duration of Appointment and Conditions for Reappointment: Your initial appointment will begin on July 1, 201_ and may continue for a period of three total year(s). Your appointment will be processed by the University after you have accepted this official letter of offer, have met the conditions stated, and completed applicable registration, licensure, and proof of the right to work in the United States as required by law. We anticipate you will remain in the prescribed course of your residency until completion. However, it is understood that appointments are renewed annually and that continued retention in the training program depends on your satisfactory performance/training progress, including your adherence to acceptable professional behavior, as well as the continuation of requisite funding for the program and the best interests of the program as determined by the Associate Dean. A resident’s reappointment and progression to more advanced levels will be based on the results of periodic reviews of the resident’s educational and professional achievement, competence and progress as determined by the program director and teaching faculty. However, no appointment shall create any rights, interests, or expectancies of continuation beyond the term of the appointment itself. At the completion of each academic year, your performance will be reviewed and the recommendations for continuation communicated to you by the Program Director or designee. Unsatisfactory progress or performance may result in probation, non-advancement, dismissal or non-renewal. The program maintains a confidential record of the evaluations. Residents may review their evaluations with their advisor, the program director, or University representative.
The primary site of your graduate medical training will be the University of Florida Health Science Center-Gainesville with its major teaching hospital and affiliates, but the location of the training for any resident may occur at various additional sites. All assignments and call schedules are made at the discretion of the appropriate program director. In addition, should residency programs be closed or downsized, the University will inform the resident well in advance of such events. Every effort will be made to complete the resident’s course of training or to find another site for the resident to complete training.
Residents are not automatically entitled to additional training beyond the prescribed number of years in order to achieve board eligibility in the designated specialty. Any such extension of the residency and the required funding must be approved by the Program Director and the University’s College of Medicine Associate Dean for Graduate Medical Education /Designated Institutional Official (Director of Graduate Medical Education).
6C1-5.076 University of Florida College of Medicine Policies and Procedures for Discipline, Grievances, Non-renewal, Suspension or Dismissal of a Resident.
(1) The position of the resident (the term resident applies to interns, residents and fellows) presents the dual aspects of a student in post-graduate training and a participant in the delivery of patient care. A resident’s continuation in the training program is dependent upon satisfactory performance as a student and the maintenance of satisfactory professional standards in the care of patients. Behavior that reflects poorly on the professional standards, ethics and collegiality are all components of a resident’s academic evaluation. Disqualification of a resident as a student or as a member of the health care team disqualifies the resident from further continuation in the program.
(2) Grievances: A grievance is defined as dissatisfaction when a resident believes that any decision, act or condition affecting his or her program of study is arbitrary, illegal, and unjust or creates unnecessary hardship. Such grievance may concern, but is not limited to, the following: academic progress, mistreatment by any University employee or student, wrongful assessment of fees, records and registration errors, discipline (other than non-renewal or dismissal) and discrimination because of race, national origin, sex, marital status, religion, age, veteran’s status, or disability, subject to the exception that complaints of sexual harassment will be reviewed by the Chair of the Sexual Harassment Committee.
- Prior to invoking the grievance procedures described herein, the resident is strongly encouraged to discuss his or her grievance with the person(s) alleged to have caused the grievance. The discussion should be held as soon as the resident becomes aware of the act or condition that is the basis for the grievance. In addition, or alternatively, the resident may wish to present his or her grievance in writing to the person(s) alleged to have caused the grievance. In either situation, the person(s) alleged to have caused the grievance might respond orally or in writing to the resident.
- If a resident decides against discussing the grievance with the person(s) alleged to have caused such, or if the resident is not satisfied with the response, he or she may present the grievance to the Chair. If, after discussion, the grievances cannot be resolved, the resident may contact the Associate Dean of Graduate Medical Education (ADGME). The ADGME will meet with the resident and will review the grievance. The decision of the ADGME will be communicated in writing to the resident and constitute the final action.
(3) Procedure for Suspension. The Chief of Staff of a participating and/or affiliated hospital where the resident is assigned, the Dean or Dean’s designee, the ADGME, the President of the Hospital, the Chair or Program Director (PD) may at any time suspend a resident from patient care responsibilities. The resident will be notified of the reasons for the suspension and will be given an opportunity to provide information in response within five (5) working days of the date the notice was issued. The resident may be suspended from further patient care and may be assigned to such other duties as determined and approved by the Chair or Program Director. The resident shall be reinstated (with or without the imposition of academic probation or other conditions) or termination proceedings shall be commenced within thirty (30) days of the date of suspension. Such suspension and assignment of the resident to other duties may continue until final conclusion of the process. The PD may direct that the resident use accrued annual leave during the suspension. The resident shall be afforded all due process and appeal procedures as set forth below.
(4) Procedure for Non-renewal.
- A resident’s contract may be non-renewed in the event of unsatisfactory performance or training progress, failure to adhere to acceptable behavior, loss of requisite funding for the program and/or the determination by the Associate Dean that it is in the best interest of the program. In the event that the PD decides not to renew a resident’s appointment, the resident shall be provided written notice. Programs should provide a resident with as much written notice of the intent not to renew as the circumstances will reasonably allow, prior to the end of the agreement of appointment.
- If requested in writing by the resident, within five (5) working days of the date the notice was issued, the Chair will meet with the resident; this meeting should occur within ten (10) working days of the written request. The resident may present relevant information regarding the proposed non-renewal decision. The resident may be accompanied by an advisor during this meeting held pursuant to these procedures.
- If the Chair determines that non-renewal is appropriate, he or she will use his or her best efforts to present the decision in writing to the resident within ten (10) working days of the meeting. If a determination of non-renewal is made, the resident will be provided with appropriate notice, an opportunity to be heard, and all due process and appeal procedures as set forth below.
(5) Procedure for Dismissal.
- In the event the PD of a training program concludes that a resident should be dismissed prior to completion of the program, the PD shall inform the Chair in writing of this decision and the reason or reasons for the decision.
- The resident will be notified and provided a copy of the letter of proposed dismissal, and, upon request, will be provided with previous evaluations, complaints, counseling letters and other documents that support the recommendation. If requested in writing by the resident, within five (5) working days of the date the notice was issued, the Chair will meet with the resident; this meeting should occur within ten (10) working days of the written request. The resident may present relevant information regarding the proposed decision. The resident may be accompanied by an advisor during any meeting held pursuant to these procedures but the advisor may not speak on behalf of the resident.
- If the Chair recommends termination, he or she will use their best efforts to present the decision in writing to the resident within ten (10) working days of the meeting. The resident shall be informed of the right to appeal and meet with the ADGME.
6) Procedure for Appeal.
- If the resident appeals a decision the appeal must be made in writing to the ADGME within ten (10) working days from receipt of the Chair’s or Associate Chair’s decision. Failure to institute such an appeal within ten (10) working days will render the decision final.
- The ADGME or designee(s) will be provided the recommendation, previous evaluations, counseling letters, and other documents that support the recommendation. The resident will be notified of the date of the meeting with the ADGME or designee(s). The meeting should occur within fifteen (15) working days of the ADGME’s or designee(s) receipt of the appeal. The ADGME or designee(s) may conduct an investigation and uphold, modify or reverse the recommendation for suspension, non-renewal, or dismissal. The ADGME or designee(s) will notify the resident in writing of the conclusion of the appeal. If the decision is to uphold a suspension, the decision of the ADGME or designee(s) is final. If the decision is to uphold the non-renewal or dismissal, the resident may file within ten (10) working days a written appeal to the Dean of the College of Medicine or designee. Failure to file such an appeal within ten (10) working days will render the decision of the ADGME or designee(s) final.
- The Dean or designee will inform the ADGME or designee(s) of the appeal. The ADGME or designee(s) will provide the Dean or designee a copy of the recommendation with accompanying documents and any other material submitted by the resident or considered in the appeal decision. The Dean or designee should render a decision within fifteen (15) working days, but failure to do so is not grounds for reversal of the decision. The Dean or designee shall notify in writing the Chair, the ADGME, the PD and resident of the decision. The decision of the Dean or designee shall be final.
Financial Support and Other Benefits
Stipend: Each resident is given a stipend to pursue the resident’s graduate medical education in an amount appropriate to the resident’s level in the program. Stipend levels are reviewed annually by the Graduate Medical Education Committee of the College of Medicine and recommendations for changes are subject to approval by University’s Dean of the College of Medicine. Stipend levels begin on July 1 of each contract year and are paid biweekly. Residents are eligible to defer up to 20 percent of income in a 403(b) plan via payroll reduction.
Living quarters, meals, laundry, and other such expenses are the resident’s responsibilities. In some cases and at the discretion of the University, a meal subsidy may be issued to the resident when the resident is assigned in house call on nights and weekends; similarly, living quarters may be provided during some rotations outside of the primary location of the program.
Health, Life and Disability Insurance, Worker’s Compensation Insurance: Health insurance is provided to the resident and his/her family; life and disability insurance are provided to the resident. If a resident suffers a work related injury, the resident is generally covered under the workers’ compensation program of the University provided the resident complies with the requirements of the worker’s compensation program.
FICA Alternative Plan: As a resident, you automatically will be enrolled in the University of Florida’s FICA Alternative Plan. Under the provisions of this retirement plan, instead of paying 6.2 % social security taxes post-tax, you will contribute 7.5% of your pre-tax wages into an investment account in your name. The Medicare contributions at 1.45% will continue to be withheld from your biweekly paychecks and will be matched by the University of Florida. Information regarding this program is available at: http://www.hr.ufl.edu/retirement/other/FICA.asp
Confidential Counseling: psychological support services are available through the Resident Assistance Program. The Resident Policy and Procedure Manual provide details of coverage.
Professional Liability Coverage: Professional Liability Coverage: As a participant in a clinical graduate medical education program of the University, a resident is an employee of the University of Florida, Board of Trustees (UFBOT), and the State of Florida agency that operates the University of Florida. Under Section 768.28, Florida Statutes, residents are personally immune from civil liability for any injury or damage suffered by a patient as a result of negligence occurring while residents are acting within the course and scope of their employment. The UFBOT is responsible for any civil claims or actions arising from the negligent acts of its employees and agents, including residents in University graduate medical programs.
The University of Florida J. Hillis Miller Health Center/Gainesville Self-Insurance Program (SIP), a self-insurance program established by the Florida Board of Governors pursuant to Florida Statutes Section 1004.24, provides professional liability protection to the UFBOT and Shands Gainesville Medical Center, Inc. (SGMC), for incidents in which patients suffer bodily injury, personal injury, or property damage caused by the negligence of UFBOT residents.
SIP also affords residents professional liability protection when residents act in the role of a “Good Samaritan”, when involved in community service work that has been pre-approved by the University, and when serving on a University educational assignment outside of Florida. In light of the benefits of immunity provided by law, residents, while performing their duties must identify themselves at all times as UFBOT employees. Accordingly, residents must wear the University ID badge at all times while participating in the graduate medical education program.
Institutional Leave Policy: A comprehensive leave policy is outlined in the Resident Policy & Procedure Manual and includes uncompensated leave, compensated leave, temporary military duty, absences pertaining to education and training, and maternity/paternity leave. Subject to the approval of the program director and consistent with the guidelines of the appropriate specialty board, all residents accrue fifteen (15) days of annual leave. Residents may be permitted to carry over unused annual leave to a new year, as consistent with the academic departmental policy of the University; however, such carry over must be approved by the program director and annual leave accrued may not exceed twenty five (25) workdays. Unused annual leave is considered non reimbursable. Residents taking a non-medical leave of absence from the training program are not automatically guaranteed re-entry into the training program.
A resident will accrue ten (10) days of sick leave for each full year of completed participation in the program. The resident will be entitled to utilize sick leave for death, or in special cases, serious illness in the immediate family (spouse, parents, brothers, sisters, children, grandparents, and grandchildren of both resident and spouse). Sick leave may be advanced to housestaff proportionate to expected service. Housestaff may be permitted to carry over sick leave to a new year, as consistent with department policy; however, carryover must be approved by the program director and cannot be more than of fifteen days (15) work days. All unused leave is considered non-payable leave, and there is no entitlement for lump-sum payment of unused leave upon separation of or completion of training.
The total time allowed away from a graduate medical education program in any given year or for the duration of the graduate medical education program will be determined by the requirements of the specialty board involved. If leave time is taken beyond what is allowed by the University or the applicable specialty board, the resident is required to extend his or her period of activity in the graduate medical training program accordingly in order to fulfill the appropriate specialty board requirements for the particular discipline. The resident will be paid for makeup or extended time if funds are available at that time.
Medical Requirements: Prior to your appointment as a resident, you are required to complete a University pre-employment health screening questionnaire. In addition, screening of the resident for infectious diseases, prophylaxis/treatment for exposure to communicable disease, and immunizations will be provided by the University or through arrangements with other health providers. The resident will have documentation of immunity to measles, mumps, hepatitis B, rubella and varicella (chicken pox); the resident will be required to have periodic tuberculosis skin tests. The resident must comply with the infection control policies and procedures of the institutions where the resident is assigned. A resident must meet the technical standards set by the College of Medicine and his/her respective program.
Americans With Disabilities Act: The University of Florida, under the guidelines of ADA and 504 federal legislations, is required to make reasonable accommodations to the known physical and mental limitations of otherwise qualified individuals with disabilities. For assistance contact the UF ADA Office at 392-7056 or 711 (Tdd/TTY).
Policies Regarding Sexual Harassment: Complaints of sexual harassment will be handled in accordance with the specific published policies of the University of Florida and the College of Medicine (as contained in the Resident Policy & Procedure Manual).
Physician Impairment and Substance Abuse: The University of Florida is a Drug Free Workplace. Violations can result in disciplinary action up to and including termination. Residents will be required to undergo and pass Drug Toxicology screening within their first year of training at University of Florida. In addition, random drug testing maybe required during training at the University of Florida. A violation may also be reason for evaluation and treatment of a drug and/or alcohol disorder or referral for prosecution. In addition to any disciplinary action, residents identified as such will be referred to the Professionals Resource Network (PRN). The Florida Medical Practice Act (F.S. 458) rule calls for all licensed practitioners to report to the appropriate authority any reasonable suspicion that a practitioner is impaired to practice. The legislation provides for therapeutic intervention through the Professionals Resource Network (PRN). This organization works closely with the State Board of Medicine and is recognized as the primary method of dealing with physician impairment in the state. Faculty, staff, peers, family or other individuals who suspect that a resident is suffering from a psychological or substance abuse problem are obliged to report such problems. Reporting can be directly to the PRN or to the program director, Chairman, or Associate Dean for Graduate Medical Education. Residents suspected of impairment will be relieved of all patient care responsibilities. Early involvement of the PRN is essential. All referrals are confidential. If the PRN feels intervention is necessary, they handle the situation and provide for treatment and follow-up. Residents can only return to clinical duties with the approval of the PRN. Re-entry into the Program is not automatic. The PRN maintains contact with the program directors about residents in the program of recovery.
The University makes available a Resident Assistance Program to its residents. The University also provides an educational program for residents regarding physician impairment, including substance abuse.
Disclaimer or Resident Assertions; Invention and Copyright Agreement: The resident agrees that unless approved by the University’s Chair, all materials compiled or published by the resident relative to training and experiences received at the University and its affiliated hospitals, or arising from participation in training, patient care, or research pursuant to this agreement, will clearly state that the opinions or assertions contained therein are those of the resident and not those of the University. Pursuant to the University’s rules, the resident must execute the University’s Invention and Copyright Agreement.
Outside Professional Activities: All programs have established rules regarding outside and extracurricular activities that meet their RRC requirements and University policy. A prospective, written statement of permission from the program director and University’s Associate Dean for Graduate Medical Education is required and is made part of a resident’s file. Resident performance is monitored for the effect of these activities and adverse effects may lead to withdrawal of permission.
Programmatic activities are initiated by departments to provide clinical experiences which often are not afforded within the standard curriculum and which usually occur at non-campus health care affiliates. Supplemental compensation is provided by the University to residents who participate in programmatic activities.
Non-programmatic activities are initiated by the resident and do not involve any agreement between the University and the outside employer. Individual programs have total authority to decide whether non-programmatic activities are allowed in keeping with their Residency Review Committee guidelines and curriculum.
Residents are not required to engage in outside professional activities. The resident is referred to both the departmental policy for Outside Professional Activities and the complete policy on Outside Professional Activities set forth in the Resident Policy & Procedure Manual.
Certificate of Completion: A certificate of graduate medical training will be issued to a resident on the recommendation of the University’s appropriate Chair and Program Director only after satisfactory completion of service and educational requirements and fulfillment of all other obligations and debts.
Incorporated herein are policies that govern University of Florida College of Medicine residents. In signing this resident contract, you agree to fully comply with all such policies and provisions and indicate your acceptance of this position. Please return one copy to the Program Director as soon as possible. This offer of employment is contingent upon your eligibility to work under state and federal immigration laws. The immigration reform and Control Act (IRCA) of 1986 requires that the identity and residency status of all individuals employed by the University of Florida been verified and that the candidate is legally eligible for employment. Within three business days from your date of employment with the University of Florida, you will be required to present the necessary documents to satisfactorily complete the Form I-9 of the U.S. Citizenship and Immigration Services.
Sincerely, Nicole Paradise Black, M.D.
Residency Program Director, Pediatrics
Accepted Pediatric Resident