Prospective Residents & Fellows: Employment Conditions
Duration of Appointment - Appointments to a graduate medical education program are made on a year to year basis. Reappointment is based on successful attainment of satisfactory knowledge, skill and competencies required at each level of training. Each enrolled Clinical Program Trainee (CPT) applies for and is credentialed as a CPT of the University of Michigan Health System medical/dental staff. Each CPT is, therefore, governed by the medical-dental staff bylaws applicable to CPTs as well as the academic policies and procedures in place in the individual graduate medical education program and the Agreement between the Regents of the University of Michigan on behalf of the University of Michigan Health System (“UMHS”) and the House Officer Association (“HOA”).
Non Renewal of Contract - Any CPT not to be reappointed will be provided with a notice of intent not to renew no later than 4 months prior to the end of the contract year. However, if the primary reason(s) for the non-renewal occurs with the 4 months prior to the end of the contract year, the CPT will be notified as soon as circumstances reasonably allow.
Evaluation - Each program conducts an on-going formal evaluation process of each CPT based on achievement of objectives for each assignment/rotation. The program director or program designee meets no less than semi-annually with each CPT to discuss performance expectations and achievements. At least annually, each CPT is afforded an opportunity to submit a confidential evaluation of the program and program faculty with the goal of strengthening the quality and content of the program. Evaluative data may be incorporated into reference responses.
Supervision - Supervision is the responsibility of the Graduate Medical Education Committee, Residency program directors and the attending physician(s) who supervise and teach CPTs at the UMHS and UMHS affiliated training sites. It is also the responsibility of the CPTs to comply with this policy.
Responsibility for the quality of care and services provided in the UMHS rests ultimately with physician leadership who reports to the Hospitals and Health Centers Executive Board (“HHCEB”). The organized medical staff and the Graduate Medical Education Committee shall implement planned and systematic processes for measuring quality and improving performance. The Executive Committee on Clinical Affairs (“ECCA”) shall consider all matters, which pertain to patient care and the professional conduct and activity of CPTs. ECCA shall review the report of the Credentials Committee and make recommendations to the HHCEB for staff membership (as Clinical Program Trainees) and assignments to specific services or programs.
The CPT must be aware of his/her level of training, his/her specific clinical experience, judgement, knowledge, and technical skill, and any associated limitations that may have been imposed by the director(s) of the training program. The resident should not independently perform procedures or treatments, or management plans that he/she lacks the skill and training to perform. Likewise, the CPT should not institute management plans or protocols that are unfamiliar. Failure to function within graduated levels or responsibility or to communicate significant patient care issues to the responsible attending physician may result in the removal of the resident.
As part of their training program, CPTs will be given progressive responsibility for the care of the patient. The determination of a CPT’s ability to provide care to patients without a supervisor being physically present or act in a teaching capacity will be based on documented evaluation of all the CPT’s clinical experience, judgement, knowledge, and technical skill. Ultimately, it is the decision of the attending physician as to which activities the CPT will be allowed to perform within the context of the assigned levels of responsibility. The overriding consideration must be the safe and effective care of the patient.
For each assignment there is a hierarchy of supervision that is provided to the CPTs with an Attending Physician assigned and available 24 hours a day as the patient physician of record. In the hierarchy of responsibility for patient care, more senior CPTs may be assigned supervisory responsibilities for more junior CPTs and students.
CPT Mental Health Program – CPT mental health benefits are provided.
Employee Health Services (EHS) - EHS is located in the Med Inn Building. It provides health services and referrals regarding work related illnesses/immunizations. For emergency care or when the EHS is closed, CPTs should proceed to the Emergency Medicine Department for attention.
Off Campus Assignments - Many CPTs are regularly assigned to the Veteran’s Administration Ann Arbor Health Care System (VAAAHS), St. Joseph Mercy Hospital, Hurley Medical Center, Chelsea Hospital and other sites identified by the program in order to meet the requirements for completion of the graduate medical education training program. Master affiliation agreements exist between the UMHS and specific sites listed above. For any off campus assignment, written agreements must be on file in the Office of Graduate Medical Education in order to assure appropriate liability coverage, address supervision issues and delineate the rotation goals and objectives as appropriate.
Unapproved/unassigned off-campus experiences may be arranged by an individual CPT, using vacation or personal time. These instances of extracurricular medical practice are not a part of the University approved GME program, and the CPT is not covered by University professional liability insurance. In no instance may a CPT engage in extracurricular clinical activity that requires continuing responsibility for patient care.
Professional Liability Insurance - The CPT professional liability insurance is underwritten by Veritas Insurance Corporation. The coverage is structured on an occurance basis. Coverage does not cease at the end of the coverage year or upon completion of training or termination of employment. Limits of the program are marked at levels to provide coverage to CPTs and the UMHS.
Leaves of Absence (LOA) - Criteria for academic and personal LOA’s are established in each program and granted on a case-by-case basis with the effect on satisfying criteria for completion of the graduate medical education program established prior to the granting of the leave. Other types of LOA and their ramifications are described in the Institutional Leave of Absence Policy and the HOA contract.
Readress of Concerns - Procedures exist and are available to the CPTs in each program/department to address challenges to academic decisions. In the event that these steps are felt to be insufficient, a CPT may request application of the institutional "Procedure for Appeal of Academic Decisions Including Suspension or Termination from, or Non-Re Appointment to, a UMHS Graduate Medical Education Program." A formal mechanism for resolution of interpretation or application of the terms of the HOA contract is limited to non-academic concerns.
Duty Hours - Duty hours are defined as all clinical and academic activities related to the residency program, (i.e. patient care; both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences, (e.g., working out of the home). UMHS and programmatic policies exist and are available to the CPTs that provide guidelines for and compliance with ACGME Duty Hour Standards. (See UMHS Policy Web page)
VISA Requirements - Graduates of foreign medical schools are required to hold a current, valid certificate from the Education Commission for Foreign Medical Graduates (ECFMG). If the CPT applicant is not a citizen of the United States or does not have status as a Permanent Resident, a J-1 visa sponsored by the ECFMG is required. Additionally, admission requirements, as established by the Accreditation Council for Graduate Medical Education and licensure requirements established by the Michigan Department of Consumer and Industry Services, Board of Medicine must be met. It is the responsibility of foreign nationals to maintain valid immigration status for the duration of training. Failure to do so may result in the termination of employment status.
Expectations of CPTs Enrolled in Graduate Medical Education Programs:
Although not formal members of the Medical Staff they are bound by guidelines of Medical Staff Bylaws.
- To notify the program director of intentions to participate in extracurricular clinical activity (moonlighting).
- To comply with program and program director requirements in order to participate in these activities.
- To complete the “Notification of Extracurricular Medical Practice” form. This activity must be approved prospectively by the program director. CPTs are not required to participate in extracurricular clinical activities.
- To respond to all requests for information regarding duty/work hours.
- To notify and complete all needed materials in regards to Leave of Absences.
- To develop a personal program of study with appropriate program faculty and the Program Director.
- To carry out safe, effective and compassionate patient care commensurate with each level of advancement and responsibility.
- To attend and participate in scholarly activities, educational conferences and rounds associated with the program and rotational assignments. To teach and supervise junior CPTs and students.
- To actively participate as a CPT at the UMHS, especially in the area of medical staff/department quality management programs. (e.g. Mortality and Morbidity Conferences).
- To participate as an organized body or individually in departmental, inter-departmental and institutional committees and activities, especially those that relate to patient care.
- To evaluate the graduate medical education program and faculty in accordance with departmental process.
- To expand understanding of ethical, socioeconomic and medical/legal issues that affect graduate medical education and the practice of medicine through reading, seminar attendance and scholarly inquiry.
- To meet the educational standards and demonstrate expanded mastery in the following areas:
- 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 (e.g. epidemiological and social-behavioral) 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 for health care and the ability to effectively call on system resources
- To apply appropriate cost containment measures in the provision of patient care.
- To maintain current, timely, complete and accurate medical record documentation of patient care that documents patient illness, course of care, quality management and that serves as a resource for clinical research and expresses clarity for coding and billing.
- To communicate with referring physicians (internal and external) in a courteous, timely, accurate and complete manner.
- To interact with all members of the health care team in a collegial and professional manner. (See Code of Conduct from Medical Staff Bylaws)
- To comply with the professional and ethical standards of the discipline of medicine as well as all federal and state laws governing the practice of medicine.
- To comply with University of Michigan Hospitals and Health Centers’ Policies and Procedures as updated or amended from time to time. The most frequently referenced clinical policies include:
- Institutional Mandatories:
- Corporate Compliance
- Critical Incident Review
- Fire Safety
- Health Insurance Portability Accountability Act (“HIPAA”)
- Infection Control – Body Substance Precautions & Tuberculosis
- Patient Safety
- Restraint and Seclusion
- Speak Up with Safety Concerns
- Brain Death Determination
- Confidentiality of Patient Care Information
- Disaster Plan Responsibilities
- Informed Consent
- Orders, Consultations for Patient Care
- Pain Assessment & Management
- Post Mortem Care
- Refusal by Parents, and, Patient's Family or Patient's Guardian
- for the Administration of Blood, Blood Products, Other Treatment or Diagnostic and Therapeutic Procedures
- These policies reside on the institutional information system and are accessible via the internal UMHS Home Page menu.
- Other non-clinical policies of importance that are also available on the UMHS Home Page include:
- Sexual Harassment
- Scientific Misconduct
- Institutional Mandatories:
House Officer Association (HOA) - University of Michigan Agreement - House Officer compensation is established per the bargained for agreement between the HOA and the University of Michigan Regents. This Agreement specifies the bargained for commitments regarding stipends, fringe benefits and conditions of employment. Please refer to this agreement for non-academic conditions of appointment in good standing and rights of Clinical Program Trainees in the employment relationship. The details of the compensation, health care and disability benefits; various types of leave of absences such as vacation and sick leave can also be found in the HOA contract; in addition to call rooms, meal allowance and issues related to lab coats among other things can be found in the bargaining agreement listed above. The current salary ranges for HO I – HO VIII are $50,526 - $70,769.