Medical education is divided into three major components including undergraduate medical education, graduate medical education and continuing medical education. Each component provides physicians with the requisite knowledge and skills to be an effective practitioner in the art and sciences of medicine.
Pursuant to the educational mission of the
The Board of Trustees of the
Emory University School of Medicine is committed to providing quality graduate
medical education through its residency training programs. The major functions
of the programs are education, patient care, and research. The programs are
administered for the
The purpose of this House Staff Policies and Orientation Manual is to
provide residents and fellows ("residents") participating in Emory
University School of Medicine's Graduate Medical Education with a general
understanding of the policies and procedures governing the training programs.
The policies and procedures described in the Manual supersede and replace all
prior and published and unpublished policies and procedures. While the
information provided in this Manual should help familiarize and inform residents
about the training programs, it cannot detail every situation or answer every
question. NEITHER THIS MANUAL NOR ANY PROVISION IN THIS MANUAL CONSTITUTES A
CONTRACT.
Residents with questions or comments regarding information contained in this manual should contact their Program Director or the OGME.
The Office of Graduate Medical Education is located in
Each resident participating in the Emory University School of Medicine Residency Training program (TRAINING PROGRAM) has the responsibility to:
1.01 Provide compassionate, timely, and appropriate patient care; accept the duties, responsibilities and rotations assigned by the resident's department Chair or the Chair's designee; abide by the rules, regulations and policies of Emory University, Emory University School of Medicine, and the hospitals to which the resident is assigned; and conform to the ethical and professional standards of the medical profession;
1.02 Develop a personal program of self-study and professional growth with guidance from the teaching staff;
1.03 Participate fully in educational activities, accept and follow direction provided by faculty members and more senior residents and, as directed, assume responsibility for teaching and supervising other residents, medical students, and other health care students;
1.04 Participate, as appropriate, in institutional committees and councils, especially those that relate to patient care review and activities;
1.05 Apply reasonable cost containment measures in the provision of patient care;
1.06 Obtain a GA Temporary Postgraduate Permit or a GA Medical License. Each PGY 1- PGY 7 resident/fellow participating in Emory University Residency Training program has the responsibility to obtain a GA Temporary Postgraduate Training Permit. If you already have a GA Medical License, you are not obligated to get a permit. If you are PGY 8 or higher, you must obtain a GA Medical License. Refer to sections 5.04, 5.05, and 5.06.
1.07 Maintain complete and up-to-date immunity and health records in the OGME (See Section 3);
1.08 Inform OGME and the Program Director of changes in address and personal phone number;
1.09 Inform the Benefits Section of Emory University's Human Resources Department (404.727.7613) of any events requiring a change of benefits or tax status (e.g., change in marital status, birth or the adoption of a child).
2.01 The ultimate responsibility for the oversight of all aspects of a department's residency training program rests with the Chair of that department. The department Chair may appoint a Program Director that will act in whatever capacity and with whatever authority that is delegated by the Chair. The department Chairs meet regularly as the "Council of Chairs" to address matters affecting the operation of the overall residency training program.
2.02 The Dean of the
2.03 The
2.04 To the extent possible, the
2.05 The
Each resident attends a comprehensive administrative orientation session at the beginning of the training program. A portion of this orientation session is devoted to reviewing all elements of the benefits package and to answering any questions about these benefits. The benefits package is also summarized on Emory’s Human Resources website at the following address http://emory.hr.emory.edu/rtpbenplans.nsf
The Residency Training program provides each eligible resident, at no cost, the following group benefit plans:
Group Dental and Emory Vision Care Plans are available at a minimal cost.
Each resident may also enroll his/her eligible dependents for health, dental and vision coverage, with the cost paid by deductions from the resident's stipend.
The Residency Training program provides each eligible resident: · $50,000 Term Life Insurance · $50,000 Accidental Death and Dismemberment Insurance · $25,000 Term Life Insurance for spouses · $ 5,000 Term Life Insurance for eligible children
Three health care options are provided to residents. EmoryCare is a preferred provider program, which offers a network of primary care physicians and specialists and many hospitals. Use of network providers offers the lowest out-of-pocket expenses. EmoryCare also gives each resident the flexibility to use providers outside of the EmoryCare network at higher out-of-pocket expenses.
Residents can also enroll in EmoryChoice, which is an HMO. EmoryChoice offers residents a core network of primary and specialty care providers. The Aetna US HealthCare national network can also be used at a higher co-pay. If the core EmoryChoice or the Aetna US HealthCare national networks are not used there are no benefits except for emergency or urgent care.
HealthChoice is a Preferred Provider Organization (PPO) that offers the flexibility to use in-network and out-of-network providers.
House staff with family coverage can elect to pay the premiums for their family's coverage on a before-tax or after tax basis. Pre-existing conditions are covered under both options.
The Emory University Residency Training program offers residents a choice of two dental plans. Details regarding these plans will be reviewed during orientation.
Premiums for the dental plans may be paid by the resident on a before-tax or after-tax basis. Residents must remain in the Dental Plan for one year.
These accounts are established to enable residents to accumulate money on a before-tax basis to pay eligible out-of-pocket health/dental and dependent care expenses. There are annual minimum and maximum contribution amounts. Flexible spending account details are available during orientation.
Eligible residents unable to perform in their program due to a qualifying disability may qualify for long-term disability benefits through the long-term disability insurance coverage. These benefits will be provided to eligible residents in an amount equal to 60% of the resident's stipend, up to a maximum of $5,000 per month. There is a ninety-day waiting period before otherwise eligible residents may receive coverage and payments.
Each resident may contribute to
Participation in Medicare and the OASDI are conditions of participation in
the residency training program for all residents.
The Office of Graduate Medical Education (OGME) pays a monthly fee for each resident
to receive parking privileges at
Residents with questions about any aspect of the Group Benefit Plans should
call the Benefits Office of the Human Resources Division at 404.727.7613. The
main office of the Human Resources Division is located at
This section outlines general information concerning leave time. Specific questions regarding leave should be directed to the resident's Program Director. Each Program Director is responsible for maintaining accurate records of the amount of leave time his/her residents have used.
The
Residents have up to twelve (12) calendar days of paid sick leave during the academic year contract period. More restrictive Board requirements override university permitted leaves. Residents participating in the program on less than a full time schedule have their sick leave determined on a pro rata basis. Unused sick leave does NOT transfer to a resident's appointment for additional training year(s). Residents shall not be compensated for unused sick leave balances upon voluntary or involuntary removal from the program, either during a contract period or at the end of the contract period. It is the responsibility of the resident to follow the policies of their department in using sick leave. The resident will be expected to provide evidence of the need for sick leave as required by his/her Program Director.
Paid funeral leave is provided to residents to attend funeral services for relatives, same-sex domestic partner, or close personal friends. A resident's Program Director may approve up to five (5) days for funeral leave per occurrence. A resident should notify his/her Program Director as soon as possible of the need for funeral leave so that appropriate scheduling may occur. During individual departmental orientation, each resident will be informed of any other departmental requirements in completing the funeral leave request.
Paid medical leave is to be used by eligible (i.e., those receiving a stipend) residents who are unable to complete their responsibilities for a prolonged period of time due to serious illness, injury, or pregnancy. This leave is to be used in conjunction with Family and Medical Leave Act (FMLA sub-section 4.05). When a resident qualifies for FMLA leave, the paid medical leave provisions described in this sub-section are used concurrently with the FMLA leave, so that approved time away from the residency training program is credited against a resident's maximum amount of paid medical leave and FMLA leave. A FMLA qualifying resident must apply for FMLA leave when seeking paid medical leave described in this sub-section.
In the event of pregnancy, a disabling illness or injury, an eligible resident may receive up to six weeks paid medical leave for the purposes of recuperation or convalescence. The resident's personal physician must document the condition necessitating leave. The documentation must include (a) a statement that the resident temporarily cannot perform the responsibilities of the training program, (b) an explanation for the resident's needed leave, and (c) the expected length of time before the resident can resume his/her duties. The six weeks of paid medical leave includes the resident's use of all available paid sick leave, followed by the use of two of the three weeks of the resident's vacation/holiday leave (if needed and available). If a resident needs to exhaust vacation/holiday leave for medical reasons, the resident will be granted one week of vacation time after returning from leave if he/she had one or more weeks of vacation/holiday time when the leave began. If the resident has exhausted his/her vacation/holiday time before beginning medical leave, the resident will not have any vacation/holiday leave available when returning from leave. Before returning from leave, the resident must provide documentation from a treating physician verifying that the resident is medically fit to resume responsibilities in the training program. This documentation must be addressed to the resident's Program Director.
Family and Medical Leave Act (FMLA) is intended to promote the well-being of residents and their families by allowing eligible residents an unpaid leave of absence for the birth of a child, to care for a new child, seriously ill family member, or for their own recuperation or convalescence.
Residents are eligible for (FMLA) leave if they have been in the residency training program for at least twelve (12) months and have worked in the program at least 1,250 hours during the twelve (12) month period immediately preceding the leave.
Subject to the requirements set forth below, eligible residents may request and receive up to twelve (12) workweeks of leave during a 12-month period (measured backward from the date on which the leave begins) for any of the following reasons:
An eligible resident is entitled to up to twelve (12) work weeks of leave during a 12-month period for a qualifying reason. If a resident's spouse is also a resident or employee at Emory, the resident and spouse are limited to a combined total of twelve (12) workweeks of FMLA leave during the period if the reason for the leave is the birth and care of a newborn child, the foster care placement or adoption of a child, or the care of a parent or child with a serious health condition. However, for the purpose listed above, if one of the spouses has a serious health condition, each is entitled to twelve (12) workweeks of FMLA leave.
FMLA leave for the birth/care of a newborn child or for the placement of a child for adoption or foster care must be taken and conclude within twelve (12) months of the birth or placement. Unless specifically permitted, FMLA leave for these purposes cannot be taken on an intermittent basis or reduced leave schedule.
Residents who are granted FMLA leave must use any accrued paid leave beginning with the effective date of the leave. Specifically, in conjunction with the Paid Medical Leave described above, the first six weeks of FMLA leave may run concurrently with any available paid leave. As detailed in the Paid Medical Leave sub-section, the six weeks of paid leave include all accrued, available sick leave and two of the three weeks of vacation/holiday leave, if available. Upon exhaustion of any applicable paid leave, the remainder of any FMLA leave during the academic year will be unpaid. The combination of paid and unpaid leave may not exceed twelve (12) workweeks in the 12-month period.
A resident who foresees that he/she will need a leave for the birth and care of a newborn child or for the foster care placement or adoption of a child must notify his/her Program Director in writing and provide a completed healthcare provider's statement not less than thirty (30) calendar days in advance of the start of the leave, or generally within two (2) working days of learning of the need for leave. If not foreseeable, the resident must provide as much written notice as is practicable under the circumstances. A certification from a healthcare provider is required for leave requests related to the birth and care of a newborn child. Appropriate supporting court documents are required for leave requests related to the foster care placement or adoption of a child.
A resident who foresees that he/she will need a leave due to his/her planned medical treatment or to care for his/her spouse, same-sex domestic partner, child or parent with a serious health condition must notify his/her Program Director in writing as early as possible so that the absence can be scheduled at a time least disruptive to the training program. Such notice should be at least thirty (30) calendar days in advance of the start of leave, unless impracticable, in which case the resident must provide written notice, as early as circumstances permit, generally within two (2) working days of learning of the need for leave. A completed certification of the necessity of the leave from a health care provider is required. Preliminary designation of FMLA leave may be made pending receipt of this certification.
Subject to the limitation and certifications allowed by the FMLA, leaves taken to care for a spouse, same-sex domestic partner, child, parent or for the resident's own illness, may be taken on an intermittent or reduced leave schedule when medically necessary, provided a health care provider certifies the expected duration and schedule of such leave. The resident may be required to transfer temporarily to an available alternative position for which the resident is qualified but has equivalent pay and benefits and better accommodates recurring periods of leave than the resident's regular position.
A resident must inform his/her Program Director every thirty (30) days regarding his/her status and intent to return to the training program upon conclusion of the leave. A resident is required to submit to his/her Program Director a Return-to-work Certification from a health care provider before returning to the training program. Where there is reason to doubt the validity of the health care provider's statement of certification for leaves taken to care for a spouse, same-sex domestic partner, child, parent, or for the resident's illness, Emory may, at its own expense, require second and third opinions, as specified by the FMLA to resolve the issue.
A resident on FMLA leave may elect to continue participation in his/her health, dental, and Beneflex and other benefit plans for the duration of the FMLA leave. In that circumstance, the resident will be responsible for paying his/her share of the benefits contributions as if he/she was actively performing in the training program, and Emory will continue to provide the benefits and pay the portion of premiums it provides for the resident when actively participating in the program. Emory will continue to provide its premium contributions and benefits throughout the FMLA leave, whether such leave is paid or unpaid.
While on paid leave, the resident's contributions (if any) will be deducted from his/her stipend check. While on an unpaid leave, the resident will be responsible for submitting his/her premium contributions on or before the date specified by the Human Resources Department. If a resident does not pay the required premium contributions, coverage will be canceled. However, the resident will be given fifteen (15) days notice before coverage is canceled. When a resident returns from FMLA leave, Emory may elect to recover the resident's share of contributions paid by Emory for maintaining coverage(s) for the resident while on FMLA leave.
Residents who elect not to continue benefits' participation while on FMLA leave must notify Human Resources to cancel the coverage. If the resident returns to the program work in an eligible status, the resident has thirty-one (31) days from that date to reinstate coverage.
A leave of absence without compensation is intended for those residents who need an extended period of time away from their training program but have no vacation/holiday leave balance and do not qualify for or have expended their sick leave, Paid Medical Leave, and FMLA leave balances. An unpaid personal leave of absence may be requested and granted for compelling personal reasons. Requests for this leave must be submitted, in writing, to the resident's Program Director for his/her consideration. The duration of the unpaid personal leave of absence is limited to the time approved by the Program Director, but in no event longer than 120 days.
During an unpaid personal leave of absence, health care coverage, dental, and life insurance shall be continued ONLY if full payment for this coverage is made by the resident each month while on leave. It is the sole responsibility of the resident to assure that premium payments are made on a timely basis. Coverage arrangements must be made with the Benefits Department of Emory University's Human Resources Division, which may be reached at 404.727.7613.
Jury/Witness duty leave is provided to residents who are subpoenaed to serve on a jury or as a witness in a litigation proceeding. Each resident must notify his/her Program Director of jury/witness duty by submitting a copy of the subpoena. Jury/witness fees received by the resident for jury/witness duty may be retained by the resident. Time served on jury/witness duty will not count against the resident's vacation/holiday time.
Residents will be granted an unpaid military leave of absence to serve or train in the Armed Forces, the Army National Guard, the Air National Guard, or the commissioned corps of the Public Health Services, as required by the federal Uniformed Services Employment and Reemployment Rights Act (USERRA) and state law. Residents may elect to use available paid leave to receive compensation during their military leave until such pay entitlement expires. The resident may be entitled to continue health insurance coverage for a period of time. Residents MUST notify their Program Director as soon as is practicable when military leave will be required, and must provide their Program Director with appropriate documentation of their military service.
To meet the training requirements of various certifying Boards, residents may be required to spend additional time in training to make up training time lost while on a prolonged leave of absence. The residents' Program Director determines if and how much additional residency training time is required in each prolonged leave of absence circumstance.
A resident who obtains a Family Leave of Absence or Unpaid Personal Leave of Absence will be reinstated to the same or equivalent position within the same academic year, except where there has been a reduction in the number of positions during the leave period due to lack of funding, a reduction of, or reorganization in, the clinical service. Reinstatement in the following academic year will require a new letter of appointment.
All new residents receive a formal offer and appointment agreement to the Emory University Affiliated Hospitals' Residency Training program. The appointment is contingent upon successful completion of all requirements of the Office of Graduate Medical Education prior to assuming training program duties, as well as all requirements specified by the department offering the house staff appointment. See Appendices A and B.
Initial appointments are usually offered within the framework of the National Resident Matching Program (NRMP). The maximum appointment period is twelve months, and residents are typically offered appointments covering a July 1 through June 30 academic year period.
The number of available house staff positions in each training program is
determined each year by the Chair of each department, in consultation with the
Dean of the
The decision not to offer a resident re-appointment may be due to a variety of reasons, including but not limited to the resident's unacceptable performance, unacceptable conduct of the resident, and/or lack of available funding.
The amount of the stipend offered to residents in each post graduate year
level is reviewed annually by the
All residents are required to have direct deposit for their stipend checks. Forms to initiate direct deposit are completed during orientation.
· PGY-1 residents who are enrolled in training programs at Emory University School of Medicine will not be promoted to PGY 2 positions unless they have provided Program Directors evidence by January 1st of the PGY 1 year that they have passed USMLE Step two (2).
· Residents transferring from a program in another institution will not be accepted into a PGY 2 position at Emory University School of Medicine unless they have provided evidence that they have passed USMLE Step 2.
· PGY 3 residents will not be promoted to a PGY 4 position at Emory University School of Medicine unless they have provided evidence that they have passed USMLE Step 3.
· Residents will not be accepted into an Emory PGY 4 or higher position from another program unless they have passed USMLE Step 3.
· If an Emory Residency training program is 3 years in length, then a resident must pass USMLE Step 3 in order to receive a certificate from Emory University School of Medicine signifying satisfactory completion of residency training.
· The GME office does not reimburse for USMLE Step 3.
5.05 Georgia License Requirements
All residents must have a Temporary Postgraduate Training
Permit or a Medical License from the State of
5.06 License Reimbursement Policy
Residents/Fellows (PGY 1- PGY 7) will be reimbursed up to $100 to OBTAIN a Temporary Postgraduate Training Permit to practice as a resident in facilities associated with Emory University School of Medicine Residency Training Program. Residents will be reimbursed up to $50 to RENEW their training permits. Residents will not be reimbursed the cost to issue a new training permit if he/she allowed the permit to lapse.
If a resident/fellow (PGY 1 – PGY 7) elects to obtain a GA Medical License instead of a Postgraduate Training Permit, the resident will be reimbursed up to $100 toward the cost of obtaining the license without additional reimbursements. If a resident has a GA Postgraduate Training Permit and elects to obtain a GA Medical License, there will be no additional reimbursement.
Residents/Fellows (PGY 8 or higher) who are PGY 8’s or higher are required to obtain a license to practice medicine in the state of Georgia even though they remain in training positions at Emory University School of Medicine. Residents/Fellows will be reimbursed up to $400 toward the cost of the license and up to $50 for each renewal period. To receive reimbursements when it is required at the PGY 8 level or higher, the fellow must provide copies of the cancelled check (both sides) and the license.
The GME office will
not reimburse residents who obtain a GA Medical License to moonlight.
To receive reimbursement
for a permit when processed directly, residents must provide the GME office
with a photocopy (both sides) of the personal check used to obtain a
Once a permit is obtained, each resident must maintain a valid permit to participate in the Emory University School of Medicine Training Program throughout his/her residency training for a period not to exceed seven (7) years. Failure to do so will result in disciplinary action up to and including termination from the training program. Also, the GME office will not issue the contract for the subsequent year.
For more information or to obtain application forms for training permits or licensure, visit the website for the Composite State Board of Medical Examiners: www.medicalboard.state.ga.us
All residents entering Emory's training program MUST provide the OGME with documentation indicating vaccinations or serologic data showing immunity to the following:
In addition, residents must be immune to chickenpox-either by previously having the disease or by vaccination. When a resident either believes that he/she is not immune to chickenpox or is uncertain of chickenpox immunity, a serology must be drawn to check the immune status. Residents showing no immunity must be vaccinated with the varicella vaccine (2 doses - four weeks apart).
Residents MUST have a PPD skin test completed prior to the start of training at Emory, and must provide proof of such skin test to the OGME. Residents starting training on July 1st , who cannot provide documentation of a timely test or who have not had a recent PPD skin test will be given the test during residency training orientation Residents entering the training program who have not had a PPD done in the past year will need a baseline test done and if that is negative, a second test should be performed in 1 to 4 weeks.
Residents entering the training program who have a previously tested PPD positive must provide documentation of the positive PPD test. This documentation must reflect when and where the skin test was performed and what follow-up action was taken (e.g., chest radiograph date and results and any medications prescribed). Individuals who have a history of a positive PPD skin test and who have received adequate follow-up care will not be required to take any other skin test or further action unless they are, or become symptomatic. However, these residents must seek medical treatment if the following symptoms develop: cough greater than two weeks, weight loss, fever, or night sweats. House staff who previously tested positive for PPD and have not received adequate preventive therapy will be referred to a physician for evaluation.
Subsequent PPD Skin Testing of Residents
All residents who do not have documentation of a prior positive PPD skin test result must be tested annually while participating in Emory's training program. Residents will be notified in writing of the dates and place(s) where the testing will be done. The test must be administered, read and the results documented by a member of the Employee Health Department from one of Emory's five major teaching hospitals.
Residents with a History of BCG
Residents entering the training program with a history of BCG must have a PPD skin test at the start of the training program, regardless of whether they have tested positive in the past. This skin test will be administered in the first week of the resident's participation in the training program. If the test is read as positive, the resident must complete the actions as described in the provisions of the sub-section entitled "Resident Who Convert to a Positive PPD Skin Test". If the test is read as negative, a second test is required 2-4 weeks later. If the second test is negative, the resident must be tested annually.
Residents Who Convert to a Positive PPD Skin Test
Any resident who converts to a positive PPD test while in the training program MUST have a chest x-ray completed within 24 hours of the time the PPD test is documented as positive. If the chest x-ray is abnormal, the resident must be evaluated immediately by an attending physician; if the chest x-ray is unremarkable, the resident must be evaluated for preventive therapy by an attending physician within 2 weeks from the time the test was documented as positive. Any resident converting to a positive PPD must follow through with the treatment plan established by an attending physician.
Failure to Supply Records or Obtain Testing/Immunization
A resident who fails to supply the immunization and health records required by the program or fails to comply with any testing or immunization requirement will be placed on Administrative Notice.
Each new member of the house staff is required to provide his/her training program with documentation that he/she has received advanced cardiac life support training and that such training is up-to-date. To be considered up-to-date, ACLS training must have been completed within two years of the first day of residency training for those incoming residents who are immediate medical school graduates and three years for all others. Each new member of the house staff without prior training is required to obtain training in advanced life support techniques. The OGME provides access to ACLS through residency programs. Each resident is then required to ensure that their ACLS training remains up-to-date throughout his/her residency training.
Additionally, some departments require residents to be certified in other advanced training such as pediatric advanced life support. Residents must contact their Program Director to discuss program specific requirements.
For every order written, residents are required to: include the date and time; legibly print their name, and; include their pager number (PIC) after their signature. Residents must comply with the medical records completion requirements at each hospital where they train. Residents who do not comply with the medical records completion requirements will be subject to disciplinary action up to and including termination from the training program. All entries into medical records must be legible. Careless, unclear handwriting could negatively impact patient care; e.g., prescription that is for 1.0 mg, if written illegibly, could be interpreted as 10 mg. A resident who displays repeated illegible hand writing may be subject to disciplinary action up to and including termination from the training program.
All residents are required to obtain and display an
Residents are prohibited from using either their Grady produced photo ID card or their EmoryCard while moonlighting outside the Grady Healthcare or EMORY HEALTHCARE facilities.
Residents may replace a lost EmoryCard photo ID at the EmoryCard office in
the lobby of the
The EmoryCard identification badge is also used as an access card to enter
the
Upon first entering the graduate medical education program, each resident is
issued an alphanumeric physician code. This code is used at
International Medical Graduates seeking appointment to a residency position
must be certified by the ECFMG and enter the training program on a J-1 or H-1B1
visa, unless a citizen of the United States or holding an Alien Registration
Card. All such documentation must be
verified by the Graduate Medical Education Office before the resident starts in
the training program. For J-1 visas visit the ECFMG website for further
information: www.ecfmg.org. For information
on H-1B1 visas, visit
5.13 Policy on communicating with
residents via email
Email is the primary medium for official communication with
residents/fellows at
Residents/Fellows are expected to maintain their accounts and check their email regularly so that new email can be properly received and read. Certain communications may be time-critical. While residents may redirect email from their official University email address to another address (e.g. @hotmail.com, @aol.com) the University is not responsible for the delivery of email by other service providers.
“Moonlighting” refers to a service performed by a resident in the capacity of an independent physician, completely outside the scope of his/her residency-training program. “External moonlighting” refers to moonlighting at a facility that is not part of the resident’s training program. “Internal moonlighting” refers to moonlighting at an Emory facility or any other facility where the resident is receiving training as part of the residency-training program.
Residents are prohibited from external or internal moonlighting UNLESS they have the written approval of the Chair of the Department or his/her designee. The requirements necessary for such approval are set forth below under “External Moonlighting” and “Internal Moonlighting.”
Residents do not have insurance coverage through Emory’s Residency
Training Program for any moonlighting services, whether external or
internal.
In addition to the requirements below, the Chair or his/her designee’s decision to approve or deny a resident’s request to moonlight will depend on a number of factors including, but not limited to, interference with the resident’s responsibilities in the training program and the individual circumstances of the resident.
6.01 External Moonlighting Requirements:
1. The Resident must submit a written request for approval to externally moonlight by completing the “Request to do External Moonlighting” form obtained either from the Program Director, Program Coordinator or from Appendix D in this House Staff Manual.
2. In order to be considered for external moonlighting, the resident must meet the following requirements:
a) Residents must agree to obtain a signed contract with the external facility and provide a copy of the signed contract to the Program Director. The contract must state that the facility will provide professional liability insurance coverage for the resident’s moonlighting services and that the resident has received privileges. If the facility does not provide insurance coverage, residents must obtain their own professional liability insurance and provide proof of such insurance to the Program Director before moonlighting begins.
b) Residents must be fully licensed to practice medicine in the state where the moonlighting will occur. A residency-training permit is not a license to practice medicine outside the scope of residency training.
c) Residents on J-1 Visas are prohibited from moonlighting.
d) Residents must not wear identifiers as trainees in Emory University School of Medicine residency-training programs.
e) External moonlighting does not count toward the 80-hour limit set by the ACGME. The Chair of the Department and the Program Director are expected and required to assess the resident’s progress in the program and ask the resident to stop moonlighting if performance does not reach an expected level. The resident must be aware of these expected levels of academic and clinical performance before beginning the moonlighting experience.
6.02 Internal Moonlighting Requirements:
1. The Resident must submit a written request for approval to internally moonlight by completing the “Request to do Internal Moonlighting” form obtained either from the Program Director, Program Coordinator or from Appendix D in this House Staff Manual.
2. In order to be considered for internal moonlighting, the resident must meet the following requirements:
a) Residents must agree to obtain a signed contract with the facility and provide a copy of the signed contract to the Program Director. The contract must state that the facility will provide professional liability insurance coverage for the moonlighting services and that the resident has received privileges. If the facility does not provide insurance coverage, residents must obtain their own professional liability insurance and provide proof of such insurance to the Program Director before moonlighting begins.
b) Internal moonlighting services may occur only in an OUTPATIENT SETTING or in the EMERGENCY DEPARTMENT. Federal Medicare regulations are very clear on this point. (42 CFR 415.208)
c) Residents
must be fully licensed to practice medicine in the State of
d) Residents on J-1 Visas are prohibited from moonlighting.
e) Resident must not wear identifiers as trainees in Emory University School of Medicine residency-training programs
f) Residents must assure the Program Director in writing that the total hours in residency training and the moonlighting commitment DO NOT EXCEED the limits set by the ACGME. Fabrication of the duty hour information could result in termination from the training program.
The
Administrative Notice is a remedial action by which a resident is temporarily relieved of clinical duties without pay for violation of university, institutional, or departmental policy pertaining to administrative matters. Examples of inappropriate action triggering an administrative notice include, but are not limited to, failure to maintain an active medical license in the GME office, failure to provide evidence of training in basic life support techniques, failure to obtain PPD tests, and failure to provide OGME with a copy of his/her medical school diploma or ECFMG certificate. Administrative Notice is not necessarily considered censure, and the Chair or Program Director will decide whether it will become a part of the resident's permanent academic file.
The department Chair, Program Director, or their designee may impose an Administrative Notice upon a resident for failure to appropriately discharge his/her administrative responsibilities. Administrative Notice may not be invoked for deficiencies in academic performance, patient care, or any other non-program related administrative action or conduct, as those deficiencies should be addressed through verbal warnings, written warnings, probation, suspension, and/or termination. The resident may not appeal his/her receipt of an Administrative Notice.
The resident will be notified promptly of his/her placement on Administrative Notice. Such notice shall, if possible, be hand-delivered (with the resident signing and dating a copy to acknowledge receipt) or sent by certified mail (return receipt requested) to the resident's address of record. The department Chair, Program Director, or their designee will also, if possible, verbally inform the resident of the action. The Administrative Notice shall clearly delineate the resident's area(s) of deficiency and establish a reasonable period of time no longer than 10 calendar days within which the resident must correct his/her deficiencies. During the period of Administrative Notice, the resident is relieved of all clinical responsibilities without pay. Failure to appropriately address the areas of deficiency in the appropriate time frame as outlined in the letter of notification is considered grounds for additional disciplinary action, up to and including termination from the residency program.
A verbal warning, which may be given to a resident by a departmental Chair, Program Director, or other faculty member, is designed to identify a resident's minor or initial infraction of policies, standards, or expectations. The warning should be firm and fair, with the faculty member assuring that the resident understands the policies, standards, and expectations. A written record of the date and content of the discussion, as well as the underlying situation which precipitated the warning, shall be maintained in the resident's academic file.
A written warning may be issued only by a resident's department Chair or Program Director. A written warning is appropriate when a prior verbal warning has not resulted in the needed improvement or when the initial misconduct violation or performance inadequacy indicates a need for action stronger than a verbal warning. The written warning should note the unacceptable conduct or action that caused the warning, as well as the program's improvement expectations. The written warning must be signed by the resident and a copy given to him/her. A copy must be placed in the resident's academic file.
A department Chair or Program Director may place on probation a resident who is unable to meet the academic expectations of the training program (failing to progress at the expected pace), who experiences a serious lapse in complying with the responsibilities of the program, or for other serious misconduct and/or performance problems. A department Chair or Program Director should notify the Associate Dean for Graduate Medical Education or his/her designee before placing a resident on probation.
Probation is usually the second step of a series of disciplinary actions for a resident. Usually a resident will have one or more counseling sessions or receive a verbal or written warning about his/her deficiency prior to being placed on probation. In placing the resident on probation the Chair or Program Director should:
A resident will receive this probation notification in writing. Copies of the probation notice will be placed in the residents' academic file and in his/her administrative file located in the Office of Graduate Medical Education. A probation period occurring during training will be noted in all letters of reference.
The Dean of the
When suspending a resident, the Program Director or his/her designee must inform the resident, in writing, of the following:
Copies of the suspension notice will be placed in the resident's academic file and in his/her administrative file located in the Office of Graduate Medical Education. Suspensions will be noted in all letters of references.
If a residency appointment is terminated during the appointment period, the terminated resident may appeal the decision by following the procedures outlined in Section 33, "Hearing and Appellate Review Procedures for Termination of a Resident."
When a resident needs private counseling or professional assistance to
address an issue which is, or may affect his/her ability to live or work fully
and productively, assistance is available through the Faculty Staff Assistance
Program (FSAP) at the Well House,
A change in productivity, attendance, or behavior is often the first indicator of the need for help. The FSAP offers confidential and professional consulting, brief counseling, education, and referral services covering areas such as:
When a resident takes the initiative to call or visit, the FSAP can help the resident:
FSAP is available 24 hours per day, 7 days per week for residents who are in crisis and need assistance during off hours. To reach a counselor on call, residents can call the main number for FSAP at 404.727.4328. Press option “2” to reach the answering service who will page the appropriate counselor.
The
This Section outlines the Behavioral Health Policy and Procedures adopted by
the
The Emory University School of Medicine is committed to providing, through
its Residency Training Program, the highest levels of graduate medical
education, patient care, and research. To realize this commitment, the
The purpose of this policy is to ensure that all residents are fit for duty
and work free from harm to themselves and others. The
When a release from duty is needed in order for the resident to obtain inpatient or outpatient treatment for a behavioral issue, including a psychiatric condition, psychological issue, or substance abuse, such a release shall be requested and processed as stipulated in the provisions of this policy.
The Faculty Staff Assistance Program (FSAP) is available to assist residents as well as Emory faculty and staff in dealing with any issue or concern that is affecting or may affect that individual's ability to live or work in a healthy, productive manner. The FSAP facilitates the ability of its clients to discover options and manage resources that enhance health, productivity, and behavior.
Emory encourages residents to seek professional assistance at the earliest indication of physical or emotional problems related to job performance or safety. Professional assistance is generally accessed in one of the following ways:
The FSAP is available to provide coaching and consultations on when and how to make a referral, and to assist leadership as well as peers and colleagues on ways to encourage self-referral. Emory reserves the right to mandate a resident's participation in this process where circumstances indicate that a fitness for duty examination is appropriate. Residents are expected to fully cooperate in Emory's efforts to receive a fitness for duty examination. Disciplinary action, including termination from the Residency Training Program, may result from a resident's refusal to cooperate with the process.
When a resident comes to the FSAP through self-referral or other means, the FSAP will work with the resident in confidence, to the extent appropriate or permitted by law, to assess the nature of the concern or issue, to determine the cause, and to identify a plan of action. When the result of an assessment leads to the determination that a release from duty is indicated to obtain further evaluation, inpatient or outpatient treatment for a substance abuse, psychiatric, or behavioral health issue, the following provisions will apply.
It is the responsibility of the resident to request in writing an authorized release from duty as soon as possible. The request shall be submitted to the resident's department chair or program director, shall be accompanied by a certification from the health care provider attesting to the medical necessity of the release, and shall specify the beginning date of the time away from duty and the anticipated return date.
The request shall also acknowledge that the resident is aware of and will
follow the policy and provisions set forth by the
Authorizing a Release from Duty
The resident's department chair shall review the request and supporting documentation, and determine whether to grant the resident's request for a release from duty. In the absence of a specific request, the department chair or program director may release a resident from duty where objective evidence suggests that the resident's continuation of work would pose a direct threat to him/herself or others. In such circumstances, the resident shall be referred to the FSAP for a fitness for duty evaluation as otherwise described in this policy. The resident is expected to fully cooperate in these efforts to obtain a fitness for duty evaluation. Disciplinary action, including termination from the Residency Training Program, may result from a resident's lack of cooperation.
When an Emory University resident is absent from the training duties of his/her residency training program (RTP) to obtain assistance for b