Section 5: Requirements For 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.

5.01   Appointment/Reappointment

Appointments are made for a one-year term, with renewal of the appointment based on satisfactory performance by the residents and the availability of a position. 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 School of Medicine and the chief executive officers of affiliated hospitals. This number is determined by the number of ACGME approved positions and by available funding. In addition, each year, department Chairs and their designees determine which current residents should be offered re-appointment in the program during the next academic year, or portion thereof. Official offers of re-appointment and re-appointment agreements for those residents continuing in the training program after the expiration of an earlier appointment period will be mailed by the OGME to the home address of the resident. Residents who choose to accept re-appointment offers must sign and deliver the re-appointment agreement to the OGME. Program Directors must notify the GME Office by February 1st or whenever possible of their decision to not renew a position appointment agreement. Residents will be notified, in writing, by March 1st or four months prior to the expiration of their position appointment agreement whenever this early notification is possible, of the decision to not renew their position appointment agreement.

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.

Residents may appeal a residency appointment termination during a contract period pursuant to the procedures described in Section 34 of this Manual. 

5.02   Stipends

The amount of the stipend offered to residents in each post graduate year level is reviewed annually by the School of Medicine, the affiliated hospitals, and the Graduate Medical Education Committee. Adjustments in the stipends are announced to the residents by letter, memoranda, or via the Residency Appointment Agreement. Stipend amounts are based on post graduate year level, are identical for all programs, and increase for each additional year of training completed by the resident. Residents are paid on the last day of each month. It is the responsibility of the resident to plan his/her budget accordingly.

5.03   Direct Deposit

All residents are required to have direct deposit for their stipend checks. This may be setup during new resident/fellow HR Online Orientation, or on the Emory HR PeopleSoft Self-Service page: http://leo.cc.emory.edu, and select “Payroll”.

5.04   USMLE/COMLEX-USA Policy

• Emory training programs may accept residents who have taken either national licensure examinations, the USMLE or the COMLEX-USA.  “COMLEX-USA” may be substituted for anywhere “USMLE” is used in this policy.
• 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 Georgia to participate in the Emory University School of Medicine Residency Training Program. A copy of the current GA Training Permit or Medical License must be in the GME office. Residents are not permitted to provide clinical care unless they have their permit or license.

5.06   License Reimbursement Policy

• Residents/Fellows (PGY 1- PGY 7) will be reimbursed up to $150 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 $75 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 $150 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 $500 toward the cost of the license and up to $75 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 Georgia training permit and a photocopy of their permit. All residents who enter the Residency Training program are required to have a valid Georgia training permit or medical license at the time they begin their training at Emory. 

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 Georgia Composite Medical Board.

5.07   Immunization Records Required at the Start of the Program (updated February 2024)

• MMR vaccine (measles, mumps, and rubella) - 2 doses or titer results for measles, mumps, and rubella
• Varicella vaccine (chicken pox) - 2 doses, or titer for varicella
• Hepatitis B vaccine (3-dose series) and titer for Hepatitis B Surface Antibody
• Tetanus, Diphtheria w Pertussis (Tdap) or diphtheria-tetanus (Td) - within the past 10 years
• Residents with negative titers to above will be required to obtain the appropriate vaccines
• COVID-19 Vaccine (highly recommended). Follow CDC recommendations for up-to-date vaccination.

All residents/fellows are required to receive a seasonal flu shot between October1^st and March 30th each year (or as soon as the influenza seasonal vaccine becomes available) and forward documentation of completion to the GME Office.

Tuberculosis Testing Requirement

Residents MUST have an IGRA test (T-Spot/Quantiferon Gold) completed within the 12 weeks prior to the start of training at Emory and must provide proof of such test to the OGME. 

Residents entering the training program who previously had a positive IGRA must provide documentation. This documentation must reflect the test results, along with when and where the testing was performed, a negative Chest X-Ray within 3 months from start date (regardless of treatment) and any medications prescribed. House staff who previously tested positive for IGRA and have not received adequate preventive therapy will be referred to a physician for evaluation. A review of symptoms will be conducted on an annual basis by Emory Healthcare’s Occupational Health Services (OHS). Residents must seek medical treatment if the following symptoms develop: cough greater than three weeks, coughing up blood or sputum, unusual weakness or fatigue, unexplained weight loss, fever, chills, or night sweats not associated with hormonal flashes, chest pain, and lack of appetite.

Subsequent Tuberculosis Screening of Residents

All residents must be screened annually while participating in Emory's training program via a TB Risk assessment questionnaire. Residents will be contacted by Occupational Health Services (OHS) if the risk assessment identifies the need for a TB test and provide instructions for scheduling an appointment.

Residents with a History of BCG

Residents entering the training program with a history of BCG must have an IGRA test (T-Spot or Quantiferon Gold) completed within the 12 weeks prior to the start of training program at Emory, and must provide proof of such test to the OGME at the start of the training program, regardless of whether the TST was positive in the past. If the test is positive, the resident MUST have a chest x-ray completed within 24 hours of the time the IGRA 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 will be referred to a physician for evaluation and counseling of preventive therapy if indicated. The resident must provide OGME documentation. This documentation must reflect the test results, along with when and where the testing was performed and what follow-up action was taken (e.g., chest radiograph date and results and any medications prescribed).

A review of symptoms will be conducted on an annual basis by Emory Healthcare’s Occupational Health Services (OHS). Residents must seek medical treatment if the following symptoms develop: cough greater than three weeks, coughing up blood or sputum, unusual weakness or fatigue, unexplained weight loss, fever, chills or night sweats not associated with hormonal flashes, chest pain, and lack of appetite.

Residents Who Convert to a Positive IGRA Test

Any resident who converts to a positive IGRA test while in the training program MUST have a chest x-ray completed within 24 hours of the time the IGRA 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 Emory Healthcare’s Occupational Health Department (OHS). Any resident converting to a positive IGRA must follow through with the treatment plan established by Emory Healthcare’s OHS Department.

A review of symptoms will be conducted on an annual basis by Emory Healthcare’s OHS. Residents must seek medical treatment if the following symptoms develop: cough greater than three weeks, coughing up blood or sputum, unusual weakness or fatigue, unexplained weight loss, fever, chills or night sweats not associated with hormonal flashes, chest pain, and lack of appetite.

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.

5.08   Advanced Cardiac Life Support (ACLS)

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.

5.09   Medical Records

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.

5.10   Photo Identification Cards

All residents are required to obtain and display an Emory University photo ID card produced by the EmoryCard office. This card must be displayed while on duty at all hospitals except Grady Memorial Hospital. Residents are required to wear a photo ID card produced by Grady Memorial Hospital while on duty at that hospital. Residents may be denied entry into the clinical areas of the various hospitals without the appropriate photo ID card displayed.

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 located on the first floor of the Boisfeuillet Jones Building, Room 101. The office is open Monday thru Friday from 8:30am until 4:30pm and can be contacted at 404-727-6095. A lost Grady photo ID card may be replaced at the Human Resources office at Grady Hospital. This office is located in Room 108, Georgia Hall (across the street from Hughes Spalding Hospital).

The EmoryCard identification badge is also used as an access card to enter the Woodruff Physical Education Center, the Emory University libraries, and the parking facilities at Crawford Long Hospital.

5.11   Physician Code Number

Upon first entering the graduate medical education program, each resident is issued an alphanumeric physician code. This code is used at Grady Hospital every time the resident makes an entry into a patient's medical record.

5.12   International Medical Graduates (IMG)

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. For information on H-1B1 visas, visit Emory University's International Student and Scholar Programs.

5.13   Policy on Communicating with Residents via Email

Email is the primary medium for official communication with residents/fellows at Emory University. Each resident/fellow is assigned an official email address by the University. All University communications will be sent via email to this address.

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. @gmail.com, @yahoo.com) the University is not responsible for the delivery of email by other service providers.

5.14   Background Check

It is the policy of Emory University to require a criminal background check, drug screen, and sexual offender check for all newly hired residents and fellows. It is intended that the background check, drug screen, and sexual offender check be completed prior to beginning employment at Emory.