Title
a. Approve and accept the Natividad Medical Center Program Letter of Agreement (Outbound Residents) template to be used in partnering with U.S. health-care institutions, health-care organizations, community providers and professional schools (“Clinical Institutions”) permitting Natividad Residency Program residents to participate in clinical rotations outside of Natividad Medical Center (“Natividad”); and
b. Approve and accept the Natividad Medical Center Program Letter of Agreement (Inbound Residents) template to be used in partnering with hospitals or Teaching Health Centers sponsoring a medical residency program (“Sponsoring Institutions”) permitting Sponsoring Institution residents to participate in clinical rotations at Natividad; and
c. Approve and authorize updates to Natividad’s inbound and outbound Program Letter of Agreement templates in accordance with local, state, and federal law, subject to review and approval of County Counsel and County Risk Manager; and
d. Approve and authorize use of outbound Program Letter of Agreement template of Clinical Institutions where the terms are not significantly different from Natividad’s outbound Program Letter of Agreement template, do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, and subject to review and approval of County Counsel and County Risk Manager; and
e. Approve and authorize use of inbound Program Letter of Agreement templates of Sponsoring Institutions where the terms are not significantly different from Natividad’s inbound Program Letter of Agreement template, do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, and subject to review and approval of County Counsel and County Risk Manager; and
f. Approve and authorize execution by the Chief Executive Officer for Natividad or his designee of Natividad’s inbound and outbound Program Letter of Agreement templates or substantively similar templates of Clinical Institutions and Sponsoring Institutions, subject to review and approval of County Counsel and County Risk Manager, for Fiscal Years 2022-2023through Fiscal Year 2027-2028; and
g. Approve and authorize execution by the Chief Executive Officer for Natividad or his designee of amendments to inbound and outbound Program Letters of Agreements of Natividad, Clinical Institutions, and Sponsoring Institutions, which do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, subject to review and approval of County Counsel and County Risk Manager, for Fiscal Years 2022-2023 through Fiscal Year 2027-2028.
Report
RECOMMENDATION:
It is recommended the Board of Supervisors:
a. Approve and accept the Natividad Medical Center Program Letter of Agreement (Outbound Residents) template to be used in partnering with U.S. health-care institutions, health-care organizations, community providers and professional schools (“Clinical Institutions”) permitting Natividad Residency Program residents to participate in clinical rotations outside of Natividad Medical Center (“Natividad”); and
b. Approve and accept the Natividad Medical Center Program Letter of Agreement (Inbound Residents) template to be used in partnering with hospitals or Teaching Health Centers sponsoring a medical residency program (“Sponsoring Institutions”) permitting Sponsoring Institution residents to participate in clinical rotations at Natividad; and
c. Approve and authorize updates to Natividad’s inbound and outbound Program Letter of Agreement templates in accordance with local, state, and federal law, subject to review and approval of County Counsel and County Risk Manager; and
d. Approve and authorize use of outbound Program Letter of Agreement template of Clinical Institutions where the terms are not significantly different from Natividad’s outbound Program Letter of Agreement template, do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, and subject to review and approval of County Counsel and County Risk Manager; and
e. Approve and authorize use of inbound Program Letter of Agreement templates of Sponsoring Institutions where the terms are not significantly different from Natividad’s inbound Program Letter of Agreement template, do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, and subject to review and approval of County Counsel and County Risk Manager; and
f. Approve and authorize execution by the Chief Executive Officer for Natividad or his designee of Natividad’s inbound and outbound Program Letter of Agreement templates or substantively similar templates of Clinical Institutions and Sponsoring Institutions, subject to review and approval of County Counsel and County Risk Manager, for Fiscal Years 2022-2023through Fiscal Year 2027-2028; and
g. Approve and authorize execution by the Chief Executive Officer for Natividad or his designee of amendments to inbound and outbound Program Letters of Agreements of Natividad, Clinical Institutions, and Sponsoring Institutions, which do not significantly change the level of risk or the scope of a party’s obligations or responsibilities, subject to review and approval of County Counsel and County Risk Manager, for Fiscal Years 2022-2023 through Fiscal Year 2027-2028.
SUMMARY/DISCUSSION:
Elective rotations allow Natividad Family Medicine Residents to access training opportunities that may not be available at Natividad. The Accreditation Council for Graduate Medical Education, or ACGME, the accrediting body for residency training programs, permits up to 5 months of elective rotations during family medicine residency, for trainees to pursue in depth study in specific areas of interest. Most of these take place at Natividad or other local clinical sites, and a minority of electives are at sites farther afield, such as rural clinics or specialty programs at other hospitals. Likewise, trainees from medical residencies sponsored by hospitals or Teaching Health Centers sometimes wish to rotate at Natividad for their electives, and this can be helpful for clinical coverage when, for example, a Natividad resident is on a leave of absence.
The ACGME requires an educational “Program Letter of Agreement” to be signed by the residency director and the site where a resident will do an elective rotation. It lays out the educational objectives and supervision for the resident during the elective. ACGME Program Letter of Agreement requirements are built into the template presented herein, along with mutual indemnification and insurance provisions to leverage the County’s risk of liability. As the Natividad Residency Program manages about 30 Natividad resident electives per year (many local, some away), Board approval of the template will allow Natividad to enter into Program Letters of Agreement in timely response to the numerous requests it receives throughout the year from individual residents or medical schools seeking elective rotation opportunities,
OTHER AGENCY INVOLVEMENT:
County Counsel, County Risk Manager, and Auditor-Controller have reviewed and approved this Agreement as to legal form, risk, and fiscal provisions, respectively.
FINANCING:
There are no fiscal provisions included in this Agreement.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
The majority of the practicing family physicians in Monterey County are graduates of the Natividad Family Medicine Residency program. These agreements will enhance Natividad resident education by providing a broad range of elective rotation options, which is essential to successfully recruiting the best applicants to our residency. This will subsequently strengthen the pool of primary care physicians in the area, and thereby further enhancing healthcare for Monterey County residents.
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Prepared by: Melissa Nothnagle, M.D., Program Director, Family Medicine Residency Program 783-2582
Approved by: Charles R. Harris, Chief Executive Officer, 783-2504
Attachments:
Inbound Program Letter of Agreement Template
Outbound Program Letter of Agreement Template
Attachments on file with the Clerk of the Board