College of Medicine
PO Box 103450
Office of the Dean
Gainesville, Florida 32610-3450

Personnel Section
Phone: 352-265-8014
Fax: 352-265-8019

September 22, 1994

MEMORANDUM

TO: Dean's Management Group, Clinical Science Board, Louis S. Russo, M.D.,
Ann L. Harwood-Nuss, M.D., Clinical Chairmen/Jacksonville

FROM:Robert T. Watson, M.D.

SUBJECT: Outside Employment for Housestaff

 

Enclosed are copies of the revised Outside Employment Policy for Housestaff and the Outside Employment Policy in the Rules of Department of Education, Division of Universities, University of Florida, rule #6C1-5.0761, which were sent to you on March 11, 1994 with a request for comments. Comments from those who responded have been incorporated in a revised version which WAS approved by the Institutional Committee for Graduate Medical Education(ICGME) on July 14, 1994. This Policy has been developed by the Gainesville ICGME, made up of program directors, the Jacksonville ICGME, and in consultation with Louis Russo, Martin Smith, and Barbara Wingo.

Why was a new Policy needed?

1. The Accreditation Council for Graduate Medical Education(ACGME) requires policies and procedures for outside employment common to all housestaff program sponsored by an institution and documentation the ICGME is monitoring adherence. I t will be advantageous to develop a policy with sufficient flexibility for all University of Florida housestaff, including those in University of Florida programs sponsored by University of Florida Health Science Center/Jacksonville Program. During our 1992 site for the General Requirements our current policy and procedures and absence of monitoring by the ICGME were ACGME concerns. As the University of Florida College of Medicine sponsors housestaff programs geographically separated from the Gainesville campus, e.g. at Pensacola and North Broward, monitoring will be more critical.

2. University of Florida Counsel has informed the Dean's Office that outside employment of housestaff should be considered similar to outside employment of faculty. On nonprogrammatic compensated professional employment of housestaff, including during vacation and nonprogrammatic employment at the Gainesville Veterans Affairs Medical Center, must be monitored. A Nonprogrammatic Professional Employment form has been developed.

 

3. Our Self Insurance Trust Fund Office has been concerned about monitoring of outside employment activities of housestaff. Those departments sponsoring programmatic activities often have inadequate monitoring. No monitoring exists for nonprogrammatic.

What Are The Differences Between The Previous And New documents?

1. A summary paragraph explaining why the policy is needed.

2. "Nonprogrammatic activities" replaces the term "moonlighting:. The previous policy said housestaff may not moonlight during the regular work year but could during vacation. Some have been "moonlighting" during vacation but without knowledge of

their department, College, or University. Some consider time not on call as "vacation". The new policy requires each program to be more explicit about rules for nonprogrammatic activities and places us in compliance with University rules regarding outside employment.

3. The major differences are in monitoring mechanisms:

a. Each program's rules for programmatic and nonprogrammatic actives must be reviewed by ICGME.

b. The previously used ACertification for Special Duty@ form has now become a Academic Affairs dataset. The pay for "Extraduty" or " Programmatic Activity is input into the office of the Dean Extraduty database and submitted to Academic Affairs, via. a dataset on mainframe each payperiod. Programmatic Activity cannot be prepaid thus payment is certified after the work has been completed.

c. A Nonprogrammtic Profession Employment form for nonprogrammatic compensated

professional activity must be completed, for each Incident and submitted to the Office of the Dean, Personnel Section.

d. A summary annual report of programmatic and non programmatic activity must be provided by the program director to the ICGME. This report will be helpful in your preparation for an RRC site visit since it demonstrates adherence to whatever variation of the Eighty Hour Rule is required by individual RRC's. It also puts the University of Florida, as the sponsoring institution, in compliance with ACGME General Requirements.

Does The New Policy Change Your Program's Rules Regarding Outside Employment?

1. No. The new policy still leaves to the individual program the decision to allow outside employment, programmatic or nonprogrammtic. Each program's decision is based on RRC guidelines (the Special Requirements for each program), and their curriculum. Programs choosing to not allow outside employment can refer to their RRC guidelines in defending their decision.

2. It will require rethinking which activities are truly "paid educational experiences" (programmatic activities) and better monitoring of those activities.

3. It will require adherence to University policies and procedures for nonprogrammatic professional employment including during vacation, i.e. defining vacation and completing a Nonprogrammatic Professional Employment form.

In summary, the new policy is to put us in compliance with ACGME standards, University policies and procedures, and as protection from liability through our Self Insurance Trust Fund. The major changes are in monitoring mechanisms.

RTW:jc

Enclosures

Outside Employment Policy For Housestaff

Housestaff must adhere to State University System Guidelines regarding outside activities/outside employment,, conflict of interest, and additional compensation. Such outside activity includes private practice, private consolation, teaching or research, or other employment outside State government which is not part of assigned University duties and for which the University provides no compensation. In addition, the Accreditation Council for Graduate Medical Education (ACGME) requires sponsoring institutions to have outside professional employment policy and a monitoring mechanism. Individual housestaff programs are accredited by their Residency Review Committee (RRC) and must adhere to RRC requirements regarding outside employment. Although RRCs= vary, the general theme is that any professional activities which are outside the established educational program must not interfere with the resident's=established educational process or the quality care of patients. Therefore, the following policy regarding outside employment of University of Florida College of Medicine house staff is promulgated:

1. Each program must have rules regarding outside and extracurricular activity which meets their RRC requirements and University of Florida College of Medicine policy. There are two categories of such activity:

Programmatic- These 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 salary income is provided by the university to house staff who participate in programmatic activities as described in section(4).

Non programmatic- These activities are initiated by the resident and do not involve any agreement between the College of Medicine and the outside employer. Individual programs have total authority to decide whether non programmatic activities are allowed in keeping with their RRC guidelines and curriculum. Non programmatic activity of residents by the Gainesville Veterans Affairs Medical Center is included in this policy.

2. Each program'srules regarding programmatic and nonprogrammatic professional activity must be reviewed by the Institutional Committee for Graduate Medical Education(ICGME).

3. A summary/ annual report of programmatic and nonprogrammatic professional is given to the Associate Dean. The Jacksonville summary is produced by the staff in the Jacksonville Housestaff Affairs Office and can be produced by the Office of the Dean, College of Medicine.

4. Programmatic activity. A contractual agreement between the College of Medicine and sponsoring health care facility for programmatic outside activity must exist with a copy sent the ICGME. Compensation for this activity must be directed to the appropriate department for payment to participating house staff. Such opportunities will be available to qualified house staff without restrictions.

5. Since the payment process for Programmatic Activity has changed to being process via a database, a quarterly report will be generated and given to the Associate Dean and Assistant for GME and Program Directors as requested. An annual report is automatic.

PROCESSING PROGRAMMATIC ACTIVITY THAT HAS NOT BEEN APPROVED

The department should call Ms. Kay Estes to ensure that the activity will be covered under an existing contractual agreement or an agreement will need to be written and approved by the appropriate college officials and officials from the institution that will fund the Programmatic Activity.

AUTHORITY AND PENALTIES

This must have approval and signature by their Chairperson or program director and the Dean of the College of Medicine or, for Jacksonville housestaff, their Assistant Dean and the Senior Associate Dean for Jacksonville Programs.

Programs, departments and services will be responsible for enforcement of this policy; violation may lead to immediate dismissal.

The Associate Dean and Assistant Dean for Institutional Committee for Graduate Medical Education, Gainesville and Jacksonville campuses, will have final approval of Programmatic and Non-Programmatic Activity

 

I. Procedures for processing payment for Programmatic Activity

The following procedure apply for all residents appointed in the College of Medicine on or after 07/01/94.

A. Determine whether outside activities are programmatic or non programmatic - signed contracts and/or affiliation agreements for such services would normally designate programmatic activity. If you need assistance in determining which process should be completed, your Chairman or Program Director should discuss the outside activities with the Deans of Graduate Medical Education.

B. Once a decision has been made, the appropriate contract should be drawn up to cover all aspects of the activities to be performed by the resident. See website for all of the contracts presently available. Your departmental administrator should contact Ms.. Kay Estes if none off the rotation agreements are applicable

C. The outside activity must be approved by the Department Chairman or the Program Director only. Administrative and fiscal staff members cannot approve the outside activity.

Completion of Programmatic Activity Supplemental Certification is done via the Extra Duty Database. Call Brenda Thomas at 5-8014 if you have questions.

A . Deadlines - See the Deadline schedule on this website.=

B. Signature Authorization - As approved by the ICGME and Clinical Science Board, the payment for Programmatic Activity must be approved by first, the Chairman or Program Director, second , the Deans of the Institutional Committee for Graduate Medical Education (ICGME) on both campuses.

WHEN IS THE EXTRA DUTY PAYMENT PAID TO THE RESIDENT

Payments cannot be certified until the work is completed. Since this is the case, the payment is made during the next pay cycle after work has been completed.

II. Non Programmatic Professional Activity

Non programmatic activities will be determined by the Chairman and/or Program Director, consigned by the Associate Dean of Graduate Medical Education, Gainesville and the Assistant Dean on the Jacksonville campus.

A. The form should be submitted prior to work beginning for approval. A copy fully executed form will be placed in the house staff members personal file in the Office of the Dean. The staff will submit to the Associate and Assistant Deans for Graduate Medical Education, a quarterly summary of the programmatic and non-programmatic activities if requested.

B. All information requested location of employment, dates of employment description of activity, and liability insurance coverage - provider and limits - should be included on the form.

C. Signature/approvals for the Programmatic Activity Form: After approval by the appropriate campus Dean of Graduate Medical Education, Non Programmatic form will be sent to the Office of the Dean, Personnel Section who will retain a copy in the personal folder of the house staff member. The original will be forward back to the department.