Stanford University
Postdoctoral Scholars

Clinical Trainees

Appointments and Reappointments | Paying Clinical Trainees | Applying for Research Grants and Fellowships | Joint Postdoctoral Scholar/Clinical Instructor Appointments | Training | GME Office

Appointments and Reappointments
The appointment of advanced clinical trainees (post-residency) at Stanford is handled through the Graduate Medical Education Office.  The office oversees the ACGME-Accredited Residency/Fellowship Programs as well as appointments in non-standard fellowship programs. Fellows appointed through GME receive the full support of the office in setup and orientation to the clinical environment at Stanford.  Because affiliation with GME ensures affiliation with the Stanford Hospital and Clinic but does not secure an “academic” status with Stanford University (a different entity from Stanford Hospital and Clinics), the Office of Postdoctoral Affairs accepts the appointments of clinical training with Stanford University concurrently with their SHC appointment in some occasions.  Such occasions may depend on the funding sources that are supporting the trainee during a certain period of his/her fellowship.

Paying Clinical Trainees
Clinical trainees at Stanford receive stipend/salary according to the pay scale established by the Stanford Hospital and Clinics.  This funding requirement applies to trainees who are designed in a clinical training program throughout the program.  Change in pay during certain months of the training program due to the variability in activity (clinical vs. research) is not allowable.  Read Assistant Dean Sanford’s memo regarding the pay levels for clinical fellows effective July 2010.
In accordance with university policy regarding external funding, the Office of Postdoctoral Affairs accepts the appropriate documentation noting any funding that a clinical fellow is receiving from the SHC for their training program and regards such support as “external” funding.  External funding as well as funding from Stanford sources may be used towards meeting the appropriate PGY level for a clinical trainee.

Departments that wish to pay trainees for clinical activity through the University system (GFS) must do so by entering a “Salary” line, as such activity is considered wages for work performed.  This includes payments for on-call duty.  Stipends cannot be used to pay for on-call duty.

Applying for Research Grants and Fellowships
Clinical trainees without appointment with the Office of Postdoctoral Affairs may apply to grants and fellowships if allowed within the guidelines of their training program, and if they will be eligible for a postdoctoral appointment, as defined by Stanford University policy, during the period in which the proposed grant/fellowship period.  Applications must go through the Research Management Group at the School of Medicine.  A required form must be completed and signed by the trainee, his/her program director and the director of finance and administration in his/her department.  The trainee must then send the form to the Assistant Dean for Postdoctoral Affairs for review, who notifies the Research Management Group of approval. Such approval is an indication that, should the fellowship be awarded, the trainee will be approved for a postdoctoral status with Stanford University.

Clinical fellows as well as Postdoctoral Scholars with MD or MD/PhD degrees are eligible to benefit from the Expanded Pilot PI Waiver to apply for R01 type grants that require Principal Investigator status.  Contact the Research Management Group for more information and for the application process and deadlines.

Joint Postdoctoral Scholar/Clinical Instructor Appointments
In rare occasions, an advanced clinical trainee who has completed the clinical training program may wish to continue at Stanford in a research-only capacity while performing some additional hours of clinical work at the Stanford hospitals that is not part of any training or educational program, or engage in billable clinical activity as a physcian with Stanford Hospital and Clinic while undergoing a clinical training program. 

In the case of Research Scholars:  the individual must be appointed as a Research Scholar with the School of Medicine through the Office of Postdoctoral Affairs, and may receive a clinical instructor appointment that would permit the appropriate credentialing with the hospital for the clinical activity. The individual’s postdoctoral appointment is not in a clinical capacity and the postdocs will receive a Research Scholar status, and subsequent certificate at the end of the program that does not describe any clinical training.  

In the Research Scholar appointment immediately follows a clinical appointment, the department must provide the following:

  1. A Termination Form of the Clinical Appointment (submitted by the department administrator via PeopleSoft).
  2. A new appointment to recommend the individual for a Research Scholar appointment.  The Recommendation Form must note that this is a joint appointment at x% FTE as Research Scholar and x%FTE as Clinical Instructor. 
  3. Copy of the Clinical Instructor offer letter to be uploaded with the other required documents for a Research Scholar appointment.

Clinical trainees may not be appointed as Research Scholars during research-intensive periods of a Clinical Training Program.  The Research Scholar appointment is distinct from a clinical training program.  The applicable salary standard for Research Scholars is Stanford University’s postdoctoral scale, and not the GME PGY scale.

In the case of Clinical Trainees
:  Clinical trainees may not hold concurrent Clinical Instructor appointments unless the Instructor activity is distinct; i.e., outside the area of clinical training.  The School of Medicine’s policy in this regard is included below.   Such instances are reviewed on a case-by-case basis and may not be approved.  Those approved are typically made in a 90/10 or 80/20 split of FTE between the postdoctoral research scholar and the clinical instructor appointments.

In the Clinical trainee/Clinical Instructor concurrent appointments, the department must provide the following to the Office of Postdoctoral Affairs:

  1. A Recommendation Form to appoint individual as Postdoctoral Research Type = Research. The Recommendation Form must note that this is a joint appointment at x% FTE as Research Scholar and x%FTE as Clinical Instructor. 
  2. Copy of the Office of Academic Affairs Joint Offer Letter.
  3. Signed Agreement of Services Outside the Fellowship – online at http://postdocs.stanford.edu/admin/pdf-forms/MD_AgreementBilling.pdf, uploaded with the other required documents for a postdoctoral clinical appointment.

School of Medicine Policy Regarding Concurrent Trainee and Clinical Instructor Appointments (from Academic Affairs Communique, June 2011)
The policy on concurrent trainee and Clinical Instructor appointments has been updated in collaboration with the Office of the General Counsel, the Office of Postdoctoral Affairs, the Office of Graduate Medical Education, Bechtel International Center, and the Compliance Department of Stanford University Medical Center. The policy will be republished as Section 8.2.E.3.3 of the School of Medicine Faculty Handbook Chapter 8 on Clinician Educators.

A key provision of the policy is that when a department recommends a concurrent academic appointment for a trainee, it is essential that the training   rogram of the candidate not be compromised and that there be a clear and documented distinction between his or her assignment as a trainee and his or her duties as an attending physician appointed as a Clinical Instructor. If your department has submitted a Clinical Instructor appointment for a candidate who will also be a non-ACGME Resident or Fellow, please review the policy below. If the submitted recommendation needs modification, please contact Jane Volk-Brew.

If you are not sure whether the Clinical Instructor candidate also needs an appointment through the Office of Postdoctoral Affairs and/or the Office of Graduate Medical Education, please take note of Section 8.2.E.3.a.1 as well, which when compared with Section 8.2.E.3.3, distinguishes between an attending physician receiving occasional supervision and a trainee who has incidental attending physician duties. In particular, please note differences with respect to immigration, licensure and hospital compliance issues. Questions may be directed to Jane Volk-Brew, Rania Sanford, or Ann Dohn.

8.2.E.3. Specific/Supplemental Criteria for Clinical Instructors
a. Appointment as Clinical Instructor of (Subject)
1. Individuals appointed as Clinical Instructors will have completed their clinical training; this rank typically will be the first appointment for someone finishing that training. They should have demonstrated exceptional qualities and promise to become outstanding clinicians and clinical teachers. If these individuals have not had formal teaching experience, they should have demonstrated a commitment to develop the skills necessary for outstanding teaching. They must have demonstrated excellence or promise of excellence in a combination of clinical performance and clinical teaching appropriate to the programmatic need upon which the appointment will be based. The initial term of appointment is up to three years.

An attending physician appointed as a Clinical Instructor may receive occasional supervision from a more experienced physician on clinical procedures, however he or she is not a trainee. Such advanced training in a clinical subspecialty differs from a fellowship (see section 3 following) when all the following conditions are met:
1.
a) There is no curriculum associated with the candidate’s role and responsibilities;
b) the candidate was not identified by means of a trainee match;
c) he or she does not have a concurrent Fellow appointment;
d) he or she will not appear on a call schedule as a Fellow;
e) there will be no teaching attestation(s) signed by a more experienced physician for the Clinical Instructor and the Clinical Instructor must bill for the supervised services being performed by him or her;
f) he or she will not receive a trainee certification from the department, the School of Medicine or Stanford University; and
g) he or she is not seeking board eligible training and/or a Certificate of Added Qualification (“CAQ”) through the Clinical Instructor activity.
If the candidate for a Clinical Instructor position is a foreign national, he or she cannot hold a J visa.

2. Individuals fulfilling a Locum tenens role may also be appointed as Clinical Instructor to meet temporary clinical programmatic need.
3. Under exceptional circumstances, it may be appropriate to recommend the concurrent part time appointment of a non- ACGME Resident or Fellow for a one year appointment as a Clinical Instructor or, if not paid by Stanford, as a Clinical Instructor (Affiliated). Such circumstances may include the appointment of the Chief or Senior Resident (or Fellow serving in that capacity) in recognition of his or her contribution to the teaching program or of an advanced trainee on a clinical service for the purpose of recognizing his or her contribution to the clinical program of a department in a capacity other than that as a trainee.

In recommending such an appointment, it is essential that the training program of the candidate not be compromised and that there be a clear and documented distinction between the assignment as a trainee and the assignment as an appointee to the staff. The following guidelines are provided to assure that all of these conditions are met:
a) The Resident or Fellow must have completed all requirements, with the exception of practice requirements, for the Board and/or Certificate in the specialty in which he
or she will practice as a Clinical Instructor.
b) The percent time of appointment as a Clinical Instructor must be consistent with the percent time of the fellowship, grant or other support received by the Resident or Fellow. The combined total may not exceed 100% full time effort (FTE).
c) The Resident or Fellow must receive written notice that his or her appointment as a trainee will be modified and the purpose of the change described. Separate and dated periods of appointment as a part-time Resident or Fellow and as a part-time Clinical Instructor must also be specified in writing to the trainee. Appointment as Clinical Instructor must be coterminous with the period during which the trainee is formally released from training status for the purpose of the appointment.
d) Funds for the appointment of a Resident or Fellow as a part-time Clinical Instructor must have been included in the department budget and are to be derived from the
appropriate Stanford Hospital or Clinics and/or Lucile Packard Children’s Hospital accounts or other non-general funds source.
e) A document describing the services to be rendered as a Clinical Instructor, identifiable as separate and distinct from the duties required as part of the Resident’s or Fellow’s training program, must be supplied to the Office of Postdoctoral Affairs, the Office of Academic Affairs, and the Office of Graduate Medical Education. For Clinical Fellows the document must identify the codes for which the Clinical Instructor can bill for clinical services or the codes from which the Clinical Instructor is prohibited from billing. Information about billing codes is available from the Office of Graduate Medical Education.
f) As a condition of appointment as a Clinical Instructor the candidate must sign the letter of agreement to transmit professional fees to appropriate Stanford Hospitals
and Clinics and/or Lucile Packard Children’s Hospital accounts. All billable activity must be outside the area in which the candidate is training and in compliance with Stanford Hospital and Clinics’ policy 7.01.01
g) Membership on the Medical Staff of Stanford Hospital and Clinics and/or Lucile Packard Children’s Hospital must be obtained and maintained by the candidate if he or she will be responsible for the care of patients.
h) The candidate must hold a California medical or professional license. The candidate may not apply for a California Business and Professions Code Section 2113 registration from the Medical Board of California. (See Professional Licensure topic below)
i) Residency and clinical fellowship Certificates are issued only by the Office of Graduate Medical Education and/or the Office of Postdoctoral Affairs. Departments and clinical programs do not have the authority to issue Certificates upon completion of training.
j) If the candidate is a foreign national and the graduate of an international medical school, he or she must be on an ECFMG sponsored J-1 visa.
k) An identical description of the candidate’s position and intended role and responsibilities must be identical for purposes in which it is used, e.g. appointment, licensure, immigration.

Visas for and Employment of Foreign Nationals
Departments are reminded that if the candidate for an academic appointment is a foreign national, the candidate and the department must comply with the applicable policies and procedures appearing in, Administrative Guide Memo 28.1, and on the , Bechtel International Center website.

Professional Licensure
Before a clinician is permitted to assume responsibilities for the care of patients at Stanford Hospital and Clinics and/or Lucile Packard Children’s Hospital or at an outreach site of Stanford Hospitals and Clinics, he or she must have or obtain a professional license from the State of California. Information about obtaining a professional license from the State of California may be obtained from the Department of Consumer Affairs, including the Medical Board of California,
the Osteopathic Medical Board of California, the California Board of Psychology, the
Veterinary Medical Board, as well as from the Graduate Medical Education,

California Business and Professions Code Sections 2100 et seq. apply to the applications of graduates of medical schools located outside the United States or Canada. In particular, Section 2113 applies to a person who does not immediately qualify for a physician and surgeon’s certificate and who is offered by the dean of an approved medical school in the State of California a full time faculty position.

Section 2113 describes the requirements for applying for a certificate of registration to engage in the practice of medicine only to the extent that the practice is incident to and a necessary part of the person’s duties as approved by the Medical Board of California in connection with the faculty position. Section 2113 registration is for full time faculty positions only. A clinical fellowship shall not be submitted as a faculty service appointment.

Click here is a comparison of 2113 and 2111 registrations prepared by the Office of the General Counsel and the Office of Graduate Medical Education. Additional information regarding this legislation is available from the Division of Consumer Affairs, Medical Board of California and from the Graduate Medical Education (GME),.  The “Notice of Separation Under Business and Professions Code Sections 2111 and 2113”, used to notify the Medical Board of California that the faculty appointment of a 2113 registration holder has ended, is available on the GME’s web site.

Training
Spectrum develops and supports research and training programs for residents interested in acquiring or maintaining the requisite critical skills contributing to their continued career development as skilled clinician scientists. Spectrum intends to foster resident interest in CTR through several programs described here.  

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