Clinical Trainees | Office of Postdoctoral Affairs

Appointments and Reappointments

The appointment of advanced clinical trainees (post-residency) is handled through the Graduate Medical Education (GME) Office. GME oversees the ACGME-Accredited Residency/Fellowship Programs and appointments in non-standard fellowships. 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), OPA 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 fellowship period.

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 prohibited. Read the memo regarding the pay levels for clinical fellows effective July 2010. In accordance with university policy regarding external funding, the OPA accepts the appropriate documentation noting any funding that a clinical fellow receives 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 wishing 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 OPA 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 (RMG) at the School of Medicine.

Clinical Fellows, as well as Postdoctoral Scholars with MD/PhD degrees, are eligible to apply for R01 type grants that require PI status. Contact RMG for more information.

Joint Postdoctoral Scholar/Clinical Scholar 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 OPA, and may receive a clinical scholar 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.

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

A Termination Form of the Clinical Appointment (submitted by the department administrator via PeopleSoft Postdoc Web Forms).
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 Scholar.
A copy of the Clinical Scholar 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 Scholar appointments unless the Scholar 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 might 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 scholar appointments.

In the Clinical trainee/Clinical scholar concurrent appointments, the department must provide the following to OPA:

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 Scholar.
A copy of the Office of Academic Affairs Joint Offer Letter.
A signed Agreement of Services Outside the Fellowship – online at md_agreementbilling.pdf, uploaded with the other required documents for a postdoctoral clinical appointment.

Notes

Clinical trainees contining on after completion of an ACGME Fellowship do not have to be terminated in order to obtain a certificate. Instead, departments can submit a change form to extend the appointment.
This change form process is only applicable if the postdoc is remaining in the same department.
If the postdoc's GME benefits will end, please contact postdocbenefits@stanford.edu for guidance.

School of Medicine Policy Regarding Concurrent Trainee and Clinical Scholar Appointments

The policy is Section 3.2.E.3 of the School of Medicine Faculty Handbook Chapter 3 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 program 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 Scholar. If your department has submitted a Clinical Scholar appointment for a candidate who will also be a non-ACGME Resident or Fellow, review the policy below. If the submitted recommendation needs modification, please contact Jessica Salas-Mendonca or Ashley Klein.

If you are not sure whether the Clinical Scholar candidate also needs an appointment through the OPA and/or the GME, review section 8.2.E.3.a.1, which, 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, note differences with respect to immigration, licensure, and hospital compliance issues. Direct questions to Jessica Salas-Mendonca, Ashley Klein, Sofie Kleppner, or Ann Dohn.

3.2.E.3. Specific/Supplemental Criteria for Clinical Scholars

Appointment as Clinical Scholar of (Subject)

Individuals appointed as Clinical Scholars 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 Scholar may receive occasional supervision from a more experienced physician on clinical procedures, but they are 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:

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) they do not have a concurrent Fellow appointment;

d) they 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 Scholar and the Clinical Scholar must bill for the supervised services being performed;

f) they will not receive a trainee certification from the department, the School of Medicine, or Stanford University; and

g) they are not seeking board-eligible training and/or a Certificate of Added Qualification (“CAQ”) through the Clinical Scholar activity.

If the candidate for a Clinical Scholar position is a foreign national, they cannot hold a J visa.

2. Individuals fulfilling a locum tenens role may also be appointed as Clinical Scholar 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 Scholar or, if not paid by Stanford, as a Clinical Scholar (Affiliated). Such circumstances may include the appointment of the Chief or Senior Resident (or Fellow serving in that capacity) in recognition of their contribution to the teaching program or of an advanced trainee on a clinical service for the purpose of recognizing their 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. These guidelines ensure 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 they will practice as a Clinical Scholar.

b) The percent time of appointment as a Clinical Scholar 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 their 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 Scholar must also be specified in writing to the trainee. Appointment as Clinical Scholar 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 Scholar 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 Scholar, identifiable as separate and distinct from the duties required as part of the Resident’s or Fellow’s training program, must be supplied to OPA, OAA, and GME. For Clinical Fellows the document must identify the codes for which the Clinical Scholar can bill for clinical services or the codes from which the Clinical Scholar is prohibited from billing. Information about billing codes is available from GME.

f) As a condition of appointment as a Clinical Scholar, 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 they 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 GME and/or OPA. 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, they 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 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, they must have 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 a full-time faculty position by the dean of an approved medical school in the State of California.

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.

Comparison of Registration Requirements for 2113 and 2111 was prepared by OGC and GME. Additional information regarding this legislation is available from the Division of Consumer Affairs, Medical Board of California, and from the Graduate Medical Education. 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 from GME.

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.