REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
April 29, 2025
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
2025-26 Graduate Medical Education Program Master Employment Agreement
End
RECOMMENDATION(S)
Recommendation
1. Approve the 2025-26 Graduate Medical Education Program Master Employment Agreement for Arrowhead Regional Medical Center resident and fellow physicians in the following programs:
a. Anesthesia
b. Cardiology Fellowship
c. Combined Emergency Medicine/Internal Medicine
d. Emergency Medicine
e. Emergency Medical Services Fellowship
f. Family Medicine
g. General Surgery
h. Integrated Vascular Surgery
i. Internal Medicine
j. Maternal Fetal Medicine Fellowship
k. Neurology
l. Obstetrics/Gynecology
m. Pulmonary Critical Care Fellowship
n. Psychiatry
o. Radiology
p. Surgical Critical Care Fellowship
2. Authorize the ARMC Chief Executive Officer to execute individual resident/fellow physician employment agreements on behalf of the County, including non-substantive changes, subject to review by County Counsel, pursuant to the 2025-26 Graduate Medical Education Program Master Employment Agreement identified in Recommendation No. 1.
3. Authorize the Program Director, in coordination with Arrowhead Regional Medical Center Administration, to approve additional housing costs beyond the housing stipend to the resident/fellow in accordance with Section 5.21 of the Graduate Medical Education Program Master Employment Agreement for a total not to exceed amount of $37,500 for each resident/fellow per Program year.
(Presenter: Andrew Goldfrach, ARMC Chief Executive Officer, 580-6150)
Body
COUNTY AND CHIEF EXECUTIVE OFFICER GOALS & OBJECTIVES
Operate in a Fiscally-Responsible and Business-Like Manner.
Provide for the Safety, Health and Social Service Needs of County Residents.
FINANCIAL IMPACT
Approval of this item will not result in the use of Discretionary General Funding (Net County Cost) as the cost of $20,904,746 associated with Arrowhead Regional Medical Center’s (ARMC) residency/fellowship programs are funded by State Medi-Cal, Federal Medicare, and reimbursements from local area hospitals participating in the resident curriculum. Adequate appropriation and revenue will be included in the ARMC’s 2025-26 recommended budget.
BACKGROUND INFORMATION
The 2025-26 Graduate Medical Education Program Master Employment Agreement (Agreement) will allow resident/fellow physicians to receive medical training at ARMC. Authorization for the ARMC Chief Executive Officer to execute the individual agreements will enable ARMC to enter into agreements with residents/fellow physicians within particular residency/fellowship programs in a timely manner. During the 2025-26 academic year, ARMC will employ approximately 244 residents/fellows. The Agreements provide for the safety, health and social service needs of County residents by ensuring specialty training of resident/fellow physicians to provide care to ARMC patients.
The Accreditation Council for Graduate Medical Education (ACGME), the regulatory agency for the ARMC residency/fellowship programs, requires that ARMC participate in an organized resident/fellow physician interview process and selection. To meet this requirement, ARMC participates in the Electronic Resident Application Service (ERAS) and National Residency Matching Program (NRMP). ERAS allows medical students to apply and interview with appropriate medical facilities. NRMP matches postgraduate medical students with those medical facilities the student has interviewed. During the interview process, the potential resident/fellow is presented with an informational packet that outlines the ARMC residency/fellowship programs and the requirements for each of these programs. Included in the informational packet is a copy of the ARMC one-year Agreement, outlining certain work conditions, benefits, and compensation for the resident physician.
The Graduate Medical Education Program Master Employment Agreement is updated annually, per the ACGME requirements, and submitted to the Board of Supervisors for approval. The 2025-26 Agreement includes revisions to the contract language to ensure residents meet the Post Graduate Training license requirements in a timely manner. The Agreement includes a new housing stipend to each resident/fellow in the amount of $101.92 per pay period, not to exceed $2,650 for the Program Year. Also, educational rotations are necessary and serve a County purpose. In order to ensure that the resident/fellow obtains educational rotations necessary to meet ACGME Program Requirements, Section 5.21 of the Agreement provides that the Program Director, in coordination with ARMC Administration, may approve additional housing costs to the resident/fellow when the educational rotation is not available at ARMC or in the accessible region (as determined by the respective residency/fellowship program). Recommendation No. 3 would limit these additional housing costs paid for by the County to the housing entity for a total not to exceed amount of $37,500 for each resident/fellow during the Program Year. Also, the housing will be arranged and paid directly by the County to the housing entity consistent with County approved payment processes.
Additionally, revisions to the Resident Due Process Attachment of the Agreement have been made. These revisions include an additional example of academic deficiency language; clarification of ARMC personnel roles when placing residents on leave pending investigation; updated language regarding formal disciplinary actions and process; and added an outside entity to which certain disciplinary actions may be reported.
ARMC recommends approval of the Agreement to provide for the safety, health and social service needs of County residents by ensuring specialty training of resident/fellow physicians to provide care to ARMC patients.
PROCUREMENT
Not applicable.
REVIEW BY OTHERS
This item has been reviewed by This item has been reviewed by County Counsel (Scott Runyan, Principal Assistant County Counsel and Charles Phan, Supervising Deputy County Counsel, 387-5455) on April 11, 2025; Human Resources (Gina King, Assistant Director, 386-8623) on April 15, 2025; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on April 15, 2025; Finance (Jenny Yang, Administrative Analyst, 387-4884) on April 16, 2025; and County Finance and Administration (Valerie Clay, Deputy Executive Officer, 387-5423) on April 17, 2025.