REPORT/RECOMMENDATION TO THE BOARD OF SUPERVISORS
OF SAN BERNARDINO COUNTY
AND RECORD OF ACTION
May 19, 2026
FROM
ANDREW GOLDFRACH, ARMC Chief Executive Officer, Arrowhead Regional Medical Center
SUBJECT
Title
Graduate Medical Education Program Master Employment Agreement Template
End
RECOMMENDATION(S)
Recommendation
1. Approve the Graduate Medical Education Program master employment agreement template for Arrowhead Regional Medical Center resident and fellow physicians in the following programs, which master employment agreement template shall remain in effect from the appointment date until the resident or fellow physician has completed the applicable program or June 30, 2028, whichever occurs first:
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 complete and execute individual resident and fellow physician employment agreements on behalf of the County, including non-substantive changes, utilizing the Graduate Medical Education Program master employment agreement template 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 and/or fellow in accordance with Section 11.5 of the Graduate Medical Education Program master employment agreement template for a total not to exceed housing stipend amount of $37,500, for each resident and/or fellow per program/fellow 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 estimated cost of $22,632,816 for 2026-27 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 2026-27 and future recommended budgets.
BACKGROUND INFORMATION
The Graduate Medical Education Program master employment agreement template (Agreement) will allow resident/fellow physicians to receive medical training at ARMC for the upcoming 2026-27 academic year that, for most residents/fellows, will start on July 1, 2026. 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 2026-27 academic year, ARMC will employ approximately 240 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 agreement, outlining certain work conditions, benefits, and compensation for the resident physician.
The resident or fellowship program year is typically 12 months. In some circumstances, it may take the resident/fellow more than 12 months to complete the program. As a result, the Agreement template provides that the term of the agreement shall remain in effect from the appointment date until the resident or fellow physician has completed the applicable program or June 30, 2028, whichever occurs first. The Agreement template includes a program/fellow year annual stipend ranging from $76,235.83 to $110,040.72 based on a 12-month program, an additional prorated stipend and benefits through the term of the contract if it takes the resident/fellow more than 12 months to complete the program, along with other benefits, deferred compensation, and other stipends including a housing stipend to each resident/fellow in the amount of $101.92 per pay period.
In order to ensure that the resident/fellow obtains educational rotations necessary to meet ACGME Program Requirements, Section 11.5 of the Agreement template 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 housing stipend amount of $37,500 for each resident/fellow during the program/fellow year. Housing will be arranged and paid directly by the County to the housing entity consistent with County approved payment processes.
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 County Counsel (Scott Runyan, Principal Assistant County Counsel, 387-5455) on May 14, 2026; Human Resources (Gina King, Assistant Director, 386-8623) on April 24, 2026; ARMC Finance (Chen Wu, Finance and Budget Officer, 580-3165) on April 27, 2026; and County Finance and Administration (Jenny Yang, Administrative Analyst, 387-4884) on May 4, 2026.