HACKENSACK UNIVERSITY MEDICAL CENTER

HACKENSACK UNIVERSITY MEDICAL CENTER

AGREEMENT made this __th day of Month, 2015 between HackensackUMC, a not-for-profit healthcare facility and sponsor of an Emergency Medicine Residency program, established according to the laws of the State of New Jersey, located at 30 Prospect Avenue, Hackensack, New Jersey 07601, hereinafter referred to as Medical Center and ____________ residing at 29 _________________, hereinafter referred to as Doctor.

WHEREAS, Medical Center offers a Postgraduate Educational Program, with approval of the Accreditation Council for Graduate Medical Education, in the form of House Staff Member position; and

WHEREAS, Doctor desires to participate in Medical Center's Postgraduate Educational Program training as a House Staff Member and

WHEREAS, the House Staff Member meets the qualifications for resident eligibility as defined by the Accreditation Council for Graduate Medical Education; and

WHEREAS, Medical Center and Doctor wish to formalize the relationship between them

NOW, THEREFORE, in consideration of mutual covenants and promises set forth herein, and for other good and valuable consideration, Medical Center and Doctor agree as follows:

1. TERM.

The term of this Agreement shall be for one (1) year and shall commence on July 1, 2015 expire on June 30, 2016.

2. EMPLOYMENT OF THE DOCTOR.

The Medical Center hereby employs the Doctor on a full-time basis for the purpose of providing House Staff Member services to the patients of the Medical Center. The Doctor shall be responsible for fulfilling the responsibilities of a House Staff Member as defined herein. For the purposes of the Postgraduate Educational Program, the Doctor shall be also identified as "PGY1" Emergency Medicine Resident.

3. QUALITY OF SERVICE PROVIDED.

The following requirements concern the quality of the Doctor's services as a House Staff Member and are material terms of this Agreement:

(a) The Doctor shall submit a completed application for a New Jersey Permit and all other credentialing documents required by the New Jersey Board of Medical Examiners and/or HackensackUMC or a valid New Jersey Medical License prior to commencing service under this Agreement. This material must be submitted to the Office of Academic Affairs for approval.

(b) The Doctor shall abide at all times by the Medical Center policies and procedures, bylaws, rules and regulations, and shall conduct himself/herself in a professional manner. The Medical Center reserves the right to, at its discretion, change or modify the aforesaid policies and procedures, Bylaws, rules and regulations and the Doctor agrees to keep himself/herself apprised of the contents thereof at all times during the term of this Agreement.

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(c) The Doctor shall cooperate with any corporate compliance program now or hereafter in effect at the Medical Center and/or HackensackUMC Faculty Practice.

(d) The Doctor agrees that he/she will comply with all Federal and State laws including, without limitation, Medicare and Medicaid, and the Doctor agrees to immediately report to the Medical Center if (i) he/she violates any Federal or State healthcare law, regulation or policy; (ii) he/she becomes aware of any inquiry or investigation of him or her by the government; or (iii) he/she is excluded from or otherwise sanctioned by any Federal or State healthcare plan.

(e) The Doctor shall at all times perform his/her duties hereunder in accordance with the currently approved methods and standards of practice of his/her specialty and with a high standard of medical practice and sound patient care.

4. SALARIES.

During the term of the Agreement, the Medical Center agrees to pay Doctor the following annual salary $55,000 to be paid in twenty-six equal bi-weekly installments. The parties expressly acknowledge that all compensation paid hereunder shall be at fair market value for the services rendered and not based on the volume or value of patient referrals.

5. BENEFITS.

Residents are entitled to the standard benefits program available to employees.

6. ANNUAL PHYSICAL EXAMINATION.

The Doctor is required to undergo an annual physical within thirty (30) days prior to commencing service at Medical Center. The Doctor may be required to undergo an annual physical examination within thirty (30) days prior to departure from the Medical Center's Postgraduate Educational Program. Proof of immunity to measles, mumps, rubella, PPD and hepatitis B is required prior to employment.

7. DOCTOR'S OBLIGATIONS AND RESPONSIBILITIES.

The Doctor agrees to perform the duties and responsibilities required of him/her within the regular hours of work and the on-call hours as determined by the Program Director in conformity with the conditions established the accrediting organization.

All provisions of care required of the Doctor will be commensurate with the Doctor's level of advancement and competence, under the general supervision of appropriately privileged attending teaching staff. This includes:

A. participation in safe, effective and compassionate patient care; B. developing an understanding of ethical, socioeconomic and medical/legal issues that

affect graduate medical education and of how to apply cost containment measures in the provision of patient care; C. participation in the educational activities of the training program and, as appropriate, assumption of responsibility for teaching and supervising other residents and students,

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and participation in institutional orientation and education programs and other activities involving the clinical staff; D. participation in institutional committees and councils to which the Doctor is appointed or invited; and E. performance of these duties in accordance with the established practices, procedures and policies of the institution, and those of its programs, clinical departments and other institutions to which the Doctor is assigned; including, among others, state licensure requirements for physicians in training, where these exist.

The Doctor is also expected to:

1. Develop a personal program self-study and professional growth with guidance from the Medical Center attending teaching staff.

2. Participate in safe, effective and compassionate patient care under supervision commensurate with their level of advancement and responsibility.

3. Participate fully in the educational activities of their Program and, as required, assume responsibility for teaching and supervision of other residents and students.

4. Participate in appropriate institutional programs and activities involving the Medical Staff and adhere to established practices, procedures and policies of the institution.

5. Participate in appropriate institutional Committees, such as those that relate to patient care and review activities.

6. Apply cost containment measures in the provision of patient care. 7. Adhere to specific Rules and Regulations of the Department to which they are assigned. 8. Residents are required to adhere to all the Infection Control Policies, Regulation and

Procedures of the Medical Center. 9. Residents are required to adhere to all policies and procedures contained in the Employee

Handbook and Code of Conduct.

8. MOONLIGHTING.

a. Only licensed Doctors shall be eligible for approval for extramural professional activities (herein referred to as "moonlighting"). Moonlighting is forbidden without the written consent of the Medical Center secured in accordance with this section. Request for extramural professional activities must be submitted, in writing, to Program Director prior to the commencement of any and all such activities. Said notice must include clear evidence that the Doctor is covered by suitable Malpractice Insurance, procurement of which shall be the sole responsibility of the Doctor and not the Medical Center. The requests are required to be reviewed by the Program Director in conjunction with the Chief Academic Officer, and with feedback from other Department staff members.

b. In the event that the Doctor fails to secure prior approval, or if at a later date following approval the Medical Center request the Doctor to terminate moonlighting activities, the Doctor shall be given a maximum of five (5) working days to cease and desist any and all such actives. Failure to comply will be a material breach of this Agreement and shall result in the Doctor's immediate termination.

c. In exercising the authority to grant moonlighting activities approval, the following guidelines should be taken into consideration: 1. The capacity of the Doctor to fulfill his or her educational objective under this Agreement while, at the same time, pursuing additional work opportunities for income outside of the Medical Center. 2. Whether or not the additional work opportunity constitutes a conflict of interest; 3. Whether or not the additional work opportunity may occur at a time when the Doctor is expected to perform his or her assigned duties under this Agreement. 4. The Chief Academic Officer will grant or deny approval based on all considerations.

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d. Application for renewal of previously approved extramural professional activities must be made and renewed approval received by the Doctor on a yearly basis at the start of each academic year.

e. Only Emergency Medicine PGY 3 Residents are permitted to moonlight during the last 6 months of their residency per the approval of the Program Director provided they are in good standing in their training program and that moonlighting does not interfere with duty hours. They are required to present their planned moonlighting schedule to the Program Director for approval in advance of accepting the shifts for review to ensure there are no duty hour violations.

9. EVALUATIONS

Assessment of the Doctor's performance is continuously conducted throughout the term of this Agreement. The Doctor will be apprised of his performance evaluation at least on a semi-annual basis.

As the position of the Doctor involves a combination of supervised, progressively more complex and independent patient evaluation and management functions and formal educational activities, the competence of the Doctor is evaluated on a regular basis. The Program Director maintains a record of all evaluations performed.

Program Directors will timely warn the Doctor of any unsatisfactory performance of duties which will result in an unfavorable letter of recommendation, and thereby jeopardize the eligibility of the Doctor to take Board Examinations. Written documentation of these warnings will be sent to the Medical Center's Academic Affairs Committee and will become part of the Academic Affairs Committee minutes.

10. DISPUTE RESOLUTION.

All disputes arising out of this Agreement shall be addressed as follows:

Step 1

The Doctor should present his/her complaint in writing to their Program Director within fourteen (14) calendar days of the event or occurrence. The Program Director, or designee, will reply in writing within five (5) working days.

Step 2

If the Doctor is not satisfied with the reply given by the Program Director, he/she has the right to present the written complaint within five (5) calendar days to the Chief Academic Affairs. The Chairman of Academic Affairs or designee will review the grievance and will reply in writing within five (5) working days.

Step 3

If the Doctor is not satisfied with the reply from the Chief of Academic Affairs he/she shall request within seven (7) calendar days of receipt of the response from the Chairman that a committee comprised of three (3) uninvolved Residency Program Directors. The Doctor will choose one member, his or her Program Director will choose the other member of the committee and these two members will select a third member who shall act as Chairman of the committee. This committee shall review the grievance and reply in writing within five (5) working days.

In all cases, the decision by this tribunal will be final.

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11. SCHEDULES

The formulation of all work assignment schedules and on call schedules is the responsibility of the Program Director. However, Doctors shall not be assigned night call more frequently than every third (3rd) night when they are also working during those days.

12. APPOINTMENT.

It is understood that satisfactory completion of Medical Center's Postgraduate Education Program does not guarantee appointment to Medical Center's Staff as an Attending Physician.

13. TERMINATION

Notwithstanding, the foregoing Medical Center may terminate this Agreement on five (5) days prior written notice, with or without cause sent by Certified Mail ? Return Receipt Requested to the Doctor's address listed above.

14. RETENTION OF RIGHTS

Medical Center retains and may exercise all rights, powers, duties, authority and responsibilities conferred upon and vested in it by the laws and constitution of the State of New Jersey and the United States of America. Except as specifically limited or modified by the terms of this Agreement, all rights, powers, duties, authority prerogatives of management and the responsibility to promulgate and enforce rules and regulations governing the conduct and activities of employees are retained by the Medical Center, whether exercised or not, and shall remain exclusively with the Medical Center.

This Agreement expresses the entire understanding between the parties.

15. MODIFICATION

This Agreement shall not be altered or modified except in writing signed by the parties hereto.

16. SEVERABILITY.

It is understood and agreed by the parties hereto that if any part, term or provision of the Agreement is held by the Courts to be illegal or in conflict with any law of the State of New Jersey, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid.

17. GOVERNING LAW.

The validity of this Agreement and any provision thereof shall be determined under and shall be construed according to the laws of the State of New Jersey.

18. CAPTIONS

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