UW School of Medicine
GME Position Allocation Committee (GMEPAC)
Resident & Fellow Complement Change Application
Program Information
Program: _______________________________
ACGME Number: ____________________
Department/Division: _______________________
Duration of accredited training program: _________
Complement change/increase deadline: __________________________________________________
(Date by which program must have decision by GMEPAC due to NRMP deadline, RRC agenda deadline, etc.)
Is this a temporary or permanent change/increase? ______________________________________
Program Director: ________________________________________________________________________
Name
Signature
Date
Departmental Concurrence
Department Chair: _______________________________________________________________________
Name
Signature
Date
Division Head: ___________________________________________________________________________
(if applicable)
Name
Signature
Date
Hospital Concurrence – To Be Completed by GMEPAC
UWMC:
Funding Approved
Pending Hospital Review
Not Approved
HMC:
Funding Approved
Pending Hospital Review
Not Approved
SCH:
Funding Approved
Pending Hospital Review
Not Approved
VA:
Funding Approved
Pending Hospital Review
Not Approved
SCCA:
Funding Approved
Pending Hospital Review
Not Approved
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I. Program Accreditation Status
1. Attach a copy of the most recent ACGME accreditation letter for the program, as well
as the program’s response to citations (if any). If accreditation is pending, please
indicate when the program is being reviewed by the RRC for consideration of
accreditation.
2. Attach a copy of the program’s response to citations (if any) in ADS, and include any
additional updates on these citations below.
II. Educational Rationale & Impact
1. Provide a succinct rationale for the complement change, describing the primary
reason(s) for the request such as unique educational opportunities, new clinical
experience requirements by the ACGME, increased flexibility for elective experiences,
improved compliance with duty hour requirements, etc. The rationale must be
exclusively educational in nature and not based on service demands.
2. Does the program currently meet ACGME expectations regarding required clinic and/or
operative experiences? Will this complement change/increase enhance the ability of
trainees to meet such requirements?
3. What measures are in place to prevent the dilution of required educational experiences
for trainees?
4. What impact, if any, would this complement change/increase have on trainees outside
of the program?
5.
What impact, if any, would there be if the complement was NOT increased/changed?
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6. Have there been any program changes in the program’s complement in the last five
years? If yes, please describe.
III. Proposed FTE Allocations & Funding Arrangements
1. Using the attached table, please provide your program’s current allocation outlined in
the latest Single Source Service Agreement, as well as the proposed FTE allocations by
training site and resident/fellow level. If the complement change will occur over
multiple years, please provide the proposed allocation for each academic year until
complement change is fully implemented.
Chief resident stipends may be requested for residents in the final year of training in a
program in which there is a designated chief resident position with administrative
responsibilities for the residency program in addition to clinical duties appropriate to
the final year of training in the program, or for those engaging in an approved
additional year of training beyond that required for certification. Some limitations may
apply to positions based at the VA.
2. For fellowship positions including research time, what is the funding source for this
time? If grant funded, what is the duration of the grant? Is this funding source stable
for the foreseeable future?
IV. Educational & Training Resources Requirements
1. Do current clinical volumes at the relevant training sites support this complement
change? Please provide data on at least three key departmental and/or hospital
measures of patient volumes (i.e., service line inpatient admissions, technical
procedures, outpatient visits) for the last five years that supports this change.
2. What is the current and proposed faculty to resident/fellow ratio? Does the proposed
ratio meet ACGME supervision requirements?
3. Will the complement change result in the need for additional faculty in order to meet
requirements for supervision or faculty participation in other teaching experiences? If
yes, outline the department’s recruitment timeline and how the position(s) will be
funded.
4. What additional space and/or facilities (e.g., educational space, hospital beds, lab
space, clinic space, call rooms) will be required to accommodate this complement
change? If so, what is the anticipated cost and how will it be funded?
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5. If the program includes research time, does the program have the infrastructure (e.g,.
laboratory space and equipment, faculty expertise, research funding) it needs to
support the research activities of these additional residents/fellows?
V. UW Medicine Strategic/Operational Impact
1. Is the complement change consistent with the strategic plan of UW Medicine and the
medical centers, and/or its affiliates? Please explain.
2. Will the complement change affect attending physician productivity? If so, positively or
negatively?
3. What impact will the complement change have on hospital volumes (inpatient,
outpatient, ancillary services such as lab, radiology, etc.)?
4. What other additional hospital resources may be required to support the complement
change (e.g., nursing staff, OR block time, etc.)?
VI. Regional and National Workforce Needs
1. Is there a need for physicians in this specialty or subspecialty area in the WWAMI
region? What proportion of graduates from the program currently practice in the
WWAMI region?
2. Is there a need for specialists or subspecialists in this discipline at the national level? If
yes, please explain.
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VII. International Rotations (if applicable)
1. How has the program coordinated with the Department of Global Health in the
development of this rotation (e.g., orientation of residents to the international
experience, development of rotation goals and objectives)?
2. Is ACGME approval of this educational experience required? If so, what information is
required in order to apply for approval?
VIII. Chief Resident Stipend Requests (if applicable)
1. Provide a written job description for the chief resident position that clearly outlines the
administrative, educational, and teaching duties required.
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Current Allocation (see AY 2012 Single Sourc e Agreement)
R1
R2
R3
R4
R5
R6
R7
R8
CR
Total
UWMC
0
HMC
0
SCH
0
VA
0
SCCA
0
DEPT
0
Researc h
0
Other
Total
0
0
0
0
0
0
0
0
0
0
0
R4
R5
R6
R7
R8
CR
Total
Proposed Allocation (AY 20XX)
R1
R2
R3
UWMC
0
HMC
0
SCH
0
VA
0
SCCA
0
DEPT
0
Researc h
0
Other
0
Total
0
0
0
0
0
0
0
0
0
0
Allocation Changes Requested
R1
R2
R3
R4
R5
R6
R7
R8
CR
Total
UWMC
0
0
0
0
0
0
0
0
0
0
HMC
0
0
0
0
0
0
0
0
0
0
SCH
0
0
0
0
0
0
0
0
0
0
VA
0
0
0
0
0
0
0
0
0
0
SCCA
0
0
0
0
0
0
0
0
0
0
DEPT
0
0
0
0
0
0
0
0
0
0
Researc h
0
0
0
0
0
0
0
0
0
0
Other
0
0
0
0
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0
0
0
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