Tip of the week: Navigate the nuances of master affiliation agreements and program letters of agreement

Residency Program Insider, November 16, 2010

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One major part of fulfilling institutional requirements is the detailed contracts, or affiliation agreements. Your program and institution must have them in place with all hospitals where trainees will be rotating.
According to the ACGME, master affiliation agreements are agreements between a sponsoring institution and all major participating sites involved in residency education.

The ACGME defines what constitutes a major site as sites to which all residents in at least one program rotate for a required educational experience. Each resident must spend at least four months in a single required rotation or combination of rotations within two years, according to the ACGME.

Although the institutional requirements do not stipulate what items that program must cover in master affiliation agreements, programs must renew these documents every five years, signed by appropriate parties. Because master affiliation agreements tend to be complex legal documents, according to the ACGME, your program will probably leave the content of the agreement up to your institution’s legal counsel.

It is the institution’s responsibility to ensure that the master affiliation agreements are updated.
“During an institutional site visit, the site visitor will be primarily interested in reviewing and verifying the master affiliation agreements that the sponsoring institution maintains with major participating sites,” according to the FAQs section of the ACGME website at

In addition to developing master affiliation agreements, each residency program in the institution is required to have a PLA, which are agreements that each training program has to have with each of the hospital sites that residents rotate through. Your residency program should renew these agreements every five years and should:

  • Identify the faculty who will assume educational and supervisory responsibilities for residents
  • Specify the faculty’s responsibilities for teaching, supervision, and formal evaluation of residents
  • Specify the duration and content of the educational experience
  • State the policies and procedures that will govern resident education during the assignment.
  • Additionally, update these agreements whenever there are changes in program director or site director, resident assignments, or revisions to the items specified in the common program requirements or the specialty requirements.

The ACGME requires that PLAs provide details about faculty, supervision, evaluation, educational content, length of assignment, and policy and procedures for each required assignment that occurs outside the institution, according to the ACGME. They should be short, less formal documents than the master affiliation agreements and address the required content as simply as possible.

This week’s tip is from Residency Program Alert.


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