UCLA GME Working and Training at Affiliated Organizations Policy

Working and Training at Affiliated Organizations as a University of California (UC) Trainee Enrolled in a UC-Sponsored Training Program

UC’s academic health centers and health professional schools have affiliations with other health care organizations to improve quality and access for the people of the state of California, particularly those in medically underserved communities, and to support the University’s education, research, and public service missions.

Some of these organizations have policies that are different from those of UCLA. For example, some restrict certain evidence-based health care services, such as abortion, contraception, assisted reproductive technologies, gender-affirming care, and end-of-life care, that otherwise would be offered at a UCLA facility or other health care locations that do not have these policies. Organizations that have these policy-based restrictions on care are referred to as “covered affiliates” under Regents Policy 4405 and systemwide policy.

Expectations for UC Providers

The University of California is committed to delivering patient-centered, evidence-based, comprehensive medical care that addresses the needs of patients, advances health equity, and is free from discrimination. Accordingly, when UC providers are working or training at any UC or non-UC facility, they are expected to:

  • Make clinical decisions consistent with the standard of care and their independent professional judgment, respecting each individual patient’s needs and wishes. Trainees are expected to make decisions under the appropriate level of supervision by a licensed clinician as outlined in UCLA school and program supervision policies.
  • Inform patients of all health care options, regardless of whether those options are available through the covered affiliate, prescribe any interventions that are medically necessary and appropriate, and transfer or refer patients to other facilities when it is in the patient’s interest.
  • Provide any item or service deemed necessary and appropriate in the event of an emergency, without restriction, and without seeking approval from any non-licensed health care provider.

Training at a Covered Location

Training at an affiliated organization with policy-based restrictions on care is voluntary, and if a trainee has an objection, the UCLA program or school will try to identify an alternative site.

Medical residents and fellows must complete all educational and clinical experiences that are required by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties, the UCLA David Geffen School of Medicine and the UCLA residency or fellowship program in order to successfully complete the training program and be eligible for specialty board certification. Medical students must satisfactorily complete all educational and clinical activities that are required by the Liaison Committee on Medical Education (LCME) and the UCLA David Geffen School of Medicine to successfully attain their medical degrees. Likewise, trainees in other health professions, must also comply with all requirements outlined by their UC schools and pertinent accrediting agencies.

If a resident/fellow objects to training at a site because of the policy-based restrictions as described in this policy, the resident/fellow must formally submit this objection with a detailed explanation in writing to the Director of Graduate Medical Education, Lisa Payne, gme@mednet.ucla.edu within 15 days of receiving this policy.

If a sponsoring location receives a trainee objection, it will attempt to identify alternative sites with the necessary faculty, resources and clinical/educational experiences to comply with applicable accreditation standards, specialty board and institutional requirements while maintaining a consistent training experience for all UC trainees and consistent program funding. If an alternative site is found with which a training agreement has been or can be established consistent with UC policy and requirements, the trainee will be reassigned to the alternative site. If an alternative site is not found, the designated institutional official will inform the trainee and the relevant Dean. The trainee will be given the option to train at that covered affiliate site, or to find another program if possible.

Covered Affiliate Policies

Covered affiliates may ask for confirmation of adherence to their policies while working or training at their facilities. However, the major private, non-profit health systems in California with policy-based restrictions have acknowledged in their agreements with the University that all UC personnel and trainees working or training at their facilities shall at all times have the right and ability to: (i) make clinical decisions consistent with the standard of care and their independent professional judgment, respecting the needs and wishes of each individual patient; (ii) inform patients of all of their health care options; (iii) prescribe any interventions that are medically necessary and appropriate; (iv) transfer or refer patients to other facilities whenever they determine it is in the patient’s interests; and (v) provide any item or service they deem in their professional judgment to be necessary and appropriate to treat a patient’s emergency medical condition, without application of policy-based restrictions on care, and without seeking approval from any non-provider.

Government-Operated Facilities

In addition to these organizations, many government-operated facilities are prohibited by federal law from performing certain services and have adopted policies implementing those laws. These facilities also have confirmed that they expect their medical staff and personnel providing services at their clinical sites to make clinical decisions consistent with the standard of care and their independent professional judgment, considering the needs and wishes of each individual patient. As with all UC-sponsored training programs, trainees are expected to make decisions under the appropriate level of supervision by a licensed clinician as outlined in the local UCLA school and program supervision policies.

These government-operated organizations have verified that they comply with federal anti-discrimination laws and that they do not bar advising, prescribing, or referring patients, nor do they bar performing emergency services.

Covered Affiliates

UCLA has identified the following covered affiliates that have care-restricting policies. This list is not exhaustive and may change over time based on the policies of these organizations or the addition of new agreements with other health care organizations

  • Providence Health
  • Adventist Health
  • Dignity Health
  • Loma Linda University
  • QueensCare Health Centers
  • Mary Health of the Sick

Sharing Concerns or Complaints

The University expects that UC employees and trainees will deliver evidence-based health care services and, in those locations where a required service cannot be delivered, appropriate referrals or transfers must be made. If at any time a UC employee or trainee is asked to do otherwise, or a patient has a complaint or grievance related to care received or provided through covered affiliates, the University should be immediately informed as described below.

If patients have any concerns or complaints about care received at a covered affiliate’s location, they may contact UCLA’s Office of Patient Experience at 310-267-9113. 

If UC employees or trainees believe their professional judgment or freedom to counsel, prescribe, refer, transfer, or provide emergency care has in any way been impeded at a covered affiliate’s facility, they should immediately contact:

If for any reason, patients, UC employees, or UC trainees are unable to reach these points of contact, the following should be contacted:  UCLA Health, Office of Compliance Services, at compoffice@mednet.ucla.edu.  Concerns may also be reported through the University’s Whistleblower Hotline at universityofcalifornia.edu/hotline or (800) 403-4744.

More information can be found in the full text of the Presidential Policy on Affiliations with Certain Health Care Organizations and of the Regents Policy 4405 Policy on Affiliations with Healthcare Organizations that Have Adopted Policy-Based Restrictions on Care.