BOARD OF REGENTS BRIEFING PAPER

1. Agenda Item Title: FACULTY HIRE ABOVE SALARY SCHEDULE, UNSOM. 2. BACKGROUND & POLICY CONTEXT OF ISSUE: Board of Regents approval is required for faculty hires when the employment salary exceeds the maximum amount on the salary schedule. UNSOM requests such approval for the appointment of Tarek Ammar, M.D as Assistant Professor, Gastroenterology, in the Department of Internal Medicine, Las Vegas, University of Nevada School of Medicine (UNSOM). 3. SPECIFIC ACTIONS BEING RECOMMENDED OR REQUESTED: President Milton D. Glick requests approval of employment salary above schedule for Tarek Ammar, M.D., in the position of Assistant Professor, Gastroenterology, Internal Medicine, Las Vegas, UNSOM, at a salary of $410,000, which exceeds the established maximum of $184,224. Dr. Ammar’s salary will be derived from a combination of funding: (a) University Medical Center (UMC); (b) clinical practice revenues; (c) CMS funds; and (d) state funds. 4. IMPETUS (WHY NOW?): In light of the recent closures of several endoscopy centers in Southern Nevada, there is a great need for additional practitioners to perform these procedures. UNSOM is committed to partnering with UMC to provide and enhance the quantity and quality of these critical services that are currently provided to the residents of Southern Nevada. An exceptionally qualified, fellowship-trained candidate has been identified and is willing to accept this position. The Department of Internal Medicine has recently hired its first gastroenterologist and he will begin working upon completion of Nevada licensure and credentialing. The Department needs two more gastroenterologists with which to establish a division of gastroenterology. Historically, gastroenterologists have been very difficult to recruit, as the private sector is far more lucrative. With all of the recent problems with the local endoscopy centers, establishing a division of gastroenterology within UNSOM and having Dr. Ammar as a faculty member will help restore confidence to the residents of Southern Nevada. Additionally, a division of gastroenterology will offer not only medical student and resident training within the school but will also be the foundation for a fellowship program to be able to retain UNSOM residents within the system and keep them practicing in Nevada once they have completed their training. The addition of Dr. Ammar will greatly enhance the department’s residency program training in this critical sub-specialty. The current search has identified an exceptionally qualified candidate, Tarek Ammar, M.D., who is fellowship trained and board certified in internal medicine. University Medical Center has committed annual salary support of 46%, with the remaining to be derived from clinical practice revenues (25%), CMS funds, (19%) and state funds (10%). If UMC removes funding for this position, Dr. Ammar’s salary will be reduced per his offer letter. 5. BULLET POINTS TO SUPPORT REQUEST/RECOMMENDATION:

• Dr. Ammar has demonstrated the proven clinical ability to assume this position. • UMC is committing the majority of the salary. • Having a fellowship trained gastroenterologist as a faculty member of UNSOM member of

UNSOM will be invaluable in reassuring the community that all proper Infection Control procedures are being complied with.

• The number of fellowship trained gastroenterologists is decreasing, and it is becoming more difficult to recruit for an academic position, as the private sector is far more lucrative. UNSOM

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competes in a different market economy than other professional schools and relies extensively on robust industry benchmarks to set competitive salaries in order to attract the best individuals for the job.

• With the relatively low number of practitioners in relation to the population of Las Vegas, it is anticipated that this can be a profit center for the department and the UNSOM.

6. POTENTIAL ARGUMENTS AGAINST THE REQUEST/RECOMMENDATION: Physicians and other medical school faculty should be compensated at levels similar to other professors and faculty. 7. ALTERNATIVE(S) TO WHAT IS BEING REQUESTED/RECOMMENDED: Hire a more junior and less accomplished individual with compensation within Q2. 8. COMPLIANCE WITH BOARD POLICY: Consistent With Current Board Policy: Title #_____ Chapter #_____ Section #_______ Amends Current Board Policy: Title #_____ Chapter #_____ Section #_______ Amends Current Procedures & Guidelines Manual: Chapter #_____ Section #_______ Other:_ Title #2 Chapter 5 Section # 5.4.1.; 5.5.2 (Seeking exception to salary schedule)______ Fiscal Impact: Yes __X___ No_____ Explain: Dr. Ammar’s salary will be derived from a combination of funding. UMC has committed annual salary support of 46%, with the remaining salary to be derived from clinical practice revenues (25%), CMS funds, (19%) and state funds (10%). If UMC removes funding for this position, Dr. Ammar’s salary will be reduced per his offer letter.

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University of Nevada School of Medicine

March 1, 2010

Dr. Tarek Ammar 4482 Lindell Blvd #1106 St Louis, MO 63108

Dear Dr. Ammar:

We are very pleased to make this conditional offer of employment to you for the position of Assistant Professor, Gastroenterologist, in the Department of Internal Medicine, Las Vegas at the University of Nevada School of Medicine.

Your duties will include the following: • Providing consultative and procedural care for patients at University Medical Center

(UMC), in the faculty practice, and other sites as identified by the Department Chair and Division Chief

• Supervising and educating resident physicians and students on the gastroenterology rotation at UMC

• Lecturing on gastroenterology topics in the residency's Core Curriculum lecture series and student clerkship lecture series, leading case conferences for resident physicians and students

• Assisting the Department Chair in the creation of a Division of Gastroenterology. • You are also expected to develop a program of scholarly activities.

The starting date for this (non-tenure track) position at 1.0 FTE will be determined after the Department receives verification that you have obtained a Nevada medical license, and you have been credentialed at the designated entities and malpractice coverage has been obtained,

Please be advised that the negotiated salary is contingent on endorsement from the Provost and President of the University of Nevada, Reno and formal approval by the Nevada System of Higher Education (NSHE) Board of Regents.

Your compensation of $410,000.00 for the first year (first 12 months) will include two components:

1) $36,900.00 from state funds; 2) $373,100,00 from University Medical Center (UMC)*

*Soft funding clause: Notwithstanding any provision of the NSHE Code, including but not limited to Section 59.1, if, in the best judgment of the supervisor, with approval of the appointing authority, funds for this position are no longer available or must be directed to other purposes, your contract may be terminated or notice of non-reappointment to employment may be given with 30 days notice.

The Administration reserves the right to change your sources of funding in the future.

Initial here '\11 Department of Internal Medicine

2' 1_'0 W. Ch rI :ston Blv ., Suite 300

Las Vegas, Nev da 102

one 1702) -71-2345

fax 17021 671·237

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At this time, your appointment is to be considered as conditional since a firm offer of employment is contingent upon your meeting the applicable requirements designated below:

(i) Possessing and maintaining a Nevada medical license. Providing an official transcript of your professional degree(s) and/or a letter from the Nevada State Board of Medical Examiners stating that you are in "good standing".

(ii) The School of Medicine obtaining malpractice coverage for you at a rate acceptable to the School of Medicine. In the event that the School of Medicine cannot obtain malpractice insurance for you at a rate acceptable to the School, this offer is withdrawn. The School of Medicine will not provide tail coverage for any claims arising prior to and/or outside of employment with the School.

(iii) Maintaining hospital privileges at hospitals as designated by the Department of Internal Medicine.

(iv) Signing the enclosed Member Practice Agreement. The Member Practice Agreement states that as a member of the full-time faculty you will be a member of MEDSchool Associates Inc., Le. the Faculty Practice Plan, and will see those patients for which the Plan has contracted. In addition, it provides guidance as to what constitutes practice income and has a non-solicitation clause.

(v) Timely completion of third party payor credentialing information and third party payor acceptance of you into their physician panels.

(vi) Confirmation that you (i) are not currently excluded, debarred, or otherwise ineligible to practice in the federal health care programs as defined in 42 USC 1320a-7b(f) (the "federal health care programs"); (ii) are not convicted of a criminal offense related to the provision of health care programs; and (iii) are not under investigation or otherwise aware of any circumstances which may result in your being excluded from participation in the federal health care programs.

This employment offer and your hiring are contingent upon you submitting original documents to verify your identity and eligibility to work in the United States, and on completing an 1-9 Employment Verification Form as prescribed by federal law. Please be prepared to provide appropriate documentation as described on the enclosed 1-9 Form to be completed on your first day of employment. Failure to provide appropriate documentation within three (3) business days of your start date will require that the University terminate your employment.

This is a full-time twelve month "A" contract position. Since this is a non tenure-track appointment, assuming there is continued financial support for the position, you will be evaluated and considered for reappointment annually by the department and college.

You may be subject to a 4.6% salary reduction due to furlough if approved by the Board of Regents that would be effective July 1,2010.

Initial here Tit­

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In addition to your compensation and benefits package, we will provide reimbursement or payment of up to $ 7,000.00 of moving expenses allowed by State of Nevada policy, as referenced in the University of Nevadad Reno Administrative Manual. Under certain circumstances, authorized moving expenses may be paid directly to a moving company on your behalf using the University's requisition/purchase order process. Further information on moving expenses can be found in the State Administrative Manual, sections 0238.0-0252.0, (attached) as well as "Payment and/or Reimbursement of Moving Expenses" in the UnIVersity Administrative Manual.

As stated in the University of Nevada, Reno, Administrative Manual, Human Resources will attempt to verify academic credentials upon receipt of hiring documents. If the academic credentials cannot be verified, HR will notify you that an official transcript of your highest degree must be submitted within thirty days of your first day of employment. Falsification or misrepresentation of credentials, or evidence that degrees offered in support of candidacy for employment have been issued from non-accredited institutions, shall invalidate the employment contract and shaff be grounds for immediate termination.

This offer letter is not a contract of employment and does not create a binding contract This offer is sUbject to all of the terms, conditions and limitations contained in the Nevada System of Higher Education Code governing employment and requires the final approval of the appointing authority. A formal binding employment contract will be prepared and must be executed by both the appointee (you) and the appointing authority.

Benefits of this position include health, life and disability, and malpractice Insurance. A summary of the benefits is enclosed with this offer letter. There is a retirement plan with matched university funds.

Any offer made to you verbally or in writing other than stated above is null and void. This offer will be withdrawn at 5:00pm PST on Wednesday, March 31 St, 2010. Please inform us of your decision concerning this offer by signing this letter and returning it by Wednesday, March 31 St. 2010 to the following address:

University of Nevada School of Medicine 2040 W. Charleston Blvd Suite 400 Human Resources - Attn: Michelle Hogan Las Vegas, NV 89102

In addition, you may fax a copy of the letter to (702) 671-2376.

Initial here Tft

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If you have any questions about our offer or about any other aspects of the position, please contact either Dr. John Varras or Department Administrator Brian Walsh at (702) 671-2345.

Sincerely,

John Varra ,M.D., Interim Department Chair Department of Internal Medicine 01 of Medicine

Me:b,~ Milton D. Glick Executive Vice President and Provost

I, Tarek Ammar, M.D. I accept the terms and conditions contained in the conditional offer of employment and acknowledge that a formal employment contract must be executed by the University appointing authority to be binding.

3/1~/iO DateSignalur~

President, University of Nevada~Reno

Enclosures: Physicians Medical Professional Liability UNR Faculty Benefits Summary Member Practice Agreement Moving Guidelines Credentianng packet Form 1-9, Employment Eligibility Verification

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Tarek Ammar MD

1

TAREK AMMAR, M.D. 4482 Lindell Blvd Apt# 1106

St Louis, MO, 63108

Phone: 267-968-8176

Email: tammar@dom.wustl.edu

Education and Qualification:

November 2005 Diplomate of the American Board of

Internal Medicine

August 2001 ECFMG Certification

March 1999 Graduation from the University of Tunis

Medical School, Tunis, Tunisia

Degree earned: Doctor of Medicine,

Highest Honors and Congratulations of

the Jury.

June 1991 Graduation from l’académie de Paris, France

Major in Mathematics and Biologic

Sciences.

Degree earned: Baccalaureate Degree with

Honors.

Academic Training:

July 2009- Present Advanced Therapeutic Fellow/

Instructor of Medicine

Barnes-Jewish Hospital, St Louis

Washington University School of Medicine

January 2009- June 2009 Instructor of Medicine

Washington University School of Medicine

John Cochran St Louis VA Medical

Center

December 2005- December 2008 Gastroenterology Fellowship

The Graduate Hospital, Drexel University/

Barnes-Jewish Hospital, St Louis

Washington University School of Medicine

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Tarek Ammar MD

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July 2005- October 2005 Chief Medical Resident

Department of Medicine

The Graduate Hospital, Drexel University

June 2002- June 2005 Internal Medicine Residency

The Graduate Hospital, Philadelphia

Drexel University College of Medicine

Professional/ Teaching Experience:

• Instructor of Medicine Clinical training of Gastroenterology

Fellows and medicine residents.

• Chief Medical Resident: Responsibilities included daily morning

report for medical residents, daily teaching

rounds for residents and students, lectures,

presentations and supervision of students

from Drexel University College of

Medicine, Philadelphia College of

Osteopathic Medicine and Temple School of

Medicine.

• Kaplan Educational Center: Medical Advisor, USMLE Program

Clinical Skills Assessment (CSA) Instructor.

Responsibilities included small groups

teaching session, preparation for USMLE

and CSA examination for medical graduates.

Administrative Experience:

• Graduate Medical Education Committee (GMEC) 2005 to 2007

• Medical Executive Committee 2005 to 2007

• Institutional Review Board 2005 to 2007

• Resident Review Committee 2003 to 2007

• House Staff Recruitment Committee 2004 to 2007

• Ethics Committee 2003 to 2007

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Tarek Ammar MD

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Honors and Awards:

• Top 10 percent of my Medical College Class.

• Guth award: 2005 recipient, bestowed upon an exemplary house officer who

displays compassion for the sick, a true sense of humanity and meticulous regards

for human dignity.

• Selected the Chief of Medical House Staff of the Department of Internal

Medicine for the year 2005-2006.

• Represented my program in ACP Philadelphia Chapter Medical Jeopardy in 2004.

• Degree of Medical doctor awarded on March 13th 1999, with Highest Honors

and Congratulations of the Jury.

• June, 1994: Community Award, awarded to the members of the ASSOCIAMED

by the Ministry of Health, Tunis, Tunisia, for Volunteer work in the different

Pediatric department of the Capital.

Professional Memberships:

• 2005- Present Member of the American College of

gastroenterology, ACG.

• 2005- Present Member of the American Society for

gastrointestinal Endoscopy, ASGE.

• 2003- Present Member of the American Gastroenterological

Association, AGA.

• 2002- Present Member of the American College of Physician and the

American Society of Internal Medicine, ACP-ASIM

• 2002- Present Member of American Medical Association, AMA.

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Tarek Ammar MD

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Peer Reviewed Publications:

• Ammar T, Cote GA, Creach KM, Kohlmeier C, Parikh P, Azar RR. Fiducial

placement for stereotactic radiation using endoscopic ultrasound: feasibility using

a marker compatible with a standard 22 gauge needle. Gastrointestinal Endoscopy

(Submitted).

• Maple JT, Mansour L, Ammar T, Ansstas M, Cote GA, Azar RR. Physician

Controlled Wire Guided Cannulation of the Minor Papilla. Gastrointestinal

Endoscopy (Submitted).

• Keswani RN, Azar RR, Edmundowicz SA, Ammar T, Banerjee B, Early D,

Jonnalagadda SS. Stenting for Malignant Colonic Obstruction: A Comparison of

Efficacy and Complications of Colonic versus Extracolonic Malignancy.

Gastrointestinal Endoscopy, 2009 Mar;69(3 Pt 2):675-80

• Ammar T, Kreisel F and Ciorba MA. Antral Duodenal Primary Extramedullary

Plasmacytoma Presenting with Melena. Clinical Gastroenterology and

Hepatology (In press).

• Cote G, Ansstas M, Shah S, Ammar T, Keswani R, Jonnalagadda S,

Edmundowicz S, Azar R. Yiels of repeat cholangiography with balloon sweep

after the endoscopic treatment of bile leak following cholecystectomy.

Gastrointestinal Endoscopy (In press).

Published Abstracts:

• Ammar T, Maple JT, Ansstas M, Cote G, Azar RR. Physician Controlled Wire

Guided Cannulation of the Minor Papilla. Digestive Disease Week 2009.

• Keswani RN, Azar RR, Edmundowicz SA, Ammar T, Jonnalagadda SS. Stenting

for Malignant Colonic Obstruction: A Comparison of Efficacy and Complications

of Colonic versus Extracolonic Malignancy. (American College of

Gastroenterology Annual Meeting). American Journal of Gastroenterology,2008.

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Tarek Ammar MD

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Scientific Posters:

• Keswani RN, Azar RR, Edmundowicz SA, Ammar T, Jonnalagadda SS. Stenting

for Malignant Colonic Obstruction: A Comparison of Efficacy and Complications

of Colonic versus Extracolonic Malignancy. American College of

Gastroenterology Annual Meeting 2008.

• Ammar T, Maple JT, Ansstas M, Cote G, Azar RR. Physician Controlled Wire

Guided Cannulation of the Minor Papilla. Digestive Disease Week 2009.

Oral Presentations

• Galaxy of Gastroenterology 6

th. Washington University in St Louis. When is

EUS helpful in pancreatic disease? November 2008.

• GI Division Rounds. Washington University in St Louis. Cystic lesions of the

Pancreas: a clinical challenge. November 2008.

• GI Division Rounds. Washington University in St Louis. Preoperative evaluation

of patients with liver disease. May 2008.

• GI Division Rounds. Washington University in St Louis. The Narcotic Bowel

Syndrome. February 2008.

• GI Grand Rounds. Drexel University in Philadelphia. Eosinophilic Esophagitis.

May 2007.

• GI Grand Rounds. Drexel University in Philadelphia. Microscopic Colitis.

January 2007.

• GI Grand Rounds. Drexel University in Philadelphia. Helicobacter Pylori.

September 2006.

• GI Grand Rounds. Drexel University in Philadelphia. Primary Biliary Cirrhosis.

March 2006.

Research:

• Current Projects:

- A randomized prospective trial of single operator direct cholangioscopy or

pancreatoscopy ( SODC) and direct peroral balloon assisted cholangioscopy

and pancreatoscopy (DBPC) with narrow band imaging for the detection of

malignant strictures of the bile duct and pancreas and tissue acquisition.

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Tarek Ammar MD

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- A randomized prospective trial of single operator direct cholangioscopy or

pancreatoscopy ( SODC) and direct peroral balloon assisted cholangioscopy

and pancreatoscopy (DBPC) with narrow band imaging for the management

of choledocholithiasis and pancreatic duct stones.

- Long term impact of endoscopic dilation of anastamotic strictures on weight

loss after Roux-en-Y gastric bypass (RYGB). Retrospective study.

• April 2001- November 2001 Research Assistant

Robert H. Diamond, MD, Assistant

Professor of Medicine. University of

Pennsylvania School of Medicine.

Gastroenterology Division. Role of the PRL-1 Ptase in the

differentiation and apoptosis processes in

the intestine.

• October 1998- March 1999 Doctorate Thesis: Anatomo-Clinic and

Prognostic aspects of Intra-Peritoneal

rupture of Hydatid Liver Cyst.

Follow-up of 16 patients.

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