---
title: "An extension, a non-renewal notice or resigning from residency"
canonical: "https://www.joinandwise.com/crossings/training-extension-and-non-renewal"
checked: "2026-10-21"
claim: "andwise:crossing/training-extension-and-non-renewal@2026-10-21"
license: "CC BY 4.0"
---

# An extension, a non-renewal notice or resigning from residency

What the ACGME requires of the notice and the due-process policy, what one public agreement template says about notice periods and resigning, and what months added to training do to pay, the training license and loans.

**The decision:** Signing a remediation or extension letter, receiving a written notice of non-renewal or non-promotion, or resigning from a program.

## What changes

- ACGME Institutional Requirements (2026) §4.4.a: the sponsoring institution must ensure each program gives a resident or fellow written notice of intent when the agreement will not be renewed, when the resident will not be promoted to the next level, or when the resident will be dismissed. §4.4.b: it must have a policy giving due process for suspension, non-renewal, non-promotion or dismissal, whenever in the appointment the action is taken. §4.5: a grievance policy at the program and institutional level that minimizes conflicts of interest. Written notice, with no number of days, is the whole of the timing requirement. ([ACGME Institutional Requirements, including FAQs (2026), §§4.3–4.5 and §4.8.g](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); checked 2026-11-03)
- ACGME Institutional Requirements (2026) §4.3.a: the agreement of appointment must directly contain or reference the conditions for reappointment and promotion to the next PGY level (§4.3.a.4), grievance and due process (§4.3.a.5), and timely notice of the effect of leave on completing the program (§4.3.a.10). ([ACGME Institutional Requirements, including FAQs (2026), §§4.3–4.5 and §4.8.g](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); checked 2026-11-03)
- ACGME Institutional Requirements effective July 1, 2027: the same notice and due-process rules move to §4.5.a and §4.5.b, grievances to §4.6, and the agreement's contents to §4.4.a, where reappointment and promotion (§4.4.a.4) and grievance and due process (§4.4.a.5) stay; the list no longer carries the item on timely notice of the effect of leave. ([ACGME Institutional Requirements, effective July 1, 2027, §§4.4–4.6 and §4.9.f](https://www.acgme.org/globalassets/pfassets/programrequirements/2027-prs/800_institutionalrequirements_2027.pdf); checked 2026-11-03)
- Programs must give accurate information on how an extended leave affects completion and board eligibility (2026 §4.8.g; 2027 §4.9.f). The 2026 FAQ says the program director should give timely and accurate information on that impact, including any need to extend time in the program. ([ACGME Institutional Requirements, including FAQs (2026), §§4.3–4.5 and §4.8.g](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); [ACGME Institutional Requirements, effective July 1, 2027, §§4.4–4.6 and §4.9.f](https://www.acgme.org/globalassets/pfassets/programrequirements/2027-prs/800_institutionalrequirements_2027.pdf); checked 2026-11-03)
- One public agreement template, Eisenhower Medical Center's 2024 resident appointment agreement, says the hospital "shall endeavor" to give written notice of non-renewal four months before the end of the term, or as much notice as circumstances allow when the reason arises later, and applies the same to non-promotion (§6.2). Either party can end that agreement without cause on 90 days' written notice (§17). ([Eisenhower Medical Center, Resident Appointment Agreement template (2024), §§6.2 and 17](https://gme.eisenhowerhealth.org/wp-content/uploads/2024/09/PGYX-RESIDENT-AGREEMENT-2024.pdf); checked 2026-11-03)
- The ABMS requires member boards whose training lasts two years or more to allow at least six weeks away for parental, caregiver and medical leave once during training, without using up other allowed time away and without requiring the training to be extended. ([ABMS, policy on parental, caregiver and medical leave during training](https://www.abms.org/policies/parental-leave/); checked 2026-10-27)
- Training licenses run on the program's dates. Iowa's resident license: "None; the license expires on the program's expected completion date ($25 extension if training runs longer)." Minnesota's residency permit: "$20; extending the end date in the same program costs $15." In 8 states (Colorado, Connecticut, Maine, Missouri, New Hampshire, North Carolina, Tennessee and Wyoming), the recorded terms say the training license ends, is revoked or becomes inactive when the holder leaves the program. ([Iowa Board of Medicine, training license (Iowa)](https://www.legis.iowa.gov/docs/iac/chapter/09-30-2026.481.653.pdf); [Minnesota Board of Medical Practice, training license (Minnesota)](https://www.revisor.mn.gov/statutes/cite/147.0391); [Colorado Medical Board, training license (Colorado)](https://dpo.colorado.gov/Medical/Applications); [Connecticut Department of Public Health, Physician Licensure, training license (Connecticut)](https://portal.ct.gov/DPH/Practitioner-Licensing--Investigations/Physician/Residency-Training-Permits); [Maine Board of Licensure in Medicine, training license (Maine)](https://www.maine.gov/md/licensure/license-types); [Missouri State Board of Registration for the Healing Arts, training license (Missouri)](https://www.law.cornell.edu/regulations/missouri/20-CSR-2150-2-060); [New Hampshire Board of Medicine (Office of Professional Licensure and Certification), training license (New Hampshire)](https://www.gc.nh.gov/rules/state_agencies/med100-600.html); [North Carolina Medical Board, training license (North Carolina)](https://www.ncmedboard.org/licensing-registration/licensing/residents); [Tennessee Board of Medical Examiners, training license (Tennessee)](https://www.tn.gov/content/dam/tn/health/healthprofboards/medicalexaminers/Special-Training-Checklist-and-Forms.pdf); [Wyoming Board of Medicine, training license (Wyoming)](https://wyomedboard.wyo.gov/physicians/other-applications); checked 2026-10-21)
- Residency forbearance: mandatory forbearance for a medical or dental internship or residency (34 CFR 685.205(a)(3)), granted up to 12 months at a time and renewable for the length of training. PSLF counts months of full-time work, an average of at least 30 hours a week, at a qualifying employer; a nonprofit or government teaching hospital is one, during an extension as before it. ([34 CFR 685.205, forbearance](https://www.ecfr.gov/current/title-34/section-685.205); [34 CFR 685.219, Public Service Loan Forgiveness](https://www.ecfr.gov/current/title-34/section-685.219); checked 2026-10-21)
- Each state's law sets how its physician health program is funded. Texas: the medical board collects a surcharge of up to $15 on each first license and renewal for the Texas Physician Health Program; that money cannot pay a participant's monitoring or own medical costs. Washington: a $70-a-year surcharge on each physician and physician assistant license funds the program the commission contracts with, and the legislature's 2024 findings call license surcharges the majority of the program's funding. North Carolina: the medical board, the North Carolina Medical Society and the North Carolina Academy of Physician Assistants may provide funds for the independent program's administration. ([Tex. Occ. Code §167.014, surcharge to administer the Texas Physician Health Program](https://tcss.legis.texas.gov/resources/OC/htm/OC.167.htm); [Rev. Code Wash. §18.71.310, physician health program license surcharge, with the 2024 c 15 findings](https://app.leg.wa.gov/RCW/default.aspx?cite=18.71.310); [N.C. Gen. Stat. §90-21.22, health program for medical professionals](https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-21.22.html); checked 2026-11-03)
- Not measured: How often residents receive extension letters or notices of non-renewal or non-promotion.
- Not measured: Physician health program funding by state; only Texas, Washington and North Carolina were read, and the FSPHP's about page does not set it out by state.

## Who is paid for what

- **The residency program and its sponsoring institution.** Medicare's direct GME payment counts a resident at a weighting factor of 1.0 during the initial residency period, the minimum number of years required for board eligibility, up to five, and at 0.50 after it. ([42 CFR 413.79(a)–(b), initial residency period and weighting](https://www.ecfr.gov/current/title-42/section-413.79); [CMS, direct graduate medical education (DGME) payments](https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme)) Not part of its role: Representing the resident in a grievance or due-process hearing.
- **Federal loan servicer.** The Department of Education pays contracted servicers a monthly amount for each borrower account, with up to 20% of a bill withheld for missed performance metrics. ([GAO-16-523, federal student loan servicing (May 2016)](https://www.gao.gov/assets/gao-16-523.pdf); [GAO-26-108534, student loan servicing contracts (March 2026)](https://www.gao.gov/assets/gao-26-108534.pdf)) Not part of its role: Deciding whether a program's dates qualify for forbearance or PSLF; the servicer applies the regulation to the records it receives.

## Costs that come later

- An extension letter that adds months at a PGY salary → The attending start date: months of the extension × (attending pay − PGY pay), before tax — https://www.joinandwise.com/decide/career
- A new completion date → The training license's end date, and any extension the board charges for — https://www.joinandwise.com/residency
- Months in training after the original end date → Residency forbearance, the PSLF count and the RAP or IBR payment — https://www.joinandwise.com/decide/loans
- The agreement's notice, due-process and extension terms (at signing) → A notice of non-renewal or non-promotion, or an extension — https://www.joinandwise.com/documents
- Resigning before the agreement's end → The agreement's notice period, the training license and PSLF employment — https://www.joinandwise.com/residency/union-contracts

## What is fixed and what moves

- Written notice of non-renewal or non-promotion: Set by program or union contract. ACGME requires written notice of intent and sets no period; any period comes from the agreement, institutional policy or a union contract. ([ACGME Institutional Requirements, including FAQs (2026), §§4.3–4.5 and §4.8.g](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf); [Andwise: resident union contract benchmarks](https://www.joinandwise.com/residency/union-contracts))
- Leave allowed before training is extended: Mostly fixed. Each certifying board sets its own time-away rule, within the ABMS six-week floor. ([ABMS, policy on parental, caregiver and medical leave during training](https://www.abms.org/policies/parental-leave/))

## Deadlines

- The notice period before the term ends, where the agreement states one (four months in the template quoted above) — Set in the contract
- The deadlines to start a grievance or appeal, in the institution's due-process policy — Set by the program or a licensing body
- July 1, 2027: the ACGME's revised requirements renumber the notice and due-process rules — Set by the program or a licensing body

## Tools

- [Read the residency agreement](https://www.joinandwise.com/documents): The notice period, due-process clause and extension terms, each quoted with its page, or named when not stated.
- [Compare ways of working](https://www.joinandwise.com/decide/career): Attending and resident pay side by side, for the months an extension adds.
- [Compare repayment plans](https://www.joinandwise.com/decide/loans): Forbearance, RAP or IBR through the added months, and the PSLF count.
- [Training licenses by state](https://www.joinandwise.com/residency): Each state's license term, renewal and what happens on leaving a program.
- [Union contract benchmarks](https://www.joinandwise.com/residency/union-contracts): Due-process and grievance terms in ratified resident contracts.

## Questions

### The program or the GME office

- Which policy sets the due-process steps for this notice, and what is the deadline to start them?
- Does the extension letter state its end date, the PGY level and the salary during the extension?
- How does the extension change the completion date the program reports to the certifying board?
- What notice does the agreement require for a resignation, and what happens to benefits and malpractice coverage on the last day?

### Counsel

- How do the agreement's due-process terms and the institution's policy apply to this notice?
- Does the agreement state a notice period, and does it state any exception to it?

### The loan servicer

- Does residency forbearance continue through the extension's dates, and what changes after the last day in a program?
- Do the months of the extension count toward PSLF at this employer?

### The certifying board and the state medical board

- What is the board eligibility window after the new completion date?
- When does the training license end, and what does it take to extend it or to hold a license after leaving the program?

An extension, a notice or a resignation turns on its documents, dates and rules; a program's decision in a given case turns on that case.

## Sources

- [ACGME Institutional Requirements, including FAQs (2026), §§4.3–4.5 and §4.8.g](https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/800_institutionalrequirements_2026.pdf)
- [ACGME Institutional Requirements, effective July 1, 2027, §§4.4–4.6 and §4.9.f](https://www.acgme.org/globalassets/pfassets/programrequirements/2027-prs/800_institutionalrequirements_2027.pdf)
- [Eisenhower Medical Center, Resident Appointment Agreement template (2024), §§6.2 and 17](https://gme.eisenhowerhealth.org/wp-content/uploads/2024/09/PGYX-RESIDENT-AGREEMENT-2024.pdf)
- [ABMS, policy on parental, caregiver and medical leave during training](https://www.abms.org/policies/parental-leave/)
- [Iowa Board of Medicine, training license (Iowa)](https://www.legis.iowa.gov/docs/iac/chapter/09-30-2026.481.653.pdf)
- [Minnesota Board of Medical Practice, training license (Minnesota)](https://www.revisor.mn.gov/statutes/cite/147.0391)
- [Colorado Medical Board, training license (Colorado)](https://dpo.colorado.gov/Medical/Applications)
- [Connecticut Department of Public Health, Physician Licensure, training license (Connecticut)](https://portal.ct.gov/DPH/Practitioner-Licensing--Investigations/Physician/Residency-Training-Permits)
- [Maine Board of Licensure in Medicine, training license (Maine)](https://www.maine.gov/md/licensure/license-types)
- [Missouri State Board of Registration for the Healing Arts, training license (Missouri)](https://www.law.cornell.edu/regulations/missouri/20-CSR-2150-2-060)
- [New Hampshire Board of Medicine (Office of Professional Licensure and Certification), training license (New Hampshire)](https://www.gc.nh.gov/rules/state_agencies/med100-600.html)
- [North Carolina Medical Board, training license (North Carolina)](https://www.ncmedboard.org/licensing-registration/licensing/residents)
- [Tennessee Board of Medical Examiners, training license (Tennessee)](https://www.tn.gov/content/dam/tn/health/healthprofboards/medicalexaminers/Special-Training-Checklist-and-Forms.pdf)
- [Wyoming Board of Medicine, training license (Wyoming)](https://wyomedboard.wyo.gov/physicians/other-applications)
- [34 CFR 685.205, forbearance](https://www.ecfr.gov/current/title-34/section-685.205)
- [34 CFR 685.219, Public Service Loan Forgiveness](https://www.ecfr.gov/current/title-34/section-685.219)
- [Tex. Occ. Code §167.014, surcharge to administer the Texas Physician Health Program](https://tcss.legis.texas.gov/resources/OC/htm/OC.167.htm)
- [Rev. Code Wash. §18.71.310, physician health program license surcharge, with the 2024 c 15 findings](https://app.leg.wa.gov/RCW/default.aspx?cite=18.71.310)
- [N.C. Gen. Stat. §90-21.22, health program for medical professionals](https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-21.22.html)
- [42 CFR 413.79(a)–(b), initial residency period and weighting](https://www.ecfr.gov/current/title-42/section-413.79)
- [CMS, direct graduate medical education (DGME) payments](https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme)
- [GAO-16-523, federal student loan servicing (May 2016)](https://www.gao.gov/assets/gao-16-523.pdf)
- [GAO-26-108534, student loan servicing contracts (March 2026)](https://www.gao.gov/assets/gao-26-108534.pdf)
- [Andwise: resident union contract benchmarks](https://www.joinandwise.com/residency/union-contracts)

Reviewed 2026-11-03; oldest source check 2026-10-21. General information, not legal, tax or financial advice. The text states what the law and rules say; applying them to a contract is a question for a licensed professional.