Residents and COVID-19

The COVID-19 pandemic is demanding a lot of our health care system. PARO is committed to ensuring that you are kept healthy and safe. We have created this dedicated web page to provide you with useful information and to answer many of the questions we are receiving. Because this is a rapidly changing situation, recommendations and guidance may change, so if in doubt, check back to find the most current information. We will only provide information that we know to be accurate or believe to be helpful.

Page last updated on October 12th, 2022.

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[su_spoiler icon=”chevron” title=”Recent Updates” style=”fancy”]

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[su_spoiler icon=”chevron” title=”Vaccination” style=”fancy”]

[_su_spoiler icon=”chevron” title=”What is PARO’s perspective on residents and the vaccination roll out? ” style=”simple”]

PARO has consistently advocated that:

Residents must be included in the roll out plan, and appropriately prioritized on the same terms as other health care workers.
In planning and prioritization, PGME and the hospitals should consider not just the rotation and/or site where residents are currently but where they will be working in upcoming rotations.
DME residents must be appropriately included in roll out planning.
There should be consideration of how planned or urgent redeployment may impact who needs to be prioritized for vaccination.
There must be clear communication to residents about the roll out. In this time of great uncertainty, clear communication is an important way to minimize sources of stress.

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[_su_spoiler icon=”chevron” title=”Will residents be recognized as front-line health care providers related to Ontario’s vaccination roll out?” style=”simple”]

Yes. We have confirmed with the Ministry of Health as well as the Council of Academic Hospitals that residents will not be forgotten or overlooked. It is entirely possible that priority will be given to those residents who are working in higher risk areas. We are working closely with the PGME Offices as well as with CAHO to ensure that we are not overlooked. Coincident with focusing on the vaccine rollout, we are continuing to ensure that appropriate PPE is available so that all residents, regardless of when they receive their vaccination, are protected while they work.

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[_su_spoiler icon=”chevron” title=”What is the current guidance around the COVID-19 Vaccine(s)?” style=”simple”]

The Ontario Ministry of Health’s Recommendations for third doses may be found here.

The NACI’s Dec 3rd, 2021 guidance regarding boosters may be found here.

The NACI’s guidance regarding the interval between the first and second doses may be found here.

The NACI’s May 3rd, 2021 statement on use of COVID-19 Vaccines may be found here

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[_su_spoiler icon=”chevron” title=”MOHLTC Guidance for Individuals Vaccinated Outside Ontario” style=”simple”]

On Feb 1st, 2022, the MOHLTC issued the following guidance for those who have been vaccinated outside of Ontario:

Individuals who have received a partial or complete COVID-19 vaccine series outside of Ontario or Canada:
- These individuals should contact their local public health unit to have their COVID-19 immunization record documented in COVaxON prior to receiving any additional doses and for their enhanced vaccine certifictes.
Individuals who have proof of immunization and have received all recommended doses of a Health Canada authorized COVID-19 vaccine or a combination of Health Canada authorized vaccines with at least the minimum recommended interval between doses outside of Ontario or Canada:
- These individuals are considered to have a complete vaccine series and no additional doses are needed to be considered fully vaccinated.
Individuals who received the first dose of a two-dose Health Canada authorized COVID-19 vaccine series outside of Ontario or Canada:
- These individuals do not need to restart the vaccine series, but should receive the second dose of a COVID- 19 vaccine as close to the Ontario recommended interval as possible be considered fully vaccinated.
Individuals who have proof of immunization and have received one or two-doses of a COVID-19 vaccine that is not authorized for use by Health Canada:
- These individuals will be offered one additional dose of an mRNA vaccine to complete their primary series and be considered ‘fully vaccinated’ in Ontario.
Individuals who have proof of immunization and have received three doses of any non-Health Canada authorized COVID-19 vaccine at the appropriate interval:
- These individuals need no additional doses to be considered ‘fully vaccinated’ in Ontario.

To read the full document, click here.

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[_su_spoiler icon=”chevron” title=”What should I do if I am moving/changing sites between receiving doses?” style=”simple”]

The MOHLTC has advised PARO, regarding our current members who will be relocating, of the following:

They do not currently have a strategy in place for specific scenarios like this. Given the variability of each resident’s circumstances, there is no one-size-fits-all guidance they can provide on that question.

Their best advice is to engage the first-dose clinic on the question and, if there comes to be a ‘next location’ scenario, to then engage the local vaccine-delivery provider(s).

They also advised that this issue is receiving attention at a variety of levels including at national tables, with universities involved in the dialogue. The advice may become more specific down the road.

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[_su_spoiler icon=”chevron” title=”Will residents be involved in administering the vaccine?” style=”simple”]

Yes. As hospital employees, residents can be assigned specific duties that are within their scope of practice and competencies. In addition, the Council of Faculties of Medicine of Ontario has a policy that spells out the relationship between service and learning and addresses the fact that new work assignments can be given as long as they don’t compromise training.

Another thing to keep in mind is that we are also currently working under the Government Emergency Act, which gives the government additional powers to manage the pandemic. We have appreciated that our employers have been responsible in how they have applied this power.

As always, PARO has been communicating that we expect that all the members of the healthcare team who are qualified to participate in vaccination are included in the rollout strategy.

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[_su_spoiler icon=”chevron” title=”Am I entitled to additional pay beyond my salary for administering the vaccine?” style=”simple”]

If you are required to work in a vaccine clinic outside of your regular working hours, you are entitled to be paid a home call stipend if the work doesn’t extend beyond 2300 hrs. In the event that you work in a vaccine clinic beyond 2300 hrs, then you are entitled to an in-hospital call stipend. Similarly, if you are already working home call on your service and you are asked to come into the hospital to work in a vaccine clinic for more than four hours, of which more than one hour is past midnight and before 6 a.m., the stipend would convert to an in-hospital call stipend.

If you are available outside of the specific requirements of your training program, or on vacation, and you are needed and available to provide services, you may also be eligible for compensation as outlined in PARO’s May 3rd Update.

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[su_spoiler icon=”chevron” title=”Information for Incoming PGY1s” style=”fancy”]

[_su_spoiler icon=”chevron” title=”MOHLTC Guidance for Individuals Vaccinated Outside Ontario” style=”simple”]

On Feb 1st, 2022, the MOHLTC issued the following guidance for those who have been vaccinated outside of Ontario:

Individuals who have received a partial or complete COVID-19 vaccine series outside of Ontario or Canada:
- These individuals should contact their local public health unit to have their COVID-19 immunization record documented in COVaxON prior to receiving any additional doses and for their enhanced vaccine certifictes.
Individuals who have proof of immunization and have received all recommended doses of a Health Canada authorized COVID-19 vaccine or a combination of Health Canada authorized vaccines with at least the minimum recommended interval between doses outside of Ontario or Canada:
- These individuals are considered to have a complete vaccine series and no additional doses are needed to be considered fully vaccinated.
Individuals who received the first dose of a two-dose Health Canada authorized COVID-19 vaccine series outside of Ontario or Canada:
- These individuals do not need to restart the vaccine series, but should receive the second dose of a COVID- 19 vaccine as close to the Ontario recommended interval as possible be considered fully vaccinated.
Individuals who have proof of immunization and have received one or two-doses of a COVID-19 vaccine that is not authorized for use by Health Canada:
- These individuals will be offered one additional dose of an mRNA vaccine to complete their primary series and be considered ‘fully vaccinated’ in Ontario.
Individuals who have proof of immunization and have received three doses of any non-Health Canada authorized COVID-19 vaccine at the appropriate interval:
- These individuals need no additional doses to be considered ‘fully vaccinated’ in Ontario.

To read the full document, click here.

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[_su_spoiler icon=”chevron” title=”Perspective on CaRMS and Rotation Schedules” style=”simple”]

COVID has created many challenges our medical education system has had to address and the delay of the CaRMS match in the spring of 2021 was certainly one of them. We understand that some University PGMEs experienced difficulties in providing rotation schedules to the incoming PGY1s as early as they have in past years as a result.

The PARO-CAHO Collective Agreement requires call schedules to be published two weeks prior to the start of a rotation.

There isn’t a specific requirement for provision of the yearly rotation schedule for each resident; however, there is no doubt that residents rely heavily on early provision of their rotation schedules to be able to plan out their lives.

Factors to be cognizant of:

Residents may have out of town rotations for which accommodations must be made and may have to make arrangements for additional care for dependants for rotations of a more intense nature or other such impacts.
Knowing where your rotations will be primarily-based will for some residents factor significantly in terms of choosing a location for where they will live.
Many electives need planning far in advance and a short turnaround time for announcement of the schedule will make it difficult for residents to schedule their preferred electives.

To mitigate the disruption to the extent possible we ask that PGMEs:

As early as possible in the match process, communicate with the students who are going through the CaRMS match this year of the anticipated timeline for provision of rotation schedule.
Provide clear communication between all key stakeholders during this whole process will be key (ie. PGME, PDs/PAs, incoming residents, Chiefs/Seniors, other schedulers etc).
As soon as is possible provide specific info for your university to incoming matched residents to let them know the schedule is going to be available on ‘x’ date, assure it is coming, and will be available with time to prepare for first day.
When the final schedule is provided if a change needs to be made after that date then it should be done in consultation with the affected residents.
Let incoming residents know a specific date when professional leave/vacation time can be requested to help them plan their first year accordingly and ensure schedulers are compliant with the requirements under the PARO-CAHO Collective Agreement regarding vacation requests.
Recognize that where there might be off-site rotations, short notice will be especially disruptive and they should consider implications re: housing et cetera or move those rotations to later in the year when residents have more time to prepare.
They should consider that those who do the scheduling, especially sensitive to Chief/Sr residents performing that task, that short timelines will be problematic/stressful for them as well- communicate this change to Chiefs and Senior Residents or others who do the call schedules.

Our hope is that you find this perspective helpful in answering the specific question and in helping us all to navigate this unique CaRMS match in the coming months.

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[_su_spoiler icon=”chevron” title=”Will I be eligible for exam leave for the MCCQE1?” style=”simple”]

Under the terms of the PARO-CAHO Collective Agreement, residents must be provided with time to write any Canadian or US certification exam, as well as reasonable travel time to and from the exam site. You should be provided with this time for the LMCC1, should you need to write it.

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[_su_spoiler icon=”chevron” title=”I am an incoming resident. Do I need to complete a self-isolation period before July 1?” style=”simple”]

PARO Perspective on Self-Isolation Prior to Employment Start

Where the employer reasonably requires self-isolation for incoming residents to a hospital/site, for example, because of the particular needs of the patient community, because the resident has travelled internationally, or because of other personal circumstances, the resident may agree to do so prior to the start of the residency, provided that any resident who is unable to self-isolate fully before the start of residency will face no repercussions and will be permitted to self-isolate or complete self-isolation upon the start of residency, without loss of pay or benefits under the PARO-CAHO Collective Agreement or additional costs to the resident.

In addition PGME must commit that:

They have support of Program Directors to permit residents, where necessary, to start or continue self-isolation after July 1, without loss of pay or benefits or other repercussions, recognizing their employment doesn’t start until July 1st.
Residents who self-isolate, in whole or in part, from July 1st on will not be required to use vacation/professional leave days or other such days for the period of self-isolation.
They expand in-place housing strategies for residents required to self-isolate when coming to new site for those residents who do not have housing already in place for that period of time.
They provide guidance to Programs on how to integrate residents who do not complete self-isolation before July 1 into their programs when they are able to come out of self-isolation.
They cooperate with hospitals to provide training online or virtually with multiple dates and times available for these sessions with a mentorship-style program and with a more senior resident, to allow for informal orientation and briefing on what to expect to ease the transition for residents who do not complete self-isolation before July 1.
Residents who do not self-isolate prior to their start of employment must not be disadvantaged in any way, including not being at greater risk for extension of training.
They provide clear communication to incoming trainees at the site, Program Directors, administrative staff and individual preceptors of all of the above.

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[su_spoiler icon=”chevron” title=”Residents Working With COVID Cases ” style=”fancy”]

[_su_spoiler icon=”chevron” title=”PARO Principles for Duty Hours and the Government Emergency Act” style=”simple”]

Updated March 31st, 2020 to reflect PARO’s newly developed principles for duty hours under the Act.

By now, you have no doubt heard that in March, the Ontario Government issued a temporary order enabling Hospitals to implement measures that are not consistent with collective agreements in order to address the ongoing COVID-19 pandemic. This order applies to the PARO-CAHO Collective Agreement, as well as the Agreements governing other healthcare workers.

These are extraordinary times, and we know that the Government and hospitals are facing unprecedented challenges. We know our members are already working extremely hard to help combat COVID-19 in Ontario, and have been making extraordinary contributions. While we recognize that the Ontario Government’s Emergency Act provides ability to contravene the Maximum Duty Hours provisions in the PARO-CAHO Collective Agreement, we believe this ability must be exercised judiciously. Therefore, in situations where an emergent need prevents the hospital from adhering to the strict terms of the Collective Agreement, PARO asks that:

Services not take advantage of this time, and those who are responsible for creating schedules avoid adding to residents’ work schedules unless necessary;
that workload is distributed as equitably as possible amongst all team members, including staff, residents, and other trainees;
that schedulers consider providing rest periods for services/residents;
that consideration of health and safety be the priority: is the individual at a level of competence such that they can work safely, at the intensity the situation requires?;
that schedulers consider using one of the PARO-approved COVID models of scheduling (see section titled “PARO-Approved Scheduling Models” below for full descriptions) that could work for your service/program;
should there be a need to make changes to the call schedule post-distribution, or after the two week deadline, services should provide as much notice and compassion to the affected residents as possible and, where possible, utilize the emergency clause process in the PARO-CAHO Collective Agreement (Article 16.1c):
residents be paid call stipends if required to work in excess of the provisions of the Agreement, even if it exceeds the maximum call stipends also included in the Agreement;
that we all remain flexible in scheduling to support residents who are experiencing difficulties during this time, including but not limited to, residents with families to care for, and residents dealing with grief, burnout, and anxiety.

If you have concerns about your health and safety, including the sustained ability to provide service as a result of any measures that are implemented, please send an email to covid19@paroteam.ca
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[_su_spoiler icon=”chevron” title=”What do I need to know about Personal Protective Equipment?” style=”simple”]

Updated April 24th, 2020

In response to PARO’s concerns about protections for residents who refuse unsafe work, our employer has now provided us with Ontario Health’s recommendations for COVID-19 work refusals. One of the principles set out by Ontario Health is that, ‘no employee shall suffer any form of reprisal for refusing work he or she believes to be unsafe’.

It is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.

We have also been in discussion with the CPSO, and while they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available. We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.

You must be given training on how to use PPE.
You must be provided with, and use required PPE.
You must follow the Hospital’s directives on the appropriate use of PPE including appropriate donning/doffing
You have the right to refuse work if you aren’t provided required PPE, provided that refusing work does not directly endanger the life, health, or safety of another person.*
You must do your part to ensure that you don’t contribute to diminishing supplies.
If you are aware of a risk of a shortage of PPE, then you should raise the concern with your supervising staff, program director, occupational health or the Hospital Administrator on call. We understand that in many hospitals, it is the ‘supervisor or unit manager/leader’ who is responsible for monitoring and securing PPE supply.

Your safety is of paramount importance to PARO, and that includes the provision and use of Personal Protective Equipment.

In situations where the hospital does not provide you with appropriate PPE and there is no risk to a patient’s life or need for urgent care, it is PARO’s position that you can refuse work that you reasonably believe to be unsafe.

In any refusal to work, you must immediately notify your supervisor of the refusal.

It remains PARO’s position that you must be trained and provided with appropriate PPE. However, it is also important that you also be aware of your obligations and the limitations of the right to refuse unsafe work under the Occupational Health and Safety Act.

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[_su_spoiler icon=”chevron” title=”What if I do not have access to Personal Protective Equipment?” style=”simple”]

Updated April 24th, 2020

In non-urgent situations where appropriate PPE is not provided to you, it is PARO’s position that a refusal to work is a right under the Occupational Health and Safety Act and you are protected from reprisal.

Working without appropriate PPE is not a normal condition of employment of residents. In situations where life-saving urgent care is required, the law does not protect you from reprisal and you face three risks in any refusal of work: 1) the risk of discipline by the hospital; 2) the risk of discipline by the CPSO; and 3) the risk of civil action.

We take this as assurance that, during the COVID-19 pandemic, our employer hospitals will not discipline any resident who refuses work that he or she believes to be unsafe.

In all of our messages to you related to PPE, we have told you that in non-urgent situations, where appropriate PPE is not provided, your right to refuse work is protectedby the Workplace Occupational Health and Safety Act. What has always concerned us is that the Act specifically excludes hospital workers from the right to refuse work in situations where life-saving urgent care is required.

However, having obtained Ontario Health’s recommendations for COVID-19 work refusals from our employer, it is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.

We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.

In any refusal to work, you must immediately notify your supervisor of the refusal.

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[_su_spoiler icon=”chevron” title=”Why does your guidance on PPE differ from that provided by other organizations? ” style=”simple”]

Updated April 24th, 2020

PARO is committed to providing you with accurate advice and will not minimize the truth, no matter how hard it may be to share, if that could put residents at risk.

While we do not get to dictate what is in provincial legislation, such as the Occupational Health and Safety Act, it is PARO’s obligation to make sure our members know what is required and to tell you exactly what we are doing to make sure that you are able to stay safe.

The fact that doctors working in hospitals, as well as a few other designated workers, are limited in their right to refuse work that is unsafe where the danger is a normal condition of employment or in situations where someone’s life is at stake, is not PARO’s opinion – it’s the law in Ontario. The fact that other organizations might be providing conflicting information doesn’t guarantee that they understand how Ontario labour law applies to residents nor does it remove our obligation to ensure you understand the risks of not providing care.

In situations where life-saving urgent care is required, the law does not protect you from reprisal and you face three risks in any refusal of work: 1) the risk of discipline by the hospital; 2) the risk of discipline by the CPSO; and 3) the risk of civil action.

In response to our concerns about residents who refuse unsafe work, we are pleased that our colleagues at CAHO have provided us with Ontario Health’s recommendations for COVID-19 work refusals.

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[_su_spoiler icon=”chevron” title=”What is PARO doing to help residents stay safe? ” style=”simple”]

Updated April 24th, 2020

We do not believe you should be providing care when you are not safe – so let us share with you what we are doing to ensure that you can stay safe and avoid these risks:

We have been speaking with our employer hospitals to get written assurance that, if a hospital is unable to provide appropriate PPE and a resident feels that it is unsafe to provide care, even in situations where the refusal to provide care endangers the life, health or safety of another person, the resident will not be subject to any disciplinary measures.
In response to PARO’s concerns about protections for residents who refuse unsafe work, our employer has now provided us with Ontario Health’s recommendations for COVID-19 work refusals. One of the principles set out by Ontario Health is that, ‘no employee shall suffer any form of reprisal for refusing work he or she believes to be unsafe’. We take this as assurance that, during the COVID-19 pandemic, our employer hospitals will not discipline any resident who refuses work that he or she believes to be unsafe.
It is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.
We have been in contact with the College of Physicians and Surgeons of Ontario. While they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available. Key to their posting is the assurance that any complaints will be evaluated in context. You can find their latest advice here.
We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.
We are advocating to the provincial government to ensure that we have enough PPE available for all health care providers.
Through Resident Doctors of Canada, we have joined with all of the other national medical organizations to write to all levels of government about the provision of PPE.
We are pushing for national guidelines on the appropriate provision and use of PPE so that each jurisdiction and hospital has a consistent evidence-based approach.

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[_su_spoiler icon=”chevron” title=”I am immune compromised and/or pregnant. Should I be working with COVID cases?” style=”simple”]

If you are immune-compromised, listen to the advice of your treating physician. If they feel that you should be deployed in a manner that minimizes your risk of exposure to COVID-19, let your Program Director or your PGME Office know. Do not hesitate to contact PARO if you require any assistance in ensuring you’re protected.

The Canadian Government website identifies that there is insufficient evidence to suggest pregnant people are at greater risk. PARO’s view is that we should err on the side of caution. If you are pregnant and have been told by the hospital that you need to go to work, please let us know by emailing covid19@paroteam.ca

If your personal physician advises that there is a medical reason for you to not be exposed to COVID-19 then advise the hospital that you require accommodation. The hospital may require that your personal physician provide medical documentation to support the request for accommodation. If the hospital refuses to accommodate, advise PARO immediately so that we can determine whether further steps need to be taken.

In the absence of advice from your personal physician you must follow the hospital’s directive.

Depending on your particular circumstances, general health and the service you are on, additional measures like redeployment may also work for you.
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[_su_spoiler icon=”chevron” title=”Am I allowed to refuse to work or request modified duties if I don’t want to work with COVID-19 patients?” style=”simple”]

Ontario’s residents are an integral part of the healthcare system and an important source of care for patients, and Ontario’s citizens depend on you and your resident colleagues, along with other health care workers, to provide them with a high standard of care during this time. Certainly, we are now, as we were during SARS 2003, extremely proud that our members are a key resource in our hospitals.

As a licensed physician and employee of the hospitals you work in, you do have a professional obligation to provide care to patients within your scope of competence, including critically ill patients and those with conditions such as COVID-19.

Certainly, any safety equipment that has been identified by the hospital as appropriate to that care, such as N95 fit masks and/or other measures, must be provided to you. For further information on requirements around PPE, please review our response to “What do I need to know about Personal Protective Equipment?” above.

If a resident is pregnant or immunocompromised, we advise they listen to the advice of their treating physician. If they feel that the resident should be deployed in a manner that minimizes their risk of exposure to COVID-19, they should let their Program Director or PGME Office know. Solutions may include moving them to a service with a low risk of exposure or placing them on a paid leave of absence if they cannot be redeployed safely. Residents may be required to provide a letter from their personal physician.

Do not hesitate to contact PARO if you require any assistance in ensuring you’re protected.
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[_su_spoiler icon=”chevron” title=”I’m being assigned to work in the ICU. What can I do to prepare?” style=”simple”]
The University of Toronto has developed an online resource for non-intensive care clinicians — doctors, nurses, RTs, and others — who may find themselves working in critical care during the pandemic. www.QuickICUTraining.com can serve as a study guide and quick reference resource for those upskilling, renewing, or reviewing their critical care capabilities in response to COVID-19. It is meant to supplement simulation- and/or on-the-job learning and more formal training programs that your local region may be using.

QuickICUTraining.com is comprised of short “pocket card” summaries, evidence-focused lectures, procedural demonstration videos, and links. Content on this website is a result of both collation of existing materials and novel creation. The website also houses triage guidelines and recommendations.
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[_su_spoiler icon=”chevron” title=”Where can I go to get answers about my medico-legal responsibilities?” style=”simple”]
The CMPA has a dedicated hub for physicians with questions. You can also call their hotline at 1-800-267-6522.
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[_su_spoiler icon=”chevron” title=”What should I do if I am concerned about exposure or testing?” style=”simple”]
As an employee of the hospital, you have access to Occupational Health services on the same terms and conditions as other employees. We encourage you to make use of any services being provided by the hospital in order to minimize your exposure while carrying out your clinical duties.
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[_su_spoiler icon=”chevron” title=”Where can I find more information about how residents should be deployed during emergencies?” style=”simple”]
COFM Residents and Public Health Emergency Preparedness Guidelines(Updated March 26, 2020)

Residents are a critical resource during public health emergencies. With dual roles as healthcare providers and as trainees, residents are uniquely situated to participate in emergency preparedness and the mobilization of the response.

During SARS and H1N1, PARO members made a significant contribution in the delivery of important health care service even where the outbreaks resulted in significant disruption to their regular training schedule and experiences.

Having learned from these previous experiences these guidelines were developed by the Council of Ontario Faculties of Medicine in collaboration with PARO, so that programs, hospitals, and residents are able to optimally navigate emergency situations if they arise.
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[su_spoiler icon=”chevron” title=”Medical Resident Redeployment Program” style=”fancy”]

[_su_spoiler icon=”chevron” title=”PARO FAQ on the MRRP” style=”simple”]

To review PARO’s full FAQ, click here

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[_su_spoiler icon=”chevron” title=”What is the MRRP?” style=”simple”]

The MRRP is a government program that allows residents to provide additional services between April 28-July 31, 2021* without requiring an independent practice license or Restricted Registration certificate, at a rate of $50/hour.

*As of September 30th, 2022, the Government announced their intention to reimplement the program until March 31st, 2023.

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[_su_spoiler icon=”chevron” title=”If I worked in a vaccine clinic, or provided other voluntary services prior to April 28th, am I entitled to additional money for that work?” style=”simple”]

No. This Government program is only applicable as of April 28th; therefore, previous work is not eligible.

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[_su_spoiler icon=”chevron” title=”Where can you work under the program?” style=”simple”]

There are no limitations on where you may work, provided that it is at an Ontario hospital. You are able to work at community hospitals, including those not affiliated with the University.

Work in vaccine clinics which are affiliated with an Ontario hospital are eligible, effective April 28th, provided it is not work scheduled as part of your current training rotation.

You do not need to be training in the location you work (i.e. if you are a Queen’s resident, you would be eligible to work in Ottawa).

The program does not apply to work done in non-hospital clinical environments.

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[_su_spoiler icon=”chevron” title=”Where can I sign up for this work?” style=”simple”]
Implementation details are still be worked out. If you are approached directly about opportunities, you are free to accept! We advise that in accepting you confirm that the work will be compensated under the Medical Residents Redeployment Program with the individual soliciting for volunteers before accepting any additional shifts/calls. If you are told it is not covered, please do send a note to the PARO (paro@paroteam.ca) with all the details so we can follow up with you.

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[_su_spoiler icon=”chevron” title=”Does my Program Director need to approve my participation?” style=”simple”]
PARO recognizes and values the role of Program Directors in ensuring that residents are able to achieve the educational objectives of their training rotations. We value the expertise and responsibility of clinical educators to assess each resident’s training progress. If a Program Director has concerns that an individual resident’s ability to take on additional calls or shifts under this Program will impact that resident’s ability to meet educational objectives, the Program Director and the resident should meet to discuss those concerns.

Although this work is not subject to approval of your Program Director, we encourage residents to dialogue with their PD to ensure that you can undertake this work in a way that ensures you continue to meet your rotational educational objectives. MRRP participants should consider your own well-being and that of your patients.

Finally, we understand that there are some circumstances (at some locations) where Program Directors may want to provide post-call relief opportunities to their residents; in these instances, it would be important for expressed consent of the Program Director to be obtained prior to accepting that MRRP opportunity.
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[_su_spoiler icon=”chevron” title=”Can I work even if it means I exceed the maximum duty hours in the PARO-CAHO Collective Agreement?” style=”simple”]

The PARO-CAHO Collective Agreement is not applicable to the work one undertakes in this Government Program. You should volunteer for this work when you can do it safely and when it doesn’t interfere with your regular duties or your ability to meet your rotational educational objectives.

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[_su_spoiler icon=”chevron” title=”If I do extra work overnight, am I entitled to be relieved of duties post-call?” style=”simple”]

No. As this is work you would be undertaking outside of the provisions of the PARO- CAHO Collective Agreement on your own time it does not relieve you of any duties/responsibilities for the rotation/service you are assigned to. Therefore, volunteering for this work should be done when you can do it safely and where it doesn’t interfere with your regular duties.
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[_su_spoiler icon=”chevron” title=”If I am asked to swap shifts/calls with another resident, will this qualify?” style=”simple”]

No. However, if you are asked to take additional call to provide additional services, beyond what you are already scheduled to work for your rotation, it does qualify.

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[_su_spoiler icon=”chevron” title=”If I volunteer to take a call or shift under the MRRP program, will I receive a call stipend in addition to the $50/hour compensation?” style=”simple”]
No. If you are scheduled for call or an overnight shift as part of your current rotation that work continues to be compensated through your regular salary and call stipends.

If you are available outside of the specific requirement of your training program, or on vacation, then this hourly rate can be used by the hospital to hire you to do the work. This includes situations where a service has a hole in the call schedule and ask someone to volunteer to cover the call. Similarly, if you are asked to volunteer to cover extra call on the weekend or at night, then this program would apply.
[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”If I have been redeployed, will it fall under the MRRP?” style=”simple”]
Training rotations, even those which are through redeployment, continue to be compensated through regular salary and call stipends. However, if redeployed residents are asked and agree to take on additional calls/shift over and above what is scheduled for the rotation to help bridge coverage gaps, it would be eligible. We advise that you confirm that the work will be compensated under the Medical Residents Redeployment Program with the individual soliciting for volunteers before accepting any additional shifts/calls. If you are told it isn’t, please do send a note to the PARO (paro@paroteam.ca) with all the details so we can follow up with you.

In addition, the existence of this MOH Medical Resident Redeployment Program may reduce the need for further rotation redeployment and open additional opportunities for more residents to participate.

[_su_spoiler icon=”chevron” title=”If I am asked to provide cross-coverage, will it be eligible?” style=”simple”]
Training rotations that are scheduled with cross coverage continue to be compensated through regular salary and call stipends. However, if residents are asked and agree to take on additional calls/shift over and above what is scheduled for the rotation to help bridge coverage gaps, those additional services would be eligible. We advise that you confirm that that additional work will be compensated under the Medical Residents Redeployment Program with the individual soliciting for volunteers before accepting any additional shifts/calls. If you are told it isn’t, please do send a note to the PARO (paro@paroteam.ca) with all the details so we can follow up with you.

Similarly, if residents who are part of the rotation are asked to do cross-coverage not normally scheduled when residents are on that rotation, those cross-coverage calls are eligible under the MRRP. If residents, including internal medicine, who are not on CTU service and are on subspecialty rotations and assigned “COVID call”, or any additional calls/work as a result of the pandemic (though it doesn’t have to be directly providing COVID-care, just resulting from the surge due to COVID), those additional call are eligible for compensation under the MRRP.
[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”Why is this paid less than Restricted Registration?” style=”simple”]
The MOH is providing $125 per hour for the Restricted Registration Program. Those participating in RR must go through the CPSO RR application process and must meet all the training and other requirements, as well as pay RR licensing fees. It is also worth noting that RR is subject to the maximum duty hours of the PARO-CAHO Collective Agreement and requires the support of your Program Director.

The MRRP was created so that all residents could be eligible to help provide additional care required during the pandemic without paying to register for Restricted Registration license. Certainly, those residents who are eligible for RR can still apply for an RR license while participating in the MRRP in the interim (https://restrictedregistrationontario.ca). Please note that there can be a delay in obtaining an RR license due to the number of approvals required.
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[_su_spoiler icon=”chevron” title=”Can I participate if I have an independent license?” style=”simple”]
No, the Government will pay each provider through one source of funds only. This is applicable to residents doing extra work who are not being paid to do the work under the RR Program or work as an independent practitioner paid through OHIP or other payment models.
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[su_spoiler icon=”chevron” title=”Residents in Quarantine/Self-Isolation ” style=”fancy”]

[_su_spoiler icon=”chevron” title=”I am an incoming resident. Do I need to complete a self-isolation period before July 1?” style=”simple”]

PARO Perspective on Self-Isolation Prior to Employment Start

In addition PGME must commit that:

They have support of Program Directors to permit residents, where necessary, to start or continue self-isolation after July 1, without loss of pay or benefits or other repercussions, recognizing their employment doesn’t start until July 1st.
Residents who self-isolate, in whole or in part, from July 1st on will not be required to use vacation/professional leave days or other such days for the period of self-isolation.
They expand in-place housing strategies for residents required to self-isolate when coming to new site for those residents who do not have housing already in place for that period of time.
They provide guidance to Programs on how to integrate residents who do not complete self-isolation before July 1 into their programs when they are able to come out of self-isolation.
They cooperate with hospitals to provide training online or virtually with multiple dates and times available for these sessions with a mentorship-style program and with a more senior resident, to allow for informal orientation and briefing on what to expect to ease the transition for residents who do not complete self-isolation before July 1.
Residents who do not self-isolate prior to their start of employment must not be disadvantaged in any way, including not being at greater risk for extension of training.
They provide clear communication to incoming trainees at the site, Program Directors, administrative staff and individual preceptors of all of the above.

[_/su_spoiler][_su_spoiler icon=”chevron” title=”Will I be paid while on quarantine or in self-isolation?” style=”simple”]
If you are quarantined or directed to self-isolate as a result of exposure to COVID-19, or on the advice of your physician, you will continue to be paid.

If you choose to travel against the directives of the hospital and advice of the government, it is likely that you will be placed on an unpaid leave until your quarantine period has ended. If this were to happen, you would need to apply for EI during this period. Regardless, you can expect the likelihood of an interruption in earnings in the likely event you are required to self-isolate.If there are extenuating circumstances that require you to be out of the country, or if you are unable to access EI, please contact PARO.

If you traveled internationally prior to the recent Federal Government advisory, or if you were already out of the country when the advisory was issued, or if for any other reason you are directed by the hospital to self-isolate or are put under quarantine, it is PARO’s position that you should continue to be paid while you are on leave. If you are placed on an unpaid leave, please contact the PARO office so that we can determine what further steps to take. If you are placed on an unpaid leave, you should also apply for EI.
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[_su_spoiler icon=”chevron” title=”What do I do if my hospital and Public Health are giving me different instructions?” style=”simple”]

We are aware that some of you may have received instructions from your hospital that differ from the Public Health authority in your city regarding whether to self-isolate or to continue to go to work.

The answer is that you should follow the advice of your employer. Public Health is responsible for issuing advisories to the broader public and there may be reasons why there are different expectations of you as a health care worker.

Given the enhanced need to ensure a high volume of patients can be cared for safely during this time, hospitals are relying on their employees, including residents, to self-monitor responsibly and self-isolate if they meet the criteria established by the Hospital’s Occupational Health Office.
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[_su_spoiler icon=”chevron” title=”If I am quarantined or directed to self-isolate, will my training be extended?” style=”simple”]

Updated March 31, 2020 to reflect the principles agreed to and circulated by the PG Deans, and an updated version of the COFM Guidelines.

PARO’s experience during SARS was that programs worked to minimize cases where training needed to be extended as much as possible, and it is our hope that the same will happen now. Working during a pandemic provides unique training opportunities, and the COFM Residents and Public Health Emergency Preparedness Guidelines(Updated March 26, 2020) sets out the expectation that residents receive credit for their work during this time, and that disruptions to training be minimized wherever possible.

In specific cases where a Program Director believes that a resident was not able to achieve specific training objectives due to time away from rotation, they may take steps to ensure the resident can be successful in meeting their requirements. This may sometimes, though not always, include reasonably lengthening training in order to provide an opportunity to gain necessary clinical exposure. These decisions are made on a case by case basis, taking into account the individual learning needs of a resident.

The Ontario PG Deans have agreed with these PARO principles and notified all Program Directors that their help will be needed to operationalize them:

Being as judicious as possible in determining whether a resident has been able to sufficiently achieve the competencies in the context of measures needed to ensure the health and safety of residents and the public, including, but not limited to, time spent redeployed, in quarantine, self-isolation, or due to time off to care for children or dependents;
Being willing to focus promotional decisions on the entirety of a residents training competencies and performance with a decreased focus on minimum or maximum time spent on certain rotations, particularly for those senior residents not currently enrolled in a CBME-program;
Recognizing that this cohort of residents are obtaining training in medicine during a pandemic where unique competencies can be achieved that should be recognized and factored into promotion decisions;
Recognizing that competencies achieved while redeployed will be considered as applicable and transferrable for rotations where those competencies are relevant.
In addition, the PG Deans will continue to advocate with the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to move towards more competency based training rather than time based measures for advancement.

[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”Do I need to use vacation for my quarantine period?” style=”simple”]
No, quarantine is separate from vacation and other leave.

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[su_spoiler icon=”chevron” title=”Residents and Travel” style=”fancy”]
[_su_spoiler icon=”chevron” title=”If I am quarantined or in self-isolation because of travel, will I be paid?” style=”simple”]
If you choose to travel against the directives of the hospital and advice of the government, it is likely that you will be placed on an unpaid leave until your quarantine period has ended. If this were to happen, you would need to apply for EI during this period. Regardless, you can expect the likelihood of an interruption in earnings in the likely event you are required to self-isolate.If there are extenuating circumstances that require you to be out of the country, or if you are unable to access EI, please contact PARO.

[_su_spoiler icon=”chevron” title=”Should I travel during COVID?” style=”simple”]
We recognize that while you may have a right to travel, there are a number of other considerations you should take into account, including government advisories and border closures. As licensed physicians, you are an essential resource in the healthcare system. In most jurisdictions, returning from another country requires that you self-quarantine for 14 days, making you unavailable to provide care. A significant reduction in the physician workforce during this time could have devastating effects for the patient population in Ontario as well as increase the burden on our colleagues. Therefore, we urge you to be considerate and responsible about the choices you make. We know that sometimes there are extenuating circumstances that might make international travel necessary – but if you don’t need to place yourself at risk of being required to self-isolate or quarantine, then we encourage you to weigh the benefits carefully against the impact on you, your family, and the healthcare system.

[_/su_spoiler]
[_su_spoiler icon=”chevron” title=”Travel Advisories” style=”simple”]

Government of Canada Travel Advisory

Government of Canada COVID Outbreak Updates
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[su_spoiler icon=”chevron” title=”Scheduling, Redeployment, and Cancelled Procedures” style=”fancy”]
[_su_spoiler icon=”chevron” title=”What happens if I fall ill and am unable to make my scheduled call?” style=”simple”]

Article 16.1(c) of the PARO-CAHO Collective Agreement sets out the process your service can use to cover unexpected gaps in the call schedule. This clause may only be enacted in circumstances where a resident is forced to miss a scheduled call due to circumstances beyond their control (such as illness) or due to an emergency.

The service must first ask for volunteers. If no volunteers come forward, a resident may be required to provide coverage, provided no other breach of call provisions is made (for example, a resident could not be required to cover the call on a day they were post-call) and it does not result in exceptional personal or family hardship.

A resident may be asked to work up to a maximum of three additional call periods over a 6 month block period (July 1- Dec 31 and Jan 1-June 30). Where this clause is used, the hospital must inform both PARO and the resident’s program director within two weeks.

Ultimately, it is the responsibility of the hospital to ensure patient care needs are met. While residents are an important resource for the hospital, they are not the only resource available to the hospital, and use of the emergency clause should be limited to where there are no other options for the service to make up coverage gaps.
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[_su_spoiler icon=”chevron” title=”Can residents be redeployed?” style=”simple”]
Under conditions such as COVID-19, residents can be redeployed to ensure patient care needs are met. PARO is proud of the service our members provide, and we appreciate that they are being recognized as the crucial healthcare resource they are during this challenging time. Where a resident is redeployed:

they must only be expected to practice within their scope of competency
the hospital must respect advice from their treating physician if they are pregnant or immune-compromised
and, should an emergent need prevent them from working within the maximum duty hours set out in the PARO-CAHO Collective Agreement, they should work in a manner consistent with PARO’s principles around Duty Hours and the Ontario Government Emergency Order (see above).

[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”If I am redeployed, do I need to make up time?” style=”simple”]

Updated March 31 to reflect the principles agreed to and promoted by the PG Deans

The Ontario PG Deans have agreed with these PARO principles and notified all Program Directors that their help will be needed to operationalize them:

Being as judicious as possible in determining whether a resident has been able to sufficiently achieve the competencies in the context of measures needed to ensure the health and safety of residents and the public, including, but not limited to, time spent redeployed, in quarantine, self-isolation, or due to time off to care for children or dependents;
Being willing to focus promotional decisions on the entirety of a residents training competencies and performance with a decreased focus on minimum or maximum time spent on certain rotations, particularly for those senior residents not currently enrolled in a CBME-program;
Recognizing that this cohort of residents are obtaining training in medicine during a pandemic where unique competencies can be achieved that should be recognized and factored into promotion decisions;
Recognizing that competencies achieved while redeployed will be considered as applicable and transferrable for rotations where those competencies are relevant.
In addition, the PG Deans will continue to advocate with the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to move towards more competency based training rather than time based measures for advancement.

PARO’s experience during SARS was that programs worked to minimize cases where training needed to be extended as much as possible, and it is our hope that the same will happen now. Working during a pandemic provides unique training opportunities, and the COFM Residents and Public Health Emergency Preparedness Guidelines(Updated March 26, 2020)sets out the expectation that residents receive credit for their work during this time, and that disruptions to training be minimized whereever possible.

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[su_spoiler icon=”chevron” title=”PARO-Approved COVID Scheduling Models” style=”fancy”]

Many programs have begun implementing new scheduling models in order to minimize resident exposure, prevent burnout, and ensure service provision during times of heightened need. PARO has identified a number of models across the province do this well, and have included them here in order to share best practices. If your program would like assistance in developing a new model, please email covid19@paroteam.ca.

[_su_spoiler icon=”chevron” title=”Creating a Back Up Schedule” style=”simple”]
Updated March 25, 2020, to clarify around required time of notification.

As this pandemic unfolds it is likely that, in addition to increased demand on healthcare resources, growing numbers of healthcare workers may be placed on self-isolation or quarantine. We saw this during the SARS outbreak in 2003 and, to help services manage increased work with fewer resources, PARO permitted programs and services to implement a back-up call model.

We advise programs use a similar strategy with the following criteria:

If a resident scheduled for back-up call is notified prior to the start of the call (for example, 5PM on weekdays, 9AM on weekends) the day of the call that they are not required, the call will not be counted in the calculation of their duty hour maximums nor will it be eligible for a call stipend.
If a resident completes back-up call or is activated for home call or in-house call, then it will count in accordance with the provisions of the PARO-CAHO Collective Agreement.

Regardless, as per the PARO-CAHO Collective Agreement, call totals (combined scheduled call and completed back-up call) should not exceed the duty hour maximums.

For reference, please see the following relevant articles of the PARO-CAHO Collective Agreement:

We encourage anyone scheduling call to recognize that some residents, such as those with young children who would need to arrange for childcare on short notice, may face additional challenges in being placed on back-up call. PARO encourages programs or services to work to alleviate undue stress for residents who are going above and beyond in these challenging times by employing strategies such as minimizing the need for residents to be on back up call or by offering support or financial reimbursement for those requiring childcare arrangements.

Back-up systems should be designed to be equitable. Calls worked should be tracked and the schedule revised if some residents are activated more frequently than others. If programs are able to utilize a sign-up process where residents can identify preferences in how they are scheduled for back-up call, this may mitigate conflicts like childcare, etc.

If your program would like assistance in designing a back-up system, PARO will be pleased to help. Email: covid19@paroteam.ca
[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”Home Call and Back Up Call Schedule” style=”simple”]
This model is designed for low-intensity call services where conversion to in hospital is rare.

Description

2 residents would be placed on the call schedule:

Resident A is on home call and is entitled to home call stipend.
Resident B is on back-up call (following backup call protocols outlined above, if they are notified by 5pm on weekdays or 9am on weekends that they are not needed, it is not considered a call, otherwise they will claim the home call stipend)
Residents can be scheduled up to the home call maximums in the PARO-CAHO Collective Agreement: an average of 1 in 3 home calls in a 28 day block.
The maximum conversion rate is 5 calls in 28. Services that convert to in hospital more frequently should use a different model.

Note: Conversion requirements for home call relief of duties post-call :

a resident who commences work in the hospital after midnight but before 6 a.m.; and,
a resident who works for at least four (4) consecutive hours at least one hour of which extends beyond midnight.

Examples

Scenario 1: Resident A is now on self-isolation (but not showing symptoms)

Resident A remains the resident on home call (first call) and they are to manage any issues that can be dealt with over the phone. They would be entitled to the home call stipend.
Resident B would then be activated only if there is an issue that requires someone to go into the hospital. They would be entitled to home call stipend. Regular conversion/post-call day rules would apply.

Scenario 2: Resident A develops symptoms while on self-isolation

Resident A is immediately removed from the call schedule. Ill residents should not be expected to continue working home call.
Resident B would be activated as first-call.

Potential Benefits

Provided that conversion is rare, the resident who is most likely to be up frequently during the night doesn’t need to worry about reporting to work or taking a post-call day, as they have a day to rest.
The resident who is scheduled to work the next day is most likely going to be pretty well rested.
Engages residents who are self-isolating for medical reasons (ex. Pregnancy or immunosuppression)

Providing Patient Care Virtually or By Phone

Where appropriate and possible, residents should provide care virtually or over the phone to limit the number of healthcare providers in hospital or clinics.
[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”7 On/7 Off – Call” style=”simple”]

Though this is an approved model, it is not ideal from a Fatigue Risk Management perspective. If using this model we suggest that it be paired with the PARO-Approved COVID Back-Up Model.

Description

Working in separate teams, residents work 7 days on and 7 days off of service for the duration of the 4-week block.
First week ‘on’: 3-4 24 hour in-hospital call with post-call relief of duties after handover (maximum of 2 hrs) per week.
There are no regular daytime clinic duties in this schedule – residents will only be scheduled to work call as outlined.
Week ‘off’: residents are completely off with no clinical duties and are home to self-monitor for symptoms.
This week away from service should not be counted as vacation or other leave time provided in the PARO-CAHO Collective Agreement.
Second week ‘on’: Residents work a maximum of 3 calls if they worked 4 calls in Week One, or 4 calls if they worked 3 calls in Week One.
In total, residents work the maximum 7 calls over the course of the 4-week block.
In-hospital call stipends would apply to the 24-hour calls.
It is recommended that ‘on’ weeks begin on a Monday or Tuesday so that residents will have a weekend free of service.
This model is also being used in 6 days on, 6 days off format

Back Up System

One of the residents on the team that is on their week ‘off’ will act as back up in the event a member of the team that is ‘on’ becomes ill or where service demands require extra support.

Example Schedule

Week 1 – Team 1

Resident A has 4 calls:
M – 24h call, T – post call, W – 24h call, TH – post call, F – 24h call, SA – post-call, SU – 24h call

Resident B has 3 calls:
M – off, T – 24h call, W – post call, T – 24h call, F – post call, S – 23h call, S – post call

Resident C (from Team 2) – back up call Monday-Sunday

Considerations

To ensure that a resident is not scheduled to work 14 consecutive days, collaborate with other services that the resident may transfer to, particularly if the receiving service is also scheduling in this way.

Potential Benefits

Limits the number of residents interacting with patients during a given period of time;
Allows time for residents to self-monitor for symptoms after their week ‘on’
Allows for a period of rest and recuperation after an intensive week of work.
Preserves two weekends off per every 4 weeks.

[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”4 On/4 Off – Shifts” style=”simple”]

Best for programs and services with a larger number of residents and staff that can be placed in separate care teams.

Description

Working in at least four separate teams, residents will work 12-hour shifts for 4 days, either during the day or overnight.
Residents have a minimum of 12 hours off between shifts.
After a period of 4 days on service, residents will be completely off for a period of 4 days to rest and self-monitor for symptoms.
Residents will work a total of 48 hours per week
Residents work a maximum of 8 night shifts per 28 day block
Qualifying shift stipend applies for overnight shifts and weekend premium will apply for weekend shifts (Friday overnight to Sunday overnight)

Sample Schedule (for rotations beginning on a Monday):

4 Resident Teams: 1, 2, 3, and 4

[su_table responsive=”yes”]

MON	TUE	WED	THU	FRI	SAT	SUN
Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 3 Night: 4 Off: 1, 2	Day: 3 Night: 4 Off: 1, 2	Day: 3 Night: 4 Off: 1, 2
Day: 3 Night: 4 Off: 1, 2	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4	Day: 4 Night: 3 Off: 1, 2	Day: 4 Night: 3 Off: 1, 2
Day: 4 Night: 3 Off: 1, 2	Day: 4 Night: 3 Off: 1, 2	Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 1 Night: 2 Off: 3, 4	Day: 3 Night: 4 Off: 1, 2
Day: 3 Night: 4 Off: 1, 2	Day: 3 Night: 4 Off: 1, 2	Day: 3 Night: 4 Off: 1, 2	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4	Day: 2 Night: 1 Off: 3, 4

[/su_table]

Team 1: 8 Days, 8 Nights, 12 Off, 5 Weekend Shifts

Team 2: 8 Days, 8 Nights, 12 Off, 4 Weekend Shifts

Team 3: 8 Days, 4 Nights, 16 Off, 5 Weekend Shifts

Team 4: 4 Days, 8 Nights, 16 Off, 6 Weekend Shifts,

Considerations

This model does mean that residents do work more than two weekends per 28 day calendar, however, the number of weekend shifts are approximately on par between different Team schedules.
This model does have a differential between the number of days worked between residents in a month, with two groups of residents working 4 additional days compared to the other two. These residents do slightly more weekend work. This should be balanced out over multiple months.

Potential Benefits

Limits amount of time spent per resident in hospital;
Allows period of time for residents to self-monitor for symptoms after a period of time on service
Allows for a period of rest and recuperative after an intensive period of work.

[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”Modified Night Float” style=”simple”]

This model works best for a large program, where on any given day there may be residents who are not scheduled for any shifts at all.

Description

Duty Hours

Residents work in two shifts; a “late stay” shift (5-10pm) or overnight (10pm-8am).
There are no additional clinical duties and daytime work is done by staff and fellows – i.e. there is no daytime work done by residents except for weekend call.
Residents on overnights are typically scheduled Monday-Thursday or Friday-Sunday – not both
Late stay shifts are more intermittent – you could be scheduled for a few during weeks that you are not covering the overnight Mon-Thurs night float.
There is 1 resident per shift scheduled on back up; there are residents who are completely off work who would be called in if the scheduled and back up residents were all directed to self-isolate.
Highest workload is overnights Mon-Thurs (40hr/week)
Minimum time off is 12 hours between shifts (weekend overnights); max time off between shifts is 19 hours.
Maximum duty hours based on weekly shift-based max of 60 hours/week.

Stipends are based on the existing night float model:

Weekdays:
Late stay – receives home call stipend
Overnight shift – receives in hospital
Weekend:
Treated as split call – each receives home call stipend

Potential benefits

Limits the amount of time spent per resident in hospital, while still being able to cover multiple sites
Allows residents to continue to study, do self-directed learning, and research during daytime hours
Residents get regular full days off to rest
Robust back up model in place
Being present on the service day-to-day consistently without interruption for post-call days would enhance the resident experience. It could allow for improved opportunities to hone leadership skills, to get to know each inpatient more comprehensively, and to develop/maintain an appropriate longitudinal care plan for each inpatient.
Potential for improved wellness as would be different than typical call 24+2 hour call experience.

[_/su_spoiler]

[_su_spoiler icon=”chevron” title=”Graduated Call” style=”simple”]

Description

Nights

Every resident has a standard night call schedule and post-call day (respecting the call maximums in the PARO-CAHO Collective Agreement.
Residents on back up call are paid a home call stipend and may be called in overnight if there is a surge of patients.
Residents on Standby will pick up any emergency calls dropped – if they are not needed, they will be notified by 4pm, in keeping with PARO’s approved COVID back up system.

Days – CTU JMR

The staff, SMR, and the resident on call will attend the ward.
All remaining residents on the team will stay home, unless a designated threshold for patient numbers are exceeded. Residents will check patient numbers by 7am at latest, and if required, will attend in hospital by 8am.
Additional residents will be called in for daytime work depending on the number of patients.

Days – CTU SMR

Senior residents will work one week on and one week off.
During the “off” week, the SMR will stay home unless patient numbers surge and require them to attend in hospital.
They may be scheduled for standby shifts,

Days – Consult and Triage

Three residents will be designated to show up in the morning. The “Day SMR” will take pages for the medicine senior during the day.
Remaining members of the team will remain home on standby, with the expectation they would attend in hospital if the volume of consults is high.

Back Up

Residents on back up call are paid a home call stipend and may be called in overnight if there is a surge of patients.
Residents on Standby will pick up any emergency calls dropped – if they are not needed, they will be notified by 4pm, in keeping with PARO’s approved COVID back up system.

Potential benefits

Scheduling is flexible, and can allow for honouring of vacations.
Minimizes number of residents in hospital/minimizes exposure while ensuring patient safety.
Is compliant with the PARO-CAHO Collective Agreement and PARO-approved COVID Back Up schedule

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[_su_spoiler icon=”chevron” title=”Team Call Model for Multiple Services” style=”simple”]

This model works best for a large program that is responsible for covering multiple services/sites.

Description

Team 1 – Core Team

Each essential service (i.e. CTU, NICU) has a core team of residents assigned.
For each member of the core team, they are placed on call once every 4 days for a total of 7 days (24 hour calls) in a 28 day block.
in a 4-week period, a resident is on call for: 1 Friday, 1 Saturday and 1 Sunday all on separate weekends.
In addition, they will work 4 week days during the month (no call, daytime duties only).

Team 2 – Non-Core

There is a second team of “non-core” residents to act as backup to cover approved leave days of the “core” residents.
The non-core team works similarly to the core team, but has fewer calls scheduled by design so that if one of the “core” residents is unwell, then the “non-core” resident is available to take the sick call.

Team 3 – Senior Team

There will be a third team of senior residents who work 10 days of daytime duties (2 weeks on, 2 weeks off), with no scheduled calls.
On their off weeks, they are expected to be on back up call and be available to take sick calls.

Back Up System

There is a tiered system based on the resident’s role for the block that sets out the order in which residents would be contacted to fill in should someone call in sick.
The senior team would be at the top of the list, and the core team would be at the bottom of the list.
If a resident scheduled for back-up call is notified by 1700 hrs the day of the call that they are not required, the call will not be counted in the calculation of their duty hour maximums nor will it be eligible for a call stipend. If the resident is not notified by 1700 hrs and completes the back-up call, then it will count in accordance with the provisions of the PARO-CAHO Collective Agreement.

Potential benefits

The overall clinical load on each resident will be reduced, as every resident’s daytime workload is significantly reduced.
Everyone has one or two “off-days” (stay at home) during the week, in an effort to minimize hospital exposures.
Minimizes frequent changes to the call schedule due to having to activate back up system frequently.
Back up system addresses issue of a resident needing to take an extended leave.

Considerations

This model does result in some residents working 3 weekends every 4 weeks (1 day/weekend worked). Over the course of the month and/or multiple blocks, there will be an effort to rebalance calls to ensure this burden is shared equally.
Number of times residents get called in cannot exceed maximums in the CA.

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[su_spoiler icon=”chevron” title=”Vacations and Leaves” style=”fancy”]

[_su_spoiler icon=”chevron” title=”My program has cancelled my vacation. What do I do?” style=”simple”]

Given the extraordinary circumstances that are unfolding related to the COVID-19 pandemic, it is very important that residents comply with any directions you receive to report to work.

If you have been required to cancel your vacation, comply with the direction to report to work and let us know the details by emailing covid19@paroteam.ca

PARO is monitoring the situation and we are actively looking into what options might be available should you be unable to take vacation or have it cancelled.
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[_su_spoiler icon=”chevron” title=”Will I be eligible for exam leave if my RCPSC/CFPC exams are delayed?” style=”simple”]

If you are continuing as a resident in Ontario during the next academic year, it is PARO’s position that you must receive exam preparation leave time in accordance with the PARO-CAHO Collective Agreement.

If you are continuing as a resident in another province during the next academic year, we are working to understand what provision can be made for the exam preparation time. We will provide you with that information when it becomes available. Please note that not all provinces’ Collective Agreements provide exam leave preparation time.

If you are continuing as a resident in another country during the next academic year, you will need to ask your new program director to provide you with adequate time to prepare for the rescheduled exams.

If you are completing residency training prior to the postponed Canadian certification examinations and starting a clinical practice or Clinical Fellowship* in Canada or abroad, you will need to ask that your contract for that position include providing you with adequate time to prepare for the rescheduled exams.

*Clinical Fellowship is further training that is not in a RCPSC or CFPC recognized specialty/subspecialty and does not lead to certification or certificate of competence.
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[_su_spoiler icon=”chevron” title=”How long do I have to take lieu days I earned during the pandemic?” style=”simple”]

We were able to get the Hospitals and Government to agree that for any lieu day earned during the period of the COVID-19 pandemic, that the 90 day period under Article 13.3 of our Collective Agreement would be extended for an additional 30 days, subject to the approval of your Program Director.

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[su_spoiler icon=”chevron” title=”PARO-CAHO Collective Agreement – Other FAQs” style=”fancy”]

[_su_spoiler icon=”chevron” title=”Will the hospitals extend the period for claiming extended health benefits?” style=”simple”]

We are aware that many of you have been unable to make use of your extended health care benefits during the pandemic. We tried very hard to find a way to have these benefits carried over to the new academic year. Unfortunately, we have not been able to find a solution that the Hospitals could implement. The extended health benefits are not structured in a way that they can be tracked and carried over to a new year.

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[su_spoiler icon=”chevron” title=”Resident Wellness Resources” style=”fancy”]
[_su_spoiler icon=”chevron” title=”PARO Helpline” style=”simple”]

1-866-HELP-DOC

The PARO 24 Hour Helpline is available to residents, their partners and family members, as well as medical students. The toll-free number, 1-866-HELP-DOC (1-866-435-7362), is accessible anywhere in Ontario, 24 hours a day, 7 days a week. In order to provide this service, PARO has partnered with Distress Centres of Toronto.

Since 1967, Distress Centres of Toronto volunteers have answered approximately 80,000 calls per year, 24 hours a day, 365 days a year.

When you call the toll-free number you will be directly connected to a Helpline volunteer. These volunteers have had extensive training in acute crisis intervention, depression, anxiety and many other conditions. They have also received special training relating specifically to residents including information about hours of work, working conditions and common stressors.

In addition to providing immediate assistance in emergency or urgent matters, the Helpline may be able to provide guidance to other resources for such issues as but not limited to:

Stress management
Eating disorders
Sexual, emotional or physical abuse
Anxiety
Anger management
Depression
Gender issues
Intimidation or harassment
Substance abuse
Relationship counseling
Career or work-related crisis
Sexual issues

All calls are strictly confidential and cannot be traced.
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[_su_spoiler icon=”chevron” title=”OMA Physician Health Program” style=”simple”]
Call the OMA PHP at: 1.800.851.6606 or visit their website.

The PHP welcomes self-referrals from medical students, residents, physicians and veterinarians in Ontario who may have concerns about their health and well-being. PHP’s confidential services are to assist those experiencing distress, substance use or mental health issues that can have personal or professional impact.
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[_su_spoiler icon=”chevron” title=”Employee Assistance Programs” style=”simple”]
Some of the hospitals (your employers) where residents work have Employee Assistance Plans (EAPs) and if they do, you are able to access those services as a result of the PARO-CAHO Collective Agreement.

Each EAP is different depending on the services the employer has arranged – but examples of services may include legal support, parenting and child care, and counseling services to name a few.

EAPs are intended to be short-term solutions, providing the individual with the immediate support they need to be well, and then develop a plan for the long-term, sometimes with a referral from the EFAP service provider for further treatment.

Psychotherapy is available each centre at no cost to the employee on a short-term basis until the employee is well. A long term solution is then determined based on their specific needs.

Please find below a list with links to some EAP plans. If you are unable to find a specific hospital site on the list below, we recommend you contact the Human Resource department at the hospital you are working at for more information.
McMaster University

HHS

St. Joseph’s Healthcare Hamilton

Western University

University of Ottawa

The Ottawa Hospital

Children’s Hospital of Eastern Ontario

NOSM

North Bay General Hospital

University of Toronto

Queen’s University
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[_su_spoiler icon=”chevron” title=”PGME Wellness Programs” style=”simple”]
The Resident Wellness Office located in your university’s postgraduate medical education (PGME) office have resources that can put you in touch with the right people who will help you manage conflicts. Whether you’re feeling burnt out, are having a relationship issue, or are struggling in your residency program, your PGME office is always available to assist you.

Queen’s
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[_su_spoiler icon=”chevron” title=”OMA Burnout Toolkit” style=”simple”]
The OMA’s Burnout Toolkit contains information on:

Signs and symptoms of burnout
Self-assessments
Tools to help prevent and manage burnout
Resources for physician leaders to help them identify, prevent and manage burnout on their teams.

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[_su_spoiler icon=”chevron” title=”Canadian Psychological Association Resources and Support” style=”simple”]
Hundreds of registered psychologists have signed on to an initiative of the CPA to provide psychological services, via tele-health, to health care providers working at the front lines of the COVID-19 crisis. Click here to read more about this initiative and to find a psychologist in your area who has volunteered to provide psychological services at no charge.

Their COVID webpage also contains numerous other public resources to support those struggling during this time.

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[_su_spoiler icon=”chevron” title=”Canadian Mental Health Association Wellness Resources” style=”simple”]

The CMHA has put together a master list of resources for individuals facing wellness struggles. The guide includes mental health supports, online resources, and COVID-specific resources for both individuals and healthcare providers.

To download the guide, click here.

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[_su_spoiler icon=”chevron” title=”Free Online Health and Wellness Resources” style=”simple”]

Taking the time to support your mental and physical health helps you to show up better for yourself, your loved ones, your peers, and your patients. Whether you are a self-care novice, or expert, this list of resources offers excellent health and wellness support.

Guided Meditations

Mental Health Resources

Yoga Classes

Fitness Classes

Private e-Counselling

Free Trial: Better Help

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[_su_spoiler icon=”chevron” title=”Free Online Virtual Experiences” style=”simple”]

Running low on novel things to do on your time off or in self-isolation? This list of resources offers unique experiences that will get out of your home, and back into the world, from the comfort of your living room.

Live Zoo Cams

Virtual Tours

More

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[su_spoiler icon=”chevron” title=”PGME COVID Resources and Updates” style=”fancy”]

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[su_spoiler icon=”chevron” title=”Certification Exam Updates ” style=”fancy”]

RDoC Update: MCC Ceases QE2 – June 10, 2021

RDoC Update on MCCQE2 – June 1

RDoC Update on MCCQE2 Exams – May 19, 2021

RDoC Update on RCPSC Oral Exams – April 29, 2021

RDoC Exam Update – April 19, 2021

RDoC MCCQE2 Update – March 16, 2021

PARO Update on CPSO MCCQE2 Exemption Policy – March 9, 2021

RDoC MCCQE2 Update – March 8th, 2021

RDoC MCCQE2 Update – March 5, 2021

RDoC MCCQE2 Update – October 23rd, 2020

RDoC MCCQE2 Update – October 7, 2020

RDoC Exam Update #6 – April 3, 2020

CFPC Update – April 15, 2020

CFPC FAQ – March 13th, 2020

RCPSC Update – April 9, 2020

RCPSC FAQ – April 24, 2020

MCC Update – March 13, 2020

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[su_spoiler icon=”chevron” title=”Licensing Information” style=”fancy”]
[_su_spoiler icon=”chevron” title=”Restricted Registration During COVID-19 ” style=”simple”]

A number of members have reached out to us to ask about Restricted Registration (RR) licensing in order to help out in critical care and community settings during this time. As you may know, the application process to obtain an RR certificate can be lengthy. However, PARO has been collaborating with the College of Physicians and Surgeons (CPSO) to develop an expedited submission and review process in recognition of the increased need due to COVID-19.

To find out if you are eligible to obtain an RR certificate, please visit the RR website or contact info@restrictedregistrationontario.ca

It is important to keep in mind that you must obtain an RR certificate to work extra shifts for pay outside of your residency training program.
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[_su_spoiler icon=”chevron” title=”CPSO Updates ” style=”simple”]

A link to the CPSO FAQ on COVID may be found here:

CPSO Updates

CPSO Supervision Requirements Update – May 4, 2020
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[su_spoiler icon=”chevron” title=”Public Health Resources ” style=”fancy”]

[_su_spoiler icon=”chevron” title=”Health Canada Resources for Health Care Professionals ” style=”simple”]

Optimizing the use of masks and respirators during the COVID-19 outbreak;

Guidance on the use of expired N95 respirators and masks; and
Guidance on the use of commercial-grade respirators for medical purposes.

List of diagnostic devices for use against coronavirus (COVID-19)

For health professionals

Interim national case definition: Coronavirus Disease (COVID-19)

Infection prevention and control for coronavirus disease (COVID-19): Interim guidance for acute healthcare settings

Routine practices and additional precautions for preventing the transmission of infection in healthcare settings

Interim national surveillance guidelines for human infection with Coronavirus Disease (COVID-19)

Coronavirus disease (COVID-19): Summary of Assumptions

Public health management of cases and contacts associated with coronavirus disease (COVID-19)

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Health Canada Updates

Public Health Ontario

Public Health Agency of Canada

Hamilton Public Health Updates

Kingston Public Health Updates

Middlesex-London Public Health Updates

Ottawa Public Health Updates

Sudbury and Districts Public Health Updates

Thunder Bay District Public Health Updates

Toronto Public Health Updates

Ontario Public Health Units – Full Listing

WHO COVID Outbreak

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[su_spoiler icon=”chevron” title=”PARO Updates” style=”fancy”]

Read This If You Have Been Asked To Provide Additional Coverage – December 23, 2021

Update on MRRP – September 28, 2021

Important Update – June 14, 2021

PARO President’s Update – Sent May 3rd, 2021

PARO Update on CPSO MCCQE2 Exemption Policy – Sent March 9, 2021

Work Alert #11 – Sent Dec 22, 2020

Work Alert #10 – Sent Dec 12, 2020

Work Alert #9 – Sent June 25, 2020

Work Alert #8 – Sent May 29, 2020

Work Alert #7 – Sent May 22, 2020

Work Alert #6 – Sent April 29, 2020

Work Alert #5 – Sent April 24, 2020

Work Alert #4 – Sent April 9, 2020

Work Alert # 3 – Sent March 25, 2020

Work Alert # 2 – Sent March 18, 2020

Work Alert # 1 – Sent March 16, 2020

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[su_spoiler icon=”chevron” title=”RDoC Updates” style=”fancy”]

RDoC Update: MCC Ceases QE2 – June 10, 2021

RDoC Update on MCCQE2 – June 1

RDoC Update on MCCQE2 Exams – May 19, 2021

RDoC Update on RCPSC Oral Exams – April 29, 2021

RDoC Exam Update – April 19, 2021

RDoC MCCQE2 Update – March 16, 2021

RDoC MCCQE2 Update – March 8th, 2021

RDoC MCCQE2 Update – March 5, 2021

RDoC Update on COVID-19 and Exams – October 30th, 2020

RDoC MCCQE2 Update – October 23rd, 2020

RDoC MCCQE2 Update – October 7, 2020

RDoC Exam Update #6 – April 3, 2020

CMF PPE Call To Action – March 30, 2020

RDoC Exam Update #5 – March 24, 2020

RDoC Exam Update # 4 – March 18

RDoC Exam Update #3 – March 14

RDoC Exam Update #2 – March 12

RDoC Message to Members – COVID and Exams – March 11

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[su_spoiler icon=”chevron” title=”Where can I learn more about COVID-19? ” style=”fancy”]

U of T’s Online Resource

IBCC COVID-19 Resource

Updated Scientific Literature from the National Library of Medicine (USA)

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[su_spoiler icon=”chevron” title= “Child Care” style=”fancy”]

Update as of Jan 1, 2022:

It is our understanding that the Ontario government is still working on a plan for free emergency child care for school-aged children of health care workers and other eligible frontline workers. Further updates will likely be shared on their “COVID-19: Keeping Schools Safe” webpage.

In the meantime, they have a resource that lists the supports available to working parents during the pandemic on their “COVID-19: Health and Safety Measures for Child Care” webpage.

There is no specific language in the PARO-CAHO Collective Agreement on emergency child care. As such, in the absence of support from the Ontario government or a local child care service, the logistics of emergency child care will largely be a resident/program-level decision. In our experience, programs can make accommodations on a case-by-case basis, and a face-to-face meeting between the resident and the program to discuss the accommodation request is optimal.

There is Emergency Leave provided for by the Employment Standards Act (ESA) that residents may be eligible. However, it is our understanding that Emergency Leave is unpaid.

Residents can where necessary, use vacation. In our experience, even where other requests cannot be approved, vacation has been approved where there is an issue with child care. If the resident no longer has remaining vacation, they should be able to take an unpaid Leave of Absence.

A program cannot be compelled to provide a virtual care option to their residents, but we are aware of this option having been offered to some residents.

Finally, residents may qualify for the Canada Recovery Caregiving Benefit (CRCB).

If you cannot access any of these options, contact PARO for support.

[_su_spoiler icon=”chevron” title=”Ontario Government’s Guidance for Schools and Childcare” style=”simple”]

On October 2nd, 2020, the Ontario Government updated their Guidance for Schools and Childcare to help parents make decisions about when to keep their children at home, and when to seek a test for COVID-19.

Click here to read about the updated Guidance.

Click here to access the updated online screening too.

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[_su_spoiler icon=”chevron” title=”Government-provided Emergency Childcare for Frontline workers” style=”simple”]

Updated May 12, 2021

Information about free Emergency Child Care for Frontline workers and the complete list of Emergency Child Care centres throughout the province can be found here.

Toronto

Emergency childcare for kindergarten and school-aged children of eligible essential workers will be available during the provincially-mandated remote learning period. The service is available at no cost to eligible families who qualify as essential workers and who are not able to accommodate their school-aged child’s care at home.