- Attachment 1 – CAHO Membership
- Attachment 2 – Maximum Duty Hours
- Attachment 3 – Working During Pregnancy
- Attachment 4 – Unfunded Residents
- Attachment 5 – Liability Insurance
- Attachment 6 – Implementation of Salary
- Attachment 7 – Other Training Programs Leading to CPSO Licensure
- Attachment 8 – Out of Hospital Call
- Attachment 9 – Computer Data Entry
- Attachment 10 – CAHO Status
- Attachment 11 – Employment Insurance Hours of Work
- Attachment 12 – Article 16 Maximum Duty Hours
- Attachment 13 – Tuition Fees
- Attachment 14 – Job Assessment Process
- Attachment 15 – Benefit Plans
- Attachment 16 – Application of Agreement to Non-CAHO Sites
- Attachment 17 – Day Care
- Attachment 18 – Electronic Call Schedules
- Attachment 19 – Maximum Call Calculations for In House Call
- Attachment 20 – Non Traditional Work Hours
- Attachment 21 – Administrative Supplements
- Attachment 22 – Implementation of Call Stipends
- Attachment 23 – Administrative Rules for Call Stipends
- Attachment 24 – Information to PARO
- Attachment 25 – Post Call Travel Safety
- Attachment 26 – Hours of Work Committee and Third Party Dispute Resolution
- Attachment 27 – Employee Assistance Program
- Attachment 28 – Chief/Senior Released Time for Administrative Duties
- Attachment 29 – PGY1 Call Schedule
- Attachment 30 – Non-Urgent Pages
- Attachment 31 – Salary and Benefit Continuance During Dismissal or Suspension
Kingston Health Sciences Centre
London Health Science Centre
St. Joseph’s Health Care London
Children’s Hospital of Eastern Ontario
The Ottawa Hospital
Royal Ottawa Health Care Group
Bruyère Continuing Care
Sunnybrook Health Sciences Centre
Sinai Health System
University Health Network
St. Michael’s Hospital
The Hospital for Sick Children
Baycrest Health Sciences
Centre for Addiction & Mental Health
Holland Bloorview Kids Rehabilitation Hospital
North York General Hospital
Women’s College Hospital
St. Joseph’s Healthcare Hamilton
Hamilton Health Sciences
Health Sciences North/Horizon Santé Nord (HSN)
Thunder Bay Regional Health Sciences Centre
MEMORANDUM RE: MAXIMUM DUTY HOURS*
COFM and the parties affirm their support for the in hospital duty assignment and out of hospital call provisions set out in Article 16 of the Collective Agreement.
If a Program Director in a hospital believes that in an exceptional case there is educational justification for an in-hospital duty assignment which would be more than a one in four average, or for out-of-hospital call which would be more than a one in three average, such assignment will not be made until the matter has been discussed with and approved by the Faculty Post-Graduate Education Committee, or as set out below, which shall include appropriate resident representation.
If the matter is not resolved satisfactorily to PAIRO or the Program Director it may be referred to the COFM Post-Graduate Education Committee for further consideration.
In the event the difference remains unresolved it may be referred by PAIRO or the Program Director to the Medical Post-Graduate Consultation Committee for final resolution by the Committee or as it directs.
|“Amir Janmohamed, MD”||“Jeff Kolbasnik, MD”||“Brad Sinclair”|
|For PAIRO||For PAIRO||For OCOTH*|
*This replaces the previous memorandum dated August 18th, 1977 and July 16th, 1990 and included as Attachment 2 to the predecessor Agreements.
* Now referred to as CAHO
Workload During Pregnancy
April 8, 2017
The Hospitals recognize that the training for housestaff is such that an extended absence due to pregnancy could present difficulties in the completion of the training program.
Under certain circumstances, it may be beneficial to the housestaff member, the hospital, and the university to have the workload modified somewhat because of the physical limitations caused by pregnancy to enable the person to continue training with minimal interruption.
In such cases, the housestaff member so affected, with counsel from her attending physician, shall review the issue with her Clinical Supervisor. The Hospitals support the position that, if in the opinion of the attending physician of a pregnant resident, a reduction in workload is warranted, then the workload shall be reduced to the extent prescribed by the attending physician including the elimination of on call duty if necessary. In no event will a resident be scheduled or required to participate in on call duty after twenty-seven (27) weeks gestation unless otherwise agreed to by the resident.
This letter is subject to the grievance procedure contained in the Agreement. Stephanie
Kenny, M.D. Jack Kitts, M.D.
POLICY RE: UNFUNDED RESIDENTS
Further to the extensive discussions between OCATH* and PAIRO with regard to unfunded internes and residents, OCATH has received PAIRO’s policy statement dated October 31, 1984, regarding such internes and residents and agrees that effective July 1, 1986, no OCATH hospital will permit in its hospital any unfunded internes and residents, save and except those currently in training programs to whom OCATH will apply the policy which is set out as follows:
- All internes and residents in teaching hospitals covered by the PAIRO-OCATH Agreement are represented by PAIRO and are entitled to the protection of that Agreement, regardless of the source of funding. Thus, all internes and residents working in the hospitals covered by the PAIRO-OCATH Agreement are entitled to be remunerated in accordance with the Agreement.
- All hospitals where internes and residents work shall take immediate steps to ensure that all internes and residents are being paid according to the PAIRO-OCATH Agreement.
- All funding sources are urged to take immediate steps to ensure that the internes and residents who are the ultimate recipients of their funds are paid according to the PAIRO-OCATH Agreement.
- PARO recognizes that it might be unfair, in some circumstances, to interfere with existing arrangements between hospitals and some housestaff despite the fact that such arrangements do not comply with the PAIRO-OCATH Agreement. In such circumstances where internes or residents are unfunded, PAIRO will not insist that the PAIRO-OCATH Agreement be fully applied to those persons who are now in programs or who have arranged or will arrange to enter programs commencing before July 1, 1986, so long as the salaries and benefits presently being paid are not further reduced. It must be made clear, however, that all individuals entering new programs after July 1, 1986, must be compensated in accordance with the Agreement. In all other respects, PAIRO will expect that hospitals adhere to the PAIRO-OCATH Agreement for all internes and residents working in those hospitals.
|"G. Turner"||"M. Levine, M.D."|
* Now referred to as CAHO.
LETTER OF UNDERSTANDING RE: LIABILITY INSURANCE
Representative(s) of PAIRO will be permitted to review each Hospital’s Liability Policy at a time mutually agreed between PAIRO and each hospital. Each hospital will facilitate the scheduling of such meetings, and a hospital or hospital representative will be present during the review of the liability policy.
It is understood that no copies will be made of the policies but brief relevant notes may be taken.
|"P. Hassen"||"B. Winston, M.D."|
* Now referred to as CAHO.
RE: IMPLEMENTATION OF SALARY
In the event that the parties voluntarily negotiate a settlement, and subject to ratification by the Teaching Hospitals, member hospitals shall implement applicable new wage rates, if any, on or before the third full pay period following receipt by CAHO of written notice of ratification from PARO and shall make retroactive payments on or before the fourth full pay period following receipt of such written notice of ratification.
In the event of an arbitration decision under Article 4, member hospitals shall implement applicable new wage rates, if any, on or before the third full pay period following receipt by CAHO of such arbitration decision under Article 4 and shall make retroactive payments on or before the fourth full pay period following receipt of such arbitration decision.
LETTER OF UNDERSTANDING RE: OTHER TRAINING PROGRAMS
LEADING TO CPSO LICENSURE
The parties agree that, if the College of Physicians and Surgeons of Ontario (CPSO) establishes or recognizes a program of training as leading to licensure other than through RCPSC or CFPC certification, training in that program will be compensated on a manner consistent with the principles established in respect of RCPSC and CFPC training programs, with training in the first year compensated at the PGY1 level, training in the second year at the PGY2 level, etc.
OUT OF HOSPITAL CALL
Where a service schedules a resident or residents for out of hospital call but the resident or residents regularly spend more than four (4) hours in the hospital on such shift, the parties agree that PARO may refer the matter to the Provincial Call Monitoring Committee (*PCMC), which shall treat the referral in the same manner as a referral to the committee under Attachment 12. PARO agrees that the decision as to whether to deem the out of hospital call to be in hospital call is not subject to the grievance and arbitration process.
COMPUTER DATA ENTRY
Residents will not normally be required to enter, or co-sign orders or enter other data into a computer, in addition to being required to enter, or co-sign such orders or enter such other data in a handwritten version.
Each hospital listed in Attachment 1 confirms that it and its successors (as defined in the Ontario Labour Relations Act) are bound by this Collective Agreement, and that if CAHO ceases to exist or function, a successor to CAHO shall represent the teaching hospitals for all purposes of this Collective Agreement.
LETTER OF UNDERSTANDING
RE: EMPLOYMENT INSURANCE HOURS OF WORK
For employment insurance eligibility purposes, the hospitals agree that they will work with PAIRO and the resident involved to ensure that such resident is credited with his or her actual hours worked, rather than any hours recorded for payroll or other administrative purposes.
|"K. Sonu Gaind, MD"||“Hugh Graham"|
* Now referred to as CAHO.
RE: ARTICLE 16 MAXIMUM DUTY HOURS
PARO and OCOTH* affirm their support for Maximum Duty Hours provisions set out in Article 16 of this Agreement.
It is agreed to be of benefit to both parties that mechanisms be established to promptly and effectively resolve disputes related to the provisions of this Article brought forward either by a resident or PARO.
A Provincial Call Monitoring Committee (PCMC) shall be established consisting of two (2) persons named by PARO and two (2) persons named by OCOTH, plus one (1) person named by COFM to serve as a non-voting advisor.
In the event that PARO, or a resident, is aggrieved by an alleged breach of Article 16, a representative of PARO (with or without the resident) and the resident’s hospital program co-ordinator or Program Director shall meet in person or by telephone as soon as practicable after the alleged breach to resolve the matter.
If resolution is not achieved, PARO or the resident may bring the alleged violation to the attention of the hospital CEO, or his/her designate, in writing. The Hospital CEO (or designate) shall meet in person, or by telephone, with a representative of PARO within five (5) working days after the filing of the complaint. The Postgraduate Dean may also be invited to this meeting at the request of either party.
If the matter cannot be resolved within seven (7) days after the meeting with the Hospital CEO, the matter may be referred to the PCMC who shall meet within seven (7) working days, either in person or by telephone, for final resolution by the Committee or as it directs.
If the matter is not resolved by the PCMC process, PARO may then give written notice to the Hospital of intent to take the matter to arbitration under Article 7 of this Agreement. This does not apply to Attachment 8 issues.
The Provincial Call Monitoring Committee shall meet, in any event, at least three times annually, to discuss the application of this provision and issues arising there from for the purposes of reviewing patterns of alleged violations and to improve the understanding of our respective members on the appropriate administration of this provision.
|“Amir Janmohamed, MD”||“Jeff Kolbasnik, MD”||“Brad Sinclair”|
|For PARO||For PARO||For OCOTH*|
* Now referred to as CAHO.
LETTER OF UNDERSTANDING
RE: TUITION FEES
The parties agree that should a university commence the process of actively considering a policy to charge tuition fees for residents prior to the June 30, 2016 expiry of the Collective Agreement, the following terms and conditions apply:
PARO may raise the issue of reimbursement and indemnification for such fees by the employer during negotiations for the renewal of the Collective Agreement. In this regard, CAHO recognizes that PARO may give notice to bargain for a renewal Collective Agreement at any time after it becomes concerned that a university may adopt a policy to charge tuition fees, including during the currency of the 2013 to 2016 Collective Agreement.
Should the matter not be resolved in negotiations, PARO may at any time after the commencement of negotiations, and notwithstanding that the 2013 to 2016 Collective Agreement may not have expired, refer the tuition issue to arbitration, and the board of arbitration may determine the tuition issue and any other matters in dispute in accordance with Article 4 of the Collective Agreement. Unless the parties agree otherwise, the renewal Collective Agreement shall be for a one-year period. The parties agree that they shall cooperate to expeditiously schedule and complete any arbitration proceedings.
Should the arbitrator determine that residents are to be reimbursed and/or indemnified for the costs of tuition, the arbitrator shall, as part of the entire award for the renewal Collective Agreement, provide for such reimbursement retroactive to the date of the effective implementation of tuition. For certainty, this includes a date prior to July 1, 2013. All other issues decided by the arbitrator must fall within the term of the renewal Collective Agreement.
This letter of understanding is without prejudice to any argument CAHO might pursue that the issue of tuition is beyond the jurisdiction of the Board of Arbitration and CAHO’s view that the Collective Agreement should not provide for tuition reimbursement. This letter of understanding is also without prejudice to PARO’s position that reimbursement and/or indemnification for tuition is a matter within the jurisdiction of a board of arbitration, that CAHO does not have the right to argue that reimbursement and/or tuition is beyond the jurisdiction of the Board of Arbitration and that entitlement to reimbursement and/or indemnification for tuition is a matter to be determined separate and apart from entitlement to salary and other monetary increases.
The parties further agree that PARO shall not in any way be prejudiced as a result of the parties mutually agreeing to defer the issue of tuition beyond the 2013 to 2016 Collective Agreement, and further agree that the board of arbitration shall determine the tuition issue as if the status quo was that residents were not yet paying tuition fees and in this respect shall not take into account the fact that residents may already have been required to make tuition payments.
JOB ASSESSMENT PROCESS
LETTER OF UNDERSTANDING
TERMS OF REFERENCE FOR THE JOB ASSESSMENT PROCESS
THE COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO (CAHO)
THE PROFESSIONAL ASSOCIATION OF RESIDENTS OF ONTARIO (PARO)
Pursuant to the Award of a Board of Arbitration Chaired by Mr. William Kaplan,
issued November 18, 2014
Pursuant to an award by a Board of Arbitration chaired by Mr. William Kaplan dated November 18, 2014, the Council of Academic Hospitals of Ontario – CAHO (“CAHO”) and the Professional Association of Residents of Ontario – PARO (“PARO”) agree to engage in a joint process of job assessment, to be completed by December 1, 2018.
These Terms of Reference may be modified by mutual agreement of CAHO and PARO (the “Parties”).
A. Basic Principles
- The parties have traditionally not agreed on the appropriate comparators to be used in bargaining and interest arbitration, and through this process will consider other potential comparators.
- It is agreed that the effect, if any, of the findings of the job assessment process on compensation practices will be for the purposes of assisting the parties in their negotiations.
- It is agreed that the job assessment process is not intended to alter existing classification schemes or existing relativities within the PARO unit.
B. Establishment of Joint Committee
- The Parties agree to establish, within 30 days of the signing of these Terms of Reference, a Joint Committee (“JC”) comprised of three (3) representatives of PARO and three (3) representatives of CAHO.
- Each Party will designate its representatives, one of whom will act as Co-Chair.
- Each Party will designate up to two (2) alternates to replace JC members during unavoidable absences. Alternates shall have all rights and responsibilities of that member in his or her absence.
- Each Party may additionally retain, at its own cost, one or more advisors to assist it in carrying out its work.
- The Parties may agree to retain one or more advisors jointly to assist the JC at shared cost.
C. Mandate of Joint Committee
The JC will meet regularly as set out below, and will undertake the following activities:
Collaborate on investigation of options for assessing the comparability of the work of Residents with the requirements of other jobs, based on comparisons of the skill, effort, responsibility and working conditions required to perform the jobs (including as appropriate consideration of both the work and education components and the related hours).
Develop a work plan with timelines to complete the process, including a schedule of meetings of the JC.
Adopt an effective information-gathering process to identify the same information as set out in C1 above for the comparator jobs
Share all information collected about the requirement of jobs and the context in which jobs are performed, including any existing job descriptions for those positions. Member Hospitals will provide such access as is reasonably necessary to Joint Committee members or their designates to staff and facilities of member Hospitals for the purposes of developing and carrying out the joint job assessment process including, but not limited to, opportunity for observation of jobs and discussion with Residents and persons in roles under consideration as comparators.
Making key decisions in such areas as:
Sharing of costs incurred in the development of the tools;
The method of job information gathering required to reach agreement on a set of job comparison tools, including pre-testing of job evaluation tools; and
The adoption of a system to compare the requirements of jobs, including:
the subfactors, their descriptions or definitions, and their levels;
factor and subfactor weighting;
a process for gathering and clarifying job content information;
the format for recording evaluations and evaluation results;
a process to verify the evaluation and comparison results; and
Determining appropriate comparator position(s) and the calculation of their compensation level to be applied for the purposes of this exercise.
Based upon the value ratings arrived at in the course of the joint assessment process, make recommendations to the parties as to the value of Resident jobs in the PARO unit relative to non-bargaining unit comparators and compensation appropriate to those established values.
D. Role of Co-Chairs
Co-Chairs will have the following responsibilities:
Determine the frequency and scheduling of JC meetings, (and absent agreement meetings will take place at least monthly);
Attend all meetings of the JC;
Establish the agenda for meetings and ensure circulation in advance of such agenda;
Liaise with their respective Party as appropriate, including any decisions requiring shared expenditures;
Ensure the production of minutes of meetings and timely distribution of such minutes;
Recommend to the Parties that a dispute be referred to an agreed-upon dispute resolution mechanism.
E. Quorum, Decision Making, and Replacement of Members
The Parties will endeavour to ensure participation of all members at meetings. However, where absence is unavoidable due to illness or emergency, at least two (2) members or alternates from each Party must be present for the meeting to proceed.
Decisions will, where possible, be made by consensus (that is, committee members must agree that they can support and defend every decision; if one or more committee members disagree, the decision shall not be approved). If consensus cannot be reached, the differences will be referred to Dispute Resolution under Section F below.
Each Party may retain its own advisor or advisor. An advisor thus retained may attend any meetings of the working group on the invitation of the Party retaining her or him and will have shall be entitled to participate in discussions but shall not be considered a member of the committee.
In the case of notice of a prolonged absence of any member, CAHO or PARO, as applicable, will designate a replacement within two (2) weeks of the notice of absence.
F. Dispute Resolution
If the Committee is unable to reach agreement on any issue, including but not limited to questions of appropriate comparators, comparison tools, and values to be assigned, the dispute will be referred for determination by Mr. William Kaplan, or by such individual as Mr. Kaplan may appoint.
Signed on this 7TH day of July 2015.
“Kaif Pardhan, MD”
LETTER OF UNDERSTANDING RE: BENEFIT PLANS
The parties agree that for the currency of this Collective Agreement the benefit plans will remain consolidated among the various paymaster hospitals.
LETTER OF UNDERSTANDING RE APPLICATION OF
COLLECTIVE AGREEMENT TO NON-OCOTH* SITES
PAIRO, OCOTH and COFM affirm their support for the application of the Collective Agreement to residents in non-OCOTH sites in Ontario.
As a result, it is agreed that, as a condition of the placement of a resident through an affiliated university program, each non-OCOTH site will sign an agreement with PAIRO in the form attached to this Letter as Appendix 1. It is agreed that a resident will not be placed outside of an OCOTH site without such an agreement.
It is also agreed that each site may be provided with a copy of the letter attached as Appendix 2.
Appendix 1 will be signed prior to the placement of the resident.
This Letter of Understanding to the Collective Agreement is to take effect prior to the July 1, 2003 academic year.
“Kevin Lefebvre, MD”
“David Walker, MD”
Signed this 30th day of September, 2002
* Now referred to as CAHO.
APPENDIX 1, ATTACHMENT 16
LETTER OF UNDERSTANDING RE APPLICATION OF COLLECTIVE AGREEMENT TO NON-CAHO SITES
Letter of Agreement
B E T W E E N:
(Hereinafter referred to as “the XXXXX”)
– And –
PROFESSIONAL ASSOCIATION OF INTERNES AND RESIDENTS OF ONTARIO
(Hereinafter referred to as “PARO”)
As a condition of the placement of a resident through an affiliated university program, “XXX” hereby agrees to stand in place of the CAHO Hospitals as the employer for the purposes of the application and administration of the Collective Agreement between CAHO and PARO, as amended from time to time, based on the following terms and conditions:
1. Article 18 – Facilities
Unless a site requires residents to work call, Articles 18.2 and 18.3 will not apply.
With respect to 18.9, if a locker is not available, a resident will be provided with a secure location for storage of personal items.
The requirement for a PARO Bulletin Board will not apply.
Otherwise the provisions of Article 18 apply.
2. Except for those noted above, all other provisions of the Collective Agreement will apply.
Where the Collective Agreement is renewed, the site may, within 30 days of ratification of the agreement or of an arbitration award, choose to opt-out of this letter of agreement, in which case residents will be withdrawn from and no longer placed at the site.
DATED at this day of 20__.
FOR THE “SITE”: FOR PARO
APPENDIX 2, ATTACHMENT 16
LETTER OF UNDERSTANDING RE APPLICATION OF
COLLECTIVE AGREEMENT TO NON-OCOTH* SITES
TO: “(NON-OCOTH SITE)”
FROM: GARRY CARDIFF, CHAIR, OCOTH.
DR. DAVID WALKER, CHAIR, COFM
RE: Placement of Residents Outside of O.C.O.T.H. Hospitals
Post-graduate medical trainees who are registered in approved Ontario university programs are covered by a Collective Agreement between OCOTH and P.A.I.R.O. Therefore, your acceptance of such trainee(s) requires that you execute a Letter of Agreement with P.A.I.R.O. wherein you agree to stand in place of an OCOTH. Hospital as employer of the resident (see attached).
Please find enclosed a copy of the Collective Agreement between OCOTH. and P.A.I.R.O. We recommend that you read it carefully to understand the implications for your organization.
Please be assured that issues relating to salary, benefits, Association dues (Articles 6, 14, 15.7 and 15.8, 19, 21 and 22) will continue to be administered by the teaching hospital designated as the Paymaster for the resident. We have enclosed a list of Paymaster contact information.
Notwithstanding the foregoing, the remainder of the obligations under the Collective Agreement continues to apply and become your responsibility (subject to the exceptions as outlined in the attached Letter of Agreement).
If you should have any questions regarding the Collective Agreement, please feel free to contact Employee Relations Services at the Ontario Hospital Association, 416-205-1377, or the Council of Teaching Hospitals, 416-205-1329.
“Dr. David Walker”
* Now referred to as CAHO
LETTER OF UNDERSTANDING
In circumstances where there is a Hospital-based Day Care program where the Hospital has primacy of access to a number of day care spots, the Hospital will use its best efforts to ensure that PARO can purchase day care spots. The number of available spots at each hospital will be proportionate to the number of residents at that hospital as of July 1 of each year, relative to the overall employee workforce, physicians, scientists and other professional trainees at the hospital eligible for access to the day care spots to which the hospital has primacy of access. Details of the administration of prepayment by PARO and the resident will be arranged between the Day Care and PARO.
ELECTRONIC CALL SCHEDULES
PARO and CAHO agree to establish an Electronic Call Schedule Task Force, comprised of up to three PARO representatives, three CAHO representatives and potentially a participant from PGE COFM, to undertake a feasibility study for electronic call scheduling. The Task Force will have its initial meeting within one month of the ratification of the Collective Agreement, with the objective of completing the feasibility study within six months of ratification of the Collective Agreement. The Task Force will seek advice and input from hospital administrators, residency program directors, chief residents and others as required. If the Task Force concludes that electronic call scheduling is feasible, the parties will establish a representative pilot project(s) to commence within six months of completion of the feasibility study.
LETTER OF UNDERSTANDING
MAXIMUM CALL CALCULATIONS – IN HOSPITAL CALL
1. Where a resident is scheduled on a “one-month” rotation that is not 28 days, the following formula would apply, replacing the 7:28 call limitations. (The reference to numbers of days on service is specific to any individual resident, and reflects the number of working days subtracting, as the Collective Agreement requires in Article 16.3, any time the resident is away from the workplace for any reason, including vacation and leaves):
19-22 days on service – 5 calls
23-26 days on service – 6 calls
27-29 days on service – 7 calls
30-34 days on service – 8 calls
35-38 days on service – 9 calls
2. Where the rotations are more than one month in duration the maximum number of call periods would be determined by dividing the number of days the resident is on the service (i.e. minus vacation, leaves and other absences) by 4, and rounding up if the decimal is equal to or greater than .5, to get the maximum calls over that period. The maximum averaging period is 3 months (even where the rotation is longer than 3 months). However, there would be an overall limitation of 9 calls in any given calendar month, with calls correspondingly reduced in other months of the schedule to make up for this excessive call. For example, if over a 3 month period, a resident was on the service 90 days, 90 divided by 4 equals 22.5 which is rounded up to 23 call periods. However, if the resident were only on the service for 89 days, 89 divided by 4 equals 22.25 which would mean that the resident can only work 22 call periods.
3. As well, the hospitals agree that any and all occurrences of the employer exercising its right under Article 16.1 c(iii) – to schedule a resident for call without notice in exceptional and unexpected circumstances – will be documented by the employer and forwarded to the joint Provincial Call Monitoring Committee at the time it occurs.
NON TRADITIONAL WORK HOURS
“The parties agree that the restrictions under the maximum hour/call provisions in the Collective Agreement on scheduling residents to work hours outside of daytime working hours, including call and shift limitations, may prevent implementation of some alternate scheduling arrangements. As a result, the parties agree that any proposal to schedule residents to work in a manner which violates the provisions of the Collective Agreement providing for night time or weekend call following daytime working hours or providing for shift work, may be implemented, but only following agreement by the parties following discussions at the Provincial Call Monitoring Committee (PCMC). Such new scheduling arrangements may be discontinued by either party with 90 days notice“
SUBCOMMITTEE – ADMIN SUPPLEMENTS
In the 1991-1992 Agreement the parties agreed to establish the following committee. The parties agree to continue in effect the provisions of this attachment to the Agreement.
The parties agree to establish a sub-committee comprised of an equal number of representatives from the Hospitals, PARO and COFM to establish and propose to the parties, for the next round of negotiations, a clear and concise definition of “Senior and Chief” residents for the purpose of administrative supplements.
Letter of Understanding Re: Implementation of Call Stipends
- Call Stipends were implemented on July 1, 2006, pursuant to Article 23 of the Collective Agreement. Recognizing that some details of implementation may vary on a hospital by hospital basis, the parties nonetheless recognize the importance of some province-wide standards and rules, and a common and consistent approach in certain aspects of the implementation of the call stipends provisions. In this respect, the collective agreement specifically recognizes that the “hospitals have the right to implement reasonable rules to verify that residents are entitled to be paid the in-hospital call stipend for that call.”
- As a result, the parties have now agreed to the following rules, which will be deemed to be reasonable in the context of the collective agreement:
- Call stipend claims must be submitted to the person(s) designated by the hospitals to receive such claims within 30 days following the end of the month in which the call was worked, save and except for circumstances reasonably beyond the control of the resident. Otherwise, untimely call stipends will not be paid.
- Any call stipend claims which have not been submitted as required by a) above will be paid, so long as they are submitted by July 20, 2007, and relate to call worked on or after April 1, 2007.
- Residents claiming entitlement to a call stipend, including conversion from a home call stipend to an in-hospital call stipend (or to a qualifying shift stipend) will not be required to obtain sign-off or confirmation from an attending or supervising physician. However, where a hospital demonstrates what it reasonably believes to be an excessive pattern of conversions within a program or service, it may implement reasonable monitoring and sign-off mechanisms for that program or service. Furthermore, PAIRO agrees to facilitate the hospital’s efforts in this regard, having regard to the obligation on residents, as physicians and as hospital employees, to conduct themselves in a professional manner.
- The hospitals agree to provide the information specified in Article 23.7 of the collective agreement in an excel spreadsheet or equivalent format, in the form that they have been accumulating the information to date for internal review and analysis, including information about any calls converted to in hospital call, but it is agreed that the information provided does not have to include the specific date on which each call or shift was worked, so long as PAIRO is able to determine the amount and kind of call worked by each resident on a monthly basis.
- PAIRO and CAHO agree to continue to meet on a regular basis to review such other implementation issues or concerns as may arise in relation to the call stipend, with a view to resolving any such matters.
Signed at Toronto, this 29th day of June, 2007
“Alim Pardhan, MD”
“Robert Bass” on behalf of Mary Catherine Lindberg
Letter of Understanding Re: Administrative Rules for Call Stipends
(As amended by Memorandum of Settlement dated September 23, 2012)
- Clarification that the sub clause (c) of paragraph 2 of the initial Administrative Rules sign-off applies to individual incidents of call and that the monthly or quarterly sign off by both the Resident and Program Chief or Chief Resident or an administrator, scheduler, etc. would continue to be required where it had previously been required.
- In circumstances where the sign off official is “not at work” in the same hospital or physical location as the resident, the resident can avoid the inconvenience of obtaining the appropriate signature by emailing their schedule to the sign off official and filing the email response confirming the call frequency within the 30 day deadline. In such circumstances, if the sign off official does not provide to the resident a sign off /confirmatory email by the 30 day deadline the resident will not be paid unless the exception set out in 2a) of the initial Letter of Understanding applies (i.e. circumstances reasonably beyond the control of the resident) [For clarity “not at work” would capture situations where the sign off official is on vacation or an extended absence]. In any case, where the resident cannot obtain timely sign off but believes that the exception set out in 2 a) applies, the resident should submit their call stipend claim with an explanation for there being no sign off and should attempt to obtain the sign off as soon as possible.
- Any resident that sent in the call information in a timely fashion pursuant to 2a) of the original settlement, but without the sign off, after the date of the original settlement but before the date of notification being provided of this clarifying settlement would not lose payments but would not be paid until the call pattern was verified. In these unique circumstances, the resident could accomplish this verification by signature of the Program Chief or Chief Resident (as appropriate) or by emailing the Program Chief (or administrator) or Resident (as appropriate) and receiving email response confirming the call frequency. A copy of such emails (provided by the resident within 30 days following notification of the signing of this document) will be deemed to be acceptable by the employer for this window of time (i.e. after June 28, 2007 but before October 11, 2007). This paragraph would only apply where signatures have previously been required – but not in new sites that have historically not needed signature – e.g. Mac, UWO.
- The process described in Item 2 above can be used for non-CAHO hospital call frequency confirmations.
- PAIRO and CAHO endorse the Hospital for Sick Children’s Call Frequency form as a template for use in those hospitals currently requiring sign off, absent any reference to the reasons for conversion.
- PAIRO and CAHO hereby endorse the St. Mike’s electronic call stipend and will mutually encourage and recommend its use to both residents and the hospitals.
- OB Family Call Language: Where a family medicine resident carries a pager for obstetrics call to fulfill the requirements of the resident’s training program, the resident is not entitled to claim the home call stipend unless he or she is required or expected to respond to the page by providing medical care or attendance. Where the resident is required or expected to respond to the page, either the home or in hospital call stipend should be paid, depending on the time in attendance at a delivery, the amount of such call stipends not to exceed the maximums specified in the collective agreement. However, it is agreed that, where the resident is not required or expected to respond to the page, there should be no call stipend paid. The parties agree that where such family medicine resident responds to a page and is required to return to the hospital, the normal conversion rules apply
- Where 24-hour weekend in-hospital call (or 24-hour statutory holiday call) is split into two shifts, only the resident working the night call shift will receive the in-house call stipend, unless the employer has already determined or determines in future that each resident will receive the Home Call Stipend. For clarity, the total amount paid for each 24-hour in-hospital call worked will be $103 (increased to $105).
- The Home Call Stipend rate will be paid in the following scenarios where the call does not extend beyond 11 pm:
- a resident works a shorter in hospital call on either a weekday, or a weekend; or
- where a family medicine resident works a shift on either a weekday or a weekend. For clarity, (b) applies where a family medicine resident works a shift on a weekday or weekend, after working a normal five-day week of clinical duties.
This rule does not apply where a resident works 12 hours or more of in hospital call on a weekend day, in which case the resident is, unless covered by paragraph 8 above (split 24 hour call),entitled to receive the In Hospital Call Stipend.
The In Hospital Call Stipend rate will be paid in the following scenarios where the call extends beyond 11 pm:
- a resident works a shorter in hospital call on either a weekday or a weekend; or
- where a family medicine resident works a shift on either a weekday or a weekend.
For clarity, (b) applies where a family medicine resident works a shift on a weekday or weekend, after working a normal five-day week of clinical duties.
- The parties agree that no stipend will be payable when a resident is required to work an evening clinic up to 8pm.
- The parties confirm that where residents who are not otherwise on-call are scheduled or required to round on weekends, and actually attend in hospital for such rounding, they will be paid the Home Call Stipend.
- Where a resident arranges to work home call over a full weekend (Friday to Monday morning) or to work three (3) twenty-four (24) hour calls, they will receive three (3) Home Call Stipends. Where a resident agrees to work a full week of Home Call, inclusive of weekends, they will receive the Home Call Stipend for each shift up to the Home Call Stipend maximum as set out in the agreement.
- Where a resident is required to work a half day of clinic or other formally scheduled duties, followed by working a regularly scheduled shift, they will receive the Home Call Stipend if the shift does not go beyond 11 pm; however they will receive the In Hospital Call Stipend if the shift does go beyond 11 pm.
SIGNED at Toronto, this 4th day of October, 2007.
“Alim Pardhan, MD”
“Kevin Ramchandar, MD”
“Robert Bass” on behalf of Mary Catherine Lindberg
Letter of Understanding: Information to PARO
As discussed during bargaining, the Hospitals recognize that PARO should continue to receive the following information, provided to PARO through the universities/ OPHRDC, in order for PARO to carry out its obligations in representing residents, including administering the LTD plan: email and, where available, second email; university centre; CPSO number, birth date, gender, funding pool and group, source of funding, legal immigration status, start date, and end date.
Letter of Understanding Re: Post Call Travel Safety
The parties will meet to discuss mechanisms for ensuring resident safety in relation to driving home after being on call.
Hours of Work Committee and Third Party Dispute Resolution
1. Committee Purpose/Mandate
An hours of work committee (hereinafter referred to as the “Committee”) shall be constituted. The purpose of the Committee is to examine the existing call model, and to attempt to reach agreement on a new hours of work model(s) which will improve patient care, enhance resident education, improve resident well-being, and reflect the hospital sector fiscal environment.
In developing a new hours of work model(s), the scope of the Committee’s mandate will be limited to consideration of changes relating to the following matters:
- Total consecutive hours of work permitted;
- Length of time free of clinical and/or educational duties between call/shifts or within call/shifts;
- Frequency of scheduling calls/shifts/days off over a period or periods of time;
- Total hours permitted in a week and on a rotation;
- Length of a normal work day (including start and end times);
- Defining the meaning of hospital and home call and shift;
- Matters relating to handover; and
- Any additional matters relating to hours of work mutually agreed between the parties.
3. Committee Composition
The Committee shall be composed of:
- up to four members appointed by PARO;
- up to four members appointed by CAHO; and
- up to three observers appointed by COFM.
The Committee will have two co-chairs, one appointed by CAHO and one by PARO.
The Committee may also seek the assistance of other members of the medical and academic community, as well as other experts outside of health care (e.g. experts from other industries and specialists including in scheduling or reorganizations) as needed, in order to assist the parties in crafting a creative and workable alternative to the existing call model.
Each party will bear the costs of its own advisors, counsel or experts, and the parties will otherwise share the costs of the Committee.
Reference to “the parties” throughout this document shall mean CAHO and PARO.
4. Committee Process/Decision-Making
The Committee shall determine its own practice and procedure with respect to meeting times, locations, frequency of meetings and similar matters.
Any decisions of the Committee, including any agreement on a new hours of work model(s), must be made by agreement between the parties.
In carrying out its mandate to examine into and reach agreement on a new hours of work model(s), the Committee will take into account such matters as it deems to be relevant, but will give primary weight to developing a model(s) which respects the following criteria:
- Enhancing the quality and safety of patient care;
- Supporting excellence in medical education, including the ability of the Universities and their partners to meet both formal accreditation and formal certification objectives and standards established by the CFPC and RCPSC;
- Improving resident well-being and safety;
- Recognizing the role of residents in helping the hospitals deliver high quality patient care, safely and efficiently and with due regard for the fiscal environment facing Ontario hospitals;
- Taking into account, where relevant, differences across sites and specialties (including differences in knowledge/skill acquisition and workload intensity), as well as, where relevant, differences flowing from the graduated responsibility approach over the course of training in terms of learning needs and clinical responsibilities;
- Recognizing the need for appropriate transition to a new model(s) including appropriate time for change management and evaluation.
Any agreement reached by the Committee to resolve the matters before it shall be subject to ratification by CAHO and PARO. Subject to 4.8, upon ratification of an agreement reached between the parties, the changes agreed to shall be effective within 90 days of ratification or such other date as CAHO and PARO may otherwise agree, and upon agreement of the parties will be incorporated into the collective agreement. During this period, hospitals will consult with PARO over their plans for transitioning to the new hours of work model(s).
The Committee’s initial work in examining into and seeking to reach agreement on a new model(s) will be completed within fifteen months of the date of the signing of this Letter of Understanding. This timeframe may be extended by mutual agreement between CAHO and PARO.
Any agreement reached by the Committee will include a review period, to commence on the effective date of the hours of work changes, and consisting of the following components: i) an initial trial period, followed by ii) an initial assessment, followed by iii) a longer implementation period, followed by iv) an implementation period assessment. The total length of the review period will be no less than three years, but the parties may agree to a longer review period. If the parties cannot agree to the length of time of the review period, or any of these components, the parties agree the differences between them will be referred to and determined by the Board, constituted pursuant to section 6 below, on an expeditious basis.
At any time during the review period, the Committee may recommend, and the parties may agree to, further changes to the new hours of work model(s).
In no event will the decision of the Parties be implemented prior to the expiry of this collective agreement.
5. Third Party Assistance Process – Facilitation/Mediation
The parties agree that XXX (or if he/she is unable or unwilling to assist the parties, YYY) shall be available to the Committee to serve as facilitator/mediator. The facilitator/mediator may be invited to assist the parties at any time at the request of either party. Each party shall share the cost of the fees and expenses charged by the facilitator/mediator equally
6. Third Party Assistance Process – Fact finder/assessor
Should the Committee be unable to reach agreement on a new hours of work model(s) within 15 months of the signing of this letter, or such longer period as the parties may agree (including with the assistance of the third party facilitator/mediator), any issues in dispute falling within the scope of Article 2 will be referred to a Fact finder/Assessor Board (hereafter the “Board”), chaired by [INSERT fact finder/assessor chair NAME X] (to be mutually agreed to by CAHO and PARO) who will Act as Chair of the Board. Should [INSERT NAME X] be unable to act, then [INSERT ALTERNATIVE NAME Y] (to be mutually agreed to by CAHO and PARO) will assume the responsibility of Chair. Should [INSERT NAME Y] be unable to act, then [INSERT ALTERNATIVE NAME Z] (to be mutually agreed to by CAHO and PARO) will assume the responsibility of Chair. Should [NAME Z] be unable to act, then the parties will use their best efforts to agree on a substitute chair, failing which the parties will request the Chief Justice of the Court of Appeal to appoint the Chair, who will be an individual experienced in medical education and the health care system.
The parties will each select a nominee to sit on the Board.
The Board will receive submissions from the parties, invite submissions from COFM, examine into the issues in dispute, and issue non-binding recommendations.
The decision of the majority of the members of the Board is the decision of the Board, but, if there is no majority, the decision of the Chair is the decision of the Board. Each party shall assume its own costs, including those of its appointees, and shall share the cost of the fees and expenses charged by the Chair equally.
In addition to its authority under sections 7 and 8 below, the Board will have the authority to make recommendations on any differences between the parties arising in respect of paragraph 4.6.
7. Jurisdiction of the Board
Where a referral is made to the Board pursuant to paragraph 6, the Board will make a non-binding written report, including recommendations, with respect to all issues in dispute falling within the scope of Article 2. In making its recommendations the Board will take into account such matters as it deems to be relevant, but will give primary weight to the criteria set out in Article 4.3 above.
Within 90 days following the issuance of the report and recommendations, the parties will reconvene to determine which, if any, of the recommendations will be implemented, and where appropriate, replace the hours of work provisions currently in the collective agreement. For any agreed to recommendations, the parties will work together over the plans for transition. In no event will the recommendations be implemented prior to the expiry of this collective agreement.
The recommendations issued by the Board will include a review period, applicable only to the recommendations that the parties agree to implement, to commence on the effective date of the hours of work changes, and consisting of the following components: i) an initial trial period, followed by ii) an initial assessment, followed by iii) a longer implementation period, followed by iv) an implementation period assessment. The total length of the review period, and of each component, will be as recommended by the Board, except that the total length of the review period will be no less than three years from the effective date of the hours of work changes.
At any time during a review period, the Committee may recommend, and the parties may agree to, further changes to the new hours of work model(s).
8. Further Board Review Following Trial or Implementation Period Assessment
If, following completion of either the trial period assessment process or the implementation period assessment process (whether pursuant to Article 4 or Article 7 above), the parties are unable to agree on further changes to the hours of work model(s), either party may refer any matters in dispute falling within the scope of Article 2 to the Board for further review. Any such referral shall take place within 60 days of completion of either the trial period assessment process or the implementation period assessment process, as the case may be.
Where such a referral is made, the Board will hear submissions on and examine into whether or not the new hours of work model(s) should be changed to more appropriately respect the criteria set out in paragraph 7 above.
If the Board confirms the hours of work model(s) previously agreed to or awarded following the trial period assessment process, there is a right of further review at the conclusion of the implementation period assessment process, in accordance with this Article.
If the Board finds that the new hours of work model(s) has not appropriately respected the criteria set out in paragraph 4.3 following the trial period assessment process, it will recommend a revised hours of work model(s), which more appropriately respects such criteria, and there will be a revised review period of no less than three years duration, or such longer period as the Board recommends and the parties agree. In such circumstances, this Article will apply again, with necessary modifications.
If the Board confirms the hours of work model(s) previously agreed to or recommended following an implementation period assessment process, it will have completed its review function under this Article. However, the Board will remain seized until any new hours of work model(s) has been fully implemented.
If the Board finds that the new hours of work model(s) has not appropriately respected the criteria set out in article 4.3 following an implementation period assessment process, it will recommend a revised hours of work model(s), which more appropriately respects such criteria, and there will be a further revised implementation period and implementation period assessment process of no less than two years duration, or such longer time as is the Board may recommend and the parties agree. In such circumstances, this Article, save for paragraphs 8.3 and 8.4, will apply again, with any necessary modifications.
9. Call Stipend Compensation Pool
If the parties cannot reach agreement on whether, as a result of any agreed changes to hours of work, reallocation of call stipend funding is required, and/or on any required collective agreement changes, including where appropriate changes to call stipend amounts or entitlement criteria, the dispute may be referred to and resolved in accordance with the interest arbitration provisions of the collective agreement, including under Article 23.7, which shall apply with all necessary modifications.
10. Expiry of Attachment
The parties acknowledge and affirm that this is a onetime process. Upon completion of each phase, that phase is complete and will not be re-invoked
Letter of Understanding re: Employee Assistance Program
It is agreed that each hospital will provide all residents access to Employee Assistance Programs (EAP), to the same extent and on the same basis that such programs are available to other employees of the Hospital.
It is further agreed that access to EAP programs in accordance with the terms of the EAP letter of understanding will in no way diminish the rights, benefits or protections otherwise afforded to residents under the collective agreement.
This letter of understanding forms part of the collective agreement.
PAIRO Past President
Signed this 23rd day of September, 2012
Letter of Understanding re: Chief/Senior Released Time for Administrative Duties
Programs, in consultation with their residents, should create and provide a detailed job description/terms of reference for the Chief and Senior Resident position(s) which outlines the following:
Detailed list of expected duties (e.g. Clinical, teaching, administrative and program responsibilities)
Estimated time required to completed expected duties
Number of learners under their responsibility
The degree of administrative support provided by the program, if any.
It is recommended that there should be a central repository of job descriptions for Chief and Senior positions which would be housed at PARO and CAHO for sharing of best practices.
It is recommended that programs provide release time from clinical duties, commensurate with the estimated time required to fulfill the duties outlined in the job description.
Dated at Toronto this 25th day of October, 2014
Letter of Understanding re: PGY1 Call Schedule
The first four weeks of PGY 1 residency should be used as an opportunity for residents to become familiar with the new responsibilities of being a resident and with the physical space. It is recommended that before a PGY1 takes solo overnight call following orientation, the resident:
Must have enhanced senior support available to him/her for the first four weeks.
Enhanced senior support means additional support provided to residents outside of the normal practice of providing back up or the typical level of supervisory support.
The recommended type of enhanced support during the first 4 weeks of residency would include the following:
For the first two weeks of residency PGY1’s will be provided with senior support when on overnight call to familiarize themselves with taking overnight call.
If it is beneficial to the resident for educational reasons, and to the hospital to provide safe patient care, it is recommended that programs consider the option of a “graduated on call period”, whereby PGY1’s are expected to be on call only until 11 pm with senior support.
After the first two weeks of overnight call or “graduated on call period” with senior support, PGY1ís can commence taking overnight solo call, however there must be immediate and direct access to support from a more senior clinician. This support may be in the form of having the Chief Resident, Senior Resident or Staff also on in-hospital call with the resident
Whenever possible, services should avoid scheduling PGY1’s for cross coverage of services.
Services with a high volume and high acuity of patients may wish to defer solo call for a longer period of time than the first four weeks following the completion of orientation.
At the end of the residentís four week post-orientation period, the resident should check in with a Program based Education Lead (e.g. Program Director, Chief-Resident, Site Director etc.) to ensure he/she is sufficiently prepared to begin taking solo call. The Program based Education Lead will also help to provide residents with support and advice should they be experiencing difficulties or require assistance.
Dated at Toronto this 25th day of October, 2014
Letter of Understanding Re: Non-urgent Pages
The parties agree that there are best practices applicable for services (or units), which may mitigate the effect on residents of non-urgent pages between midnight and 6AM.
The parties further agree that this is an issue of mutual concern that would appropriately be addressed at a hospital/ PARO Committee meeting pursuant to 25.1 of the collective agreement, an equivalent existing committee/ forum which is appropriate to address resident issues, or where mutually agreed a joint committee specifically established to address non-urgent pages.
It is understood and agreed that issues of the quality of care, the safety of the patient, and resident fatigue and risk management will be primary considerations in these discussions. The committee’s work may include developing a plan for implementation, the details of which may change from time to time. The application or changes of such plan is not grievable.
Letter of Understanding re: Salary and Benefit Continuance During Dismissal or Suspension
The parties agree to the following as a trial for the duration of this agreement. The parties agree to review the experience under this letter in advance of the next round of negotiations.
A resident will not suffer loss of salary or Employee Benefits provided under Article 19.1 while dismissed or suspended, to a maximum of four (4) months or such longer period as the Hospital agrees pending the outcome, including the appeal, of a decision by the University for dis missal or suspension, or the CPSO for licensing or disciplinary matters.
It is further agreed that CAHO will collaborate with PARO and PGME Deans to discuss with the CPSO Registrar issues regarding registration of residents in circumstances where licensing may be impacted by previous CPSO proceedings.