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.

New Updates - Week of March 30
PARO-Approved COVID Scheduling Models

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 in new dedicated section below in order to share best practices. If your program would like assistance in developing a new model, please email covid19@paroteam.ca.

I'm being assigned to work in the ICU. What can I do to prepare?

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.

PARO Principles for Duty Hours and the Government Emergency Act

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, in circumstances where the emergent need necessitates it, we ask that:

  • we not take advantage of this time to add 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 you consider providing rest-periods for services/residents;
  • that consideration of health and safety be foremost: is the individual at a level of competence such that they can work safely, at the intensity the situation requires?;
  • 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, 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, grief, burnout, and anxiety.
Exam Leave And Postponed Exams

If you were among those who used exam leave preparation time for the now postponed Spring Certification examinations, it is PARO’s position that you must not lose any outstanding vacation or other leave time due to having used the exam preparation time in your current contract/academic year. 

If you have preparation time currently scheduled for the cancelled exam period, the employer (or your program in the role of employer) may decide to cancel the preparation time given the emergency measures and given the postponement of exams.

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 regardless of whether you obtained exam preparation leave time this spring.

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.

Financial Updates and Tax Changes due to COVID-19

Tax Filing and Payment Deadlines

Tax Return

Normal Due Date: April 30

Extended Due Date: June 1

Taxes Owing

Normal Due Date: April 30

Extended Due Date: September 1

Tip: In order to speed up the determination of your eligibility for the different provincial rebates such as the GST/HST credit and Canada Child Benefit, try to file your tax refund as early as possible.

Read More

Ontario Student Assistance Program (OSAP) Loan Defferal

From March 30 until September 30, there will be an automatic pause on OSAP repayment schedules.
Therefore, you do not need to apply for the pause. Interest won’t accrue during this period from your OSAP loan.

Note: If you carry a student loan from another province, the federal portion of the student loan deferral will apply. If you have consolidated your student loan with the bank, and are experiencing financial hardship, you may want to contact your bank directly.

Read More

Canada Child Benefit: One time extra payment

If you are an eligible recipient of the CCB, you will receive a one-time extra payment of $300 per child in May.

Tip: Try to file your personal tax return earlier so it doesn’t delay the determination of your CCB benefits for 2020–21.

Read More

Mortgage Payments and Other Credit Products

If you or a member of your family are experiencing financial hardship, you can request a mortgage deferral for up to 6 months. You should contact your bank directly to discuss what options could be available to you.

Note: Interest will continue to accrue during the mortgage deferral period. Therefore, your payments will be slightly higher after the deferral period ends. Although you will pay more interest over the life of your mortgage, a deferral could help with your short-term cash flow.

Read More

Additional Information for Family Members of Residents

Canada Emergency Response Benefit

The government will provide a taxable benefit of $2,000 a month for up to 4 months to:

  • workers who must stop working due to COVID19 and do not have access to paid leave or other income support.
  • workers who are sick, quarantined, or taking care of someone who is sick with COVID-19.
  • working parents who must stay home without pay to care for children that are sick or need additional care because of school and daycare closures.
  • workers who still have their employment but are not receiving income because there is currently not sufficient work and their employer has asked them not to come to work.
  • wage earners and self-employed individuals, including contract workers, who would not otherwise be eligible for Employment Insurance.

Read More

GST/HST Credit: One time extra payment

If you or a family member is eligible for this credit, you will get a one-time extra payment in May. Regular payments occur in January, April, July and October.

Tip: Remember you need to file your 2019 tax return to continue receiving benefits like this one.

Residents Working With COVID Cases
PARO Principles for Duty Hours and the Government Emergency Act

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

On March 21,  the Ontario Government issued a temporary order enabling Hospitals to implement measures that are not consistent with collective agreements. This order applies to the PARO-CAHO Collective Agreement.

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, in circumstances where the emergent need necessitates it, we ask that:

  • we not take advantage of this time to add 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 you consider providing rest-periods for services/residents;
  • that consideration of health and safety be foremost: is the individual at a level of competence such that they can work safely, at the intensity the situation requires?;
  • consider using one of the PARO-approved COVID models of scheduling (see below) 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, 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, 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

What do I need to know about Personal Protective Equipment?
  • You must be given training on how to use PPE.
  • You must be provided with, and use required PPE.
  • 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 follow the Hospital’s directives on the appropriate use of PPE.
  • 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.

As doctors, we know that with a new pathogen, emerging knowledge may contribute to frequent changes in expectations on adequate PPE for patient investigation, contact, or procedures.

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

Most employees can refuse to do unsafe work without the risk of discipline, if the employee has a reasonable basis to believe the work to be unsafe – this is enshrined in Ontario’s Occupational Health and Safety Act.

However, employees who work in hospitals, like firefighters, police and some others, have a more limited right to refuse unsafe work. Under the Occupational Health and Safety Act, employees who work in hospitals are not allowed to refuse unsafe work if the danger is inherent in the work or the refusal directly endangers the life, health or safety of another person. If, for example, a patient requires urgent care or the patient’s life is in jeopardy and you refuse to work, even if you think it is unsafe, then you are at risk of discipline and personal liability.

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. There is a continuum of urgency to the provision of care and you will need to use your professional judgement to navigate each situation to ensure that the patient’s life is not in jeopardy and that the need for care is not urgent. 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.

I am immune compromised and/or pregnant. Should I be working with COVID cases?

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 women 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.

Am I allowed to refuse to work or request modified duties if I don't want to work with COVID-19 patients?

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.

I'm being assigned to work in the ICU. What can I do to prepare?

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.

Where can I go to get answers about my medico-legal responsibilities?

The CMPA has a dedicated hub for physicians with questions. You can also call their hotline at 1-800-267-6522.

What should I do if I am concerned about exposure or testing?

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. 

Where can I find more information about how residents should be deployed during emergencies?

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.

Residents in Quarantine/Self-Isolation
Will I be paid while on quarantine or in self-isolation?

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.

What do I do if my hospital and Public Health are giving me different instructions?

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.

If I am quarantined or directed to self-isolate, will my training be extended?

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.
Do I need to use vacation for my quarantine period?

No, quarantine is separate from vacation and other leave.

Residents and Travel
If I am quarantined or in self-isolation because of travel, will I 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.

Should I travel during COVID?

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.

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.

Scheduling and Redeployment
What happens if I fall ill and am unable to make my scheduled call?

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. 

Can residents be redeployed?

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, they must work in a manner consistent with the PARO-CAHO Collective Agreement. 
If I am redeployed, do I need to make up time?

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. 

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.

PARO-Approved COVID Scheduling Models

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.

Creating a Back Up Schedule

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

Home Call and Back Up Call Schedule

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 :

  1. a resident who commences work in the hospital after midnight but before 6 a.m.; and,
  2. 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.

7 On/7 Off - Call

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

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.
4 On/4 Off - Shifts

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

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
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

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. 
Modified Night Float

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.
Vacations and Leaves
My program has cancelled my vacation. What do I do?

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. 

We have reports that some hospitals or services are canceling scheduled vacations. 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.

Will I be eligible for exam leave once the RCPSC/CFPC exams are rescheduled?

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 regardless of whether you obtained exam preparation leave time this spring.

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.

My scheduled exam leave was cancelled - can my program do this?

If you have preparation time currently scheduled for the cancelled exam period, the employer (or your program in the role of employer) may decide to cancel the preparation time given the emergency measures and given the postponement of exams.

I already took my exam leave. Can my program require me to use vacation time for that week now that the exams have been cancelled?

If you were among those who used exam leave preparation time for the now postponed Spring Certification examinations, it is PARO’s position that you must not lose any outstanding vacation or other leave time due to having used the exam preparation time in your current contract/academic year.

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 regardless of whether you obtained exam preparation leave time this spring.

Resident Wellness Resources
PARO Helpline

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.

OMA Physician Health Program

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.

Employee Assistance Programs

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.

Please find below a sample 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

PGME Wellness Programs

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.

Western

McMaster

Toronto

Ottawa

NOSM

Queen’s

PGME COVID Resources and Updates
Certification Exam Updates

RDoC UpdateMarch 24, 2020

CFPC UpdateMarch 19, 2020

CFPC FAQ – March 13th, 2020

RCPSC UpdateMarch 21, 2020

RCPSC UpdateMarch 18, 2020

MCC UpdateMarch 13, 2020

Licensing Information
Provisional Licenses for Exam-Eligible Candidates

As soon as we learned that the CFPC, RCPSC and MCC exams were being postponed, we were in touch with the College of Physicians and Surgeons of Ontario to discuss ways to mitigate the impact on our members. Like every provincial regulatory authority, the CPSO is bound by provincial legislation which sets out their powers. Dr. Whitmore, the Registrar of the CPSO, immediately understood our concerns and tasked her staff to find ways that they could mitigate the impact while still operating within provincial legislation. Emergency meetings were called of relevant committees and teams and a solution has been identified.

The CPSO is able to issue a provisional license to any resident who has finished their training and is exam-eligible. This license has to be limited to 6 months, but we understand that this can be renewed or extended if need be.

Restricted licenses for exam-eligible candidates require supervision. However, the CPSO has confirmed that they can adjust the requirements so that a supervisor will be permitted to supervise many physicians at any given time (as opposed to the 1:1 ratio that existed prior). The other significant change is that a supervisor can be off-site or even remote. This step will make it possible for those of you who have made or plan to make arrangements to provide locum coverage. The Registrar also has a directive that will allow the approval of provisional licenses to be streamlined rather than being sent to the Registration Committee for full review. Finally, the CPSO has amended their policies so that no additional fees will be charged when you apply for an independent license. Remember when making plans to start practice that you should ensure you have left enough time for your application for a provisional license to be received and processed.

Restricted Registration During COVID-19

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.

CPSO Updates

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

CPSO Updates

PARO Updates

Work Alert # 3 – Sent March 25, 2020

Work Alert # 2Sent March 18, 2020 

Work Alert # 1Sent March 16, 2020

Financial Updates and Tax Changes
Tax Filing and Payment Deadlines

Tax Return

Normal Due Date: April 30

Extended Due Date: June 1

Taxes Owing

Normal Due Date: April 30

Extended Due Date: September 1

Tip: In order to speed up the determination of your eligibility for the different provincial rebates such as the GST/HST credit and Canada Child Benefit, try to file your tax refund as early as possible.

Read More

OSAP Loan Deferral

From March 30 until September 30, there will be an automatic pause on OSAP repayment schedules.
Therefore, you do not need to apply for the pause. Interest won’t accrue during this period from your OSAP loan.

Note: If you carry a student loan from another province, the federal portion of the student loan deferral will apply. If you have consolidated your student loan with the bank, and are experiencing financial hardship, you may want to contact your bank directly.

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Canada Child Benefit

If you are an eligible recipient of the CCB, you will receive a one-time extra payment of $300 per child in May.

Tip: Try to file your personal tax return earlier so it doesn’t delay the determination of your CCB benefits for 2020–21.

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Mortgage Payments

If you or a member of your family are experiencing financial hardship, you can request a mortgage deferral for up to 6 months. You should contact your bank directly to discuss what options could be available to you.

Note: Interest will continue to accrue during the mortgage deferral period. Therefore, your payments will be slightly higher after the deferral period ends. Although you will pay more interest over the life of your mortgage, a deferral could help with your short-term cash flow.

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Additional Information for Family Members of Residents

Canada Emergency Response Benefit

The government will provide a taxable benefit of $2,000 a month for up to 4 months to:

  • workers who must stop working due to COVID19 and do not have access to paid leave or other income support.
  • workers who are sick, quarantined, or taking care of someone who is sick with COVID-19.
  • working parents who must stay home without pay to care for children that are sick or need additional care because of school and daycare closures.
  • workers who still have their employment but are not receiving income because there is currently not sufficient work and their employer has asked them not to come to work.
  • wage earners and self-employed individuals, including contract workers, who would not otherwise be eligible for Employment Insurance.

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GST/HST Credit: One time extra payment

If you or a family member is eligible for this credit, you will get a one-time extra payment in May. Regular payments occur in January, April, July and October.

Tip: Remember you need to file your 2019 tax return to continue receiving benefits like this one.