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 23
Government Order - March 21

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.

PARO Staff and legal counsel are examining the order to determine how this might impact you. If there are any measures taken that we think are unreasonable, PARO will, as always, advocate on your behalf to either your PG Dean or the Hospital.

You should continue to follow the directions of your Hospital and/or Program Director.

We continue to connect with PG Deans and hospitals and to review redeployment plans as they become available.

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.

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.

CPSO and 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.

Residents Working With COVID Cases
What do I need to know about the government order issued on March 21 ?

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.

PARO Staff and legal counsel are examining the order to determine how this might impact you. If there are any measures taken that we think are unreasonable, PARO will, as always, advocate on your behalf to either your PG Dean or the Hospital.

You should continue to follow the directions of your Hospital and/or Program Director.

We continue to connect with PG Deans and hospitals and to review redeployment plans as they become available.

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.

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.

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 Emergency Preparedness Guidelines

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?

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 Guidelines on Residents and Emergency Preparedness 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.

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
I am trying to make a back-up call schedule. What do I need to know?

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 fo 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

Can I be required to exceed my call maximums during COVID?

No. The terms and conditions of the PARO-CAHO Collective Agreement will continue to apply. There is no language in the PARO-CAHO Collective Agreement that would allow for residents to be scheduled over and above their call maximums, or suspend any other part of the Collective Agreement.

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?

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 Emergency Preparedness Guidelines 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.

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.

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 Help 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