The COVID-19 pandemic is demanding a lot of our health care system. PARO is committed to ensuring that you are kept healthy and safe. We have created this dedicated web page to provide you with useful information and to answer many of the questions we are receiving. Because this is a rapidly changing situation, recommendations and guidance may change, so if in doubt, check back to find the most current information. We will only provide information that we know to be accurate or believe to be helpful.
Page last updated on March 29th, 2023.
PARO has consistently advocated that:
- Residents must be included in the roll out plan, and appropriately prioritized on the same terms as other health care workers.
- In planning and prioritization, PGME and the hospitals should consider not just the rotation and/or site where residents are currently but where they will be working in upcoming rotations.
- DME residents must be appropriately included in roll out planning.
- There should be consideration of how planned or urgent redeployment may impact who needs to be prioritized for vaccination.
- There must be clear communication to residents about the roll out. In this time of great uncertainty, clear communication is an important way to minimize sources of stress.
Yes. We have confirmed with the Ministry of Health as well as the Council of Academic Hospitals that residents will not be forgotten or overlooked. It is entirely possible that priority will be given to those residents who are working in higher risk areas. We are working closely with the PGME Offices as well as with CAHO to ensure that we are not overlooked. Coincident with focusing on the vaccine rollout, we are continuing to ensure that appropriate PPE is available so that all residents, regardless of when they receive their vaccination, are protected while they work.
The Ontario Ministry of Health’s Recommendations for third doses may be found here.
The NACI’s Dec 3rd, 2021 guidance regarding boosters may be found here.
The NACI’s guidance regarding the interval between the first and second doses may be found here.
The NACI’s May 3rd, 2021 statement on use of COVID-19 Vaccines may be found here
On Feb 1st, 2022, the MOHLTC issued the following guidance for those who have been vaccinated outside of Ontario:
- Individuals who have received a partial or complete COVID-19 vaccine series outside of Ontario or Canada:
- These individuals should contact their local public health unit to have their COVID-19 immunization record documented in COVaxON prior to receiving any additional doses and for their enhanced vaccine certifictes.
- Individuals who have proof of immunization and have received all recommended doses of a Health Canada authorized COVID-19 vaccine or a combination of Health Canada authorized vaccines with at least the minimum recommended interval between doses outside of Ontario or Canada:
- These individuals are considered to have a complete vaccine series and no additional doses are needed to be considered fully vaccinated.
- Individuals who received the first dose of a two-dose Health Canada authorized COVID-19 vaccine series outside of Ontario or Canada:
- These individuals do not need to restart the vaccine series, but should receive the second dose of a COVID- 19 vaccine as close to the Ontario recommended interval as possible be considered fully vaccinated.
- Individuals who have proof of immunization and have received one or two-doses of a COVID-19 vaccine that is not authorized for use by Health Canada:
- These individuals will be offered one additional dose of an mRNA vaccine to complete their primary series and be considered ‘fully vaccinated’ in Ontario.
- Individuals who have proof of immunization and have received three doses of any non-Health Canada authorized COVID-19 vaccine at the appropriate interval:
- These individuals need no additional doses to be considered ‘fully vaccinated’ in Ontario.
To read the full document, click here.
The MOHLTC has advised PARO, regarding our current members who will be relocating, of the following:
They do not currently have a strategy in place for specific scenarios like this. Given the variability of each resident’s circumstances, there is no one-size-fits-all guidance they can provide on that question.
Their best advice is to engage the first-dose clinic on the question and, if there comes to be a ‘next location’ scenario, to then engage the local vaccine-delivery provider(s).
They also advised that this issue is receiving attention at a variety of levels including at national tables, with universities involved in the dialogue. The advice may become more specific down the road.
Yes. As hospital employees, residents can be assigned specific duties that are within their scope of practice and competencies. In addition, the Council of Faculties of Medicine of Ontario has a policy that spells out the relationship between service and learning and addresses the fact that new work assignments can be given as long as they don’t compromise training.
Another thing to keep in mind is that we are also currently working under the Government Emergency Act, which gives the government additional powers to manage the pandemic. We have appreciated that our employers have been responsible in how they have applied this power.
As always, PARO has been communicating that we expect that all the members of the healthcare team who are qualified to participate in vaccination are included in the rollout strategy.
If you are required to work in a vaccine clinic outside of your regular working hours, you are entitled to be paid a home call stipend if the work doesn’t extend beyond 2300 hrs. In the event that you work in a vaccine clinic beyond 2300 hrs, then you are entitled to an in-hospital call stipend. Similarly, if you are already working home call on your service and you are asked to come into the hospital to work in a vaccine clinic for more than four hours, of which more than one hour is past midnight and before 6 a.m., the stipend would convert to an in-hospital call stipend.
If you are available outside of the specific requirements of your training program, or on vacation, and you are needed and available to provide services, you may also be eligible for compensation as outlined in PARO’s May 3rd Update.
On Feb 1st, 2022, the MOHLTC issued the following guidance for those who have been vaccinated outside of Ontario:
- Individuals who have received a partial or complete COVID-19 vaccine series outside of Ontario or Canada:
- These individuals should contact their local public health unit to have their COVID-19 immunization record documented in COVaxON prior to receiving any additional doses and for their enhanced vaccine certifictes.
- Individuals who have proof of immunization and have received all recommended doses of a Health Canada authorized COVID-19 vaccine or a combination of Health Canada authorized vaccines with at least the minimum recommended interval between doses outside of Ontario or Canada:
- These individuals are considered to have a complete vaccine series and no additional doses are needed to be considered fully vaccinated.
- Individuals who received the first dose of a two-dose Health Canada authorized COVID-19 vaccine series outside of Ontario or Canada:
- These individuals do not need to restart the vaccine series, but should receive the second dose of a COVID- 19 vaccine as close to the Ontario recommended interval as possible be considered fully vaccinated.
- Individuals who have proof of immunization and have received one or two-doses of a COVID-19 vaccine that is not authorized for use by Health Canada:
- These individuals will be offered one additional dose of an mRNA vaccine to complete their primary series and be considered ‘fully vaccinated’ in Ontario.
- Individuals who have proof of immunization and have received three doses of any non-Health Canada authorized COVID-19 vaccine at the appropriate interval:
- These individuals need no additional doses to be considered ‘fully vaccinated’ in Ontario.
To read the full document, click here.
COVID has created many challenges our medical education system has had to address and the delay of the CaRMS match in the spring of 2021 was certainly one of them. We understand that some University PGMEs experienced difficulties in providing rotation schedules to the incoming PGY1s as early as they have in past years as a result.
The PARO-CAHO Collective Agreement requires call schedules to be published two weeks prior to the start of a rotation.
There isn’t a specific requirement for provision of the yearly rotation schedule for each resident; however, there is no doubt that residents rely heavily on early provision of their rotation schedules to be able to plan out their lives.
Factors to be cognizant of:
- Residents may have out of town rotations for which accommodations must be made and may have to make arrangements for additional care for dependants for rotations of a more intense nature or other such impacts.
- Knowing where your rotations will be primarily-based will for some residents factor significantly in terms of choosing a location for where they will live.
- Many electives need planning far in advance and a short turnaround time for announcement of the schedule will make it difficult for residents to schedule their preferred electives.
To mitigate the disruption to the extent possible we ask that PGMEs:
- As early as possible in the match process, communicate with the students who are going through the CaRMS match this year of the anticipated timeline for provision of rotation schedule.
- Provide clear communication between all key stakeholders during this whole process will be key (ie. PGME, PDs/PAs, incoming residents, Chiefs/Seniors, other schedulers etc).
- As soon as is possible provide specific info for your university to incoming matched residents to let them know the schedule is going to be available on ‘x’ date, assure it is coming, and will be available with time to prepare for first day.
- When the final schedule is provided if a change needs to be made after that date then it should be done in consultation with the affected residents.
- Let incoming residents know a specific date when professional leave/vacation time can be requested to help them plan their first year accordingly and ensure schedulers are compliant with the requirements under the PARO-CAHO Collective Agreement regarding vacation requests.
- Recognize that where there might be off-site rotations, short notice will be especially disruptive and they should consider implications re: housing et cetera or move those rotations to later in the year when residents have more time to prepare.
- They should consider that those who do the scheduling, especially sensitive to Chief/Sr residents performing that task, that short timelines will be problematic/stressful for them as well- communicate this change to Chiefs and Senior Residents or others who do the call schedules.
Our hope is that you find this perspective helpful in answering the specific question and in helping us all to navigate this unique CaRMS match in the coming months.
Under the terms of the PARO-CAHO Collective Agreement, residents must be provided with time to write any Canadian or US certification exam, as well as reasonable travel time to and from the exam site. You should be provided with this time for the LMCC1, should you need to write it.
PARO Perspective on Self-Isolation Prior to Employment Start
Where the employer reasonably requires self-isolation for incoming residents to a hospital/site, for example, because of the particular needs of the patient community, because the resident has travelled internationally, or because of other personal circumstances, the resident may agree to do so prior to the start of the residency, provided that any resident who is unable to self-isolate fully before the start of residency will face no repercussions and will be permitted to self-isolate or complete self-isolation upon the start of residency, without loss of pay or benefits under the PARO-CAHO Collective Agreement or additional costs to the resident.
In addition PGME must commit that:
- They have support of Program Directors to permit residents, where necessary, to start or continue self-isolation after July 1, without loss of pay or benefits or other repercussions, recognizing their employment doesn’t start until July 1st.
- Residents who self-isolate, in whole or in part, from July 1st on will not be required to use vacation/professional leave days or other such days for the period of self-isolation.
- They expand in-place housing strategies for residents required to self-isolate when coming to new site for those residents who do not have housing already in place for that period of time.
- They provide guidance to Programs on how to integrate residents who do not complete self-isolation before July 1 into their programs when they are able to come out of self-isolation.
- They cooperate with hospitals to provide training online or virtually with multiple dates and times available for these sessions with a mentorship-style program and with a more senior resident, to allow for informal orientation and briefing on what to expect to ease the transition for residents who do not complete self-isolation before July 1.
- Residents who do not self-isolate prior to their start of employment must not be disadvantaged in any way, including not being at greater risk for extension of training.
- They provide clear communication to incoming trainees at the site, Program Directors, administrative staff and individual preceptors of all of the above.
Updated March 31st, 2020 to reflect PARO’s newly developed principles for duty hours under the Act.
By now, you have no doubt heard that in March, the Ontario Government issued a temporary order enabling Hospitals to implement measures that are not consistent with collective agreements in order to address the ongoing COVID-19 pandemic. This order applies to the PARO-CAHO Collective Agreement, as well as the Agreements governing other healthcare workers.
These are extraordinary times, and we know that the Government and hospitals are facing unprecedented challenges. We know our members are already working extremely hard to help combat COVID-19 in Ontario, and have been making extraordinary contributions. While we recognize that the Ontario Government’s Emergency Act provides ability to contravene the Maximum Duty Hours provisions in the PARO-CAHO Collective Agreement, we believe this ability must be exercised judiciously. Therefore, in situations where an emergent need prevents the hospital from adhering to the strict terms of the Collective Agreement, PARO asks that:
- Services not take advantage of this time, and those who are responsible for creating schedules avoid adding to residents’ work schedules unless necessary;
- that workload is distributed as equitably as possible amongst all team members, including staff, residents, and other trainees;
- that schedulers consider providing rest periods for services/residents;
- that consideration of health and safety be the priority: is the individual at a level of competence such that they can work safely, at the intensity the situation requires?;
- that schedulers consider using one of the PARO-approved COVID models of scheduling (see section titled “PARO-Approved Scheduling Models” below for full descriptions) that could work for your service/program;
- should there be a need to make changes to the call schedule post-distribution, or after the two week deadline, services should provide as much notice and compassion to the affected residents as possible and, where possible, utilize the emergency clause process in the PARO-CAHO Collective Agreement (Article 16.1c):
- residents be paid call stipends if required to work in excess of the provisions of the Agreement, even if it exceeds the maximum call stipends also included in the Agreement;
- that we all remain flexible in scheduling to support residents who are experiencing difficulties during this time, including but not limited to, residents with families to care for, and residents dealing with grief, burnout, and anxiety.
If you have concerns about your health and safety, including the sustained ability to provide service as a result of any measures that are implemented, please send an email to covid19@paroteam.ca
Updated April 24th, 2020
In response to PARO’s concerns about protections for residents who refuse unsafe work, our employer has now provided us with Ontario Health’s recommendations for COVID-19 work refusals. One of the principles set out by Ontario Health is that, ‘no employee shall suffer any form of reprisal for refusing work he or she believes to be unsafe’.
It is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.
We have also been in discussion with the CPSO, and while they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available. We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.
- You must be given training on how to use PPE.
- You must be provided with, and use required PPE.
- You must follow the Hospital’s directives on the appropriate use of PPE including appropriate donning/doffing
- You have the right to refuse work if you aren’t provided required PPE, provided that refusing work does not directly endanger the life, health, or safety of another person.*
- You must do your part to ensure that you don’t contribute to diminishing supplies.
- If you are aware of a risk of a shortage of PPE, then you should raise the concern with your supervising staff, program director, occupational health or the Hospital Administrator on call. We understand that in many hospitals, it is the ‘supervisor or unit manager/leader’ who is responsible for monitoring and securing PPE supply.
*
Your safety is of paramount importance to PARO, and that includes the provision and use of Personal Protective Equipment.
In situations where the hospital does not provide you with appropriate PPE and there is no risk to a patient’s life or need for urgent care, it is PARO’s position that you can refuse work that you reasonably believe to be unsafe.
In any refusal to work, you must immediately notify your supervisor of the refusal.
It remains PARO’s position that you must be trained and provided with appropriate PPE. However, it is also important that you also be aware of your obligations and the limitations of the right to refuse unsafe work under the Occupational Health and Safety Act.
Updated April 24th, 2020
In non-urgent situations where appropriate PPE is not provided to you, it is PARO’s position that a refusal to work is a right under the Occupational Health and Safety Act and you are protected from reprisal.
Working without appropriate PPE is not a normal condition of employment of residents. In situations where life-saving urgent care is required, the law does not protect you from reprisal and you face three risks in any refusal of work: 1) the risk of discipline by the hospital; 2) the risk of discipline by the CPSO; and 3) the risk of civil action.
In response to PARO’s concerns about protections for residents who refuse unsafe work, our employer has now provided us with Ontario Health’s recommendations for COVID-19 work refusals. One of the principles set out by Ontario Health is that, ‘no employee shall suffer any form of reprisal for refusing work he or she believes to be unsafe’.
We take this as assurance that, during the COVID-19 pandemic, our employer hospitals will not discipline any resident who refuses work that he or she believes to be unsafe.
In all of our messages to you related to PPE, we have told you that in non-urgent situations, where appropriate PPE is not provided, your right to refuse work is protectedby the Workplace Occupational Health and Safety Act. What has always concerned us is that the Act specifically excludes hospital workers from the right to refuse work in situations where life-saving urgent care is required.
However, having obtained Ontario Health’s recommendations for COVID-19 work refusals from our employer, it is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.
We have also been in discussion with the CPSO, and while they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available.
We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.
In any refusal to work, you must immediately notify your supervisor of the refusal.
Updated April 24th, 2020
PARO is committed to providing you with accurate advice and will not minimize the truth, no matter how hard it may be to share, if that could put residents at risk.
While we do not get to dictate what is in provincial legislation, such as the Occupational Health and Safety Act, it is PARO’s obligation to make sure our members know what is required and to tell you exactly what we are doing to make sure that you are able to stay safe.
The fact that doctors working in hospitals, as well as a few other designated workers, are limited in their right to refuse work that is unsafe where the danger is a normal condition of employment or in situations where someone’s life is at stake, is not PARO’s opinion – it’s the law in Ontario. The fact that other organizations might be providing conflicting information doesn’t guarantee that they understand how Ontario labour law applies to residents nor does it remove our obligation to ensure you understand the risks of not providing care.
In non-urgent situations where appropriate PPE is not provided to you, it is PARO’s position that a refusal to work is a right under the Occupational Health and Safety Act and you are protected from reprisal. Working without appropriate PPE is not a normal condition of employment of residents.
In situations where life-saving urgent care is required, the law does not protect you from reprisal and you face three risks in any refusal of work: 1) the risk of discipline by the hospital; 2) the risk of discipline by the CPSO; and 3) the risk of civil action.
In response to our concerns about residents who refuse unsafe work, we are pleased that our colleagues at CAHO have provided us with Ontario Health’s recommendations for COVID-19 work refusals.
It is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required.
We have also been in discussion with the CPSO, and while they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available.
We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.
Updated April 24th, 2020
We do not believe you should be providing care when you are not safe – so let us share with you what we are doing to ensure that you can stay safe and avoid these risks:
- We have been speaking with our employer hospitals to get written assurance that, if a hospital is unable to provide appropriate PPE and a resident feels that it is unsafe to provide care, even in situations where the refusal to provide care endangers the life, health or safety of another person, the resident will not be subject to any disciplinary measures.
- In response to PARO’s concerns about protections for residents who refuse unsafe work, our employer has now provided us with Ontario Health’s recommendations for COVID-19 work refusals. One of the principles set out by Ontario Health is that, ‘no employee shall suffer any form of reprisal for refusing work he or she believes to be unsafe’. We take this as assurance that, during the COVID-19 pandemic, our employer hospitals will not discipline any resident who refuses work that he or she believes to be unsafe.
- It is our expectation that hospitals will follow the Ontario Health recommendations, and that residents will not be subject to any form of discipline or reprisal if you refuse work that you believe to be unsafe, even in situations where life-saving urgent care is required. In the event that appropriate PPE is not available, and you face any sort of discipline or reprisal for not providing care, even in life-saving situations, contact PARO immediately so that we can advise you and assist with defending you.
- We have been in contact with the College of Physicians and Surgeons of Ontario. While they are unable to provide firm assurance one way or the other regarding the outcome of any future complaint, they have adjusted their advice on their web site to specifically deal with our concerns about decision-making and what care to provide as it relates to life-saving/life-sustaining treatment in the event that PPE is not available. Key to their posting is the assurance that any complaints will be evaluated in context. You can find their latest advice here.
- We have been in discussions with CMPA and have received assurances from them that if you choose not to provide care because appropriate PPE is not available and you are subject to disciplinary action by a licensing authority, or if you face civil action, the CMPA will provide you with representation.
- We are advocating to the provincial government to ensure that we have enough PPE available for all health care providers.
- Through Resident Doctors of Canada, we have joined with all of the other national medical organizations to write to all levels of government about the provision of PPE.
- We are pushing for national guidelines on the appropriate provision and use of PPE so that each jurisdiction and hospital has a consistent evidence-based approach.
If you are immune-compromised, listen to the advice of your treating physician. If they feel that you should be deployed in a manner that minimizes your risk of exposure to COVID-19, let your Program Director or your PGME Office know. Do not hesitate to contact PARO if you require any assistance in ensuring you’re protected.
The Canadian Government website identifies that there is insufficient evidence to suggest pregnant people are at greater risk. PARO’s view is that we should err on the side of caution. If you are pregnant and have been told by the hospital that you need to go to work, please let us know by emailing covid19@paroteam.ca
If your personal physician advises that there is a medical reason for you to not be exposed to COVID-19 then advise the hospital that you require accommodation. The hospital may require that your personal physician provide medical documentation to support the request for accommodation. If the hospital refuses to accommodate, advise PARO immediately so that we can determine whether further steps need to be taken.
In the absence of advice from your personal physician you must follow the hospital’s directive.
Depending on your particular circumstances, general health and the service you are on, additional measures like redeployment may also work for you.
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.
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.
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.
IMPORTANT UPDATE – March 2023 – The Government has announced that they will be discontinuing the MRRP effective April 1, 2023.
If you did MRRP shifts, please note that you are required to report the income on your tax return. The hospital that hired you to do the MRRP shifts may have supplied you with a T4 slip, but they are not required to do so. Whether you received a T4 slip or not, you are required to report the income as self-employment income.
The MRRP was a government program that allowed residents to provide additional services between April 28 2021 and March 31, 2023 without requiring an independent practice license or Restricted Registration certificate, at a rate of $50/hour.
PARO Perspective on Self-Isolation Prior to Employment Start
Where the employer reasonably requires self-isolation for incoming residents to a hospital/site, for example, because of the particular needs of the patient community, because the resident has travelled internationally, or because of other personal circumstances, the resident may agree to do so prior to the start of the residency, provided that any resident who is unable to self-isolate fully before the start of residency will face no repercussions and will be permitted to self-isolate or complete self-isolation upon the start of residency, without loss of pay or benefits under the PARO-CAHO Collective Agreement or additional costs to the resident.
In addition PGME must commit that:
- They have support of Program Directors to permit residents, where necessary, to start or continue self-isolation after July 1, without loss of pay or benefits or other repercussions, recognizing their employment doesn’t start until July 1st.
- Residents who self-isolate, in whole or in part, from July 1st on will not be required to use vacation/professional leave days or other such days for the period of self-isolation.
- They expand in-place housing strategies for residents required to self-isolate when coming to new site for those residents who do not have housing already in place for that period of time.
- They provide guidance to Programs on how to integrate residents who do not complete self-isolation before July 1 into their programs when they are able to come out of self-isolation.
- They cooperate with hospitals to provide training online or virtually with multiple dates and times available for these sessions with a mentorship-style program and with a more senior resident, to allow for informal orientation and briefing on what to expect to ease the transition for residents who do not complete self-isolation before July 1.
- Residents who do not self-isolate prior to their start of employment must not be disadvantaged in any way, including not being at greater risk for extension of training.
- They provide clear communication to incoming trainees at the site, Program Directors, administrative staff and individual preceptors of all of the above.
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.
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.
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.
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.
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.
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.
- they must only be expected to practice within their scope of competency
- the hospital must respect advice from their treating physician if they are pregnant or immune-compromised
- and, should an emergent need prevent them from working within the maximum duty hours set out in the PARO-CAHO Collective Agreement, they should work in a manner consistent with PARO’s principles around Duty Hours and the Ontario Government Emergency Order (see above).
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.
During the pandemic, many programs implemented new scheduling models in order to minimize resident exposure, prevent burnout, and ensure service provision during times of heightened need. PARO identified a number of models across the province that did this well.
In March 2023, the government decided to end the MRRP because it was felt that the pandemic had evolved to a point that extra resident manpower was no longer required. With this in mind, PARO has notified the Hospitals and the PG Deans, that we are ending all PARO-Approved COVID Scheduling Models, effective March 31, 2023.
Given the extraordinary circumstances that are unfolding related to the COVID-19 pandemic, it is very important that residents comply with any directions you receive to report to work.
If you have been required to cancel your vacation, comply with the direction to report to work and let us know the details by emailing covid19@paroteam.ca
PARO is monitoring the situation and we are actively looking into what options might be available should you be unable to take vacation or have it cancelled.
If you are continuing as a resident in Ontario during the next academic year, it is PARO’s position that you must receive exam preparation leave time in accordance with the PARO-CAHO Collective Agreement.
If you are continuing as a resident in another province during the next academic year, we are working to understand what provision can be made for the exam preparation time. We will provide you with that information when it becomes available. Please note that not all provinces’ Collective Agreements provide exam leave preparation time.
If you are continuing as a resident in another country during the next academic year, you will need to ask your new program director to provide you with adequate time to prepare for the rescheduled exams.
If you are completing residency training prior to the postponed Canadian certification examinations and starting a clinical practice or Clinical Fellowship* in Canada or abroad, you will need to ask that your contract for that position include providing you with adequate time to prepare for the rescheduled exams.
*Clinical Fellowship is further training that is not in a RCPSC or CFPC recognized specialty/subspecialty and does not lead to certification or certificate of competence.
We were able to get the Hospitals and Government to agree that for any lieu day earned during the period of the COVID-19 pandemic, that the 90 day period under Article 13.3 of our Collective Agreement would be extended for an additional 30 days, subject to the approval of your Program Director.
We are aware that many of you have been unable to make use of your extended health care benefits during the pandemic. We tried very hard to find a way to have these benefits carried over to the new academic year. Unfortunately, we have not been able to find a solution that the Hospitals could implement. The extended health benefits are not structured in a way that they can be tracked and carried over to a new year.
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.
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.
Each EAP is different depending on the services the employer has arranged – but examples of services may include legal support, parenting and child care, and counseling services to name a few.
EAPs are intended to be short-term solutions, providing the individual with the immediate support they need to be well, and then develop a plan for the long-term, sometimes with a referral from the EFAP service provider for further treatment.
Psychotherapy is available each centre at no cost to the employee on a short-term basis until the employee is well. A long term solution is then determined based on their specific needs.
Please find below a list with links to some EAP plans. If you are unable to find a specific hospital site on the list below, we recommend you contact the Human Resource department at the hospital you are working at for more information.
McMaster University
St. Joseph’s Healthcare Hamilton
- Signs and symptoms of burnout
- Self-assessments
- Tools to help prevent and manage burnout
- Resources for physician leaders to help them identify, prevent and manage burnout on their teams.
Their COVID webpage also contains numerous other public resources to support those struggling during this time.
The CMHA has put together a master list of resources for individuals facing wellness struggles. The guide includes mental health supports, online resources, and COVID-specific resources for both individuals and healthcare providers.
To download the guide, click here.
Taking the time to support your mental and physical health helps you to show up better for yourself, your loved ones, your peers, and your patients. Whether you are a self-care novice, or expert, this list of resources offers excellent health and wellness support.
Guided Meditations
Mental Health Resources
- CAMH COVID-19 Resources for Healthcare Workers
- Mental Health Commission of Canada COVID-19 Self Care and Resilience Guide
Yoga Classes
Fitness Classes
- Training – Lululemon
- Running – Lululemon
- Free Trial: Alo Moves
- Free Trial: Obe Fitness
Private e-Counselling
- Free Trial: Better Help
Running low on novel things to do on your time off or in self-isolation? This list of resources offers unique experiences that will get out of your home, and back into the world, from the comfort of your living room.
Live Zoo Cams
Virtual Tours
More
RDoC Update: MCC Ceases QE2 – June 10, 2021
RDoC Update on MCCQE2 – June 1
RDoC Update on MCCQE2 Exams – May 19, 2021
RDoC Update on RCPSC Oral Exams – April 29, 2021
RDoC Exam Update – April 19, 2021
RDoC MCCQE2 Update – March 16, 2021
PARO Update on CPSO MCCQE2 Exemption Policy – March 9, 2021
RDoC MCCQE2 Update – March 8th, 2021
RDoC MCCQE2 Update – March 5, 2021
RDoC MCCQE2 Update – October 23rd, 2020
RDoC MCCQE2 Update – October 7, 2020
RDoC Exam Update #6 – April 3, 2020
CFPC Update – April 15, 2020
CFPC FAQ – March 13th, 2020
RCPSC Update – April 9, 2020
RCPSC FAQ – April 24, 2020
MCC Update – March 13, 2020
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.
A link to the CPSO FAQ on COVID may be found here:
Optimizing the use of masks and respirators during the COVID-19 outbreak;
- Guidance on the use of expired N95 respirators and masks; and
- Guidance on the use of commercial-grade respirators for medical purposes.
List of diagnostic devices for use against coronavirus (COVID-19)
Interim national case definition: Coronavirus Disease (COVID-19)
Interim national surveillance guidelines for human infection with Coronavirus Disease (COVID-19)
Coronavirus disease (COVID-19): Summary of Assumptions
Public health management of cases and contacts associated with coronavirus disease (COVID-19)
Public Health Agency of Canada
Hamilton Public Health Updates
Kingston Public Health Updates
Middlesex-London Public Health Updates
Sudbury and Districts Public Health Updates
Thunder Bay District Public Health Updates
Read This If You Have Been Asked To Provide Additional Coverage – December 23, 2021
Update on MRRP – September 28, 2021
Important Update – June 14, 2021
PARO President’s Update – Sent May 3rd, 2021
PARO Update on CPSO MCCQE2 Exemption Policy – Sent March 9, 2021
Work Alert #11 – Sent Dec 22, 2020
Work Alert #10 – Sent Dec 12, 2020
Work Alert #9 – Sent June 25, 2020
Work Alert #8 – Sent May 29, 2020
Work Alert #7 – Sent May 22, 2020
Work Alert #6 – Sent April 29, 2020
Work Alert #5 – Sent April 24, 2020
Work Alert #4 – Sent April 9, 2020
Work Alert # 3 – Sent March 25, 2020
Work Alert # 2 – Sent March 18, 2020
Work Alert # 1 – Sent March 16, 2020
RDoC Update: MCC Ceases QE2 – June 10, 2021
RDoC Update on MCCQE2 – June 1
RDoC Update on MCCQE2 Exams – May 19, 2021
RDoC Update on RCPSC Oral Exams – April 29, 2021
RDoC Exam Update – April 19, 2021
RDoC MCCQE2 Update – March 16, 2021
RDoC MCCQE2 Update – March 8th, 2021
RDoC MCCQE2 Update – March 5, 2021
RDoC Update on COVID-19 and Exams – October 30th, 2020
RDoC MCCQE2 Update – October 23rd, 2020
RDoC MCCQE2 Update – October 7, 2020
RDoC Exam Update #6 – April 3, 2020
CMF PPE Call To Action – March 30, 2020
RDoC Exam Update #5 – March 24, 2020
RDoC Exam Update # 4 – March 18
RDoC Exam Update #3 – March 14
- Providing care to COVID patients in ICU.
- Performing the most high-risk procedures to COVID patients such as intubation and code-blues for cardiac and respiratory arrest.
- Providing care to patients on COVID-designated wards.
- Working at COVID-19 assessment centres.
- Providing care to patients virtually and by telephone.
- Providing screening and care to employees and residents of Long-Term Care Facilities.
- Providing service at an isolation unit for shelter populations.
- Running hospital simulations for COVID-19 related care.
- Providing donning and doffing training to healthcare workers to ensure correct use of PPE.
- Actively participating in hospital pandemic committees and planning meetings.
Update as of Jan 1, 2022:
It is our understanding that the Ontario government is still working on a plan for free emergency child care for school-aged children of health care workers and other eligible frontline workers. Further updates will likely be shared on their "COVID-19: Keeping Schools Safe" webpage.
In the meantime, they have a resource that lists the supports available to working parents during the pandemic on their "COVID-19: Health and Safety Measures for Child Care" webpage.
There is no specific language in the PARO-CAHO Collective Agreement on emergency child care. As such, in the absence of support from the Ontario government or a local child care service, the logistics of emergency child care will largely be a resident/program-level decision. In our experience, programs can make accommodations on a case-by-case basis, and a face-to-face meeting between the resident and the program to discuss the accommodation request is optimal.
There is Emergency Leave provided for by the Employment Standards Act (ESA) that residents may be eligible. However, it is our understanding that Emergency Leave is unpaid.
Residents can where necessary, use vacation. In our experience, even where other requests cannot be approved, vacation has been approved where there is an issue with child care. If the resident no longer has remaining vacation, they should be able to take an unpaid Leave of Absence.
A program cannot be compelled to provide a virtual care option to their residents, but we are aware of this option having been offered to some residents.
Finally, residents may qualify for the Canada Recovery Caregiving Benefit (CRCB).
If you cannot access any of these options, contact PARO for support.
On October 2nd, 2020, the Ontario Government updated their Guidance for Schools and Childcare to help parents make decisions about when to keep their children at home, and when to seek a test for COVID-19.
Click here to read about the updated Guidance.
Click here to access the updated online screening too.
Updated May 12, 2021
Information about free Emergency Child Care for Frontline workers and the complete list of Emergency Child Care centres throughout the province can be found here.
Toronto
Emergency childcare for kindergarten and school-aged children of eligible essential workers will be available during the provincially-mandated remote learning period. The service is available at no cost to eligible families who qualify as essential workers and who are not able to accommodate their school-aged child’s care at home.
Click here to see the list of Emergency Child Care Centres and apply.
Hamilton
As Ontario schools remain closed to limit the spread of COVID-19, the Ministry of Education and the City of Hamilton is providing targeted free emergency childcare for the school aged children of designated essential service workers. Effective April 19, 2021, emergency childcare services is available for designated essential workers as defined by the Provincial eligibility requirements, who are not able to accommodate their school-aged child’s learning or care at home.
Click here to see the list of Emergency Child Care Centres and apply.
London
Due to the restrictions in place, to support front-line workers of school-aged children who may not be able to support their child’s learning or care at home, the Ministry of Education will be implementing a targeted emergency childcare program for school-aged children who are enrolled in school, at no cost to eligible parents, during the period when schools are operating remotely.
Click here to see the list of Emergency Child Care Centres and apply.
Kingston
As a measure to support health care and front-line workers during the Provincial Lock-Down, the City of Kingston in partnership with Licensed Child Care Operators is opening licensed spaces for emergency childcare services starting April 19, 2021. The service is provided at no costs to families, funded by the Province of Ontario, for school-aged children.
Click here to see the list of Emergency Child Care Centres and apply.
Ottawa
The Ministry of Education is implementing a targeted emergency childcare program for essential frontline workers, for school-age children, at no cost.
Click here to see the list of Emergency Child Care Centres and apply.
Greater Sudbury Area
Licensed child-care centres are now providing care to school-aged children of essential workers at no cost. This will support essential workers who are not able to accommodate their school-aged children’s learning or care at home due to ongoing school closures in the community.
Click here to see the list of Emergency Child Care Centres and apply.
Thunder Bay
No specific information provided regarding Emergency Child Care for essential front line workers, but a list of childcare centres, and how to apply, can be found here.
PARO understands that in some cases, the University may arrange for shared accommodation for residents on rotations away from their home base. In these cases, PARO expects that:
- The accommodations provided comply with local public health directives and COFM Guidelines;
- That alternative housing arrangements are provided for residents that are pregnant or immunocompromised and whose advising physician advises that they are unable to share accommodations with other individuals;
- That alternative housing arrangements are provided to residents who have high-risk family members at home and for whom self-isolation following a period of time spent in shared accommodations would be too burdensome.
- That the University consult with individual residents who raise concerns about their shared accommodation to understand their circumstances and make reasonable attempts to resolve any concerns.
International Learners Arriving to Canada – as of August 2021
Accommodations Resources for U of T – April 28 2021
Please reach out to Lisa Bevacqua at lisa.bevacqua@utoronto.ca who will assist you with any of your housing needs and questions.
As of January 17, 2022:
In order to help alleviate the number of learners sharing space in NOSMU Housing and to make it safer for all learners performing placements in our NOSMU communities, NOSMU is temporarily implementing a COVID Housing Reimbursement option to find self-arranged accommodations.
For more information, click here.
The CMPA has developed a free COVID-19 Healthcare Cybersecurity Update for healthcare providers. This is a bilingual eLearning course for those working in the Canadian healthcare space, created in light of the increase in virtual care. The course is comprised of two modules which take approximately 7 minutes to complete.