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 July 27
How will the payout for unused vacation be calculated?

The payout for vacation will be a straight calculation based on annual salary (i.e. one week of vacation is equivalent to one week of salary).

We understand that each payroll centre has a different system for processing payments. Given that they must pay residents in accordance with the salaries outlined in the PARO-CAHO collective agreement, the hourly rate/day must be calculated based on the agreed salary scale and the total payment should be the same regardless of what system is being used. 

For example, if the payroll system pays $1000 in a term of a week, the payroll centre who uses the 5 working days has a higher daily rate ($200 per day) than the 7 days working rate ($142.85 per day), but the total payment for the week is the same ($200 x 5=$1000, $142.86 x 7=$1,000). The payroll centre must ensure that residents are paid the same total amount during the given period.  

Please notify PARO if there are any concerns with respect to your payments. 

Will the payout apply to professional leave and/or the floating holiday?

The agreement by the employer and Government to provide payment in lieu of untaken vacation by the end of this employment/academic year does not extend to any untaken Professional Leave for educational purposes or to the floating holiday. 

Residents who are continuing training in Ontario should be able to carryover any of their remaining professional leave over into the new academic year. 

Similarly if residents were unable to take their floating holiday programs can make arrangements so that those residents can take them next year.

We appreciate the Programs’ advocacy and commitment to ensure we mitigate the impacts of COVID-19 to our members’ training and work experience these past months, and in those coming where we can.

When will I receive the payout?

We have worked hard to ensure that you receive payment for any vacation you were unable to take as a result of COVID-19 and are doing everything we can to get the money in your pocket as soon as possible. Our current understanding is that the Ministry of Health expects payouts will be issued in September or October.

You will have received a notification from your paymaster or postgraduate office requesting with specific instructions to confirm your outstanding vacation. If you have not received a notification, please contact your PGME office.

Information for Incoming PGY1s
Will I be eligible for exam leave for the MCCQE1 and/or 2?

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 both the LMCC1 and LMCC2, should you need to write them.

I am an incoming resident. Do I need to complete a self-isolation period before July 1?

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

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

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

What do I need to know about Personal Protective Equipment?

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.

What if I do not have access to Personal Protective Equipment?

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.

Why does your guidance on PPE differ from that provided by other organizations?

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.

What is PARO doing to help residents stay safe?

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.
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.

Will the Pandemic Pay announced by the Ontario Government apply to residents?

Updated May 29, 2020

On April 25, the Ontario Government’s made an announcement about pandemic pay for some frontline workers fighting COVID-19. However, we were greatly disheartened when we saw the list of health care workers and realized that residents were not included.

Every day, the Government has run full page advertisements in the major newspapers thanking the ‘heroes that go to work each day’, including the “doctors, nurses, paramedics, personal support workers and pharmacists who are caring and providing for our sick”. Despite these overtures, the governments’ pandemic pay plan has recognized some and not others and their ‘thanks’ rings hollow when you are one of the groups that they are publicly thanking, but, through their policy initiatives, are choosing to ignore. They have forgotten many frontline health care providers, including residents, laboratory workers, radiology technologists, pharmacists and more. In contrast, the two other provinces that have introduced pandemic pay plans, Quebec and British Columbia, have included residents, as well as other front-line health care providers, that Ontario has chosen to forget.

The Ontario government earned praise from many when they announced their pandemic pay plan, long before the federal government indicated that they would be footing up to 75% of the bill. We were shocked when we saw the eligibility list and realized that residents hadn’t been included, so we immediately went to work to ensure that your commitment to patients and the work that you are doing was recognized.

PARO has a long and proud history of successfully challenging decisions that adversely affect our members. We knew from past experience that we had to ensure that the Minister of Health, her political staff, and the Ministry officials understood the essential role that residents play in keeping our health care system operational. We also knew that we had to mobilize support from key influencers, both inside and outside of government. For the past few weeks, we have drawn on the experience of our senior staff, legal team, and government relations specialists to mobilize support and make our case. I wrote to the Minister of Health and the Premier on multiple occasions providing the necessary information to systematically debunk the reasons that we were hearing for why we had been excluded. We garnered support and letters and phone calls from a wide range of key influencers, including the Deans of all six medical schools, as well as representatives from the Association of Faculties of Medicine of Canada, the Canadian Medical Association, the College of Family Physicians of Canada, the Medical Council of Canada, Resident Doctors of Canada, the Royal College of Physicians and Surgeons of Canada, the Society of Rural Physicians of Canada, HealthCareCan and the Canadian Medical Protective Association. We used our networks to have trusted individuals make personal phone calls to advocate on our behalf.

We had multiple conversations with our Employer, the Council of Academic Hospitals of Ontario and dealt directly with the Vice President of Labour Relations and Chief Negotiations Officer for the Ontario Hospitals Association. The President of the Ontario Hospital Association wrote a strong letter to the government outlining the importance of including all frontline health care workers in the pandemic pay plan. The OHA advocated directly on our behalf to the Minister, her staff, and senior Ministry officials. We joined forces with and supported the efforts of a coalition of health care employers who wrote a compelling letter to the Premier and the Minister this past Monday.

At the beginning of the week of May 25, we were realizing the benefits of all of our hard work. Every indication provided reassurance that we had successfully made our case that residents were essential to the smooth operations of our health care system and that we should expect an announcement about pandemic pay before the end of the week. Many of the organizations representing overlooked frontline health workers were under the impression that the Ministry of Health was recommending an expansion of the program to include those that had been forgotten.

This is why we were shocked to learn on May 28th, that, under the cover of darkness late on Wednesday night, the Deputy Minister of Health released a Memorandum on Pandemic Pay Eligibility.  In this memorandum she explained that there was a limit to the amount of funding provided by the federal government and that, after careful consideration, ‘the government will not be expanding the pandemic pay beyond those already eligible’. The rationale seems unsatisfactory given that weeks after Ontario first announced their plan the Federal Government announced that they would pay 75% of the bill.

One of the critical skills required to make it through medical school and to thrive in residency, and one of the hallmarks of PARO, is tenacity. We know we were successful in changing the mindset of the Ministry of Health on the critical role that we play. So now we need to turn our focus on the President of the Treasury Board and Premier Doug Ford – the person who is ultimately responsible for the decisions of government. We also plan to ensure that the Federal Government fully appreciates that their plan to recognize the efforts of frontline workers is being implemented differently between the provinces.

We successfully demonstrated to the Minister of Health that we enjoy a high level of support by key players in health care and medical education and we know it made an impact.

Now is the time to galvanize public support for residents and the other frontline health care providers we work with every day, who the government has chosen to forget.

The PARO Board and senior staff met late May 28th to discuss and refine the next steps of our plan to make sure that you aren’t forgotten. We need your help. In the past few weeks, we witnessed the power of the anecdotal stories we told about the impact of the pandemic on residents’ lives.

We intend to put a face on what it means to be a resident during this pandemic.

Everyday, you make a difference in the lives of others and by sharing your story you can make a difference in your own. We will use the personal stories we receive to convince decision makers that they need to reverse their decision. Stories have a way of resonating and our human impact messages are our most persuasive tool at this time. Other healthcare workers have also been forgotten and our joint effort will make us visible to those in power who have chosen to look away. If you aren’t sure what to say, tell us how COVID has changed the way you work, or share a sacrifice you’ve made in the name of COVID, or tell us what it would mean to the hospital if residents weren’t there. Images are also powerful – so share a photo of you at work with your PPE or with other colleagues who have been forgotten – or grab a photo of you and others with handwritten “Forgotten on the Frontline” signs.

We are reaching out to the other health care groups who have been ignored and will be inviting them to join us in our Forgotten on the Frontline initiative.


April 27th: Letter from PARO to Minister of Health Christine Elliott outlining why our members should be included –  click here

April 29th: Letter from PARO to Premier Doug Ford – click here

May 1: Letter from the Ontario Deans – click here

May 12: Letter from the Canadian Medical Forum – click here

May 25: Letter from the Ontario Hospital Association, CMHA, and the Association of Family Health Teams – click here

I'm being assigned to work in the ICU. What can I do to prepare?
The University of Toronto has developed an online resource for non-intensive care clinicians — doctors, nurses, RTs, and others — who may find themselves working in critical care during the pandemic. www.QuickICUTraining.com can serve as a study guide and quick reference resource for those upskilling, renewing, or reviewing their critical care capabilities in response to COVID-19. It is meant to supplement simulation- and/or on-the-job learning and more formal training programs that your local region may be using.

QuickICUTraining.com is comprised of short “pocket card” summaries, evidence-focused lectures, procedural demonstration videos, and links. Content on this website is a result of both collation of existing materials and novel creation. The website also houses triage guidelines and recommendations.

Where can I go to get answers about my medico-legal responsibilities?
The CMPA has a dedicated hub for physicians with questions. You can also call their hotline at 1-800-267-6522.
What should I do if I am concerned about exposure or testing?
As an employee of the hospital, you have access to Occupational Health services on the same terms and conditions as other employees. We encourage you to make use of any services being provided by the hospital in order to minimize your exposure while carrying out your clinical duties. 
Where can I find more information about how residents should be deployed during emergencies?
COFM Residents and Public Health Emergency Preparedness Guidelines(Updated March 26, 2020)

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

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

Having learned from these previous experiences these guidelines were developed by the Council of Ontario Faculties of Medicine in collaboration with PARO, so that programs, hospitals, and residents are able to optimally navigate emergency situations if they arise.

Will residents receive hazard pay for work during COVID-19?

On April 25, the Ontario Government’s made an announcement about pandemic pay for some frontline workers fighting COVID-19. The Board, along with the PARO Staff, are aware of their press release. We have been advocating for increased compensation for residents for the past several weeks. As soon as the announcement was made on Saturday afternoon we began making calls to advocate for inclusion of residents in this compensation plan. We have written to the Minister of Health in addition to speaking directly with CAHO.

To read that letter, click here. 

As stated in our Work Alert on April 24, we believe that any recognition by national or provincial governments that increased compensation should be provided to care for COVID-19 patients must also be extended to the work that residents do.

We know that it can be demoralizing for resident physicians – separated from friends and family during this time of physical distancing – to feel like the work of those around them is being valued while their own essential work is not. That signalling has an emotional toll that, in some ways, is more impactful than the dollar value of hazard pay itself.

We are aware that the Ontario Medical Association and the Ontario Government have recently released updated staff physician compensation guidelines. We have been told that the guidelines do not provide hazard pay, but instead reflects that the existing fee-for-service model does not recognize the added complexity and time required to care for COVID-19 patients.

We believe that any recognition by Government that increased compensation should be provided to care for COVID-19 patients, because of the increased complexity, must also be extended to the work that residents do.

It is for this reason that we will continue to raise the issue with CAHO and the Ontario Government and monitor this situation closely.

When we have an update, it will be shared with you.

Residents in Quarantine/Self-Isolation
I am an incoming resident. Do I need to complete a self-isolation period before July 1?

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.
Will I be paid while on quarantine or in self-isolation?
If you are quarantined or directed to self-isolate as a result of exposure to COVID-19, or on the advice of your physician, you will continue to be paid.

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

If you traveled internationally prior to the recent Federal Government advisory, or if you were already out of the country when the advisory was issued, or if for any other reason you are directed by the hospital to self-isolate or are put under quarantine, it is PARO’s position that you should continue to be paid while you are on leave. If you are placed on an unpaid leave, please contact the PARO office so that we can determine what further steps to take. If you are placed on an unpaid leave, you should also apply for EI.

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

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

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

Given the enhanced need to ensure a high volume of patients can be cared for safely during this time, hospitals are relying on their employees, including residents, to self-monitor responsibly and self-isolate if they meet the criteria established by the Hospital’s Occupational Health Office.

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

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

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

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

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

  • Being as judicious as possible in determining whether a resident has been able to sufficiently achieve the competencies in the context of measures needed to ensure the health and safety of residents and the public, including, but not limited to, time spent redeployed, in quarantine, self-isolation, or due to time off to care for children or dependents; 
  • Being willing to focus promotional decisions on the entirety of a residents training competencies and performance with a decreased focus on minimum or maximum time spent on certain rotations, particularly for those senior residents not currently enrolled in a CBME-program; 
  • Recognizing that this cohort of residents are obtaining training in medicine during a pandemic where unique competencies can be achieved that should be recognized and factored into promotion decisions; 
  • Recognizing that competencies achieved while redeployed will be considered as applicable and transferrable for rotations where those competencies are relevant.
  • In addition, the PG Deans will continue to advocate with the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to move towards more competency based training rather than time based measures for advancement.
Do I need to use vacation for my quarantine period?
No, quarantine is separate from vacation and other leave.

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

If you traveled internationally prior to the recent Federal Government advisory, or if you were already out of the country when the advisory was issued, or if for any other reason you are directed by the hospital to self-isolate or are put under quarantine, it is PARO’s position that you should continue to be paid while you are on leave. If you are placed on an unpaid leave, please contact the PARO office so that we can determine what further steps to take. If you are placed on an unpaid leave, you should also apply for EI.

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

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

Scheduling, Redeployment, and Cancelled Procedures
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, 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). 
If I am redeployed, do I need to make up time?

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

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

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

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

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

When will surgeries and procedures be resumed?

On May 7th, Ontario Health released “A Measured Approach to Planning for Surgeries and Procedures During COVID-19”  outlining their approach for hospitals planning the gradual resumption of postponed surgeries and procedures. Their report identifies criteria for reintroducing and prioritizing scheduled surgical and procedural work.

The report sets out that the expectation that the resumption of scheduled surgeries and procedures at any hospital must only take place when:

  • Conventional in-patient space is available for care, and this space is evaluated in the context of physical distancing for both inpatient flow and outpatient activity. This space cannot include care in hallways
  • Confirmed critical supplies, including PPE, swabs, reagents, and medications, exceed both current usage and projected requirements for scheduled surgical and procedural work. There must be no dependence on emergency escalation to source any of the above while providing scheduled care. Stock of critical supplies needs to be confirmed with your regional or sub-regional table weekly. The target for PPE is a rolling 30-day stock on-hand, that includes the current usage rate plus forecasted additional requirements
  • Health human resources that are available for urgent and emergent care are not unduly impacted. This includes consideration of overall workforce availability, as well as health human resources being directed to support long-term care, as this still remains a provincial priority
  • The regional or sub-regional table and hospital must jointly sign-off on the hospital’s plan to resume scheduled surgeries and procedures

The full report may be read here.

PARO-Approved COVID Scheduling Models

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

Creating a Back Up Schedule
Updated March 25, 2020, to clarify around required time of notification. 

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

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

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

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

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

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

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

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

Home Call and Back Up Call Schedule
This model is designed for low-intensity call services where conversion to in hospital is rare.

Description

2 residents would be placed on the call schedule:

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

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

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

Examples

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

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

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

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

Potential Benefits

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

Providing Patient Care Virtually or By Phone

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

7 On/7 Off - Call

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

Description

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

Back Up System

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

Example Schedule

Week 1 – Team 1


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


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

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


Considerations

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

Potential Benefits

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

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

Description

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

Sample Schedule (for rotations beginning on a Monday):

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

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

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

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

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

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

Considerations

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

Potential Benefits

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

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

Description 

Duty Hours

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

Stipends are based on the existing night float model:

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

Potential benefits

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

Description 

Nights

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

Days – CTU JMR

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

Days – CTU SMR

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

Days – Consult and Triage

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

Back Up

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

Potential benefits

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

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

Description 

Team 1 – Core Team

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

Team 2 – Non-Core

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

Team 3 – Senior Team

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

Back Up System

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

Potential benefits

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

Considerations

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

The payout for vacation will be a straight calculation based on annual salary (i.e. one week of vacation is equivalent to one week of salary).

We understand that each payroll centre has a different system for processing payments. Given that they must pay residents in accordance with the salaries outlined in the PARO-CAHO collective agreement, the hourly rate/day must be calculated based on the agreed salary scale and the total payment should be the same regardless of what system is being used.

For example, if the payroll system pays $1000 in a term of a week, the payroll centre who uses the 5 working days has a higher daily rate ($200 per day) than the 7 days working rate ($142.85 per day), but the total payment for the week is the same ($200 x 5=$1000, $142.86 x 7=$1,000). The payroll centre must ensure that residents are paid the same total amount during the given period.

Please notify PARO if there are any concerns with respect to your payments.

Will the payout apply to professional leave and/or the floating holiday?

The agreement by the employer and Government to provide payment in lieu of untaken vacation by the end of this employment/academic year does not extend to any untaken Professional Leave for educational purposes or to the floating holiday.

Residents who are continuing training in Ontario should be able to carryover any of their remaining professional leave over into the new academic year.

Similarly if residents were unable to take their floating holiday programs can make arrangements so that those residents can take them next year.

We appreciate the Programs’ advocacy and commitment to ensure we mitigate the impacts of COVID-19 to our members’ training and work experience these past months, and in those coming where we can.

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.

What will happen to my vacation/leave I was unable to use due to COVID-19?

Many Ontario residents have been unable to take their vacation as a result of the COVID-19 pandemic. Early in the pandemic, as soon as we learned that vacation was being denied or discouraged, we reached out to our Employer Hospitals with a detailed proposal on how decisions related to vacation should be managed. In the past few months we have been pressing for a decision and have made the Hospitals and Government aware that their options for managing unused vacation were becoming more limited as we approached the end of the year. After many difficult discussions, I am pleased to tell you that this week we have been able to get signed agreement from the Hospitals and from Government, that any resident with unused vacation as of June 30, 2020 will receive a one-time payout for any unused vacation entitlement from the current year.

Any resident who is finishing training on June 30th 2020 who has unused vacation needs to make sure that you keep your banking information current and in place with the Paymaster so that they can facilitate payment. If you have unused vacation, you should confirm this with your Program Administrative Assistant or your Program Director so that they have a record.

When will I receive the payout?

We have worked hard to ensure that you receive payment for any vacation you were unable to take as a result of COVID-19 and are doing everything we can to get the money in your pocket as soon as possible. Our current understanding is that the Ministry of Health expects payouts will be issued in September or October.

You will have received a notification from your paymaster or postgraduate office requesting with specific instructions to confirm your outstanding vacation. If you have not received a notification, please contact your PGME office.

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

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

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

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

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

*Clinical Fellowship is further training that is not in a RCPSC or CFPC recognized specialty/subspecialty and does not lead to certification or certificate of competence.

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

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

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

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

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

How long do I have to take lieu days I earned during the pandemic?

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.

PARO-CAHO Collective Agreement - Other FAQs
Will the hospitals extend the period for claiming extended health benefits?

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.

Resident Wellness Resources
PARO Helpline

1-866-HELP-DOC

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

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

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

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

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

All calls are strictly confidential and cannot be traced.

OMA Physician Health Program
Call the OMA PHP at: 1.800.851.6606 or visit their website.

The PHP welcomes self-referrals from medical students, residents, physicians and veterinarians in Ontario who may have concerns about their health and well-being. PHP’s confidential services are to assist those experiencing distress, substance use or mental health issues that can have personal or professional impact.

Employee Assistance Programs
Some of the hospitals (your employers) where residents work have Employee Assistance Plans (EAPs) and if they do, you are able to access those services as a result of the PARO-CAHO Collective Agreement.

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

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

McMaster University

HHS

St. Joseph’s Healthcare Hamilton

Western University

University of Ottawa

The Ottawa Hospital

Children’s Hospital of Eastern Ontario

NOSM

North Bay General Hospital

University of Toronto

Queen’s University

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

Western

McMaster

Toronto

Ottawa

NOSM

Queen’s

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

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

RDoC Resiliency Webinar

Resident Doctors of Canada has developed a new one hour webinar that provides you with an overview of the primary tools from their Resiliency Curriculum. The webinar will take place on Zoom and will be facilitated by an RDoC peer trainer.

There will be two sessions. You can register online and receive more information.

Tuesday June 2 at 1900 hrs EDT – Register here

Tuesday June 16 at 1900 hrs EDT – Register here

If neither of those dates work for you, please check the Wellness Resourceson the RDoC COVID-19 webpage for future dates.

Free Online Health and Wellness Resources

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

Guided Meditations

Mental Health Resources

Yoga Classes 

Fitness Classes 

Private e-Counselling 

Free Online Virtual Experiences

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

PGME COVID Resources and Updates
Certification Exam Updates

RDoC Exam Update #6 – April 3, 2020

CFPC UpdateApril 15, 2020

CFPC FAQ – March 13th, 2020

RCPSC Update – April 9, 2020

RCPSC FAQ – April 24, 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.

What are the supervision requirements for provisional licenses for exam-eligible candidates?

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.

The CPSO has provided us with additional clarification around the role of the supervisor, which is listed below. We also know that they have created a more streamlined form that the supervisor will complete agreeing to act in the role.

  • Supervision may be conducted off-site or remotely to ensure that physicians who have committed to provide locum coverage are able to practice.
  • The supervisor can facilitate the supervision of several candidates at one time and can be any physician registered in good standing in Ontario in the same specialty, with an Independent Practice certificate (some suggestions and groups that have come forward to provide supervision include Program Directors, Preceptors, Medical Directors or Physicians practicing in the Community).
  • There are few requirements for supervision (no chart reviews, no reports) and the role is meant to act as a “mentor” or “sponsor”
  • Due to Ontario legislative framework and registration policies, the CPSO is limited to the use of the title “supervisor”
  • The supervisor is not responsible for the care that a supervised physician provides (the supervised physician is the most responsible physician) – but should be available to the supervised physician via phone/email should questions arise.

The full CPSO update (May 4th, 2020) regarding provisional license supervision may be viewed here.

Will the provisional license allow me to provide locum coverage?

Yes. The CPSO has confirmed that residents will be able to provide locum coverage with the provisional license.

The CPSO has advised that residents who plan to locum should put forward their applications now. If you do not yet have specific sites or a geographical region/location confirmed, you can advise the CPSO prior to registration.

Restricted licenses for exam-eligible candidates in Ontario 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 residents who have made or plan to make arrangements to provide locum coverage.

I am completing a fellowship after my certification exam. Will I be eligible for a provisional license?

Anyone who is completing their core training and would be eligible to sit the exam (and traditionally get an independent certificate) can apply through this provisional route for a six month license.  This includes Family Medicine residents pursuing a PGY3 Fellowship, and RCPSC residents who have completed their core training.

If you are writing the exam but have not been deemed to have completed your core training, based on the requirements of the CFPC/RCPSC, you would not be eligible for a provisional license. For example, Internal Medicine residents who will right the exam in PGY 3 are deemed to require an additional year of training before they are considered by the RCPSC to have completed their core training.

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

CPSO Supervision Requirements Update – May 4, 2020

PARO Updates

Work Alert #9 – Sent June 25, 2020

Work Alert #8 – Sent May 29, 2020

Work Alert #7Sent 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 # 2Sent March 18, 2020 

Work Alert # 1Sent March 16, 2020

PARO Outreach To Members: COVID Impacts
During the first week of May, PARO reached out to you, our members, to ask you to share what the impact of COVID-19 has been on your professional and personal lives. Within the first 24 hours of our request going out, we'd received more feedback than at any other point in PARO's history. This feedback is instrumental in directing and supporting our ongoing advocacy efforts during this time when you are being called to go above and beyond. We know the feedback we've compiled may be of interest to you, so we've taken some time to pull out some key findings and share them here. You'll find information about the many ways that residents have been going above and beyond during COVID-19. We believe the feedback demonstrates clearly that if the government were not able to retain resident doctors in the settings that they have been redeployed to, essential elements of our health care system could not function. Not shared here, however, are the many personal stories and anecdotes that members have sent us. Some of you shared stories about losing friends to COVID-19; some spoke about your fears for family members you may be putting at risk by going to work; about fears and anxieties about dwindling PPE supplies; about the patients and families you've treated; and about how your colleagues and fellow residents have pulled together to serve Ontario's citizens on the frontlines of this crisis.These stories are moving and impactful, and deeply personal. Out of respect for the privacy of those who shared their personal experiences with us, we have chosen not to publish those stories online. But, we want you to know that your important stories and experiences were heard, and inspire all our teams at PARO to continue to go to work for you, each and every day.
Resident Redeployment in Ontario
Over 40% of you who responded to our call report that you have been redeployed throughout the healthcare system to provide patient care. Much of the redeployment that is occurring is on an urgent basis with little warning and sometimes requires expedited training or retraining to ensure you can deliver this needed care safely. Some of you reflected on the stress that comes from uncertainty in your scheduling. Residents are expected to be prepared to be redeployed at any time, and to be available should unexpected gaps in scheduling arise due to colleagues being quarantined or becoming infected with the virus, or in situations where extra doctors are required to provide care.
Work Hours
Almost 45% of you who responded indicated that since the pandemic began, your overall work hours have increased. These respondents noted that days are longer, you are working more call, and that you are providing care across multiple sites and services. On some services, you report working call at a 1 in 2 frequency. This increased workload is directly due to the COVID-19 pandemic.
New Responsibilities
We know you are vital members of frontline health care teams, treating and caring for COVID-19 patients and providing essential care in hospitals and the community. We have learned that in many hospitals, residents are the only doctors with up-to-date certification in Advanced Cardiac Life Support and as a result are the only doctors on internal medicine wards able to run code blue teams. During COVID-19, many of you are taking on duties that go beyond your usual work responsibilities. Most of you who are on call overnight are not only covering your usual number of patients, but are doing double coverage also looking after the COVID wards. Other examples of the extra the work that many of you are providing during the pandemic include:
  • 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.
Resource Challenges
In some hospitals, the overnight on-call rooms are physically located on the same floors that have been converted to COVID wards. Some of you have had to physically enter the COVID ward in order to get to your call rooms, all of which share the same air circulation. Over 300 of you took the time to extensively comment on the physical and emotional toll of working on the frontlines, including access to PPE and the stress of caring for patients during this challenging time.
Vacations
Residents have been willing to forgo time away from work in order to provide this essential care. Over 70% of you who responded indicated that in recognition of the impact of COVID-19 on the healthcare system, you do not intend to ask for the vacation time that you are entitled to under the PARO-CAHO Collective Agreement. While most residents are choosing not to take vacation because they are acutely aware of how much they are needed, it is important to note that 25% of you told us that vacation that had been approved prior to the pandemic has been cancelled. We know this can have a significant impact on yourrwellbeing and ability to sustain the long hours you are working.
Financial Updates and Tax Changes
Tax Filing and Payment Deadlines

Tax Return

Normal Due Date: April 30

Extended Due Date: June 1

Taxes Owing

Normal Due Date: April 30

Extended Due Date: September 1

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

The CRA has not released any new or additional guidelines for employees who are currently working from home due to the pandemic situation, but are not required to have a home office as a condition of their employment. The current T2200 form does not include new or additional options for these employees for the upcoming 2020 income tax season.

PARO will provide an update to members if the government provides any new information related to tax deductions for working from home.

Read More

OSAP Loan Deferral

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

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

Read More

Canada Child Benefit

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

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

Read More

Mortgage Payments

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

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

Read More

Additional Information for Family Members of Residents

Canada Emergency Response Benefit

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

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

Read More

GST/HST Credit: One time extra payment

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

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

Financial Support For Families

The new Support for Families initiative offers a one-time payment of $200 per child 0-12 years age, and $250 for those 0 to 21 years of age with special needs. You are still eligible even if you are using an emergency, 24-hour child care centres as a medical professional.

Deals and Discounts

Many organizations have generously offered a variety of deals, discounts, and free products or services to healthcare workers during this challenging time. A number that are available across the province can now be found here.

Deals and Discounts

AirBnB

  • Airbnb hosts are offering “Frontline Stays” for COVID-19 responders.
  • These hosts have committed to special cleaning measures.
  • Many Frontline Stay hosts are offering their spaces for free or discounted rates.
  • Healthcare providers can sign up here.

CAA Roadside Assistance

  • CAA Clubs are offering free roadside service to health care workers and emergency responders in Ontario, whether they are a CAA member or not.
  • If you work in a hospital or health care centre, or as a first responder for emergency services, you can request CAA Roadside service by calling *222 or 1-800-222-4357.
  • This free service is currently being offered to Members and non-Members alike.   If you are a Member and a healthcare worker or first responder, these calls will not be counted on your Membership.

Coffee

  • McDonalds is offering health care workers and emergency service personnel a free McCafe premium roast coffee or tea which is available in drive-thru at participating restaurants.
  • Starbucks is offering a free tall brewed coffee (hot/iced) until May 3 for front line responders and health care workers via drive thru.   
  • Tim Hortons will be delivering free coffee to frontline workers in major cities all across the country. If they’ve missed your hospital, email THsocial@timhortons.com with a request, and they’ll do their best to get out to you as soon as possible.
  • Circle K is providing a free coffee or tea daily to healthcare workers with a valid ID.

Costco 

  • Priority access for healthcare workers. Details found here.

CPA Ontario – Tax Return Filing

  • CPA Ontario Accountants are offering free basic income tax filing for health care workers, their spouses, and dependants.
  • Applications are being accepted until May 15th.
  • Click here to complete the intake form.

Crocs

  • Crocs is offering a free pair of shoes to healthcare workers. Requests open daily at 12pm EST.
  • To get in line, click here.

Earls

  • 20% off orders, and additional 10% for health care workers when you order meal and pickup in restaurant.

Hertz

  • Free car rental for healthcare workers until May 31, 2020.

Loblaws

  • Priority access to supermarkets and pharmacies throughout the day when you show ID.

Longos

  • Priority access  when you show ID.

Nandos

  • Nandos is giving free takeout to any nurse or doctor who shows up to a Nando’s location in uniform or with a valid health-care ID.

Shoppers Drug Mart

  • Health Care Workers receive priority access to check out and pharmacy services

Snack Conscious 

  • Snack bombs are being sent to frontline care workers across Canada and the US. To nominate a hospital, click here.

UberEats

  • offering promo codes valued at $25 (not including taxes/service fees) amounting to 300,000 free meals in Canada and the US- Limit one order per user. INFO: social-impact-support@uber.com
Emergency Child Care

Update June 10: As the province continues to move forward with its reopening plan, emergency child care will wind down effective June 26, 2020 as all licensed child care centres are permitted to open province-wide. Families served through emergency child care will be supported by service system managers to return to their previous arrangement or finding new space during the transition back to regular childcare.

More information about child care reopening can be found here.

Government-provided Emergency Child Care for Frontline Workers

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.

Unless otherwise stated in a specific city website, In order to register a child for a centre, frontline workers need to contact their Child Care Services System Managers.

Toronto

The City of Toronto, through the Government of Ontario, is providing emergency child care for children of essential and critical service workers.

The service is provided at no costs to families, for children from birth to age 12. Services will operate 24 hours a day, seven days a week. Click here to see the list of Emergency Child Care Centres available and apply.

Hamilton 

The City of Hamilton has partnered with three licensed home child care agencies to offer emergency licensed home child care to health care and other essential frontline workers free of charge.

All agencies have providers who will provide child care in their homes to accommodate 12 hour shifts for children of staff aged 12 months to 12 years of age. Click here to see the list of Emergency Child Care Centres and apply.

London 

Emergency Licensed Child Care is available for children of essential and critical service workers.  Click here to see list of Emergency Child Care Centres and to apply.

Kingston

The City of Kingston is opening licensed spaces for emergency child care spaces in partnership with licensed child care operators. The service is provided at no cost to families for children up to age 12. Click here to see the centre locations and apply.

Volunteer Support - Medical Students

Many of Ontario’s medical students have volunteered to support HCPs with tasks such as childcare, pet care, and grocery shopping. To request assistance, visit the following links:

McMaster (GHA, Niagara, Waterloo)

NOSM (Thunder Bay, Sault Ste. Marie, Sudbury)

Ottawa

Queen’s (Kingston)

Toronto

Western (London)

Accommodation Options for Residents

Updated April 27, 2020

McMaster

 McMaster is offering Learners who require accommodation for either self-isolation due to COVID-19 exposure or learners who are in high-risk rotations and live with vulnerable family members, a room in Les Prince Hall on the McMaster campus. The cost per night is $32 with a commitment of a 5-night stay. Learners cannot arrange accommodations for less than 5 nights. In the event Learners are COVID positive and or have been exposed to COVID-19 and cannot leave their room, housing services is able to offer a meal plan (3 meals a day, delivered to your room) for an additional $22/day.

Learners who have incurred expenses related to COVID-19 should refer to PGME’s policy (as per April 24) for guidance on what may be eligible for reimbursement.

Learners who may be considered for PGME subsidy: 

1. Learners who have been Redeployed to ICU or GIM as a result of COVID-19.

2. Learners in High Risk Rotations. A high risk may be considered a rotation in the Emergency Department, ICU, COVID+ wards, performing operations on COVID + patients, etc.

List of Acceptable Expenses (Post-March 15, 2020)

  • Housing expenses – We recognize that some Learners live with vulnerable family members and may wish to arrange alternate accommodations during their redeployment or a high-risk rotation.
  • Childcare expenses

Guidelines

  • PGME will pay 50% of an alternate housing invoice (hotel stay, etc.), childcare invoice, up to a maximum of $500 per Learner (i.e. if a receipt is submitted for $700, PGME will reimburse theLearner for $350).
  • Applicable expenses incurred as of March 15, 2020 will be considered.
  • An official receipt must detail the incurred expense.
  • Please note: A one time submission of all expenses per Learner is preferred (to a per Learner maximum of $500). 

Learners who prefer not to return home to minimize contact with family members: Click here for further guidance on discounted hotel options available.

Housing options for Learners at Distributed Campuses:

  • Niagara Falls hotels offering discounted rates for frontline workers (list can be found here)
  • WRC- Delta hotels is offering discounted rates in the Waterloo region. 
Ottawa
  • Free accommodations are already available for residents currently at TOH. The hospital is currently working on securing additional rooms. 
  • Send requests to Axelle Pellerin, Director of Education at TOH and Dr. Alain Chaput, Associate Dean PGME to access/get approved. 
Toronto

As of July 1, 2020 the following changes will be made to Toronto’s Temporary Housing policy:

Funding for housing will remain available for all those trainees registered with UofT who are mandated to isolate – you may be requested to provide a letter from your program to support your need for housing

Funding for housing will remain available for all international trainees who require it to complete their 14-day quarantine

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 June 30th funding for car rentals and those wanting to voluntarily isolate will no longer be available. For those who still wish to voluntarily isolate from their home residence as a proactive precaution, please reach out to Lisa Bevacqua who will be happy to leverage a reduced frontline worker rate.

Western

Free rooms for medical workers are available at the London Windermere Manor. This service will be made available through to April 30 inclusive.

Contact Brenda Brandt, General Manager, by email at  bbrandt@uwo.ca or by text at 519-495-5878 

Other Resources
Extended Library Access

We heard from many graduating members that the thought of losing access to the University Library would be an impediment in preparing for the fall exams. We worked with the six Post-graduate Deans to ensure all exam-eligible candidates who are taking the exam in the fall will continue to have access to their University Library.

Toronto – residents have library access until after exams are completed.

Western – residents retain library access until December 31, 2020.

McMaster – residents have online library access until December 31, 2020.

Ottawa – continued access until January 30, 2021.

NOSM – library access will remain in place for one year.

Queen’s – library access will remain in place for one year.

COVID-19 Healthcare Cybersecurity course

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.

CMEJ Blog: Call for Submissions

The Canadian Medical Education Journal is inviting residents, medical students, faculty, and staff to submit essays about the impact COVID-19 has had on their medical education.

As per the CMEJ website:

“If you are willing and able to write about your medical education related experiences but need a medium to get your ideas out to a wide audience, consider submitting your essays to the CMEJ blog through our normal submission process.

Blogs will not be subject to a full peer review process. One or more of our editors will work with authors to polish the blog post before being published on-line. Due to the time-sensitive nature of these posts, we will try to expedite their processing.”

In order to submit any writing, you will need to register for an account with the CMEJ.