April 9, 2020 – Message from Dr. Anthea Lafreniere, PARO President
I have a few important updates related to your training and work in Ontario during the COVID-19 pandemic. We continue to add information to our COVID-19 web page as it becomes available, including changes in policies or recommendations, so please check the site often.
To ensure that all of our members are provided with the same information at the same time, we will provide information that we know to be accurate either through these emails or on our dedicated web page. For this reason, we will not be providing information through Facebook or Twitter. During times of crisis, you need to be able to trust that the information you are provided and our commitment to you is that we will only provide information that we know to be accurate for residents working in Ontario.
Some of you have shared your concerns with me regarding the guidance that PARO has posted on our website with respect to PPE. 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.
We do not believe you should be providing care when you are not safe – so let me 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. I’ve just been informed that the hospitals are working on provincial guidance on a number of matters related to the provision of care during the pandemic. They are aware of our concerns for residents who may need to refuse unsafe work, and we have told them that we expect that the hospitals will address this important issue in their upcoming provincial guidance.
- 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.
Finally, we have heard some reports that, in some hospitals, access to PPE is being managed by the head/charge nurse and that, in some instances, there has been confusion about whether or not they are to issue PPE to residents. In our conversations with our employer hospitals, we have raised this concern and they have promised to ensure that residents are provided with PPE in accordance with the hospital directives. Please review our website for information on what to do in the event that you are not provided with PPE or if you are aware of shortages in your hospital.
PARO Approved COVID Scheduling Models
Many programs have been asking about new scheduling models in order to minimize resident exposure, prevent burnout, and ensure service provision during times of heightened need. We have a number of PARO Approved COVID models to assist programs to do this well and have included them on our COVID-19 web page. We continue to add more. If the posted models don’t work for your program and you would like assistance in developing a different model, please email email@example.com.
Extension of Training
All six Ontario Postgraduate Deans have agreed with the principles that PARO developed to minimize situations where training might need to be extended because of redeployment during the pandemic. These principles were developed and adhered to during the SARS outbreak. These principles have now been distributed by PGME offices to all Program Directors. Check out our COVID-19 web page under Scheduling and Redeployment for more specifics. You will also find a link to the guidelines developed by the Council of Faculties of Medicine of Ontario for residents working during Public Health Emergencies.
Finally, we have provided a lot of new information on vacation leave, including new content on CFPC and RCPSC exam preparation leave and the implications related to the postponement of exams. Check the COVID-19 web page under Vacations and Leaves.
Royal College Exams
If you have not already heard, Resident Doctors of Canada have been successful in their advocacy that the spring 2020 cohort will not be required to sit oral exams. If you pass the written exam you will be immediately certified. For any individual who isn’t successful in the fall exam, it won’t count as an attempt and you will be extended an extra year of eligibility. The Royal College is also going to expand the number of test sites for the written exams so that you can take the exam closer to home and the Royal College announced that the everyone will receive a $2,215 refund within the next 60 days. You can read all the details here. I want to extend a huge thank you to Resident Doctors of Canada for their tireless efforts to advocate for extraordinary solutions in these extraordinary times.
Thank you again to everyone that reaches out to firstname.lastname@example.org for clarification or to ask questions. We promise to work quickly to provide you with answers to your questions that you can trust.
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COFM Residents and Public Health Emergency Preparedness Guidelines