Several months back PARO negotiated our contract with the Ontario Teaching Hospitals (OTH) with an award issued by an arbitrator in May of 2021. The term of the Collective Agreement is from July 1, 2020, to June 30, 2023. This year (2023) PARO will begin the process to prepare for the next round of bargaining. While speaking with many residents in various specialties and programs around Ontario, several issues were constantly brought up regarding the struggles of residency training. You surely have experienced some expectations through your training that you may consider as outdated, unreasonable, unsustainable, and unsafe. With the ongoing workforce shortages, more demands have been placed on residents over the past 3 years. Unlike many other domains which have recently been competing to alleviate physical, social, and financial job demands; enhancement of the residency training experience has been rather minimal, and often static across decades. These demands are no longer sustainable, and even costing residents their lives, health (mental and physical), passion for medicine, and eagerness to evolve and advance their careers and learning. 

Thus, this petition was drafted to empower residents to be pioneers of change, advocate for themselves, highlight our concerns, and convey our requests. It is crucial for institutions to realize that residents are a vital component in sustaining the healthcare system. Thus, our concerns are no longer of individuals or “exceptions”, but rather of a cohesive resident body across the province of Ontario. If any of the suggestions below reflect your concerns and you would like to see them negotiated by PARO, kindly consider signing this petition.

The goal is to reflect the consensus across the province, PGY levels, as well as various programs and specialties. Please consider sharing this petition with your colleagues and friends, as well as your PARO reps at your local institution. 

Firstly, here are some facts directly obtained from the National Resident Survey (NRS) completed by the Resident Doctors of Canada in Nov 2020:

• In 2020, a majority of residents (51.6%) reported definitive symptoms of burnout ranging from physical and emotional exhaustion to feeling completely burned out and in need of help or change. Additionally, a significant reduction in self-reported resilience was observed between 2020 (78.4%) and 2018 (87.6%).
• Survey respondents who agreed to answer questions about their mental health were screened for depression using the PHQ-2 Depression Screening tool. In 2020, 17.5% of residents screened positive for depression, a proportion that is significantly higher than in 2018 (14.8%). In 2020, 64.0% of residents reported that “A lack of control over one’s schedule” was the most significant barrier to seeking mental health care. This was a significant increase from 59.4% in 2018.
• More than one in five residents (20.2%) had thought about suicide in 2020, a proportion that is significantly higher than in 2018 (15.9%). Of those that had thought about suicide, 15.4%, or the equivalent of 3.1% of the resident population, had seriously considered suicide in the preceding 12 months
• In 2020, the proportion of residents who reported that their work schedule leaves them enough time for their personal and/or family life remained low (35.6%). This has not changed when compared to 2018, i.e 64.4% of residents lack work-life balance. 
   

We kindly request that PARO negotiates the following terms:

1.     Salary: 

• With increasing interest rates (4.25% as of Jan 2023), gas prices, and cost of living, residents have been feeling a significant financial strain. In addition, it is expected that interest rates will continue to be increased by the Bank of Canada in 2023. Not to mention, many residents are in considerable debt stemming from undergraduate education, and medical school training. Therefore, residents continue to pay interest payments on lines of credit and possible mortgages. In addition, as you may have heard economists are predicting a recession in early 2023. Many employers across the country in various domains have already implemented salary increases. In November 2019, the Ontario government passed legislation to cap public sector wage increases at an average of 1% annually for the next three years (bill 124). Bill 124 Charter challenge is heard in Ontario Superior Court in Sep 2022, and it was turned down in Nov 2022. However, as of 2023, the Ford government is appealing to reinstate bill 124.
• Residents are unable to afford to live on a resident’s salary. A 1% increase every 12 months isn’t sufficient and bluntly unfair. The current residents’ salary does not reflect the efforts invested by residents daily during working hours. Moreover, many residents continue to work after leaving the hospitals/clinics. The job demands are increasing, but our salaries aren’t reflecting this increasing demand. The current inflation rate as of Nov 2022 is 6.9%. With only 1% increase, residents are left struggling to try to bridge the gap of 5.9% difference. Residents do not have the time, or energy to seek a second job and have a second salary. Therefore, we ask that PARO diligently and actively negotiate residents' salaries to effectively increase beyond 1% and reflect the current inflation status. 
• We ask for reimbursement/retrospective payments to cover all the past months since March 2022 (as the Bank of Canada started to raise interest, and our salaries were no longer matching the cost of inflation).
• Eliminate call stipends and introduce a minimum wage per hour for on-call shifts.
• Eliminate parking costs for all residents to help alleviate some of the financial burdens.
• Introduce a gas stipend for residents required to present in person during call shifts.
• Provide meal cards for residents to access FREE food and beverages when on-call.
• Financial compensation for residents volunteering to cover above PARO’s call maximum.
• Cost of the Royal college exams review courses to be fully reimbursed by programs (as part of book/academic allowance). 
   

2. Residents' wellness: 

• A minimum of 2 complete weekend days per 7-day week. If a resident is working a shift on Saturday, then Monday is considered a weekend day and granted off.
• For residents working regular hours (not on 24 hours call): a minimum of one-hour meal break (completely free of clinical duties and academic obligations, including noon conferences). For residents working beyond the regular 8 hours shifts: a minimum of two one-hour breaks. As per the Ontario Nursing Association, article F-9: nurses can get two meal break times, each lasting 1 hr and 15 minutes. A similar and basic expectation should be reinforced for residents. Thus, including this article/clause in the PARO contract will ensure residents have this protected time to rest during their shifts.
• Lieu days should be granted to residents who are covering for other residents due to emergencies or illness.  
• Lieu days should be granted for residents covering STAT holidays that are not recognized by PARO (Remembrance Day, Reconciliation Day)
• Access to 24/7 food catering services (not vending machines) to ensure residents on-call can use meal cards to purchase food and beverages. If hospitals are allowing residents to work 24/7, then it is their responsibility to provide them with free access to food/beverages.
• Adjust the on-call requirements, outlined further below
   

3.     On-call requirements: 

• Currently, our PARO contract outlines a maximum of seven (7) nights in twenty-eight (28), including two (2) weekend days in eight (8) weekend days over that twenty-eight (28) day period. However, these numbers were likely determined pre-pandemic. As shown above, the statistics reflect higher rates of burnout and compromised mental health. Therefore, after 3 years of the pandemic, this number (7) is outdated and unsustainable given the current situation (high burnout rate, ongoing pandemic, sicker patients, increased intensity during call shifts due to providers' shortages).
• The call maximums need to be lowered to at least 5 call shifts per 28 days, to ensure residents have adequate time off to maintain their mental health and well-being.
• No more arbitrary numbers!! We want a clear guide for programs on how to manage call maximums depending on several factors: for example, the size of the program, residents on mat/pat leaves, residents who are acutely sick or dealing with emergencies, residents excused from call due to medical reasons, the number of sites/campuses covered by the residency program. We need transparency! Residents are not employees of the hospitals, our contracts and thus salaries are with educational institutions. Therefore, to protect residents from abuse, pressure, and harassment to cover additional call shifts, a clear guideline needs to be drafted for hospital institutions to adhere to.
• Residency is an opportunity for learning, it should NOT be service-based, where residents are used to fill in gaps caused by long-standing systemic issues.
• For consultation services: unless there is an emergency, residents should NOT be starting any new consults 3 hours prior to the end of their call shifts. This time should be used to wrap up clinical duties (writing notes, placing orders/reviewing investigations, prescribing medications) and prepare for the handover process.
• At times of an emergency or illness, residents should NOT be required to find a replacement to cover their shifts. It is the hospital's responsibility to sure there is adequate coverage. Residents should NOT be required to make up missed shifts due to illnesses or emergencies.
• To ensure residents are attending academic half-days/days, a resident may be scheduled a max of 1 shift per 28 days on a day preceding the academic day/half-day. Therefore, this ensures the resident is post-call only once a month on their academic half-day/day and thus not constantly missing learning opportunities. 
• Residents who have vacation time off, shouldn’t be assigned to do the max number of call shifts during their on-service time (pre- or post-vacation), for example: 5 call shifts within 2 weeks vs. 28 days.