Simple Guidelines for Residents and Fellows in the Light of COVID-19

Simple Guidelines for Residents and Fellows in the Light of COVID-19

May 29, 2020 Published by Kathrin O'Neill

Table of Contents

The recent COVID-19 outbreak was felt locally and globally. There are roughly 135,000 residents and fellows working their way through graduate medical education (GME) in the U.S. Considering this clinical experience will require supervision, residents are often considered frontline physicians working in their respective healthcare institutions to provide care.

It’s not uncommon for healthcare workers to feel the pressure physically, emotionally, and economically catering to the growing demands of hospital care. With an anticipated shortage of physicians in the U.S by 2030, COVID-19 is also another factor that could hinder better health provision in the future.

Here are common scenarios residents and fellows face today:

  • Healthcare workers are working frontline in preventing COVID-19 spread. Physicians and other healthcare providers have the highest risk of exposure. Asymptomatic carriers may also include frontline workers, which can be carried to fellow residents and fellows including their family members. The rise of medical providers affected by this virus could have an impact in their residency program with unplanned absences from quarantine or hospitalization (in worse cases).
  • As part of the emergency response, some residents may need to assume roles that are outside their specialty. This may prove to be arduous work with residents still compelled to acquire the required training and skills set as stipulated in their program. This would mean that resident physicians need to get back on training once everything goes back to normal.
  • Subspecialty fellows may need to fill in roles as attending physicians with their core disciplines. Though they may be certified to practice these disciplines, compensation is not usually adequate with a wider possibility of malpractice.
  • Resident salaries have lower per hour pay compared with other healthcare workers. On a given 80-hour workweek, residents earn approximately $15 to $20 per hour. Moreover, residents carry debt loans from medical education. This could mean that residents and fellow may earn additional income elsewhere to cover for these expenses.
  • Residents are a vulnerable part of the labor force. Although they are getting paid for training, residents have little to no influence on their working environment since they’re dependent on their employers.

On a good note, they may be able to acquire knowledge and skills that they might need if they plan to pursue a different specialty in the future.

In helping residents and fellows optimally engage in their practice, here are some principles developed by AMA Council on Medical Education:

  • Residents need to actively participate in COVID-19 response which includes promoting fellows for attending physician roles considering their specific interests.
  • Residents must be able to raise concerns about personal safety including those around them without jeopardizing their employment or training.
  • All residents must have adequate access to protective gear and tools such as PPE including other healthcare workers they interact with.
  • In case a fellow or resident became ill with COVID-19, institutions must not use vacation or personal leaves while he or she is being quarantined. If they are required to take a leave, residents must continue to receive benefits and salary as stipulated in the agreement.
  • Clinical work being performed by residents throughout this pandemic should be considered as credentials on the trainee’s academic performance. If possible, work done during this time should earn credits.
  • Residents should be allowed to stay in their programs to earn the necessary credentials and skills set for board certification. They should also continue to earn the agreed salary and benefits. Residents should also be able to access freely all the necessary clinical training.
  • All residents are subjected to forbearance or forgiveness of student loans to ease financial stress they might encounter for themselves or their families. This must be addressed since access to sideline opportunities such as moonlighting may be compromised during this period.
  • Certified and licensed fellows assuming attending physician roles in their respective disciplines will receive the amount and benefits of the role they fill in. A fellow assuming to fill in this role must be discussed thoroughly first with the institution they’re training in.

COVID-19 and its effects on future residents

  • Interviews for fellowship and residency are done through video conferencing and phone from the institutions they are applying for. Vacant positions are still open even during this crisis.
  • To meet the surge of COVID-19 patients, medical students who have completed their training and requirements have graduated early to work as frontline healthcare workers. Instructors and the institution they choose to accomplish the program will protect and supervise these fellows and residents throughout the course.