Prolonged Absence

In the event a resident had to miss a substantial period of work, whether for illness or quarantine, our residents wondered how this time would be compensated and how it would affect their academic progression. Questions of compensation and academic promotion largely fall outside the purview of chief residents; however, we did give consideration to these issues.

Our initial thought was to use leave under the Family and Medical Leave Act (FMLA). Residents at our institution are entitled to additional paid FMLA on top of vacation. With regard to academic progression, there are several factors that affect this, including ensuring the resident has completed required educational rotations. Programs could change a resident’s assigned block during leave to electives to avoid delaying graduation. Other options include working from home. For example, we have electives that allow residents to work remotely, permitting them to progress through the academic curriculum without needing to take an absence. An accommodation like this is particularly helpful in the event of quarantine.

Travel

We confronted two issues around work-related travel. The first was the issue of international electives. Several residents were scheduled to leave for global health electives that were canceled under a moratorium on work-related international travel. The second issue was resident travel to national conferences, as there were also restrictions placed on domestic travel. Often these preemptive travel restrictions are in excess of government recommendations, making it difficult for residents to obtain refunds for their travel expenses. Where programs issue travel restrictions in excess of government recommendations, we encourage programs to defray the costs associated with those cancellations.

When residents plan global travel, they could consider obtaining trip insurance, international medical insurance, and medical evacuation insurance—although coverage in settings like pandemics may be limited

Personal

Many of our residents have families that include working spouses and small children. To prepare for possible day care and school closures, an emergency list of temporary, trusted adult babysitters was built to provide our resident parents more childcare options and further protect our sick call. 

We also encouraged residents to consider how they might best protect their families should they become ill or require quarantine. Some residents felt their family would be safe to stay in quarantine with them at home, while others considered short-term lodging for their families with relatives or friends. 

We have found that we cannot treat a pandemic the same as other disaster preparedness events, such as natural disasters or acts of terrorism. Factors contributing to this include the duration of the event and the infectious nature. Residencies need sustainable solutions that could last for an unforeseeable amount of time without placing an unmanageable burden on residents. The role of residents is a unique one in the health care team. They are both learners and integral members of the patient care team. Our solutions may not be practical for smaller programs, given our size of 73 residents. However, we hope that this article will help prompt further discussion about residency preparedness.