COLORADO RESIDENT AND FELLOW PHYSICIANS

  F E A T U R E 

Colorado residents and fellows rise to the challenge of COVID-19 Kate Alfano CMS Communications Coordinator

Resident and fellow physicians face unique challenges during the COVID

19 pandemic: They are delicately balancing expanding their medical knowledge, teaching those in training years beneath them, and altering established care protocols for all patients regardless of COVID-19 positive or negative status – all in the shadow of the highly contagious respiratory illness about which information is still evolving. Training years are already acknowledged as some of the most challenging of a physician’s career; in this new health care environment, surrounded by uncertainty, physicians and trainees must develop their skills as clinicians while constantly adjusting daily routines and embracing new norms.

Daily lectures and grand rounds have been moved online. Elective surgical cases have been suspended, morning rounding limited to attendings only unless the patient is critical. Specialty and organization educational conferences have been canceled or postponed, reducing opportunities for career-advancing poster presentations, lectures, mentoring and the face time that allows faculty and trainees to develop new collaborations and future job networks. Elective rotations are tenuous as residents may be called on to help in the internal medicine or emergency departments, particularly in the case of a surge. And many patient visits are now conducted by video conference to reduce exposure and conserve personal protective equipment, increasing the potential of missing key indicators of a diagnosis or other issue – as also can be a concern for physicians in active practice. All of this exists in the setting of constant worry that they may bring this virus home to loved ones and put them at risk just for doing their job.

Brandi Ring, MD, an obstetrician-gynecologist in Denver and a member of the CMS Board of Directors, reports that across the country residents are struggling. Some have had their training and jobs delayed, board exams moved or canceled, and their institutions, facing budget shortfalls, are cutting cost of living adjustments and other benefits such as wellness days and CME allowances. “CMS must stand up for our trainees, for residents at the front lines who are asked to take on this additional responsibility while spending time getting pulled from their own specialties,” she says.

Finances are a top concern; resident salaries are low compared to those of other health workers, though they may experience some of the highest risk situations for exposure to COVID-19. Evan Manning, MD, resident representative on the CMS Board of Directors, says that housing for the upcoming year is uncertain and cost of living increases have been deferred for the next academic year but he has seen great generosity from the Anschutz Medical Campus area as leaders leveraged additional pools of money to help residents make ends meet even as moonlighting was banned. And one measure in the Coronavirus Aid, Relief, and Economic Security (CARES) Act affects those with medical student loan debt: The legislation suspended payments and accrual of interest on most federal student loans through Sept. 30, 2020.

“It’s been a challenging time for our residents and fellows,” Manning says. “But somehow when the road gets steeper, everyone still finds a way to overcome the obstacles. I am very proud of how residents and fellows from so many different disciplines stood up to fight this pandemic.”

He continues: “We are fortunate in some ways that our employment has not been affected and our salaries are secure. But these are still trying times to be a trainee and many residents have sacrificed elective opportunities, surgical training and other extremely valuable learning experiences to serve on the COVID wards. But no matter what, serving those in greatest need is the backbone of our profession. It’s a great time to be a doctor.” 

"CMS is actively involved in understanding the challenges faced by residents and fellows, and we are advocating and willing to work with training institutions to assure they are supported and their training needs are met," says CMS President David Markenson, MD, MBA. "It is essential that all realize that while residents and fellows are at facilities for education they are integral parts of the care team and our essential future workforce. As such they must be allowed access to all aspects of care even during this pandemic. In addition, while novel approaches may be needed we cannot compromise their educational activities. It is also important to work with sponsoring institutions to develop innovative methods to account for the challenges caused by the pandemic in volume of patients and surgical cases that residents and fellows have had. This could include simulation and shifting rotations to needed cases now and more elective cases in the future. Lastly, we need to assure that the financial support needed for residents and fellows is maintained, especially the minimal salary they receive, continuing education funding, housing support, and loan forgiveness and support."  ■

Resources from the AMA

The American Medical Association has curated resources to assist residents and medical students during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events.

View the list of resources at:

www.ama-assn.org/deliveringcare/public-health/medicaleducation-covid-19-resource-guide

Additionally, the AMA is offering residency programs access to transcript tracking capabilities and six modules from the GME Competency Education Program through Sept. 1, 2020, including: • Creating an Effective and Respectful Learning

Environment • Physician Health: Physicians

Caring for Ourselves • Working Effectively within an Interprofessional Team • Patient Safety • End of Life Care • Patient Handoffs

Go to:

edhub.ama-assn.org/gcep/ pages/covid-19-access