LAUSR

Abstract Background Hazard pay for resident physicians has been controversial in the COVID‐19 pandemic. Program director (PD) beliefs about hazard pay and the extent of provision to internal medicine (IM) residents are unknown. Objective To evaluate hazard pay provision to residents early in the COVID‐19 pandemic and pandemic and residency program characteristics associated with hazard pay. Design, Setting, and Participants A nationally representative survey was conducted of 429 US/US territory‐based IM PDs from August to December 2020. Main Outcome and Measures Hazard pay provision and PD beliefs about hazard pay were tested for association with factors related to the pandemic surge and program characteristics. Results Response rate was 61.5% (264/429); 19.5% of PDs reported hazard pay provision. PD belief about hazard pay was equivocal: 33.2% agreed, 43.1% disagreed, and 23.7% were uncertain. Hazard pay occurred more commonly in the Middle‐Atlantic Census Division (including New York City) and with earlier surges and greater resident participation in COVID‐19 patient care. Hazard pay occurred more commonly where PDs supported hazard pay (74.5% vs. 22.1%, p = .018). Reasons most frequently given in support of hazard pay were essential worker status, equity, and schedule disruption. Those opposed cited professional obligation and equity. Conclusion Hazard pay for IM residents early in the COVID‐19 pandemic was nominal but more commonly associated with heavily impacted institutions. Although PD beliefs were mixed, positive belief was associated with provision. The unique role of residents as both essential workers and trainees might explain our varied results. Further investigation may inform future policy, especially in times of crisis.