- A clinician must be licensed to practise medicine by a provincial medical lLicensing authority. This requires, among other things, certification by the College of Family Physicians of Canada or, for specialists and subspecialists, by the Royal College of Physicians and Surgeons of Canada. Thus, the regulations of these bodies (including the time to be spent in designated areas of clinical training) are a determinant of the time it takes to complete training as a clinician scientist.
- Responsibility for training programs is vested in the universities, but programs must be approved or accredited by national bodies. Thus, residency programs are accredited by the national colleges and graduate training programs by provincial bodies. To add to the complexity, the number of training positions is determined by the provincial ministries of health, which are driven by the perception of need in the health care system; they may be insensitive to the need for specific training positions for clinician scientists. To integrate these activities in a manner optimal for the trainee requires complex negotiation among the various bodies.
- Canada has 16 medical schools, which are funded by the provincial governments. These funds come from ministries of both education and health -- the patterns vary among the provinces. However, the generosity of these funds affects clinician scientist training.
- The Medical Research Council of Canada (MRC) has traditionally been the most important and the most prestigious source of funds for research and research training across Canada. However, with restrictive fiscal policies reducing funding to this body, and reduced commitment by the federal government to research and development in general, MRC funding has decreased, and the relative importance of various other sources of funds (National Cancer Institute of Canada, Heart and Stroke Foundation of Canada, and various provincial bodies) has increased. Funding policies affect both salary support for trainees and the research climate in which training can occur. In Canada, research grants do not include salary support, although a limited number of highly soughtafter personnel awards to career scientists are available.
- Hospitals in Canada are financed separately from university faculties of medicine (or health sciences), yet the physicians who work in these hospitals are mainly "independent health professionals" who bill provincial ministries of health for their services. The hospitals must grant them "privileges" to work and also provide the facilities they require. Usually privileges will not be granted unless the physician is given an academic appointment by the university. The ability of universities to provide salary support for clinical appointees has been progressively eroded, and the solution to this has been to encourage all clinicians to work harder in wards and clinics to generate income. This has created a particularly difficult situation for clinicians who also wish to have a career in research.
- An additional level of complexity has been introduced by the proliferation of research institutes affiliated with Canadian academic hospitals. With some funding from endowments, and some support from the hospital which sees prestige in its research institute, these bodies then recruit research staff, clinical and nonclinical, who will likely be given some academic status within the university system, but may be protected from assuming full academic responsibilities. Despite this, they will be able to apply to granting agencies in open competition with those academic colleagues who provide full support to the academic mission of the universities.
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