The effect of health care reform on academic medicine in Canada

Charles H. Hollenberg, MD, OC, FRSC, for the Editorial Committee of the Canadian Institute for Academic Medicine

Canadian Medical Association Journal 1996; 154: 1483-1489

This article was prepared from the proceedings of the annual meeting of the Canadian Institute for Academic Medicine, held Feb. 9 to 10, 1995, in Ottawa. The institute is a national, nongovernment body that aims to advance academic endeavours within the Canadian health care system.

Paper reprints of the full text may be obtained from: Dr. Charles H. Hollenberg, Ontario Cancer Treatment and Research Foundation, 620 University Ave., Toronto ON M5G 2L7; fax 416 971-6888

Abstract

Although Canadian health care reform has constrained costs and improved efficiency, it has had a profound and mixed effect on Canadian academic medicine. Teaching hospitals have been reduced in number and size, and inpatient programs have shifted to ambulatory and community settings. Specialized care programs are now multi-institutional and multidisciplinary. Furthermore, the influence of regional planning bodies has grown markedly. Although these changes have likely improved clinical service, their impact on the quality of clinical education is uncertain. Within the academic clinical department, recruitment of young faculty has been greatly complicated by constraints on licensing, billing numbers, fee-for-service income and research funding. The departmental practice plan based on university funds and fee-for-service income is being replaced by less favourable funding arrangements. However, emphasis on multidisciplinary programs has rendered these departments more flexible in structure. The future of Canadian academic medicine depends on an effective alliance with government. Academia and government must agree, particularly on human-resource requirements, research objectives and the delivery of clinical and academic programs in regional and community settings. The establishment of focal points for academic health sciences planning within academic health sciences centres and within governments would assist in these developments. Finally, government and the academic health sciences sector must work together to remove the current impediments to the recruitment of highly qualified young faculty.

Résumé

Même si la réforme des soins de santé au Canada a limité les coûts et amélioré l'efficience, elle a eu des répercussions profondes sur la médecine universitaire au Canada. Le nombre et la taille des hôpitaux d'enseignement ont diminué, et des programmes de services aux patients hospitalisés ont maintenant pris le virage ambulatoire et communautaire. Les programmes de soins spécialisés sont maintenant multi-institutionnels et multidisciplinaires. De plus, l'influence des organismes régionaux de planification a augmenté considérablement. Même si ces changements ont probablement amélioré les services cliniques, leurs répercussions sur la qualité de l'enseignement clinique reste à déterminer. Dans les départements universitaires d'enseignement clinique, les contraintes imposées à l'octroi de permis et de numéros de facturation, à la rémunération à l'acte et au financement de la recherche ont compliqué énormément le recrutement de jeunes enseignants. Des arrangements de financement moins favorables commencent à remplacer le plan de pratique par département fondé sur des fonds universitaires et sur le revenu tiré de la rémunération à l'acte. L'importance accordée aux programmes multidisciplinaires a toutefois assoupli la structure des services. L'avenir de la médecine universitaire au Canada est tributaire d'une alliance efficace avec le gouvernement. Les milieux universitaires et les gouvernements doivent s'entendre, surtout en ce qui a trait aux besoins en ressources humaines, aux objectifs de la recherche et à la prestation de programmes cliniques et pédagogiques en contexte régional et communautaire. La création de centres stratégiques de la planification des sciences de la santé en milieu universitaire dans le contexte des centres universitaires des sciences de la santé et dans les milieux gouvernementaux aiderait en l'occurrence. En fait, le gouvernement et le secteur universitaire des sciences de la santé doivent se donner la main pour éliminer les obstacles actuels au recrutement de jeunes enseignants hautement qualifiés.

Members of the Editorial Committee of the Canadian Institute for Academic Medicine

Dr. Charles H. Hollenberg (chairman), president, Ontario Cancer Treatment and Research Foundation, Toronto, Ont.; Dr. Aubie Angel, professor of medicine, University of Manitoba, Winnipeg, Man.; Dr. Dale W. Dauphinee, executive director, Medical Council of Canada, Ottawa, Ont.; Dr. Peter T. Macklem, Montreal Chest Institute, Montreal, Que.; Dr. Eliot A. Phillipson, chairman, Department of Medicine, University of Toronto, Toronto, Ont.; Dr. Claude C. Roy, professor of pediatrics, Université de Montréal, Montreal, Que.; Mrs. Eva Ryten, director of the Office of Research and Information Services, Association of Canadian Medical Colleges, Ottawa, Ont.; Dr. Eldon Smith, dean, Faculty of Medicine, University of Calgary, Calgary, Alta.; Dr. Mamoru Watanabe, professor of medicine, University of Calgary, Calgary, Alta.; and Dr. Douglas Waugh, Ottawa, Ont.

| CMAJ May 15, 1996 (vol 154, no 10) / JAMC le 15 mai 1996 (vol 154, no 10) |