One Medical Faculty

Last night we marked a major turning point in the journey to make the College of Medicine one of the best medical schools in Canada and a pillar of healthcare in Saskatchewan, with Faculty Council’s support of our proposed new policy and procedures for the appointment of medical faculty at the University of Saskatchewan. Further to this step, the policy will proceed through the required approval path at the university level.

As you will recall, a major premise of The Way Forward is that the university recognize that “(medical) faculty represent a unique category of university appointees.” As many also know, the College of Medicine has been seriously handicapped by a historic and deeply embedded town-gown divide and structural inequities—these contributed to our total physician engagement in the academic mission of teaching and research being about half of that at similar-sized medical schools.

The good news over the last few years is that more and more of our physicians have become more engaged with the CoM at our two main campuses in Saskatoon and Regina and throughout the province. Many have stepped up to important leadership roles. This is likely primarily because physicians know that their practice, quality of care and professional satisfaction are enhanced by engagement in teaching and research. Repeated surveys of students and residents demonstrate over 75 per cent want an academic component to their career. And increasingly our graduates and residents are staying in Saskatchewan and taking up faculty appointments. This is all good!

Last night’s support is one step in formalizing the recognition of all medical faculty as equal colleagues in supporting the mission of the CoM. In fact, we know that 1,500 (more than half) of the province’s doctors have appointments with the CoM. In the new model, this is a university appointment. Given appropriate qualifications and circumstances, these medical faculty can apply for and hold research grants and supervise graduate students in addition to medical students and residents, and we will work with the university to facilitate further opportunities for these faculty members in this area. The model provides equity with all university appointees.

However, confusion remains, as many are still rooted in the historical language. One of the defining characteristics of the new model is that compensation is separated from appointment. All medical faculty will follow the same procedures for appointment with the U of S and all appointments will have the same rights and privileges. However, there will be several models of compensation.

Those who choose an Academic Clinical Funding Plan (ACFP) will have defined annual compensation and defined academic and clinical deliverables for which they will be accountable to the CoM and the health authority through their department head. The real advantage for them is that the compensation for academic and clinical time is equal. If they choose to leave the ACFP and go to fee-for-service (FFS) or other compensation models they will retain their appointment and look to the CoM for one of the other compensation schemes. The health authority appointment is not linked to the university appointment in any way. On the other hand, one does need to do clinical work to do clinical teaching!!

Others who want to remain in an FFS model, but want to do substantial academic work, may choose to enter into a contract with the CoM. Reasons for this—not the least of which is FFS rates in some specialties—include partnership obligations, group dynamics or simply personal preferences. These contracts will also have defined academic deliverables and, as in any contract, there will be accountability for those deliverables. While this compensation will be fair, there is no guarantee the CoM will be able to match FFS rates in all contracts. That is simply the reality of university funding.

Finally, the vast majority of our faculty who primarily do clinical teaching will receive compensation through a stipend model done on a fee-for-service basis. We have had widespread consultation with these clinical teachers. We have proposed rates that are at the middle of the range across the country. We continue to work on the administrative efficiency of this process and the timeliness of payment. Unfortunately, further improvement is largely dependent on improving our information systems, which is also in our work plan.

Remember, this is all a work in progress. There is great interest in ACFPs and we hope to see a number of existing faculty move to ACFPs in the next six months. Limitations here are the work required to develop these on an individual basis and, of course, funding. Please bear with us as we work with our partners in the health authority and the Ministry of Health. All are in agreement that the ACFP will be an increasingly important model for both the university and the health system as we move forward. Many new graduates prefer this model, with its inherent predictability and the protected time for academic work.

In many other jurisdictions, academically oriented groups of physicians have banded together over time to enter into group ACFP agreements with their university/health authority/province. For example, at Queen’s, virtually all of the physicians in Kingston are on the same AFP. The group ACFP is administered by a practice plan governed by the physicians. This model combines the independence and business models physicians are used to with the collegial trade-offs of clinical and academic work typical of an academic environment. I have made it clear that I would like to see our ACFP model evolve in that direction. In that regard we are developing such a model for the family medicine faculty in our two family medicine teaching units in Saskatoon and Regina.

As I said, this is a work in progress. Our goal is to meaningfully engage as many Saskatchewan doctors as possible in one appointment model and offer compensation models that are fair and transparent. Without a doubt, we have made mistakes already and we will continue to make adjustments. The province’s financial reality is one with which we must contend. But the goal of One Faculty is that we suspend the historic language and don’t listen to rumours – ask questions!!

As always, I welcome your feedback and I sincerely thank all who contribute to the CoM.