clinical faculty past, present & future
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Clinical Faculty Past, Present & Future. Derryck H. Smith MD FRCP (C) Head, Department of Psychiatry Children’s and Women’s Health Centre Clinical Professor, Division of Child and Adolescent Psychiatry, University of British Columbia. - PowerPoint PPT PresentationTRANSCRIPT
Clinical FacultyPast, Present & Future
Derryck H. Smith MD FRCP (C)Head, Department of Psychiatry
Children’s and Women’s Health CentreClinical Professor, Division of Child and Adolescent Psychiatry,
University of British Columbia
3rd Annual UBCDepartment of Psychiatry Clinical Day
June 11th, 2004
The History of the Medical School
Grew out of the guild system in the middle ages
Knowledge was carefully protected (largely from classical Greek texts)
Apprentices were accepted into the guild; similar to blacksmiths, jewelers, etc.
The History of the Medical School
Mid 19th century, an explosion of “for profit” schools in North America
State Boards refused to accept the poorly trained graduate
1907 – AMA forced to close 40 schools
The History of the Medical School
Abraham Flexner, appointed by the Carnegie Foundation
1910 – “Medical Education in the United States and Canada”
Influenced by Rudolph Virchow “medical practice is nothing more than a minor off-shoot
of pathophysiology” The training of future doctors would be the
responsibility of salaried faculty in universities with a “research function”
The History of the Medical School
1911 William Osler, Chair of Medicine Oxford
Osler was not a researcher, made no new discoveries, made his living as a clinician “I can imagine nothing more subversive to the
highest ideal of the clinical school then to hand over our young men who are our best practitioners to a group of teachers who are ex-officio out of touch with the conditions under which these young men will live”.
The History of the Medical School
Flexner’s view prevailed and the medical schools evolved in facilities in which salaried faculty pursued a research agenda
“Teaching” – using charity patients To many, teaching became a chore of
secondary importance to research Clinical faculty were engaged to perform the
teachingReference: Rae, A. “Osler Vindicated”CMAJ, June 2001, 164
“No Place to Learn”“Why Universities Aren’t Working”
University research often detracts from the quality of teaching
Teaching involves different skills and imposes different obligations than research
1936 Robert Hutchins, President University of Chicago “Students who are going to be teachers are put through a
procedure designed to produce researchers”
Reference: Pocklington, T and Tupper A., “No place to Learn – Why Universities Aren’t Working”, UBC Press 2002
No Place to Learn
“No modern institution is so rife with jealously and a sense of oppression than the modern university”.
Sessional lecturers resent tenured professors.
No Place to Learn
Dedicated teachers often despise researchers who ignore their students with impunity.
“The critical pursuit of research as a university priority has weakened the universities’ commitment to student life and the quality of education”.
No Place to Learn
First year teaching has been abandoned by senior staff and assigned to “sessional lectures” with class sizes of over 600 students.
“No Canadian university in recent memory has hired a senior professor from another university because of his or her demonstrated teaching skills”.
The Role of Clinical Faculty
Provide high quality teaching Advocate for the primacy of teaching Fulfill our ethical obligations of passing on
practical skills and knowledge to the next generation
Hold the Faculty of Medicine accountable for ensuring that the teaching enterprise is appropriately funded – especially in times of expansion
The Role of Clinical Faculty
Provide role modelsa) Practicing doctors dedicated to
excellent patient careb) Advocates for patient care in the current
environment of “the corporatization” of health care
A Chronology of Events
Relationship between the Faculty of Medicine (FoM) and Clinical Faculty (CF)
University of British Columbia
Reference: Chan-Yan, C. Department of Medicine, May 2004
Relationship between FoM and CF
1980’s Informal and arbitrary
No written terms of appointment Various styles of interaction from collegial to
coercive Initially tolerated, situation deteriorated
Increasing FOM demandsChanging times for CF
FM Clinical Faculty Committee
During the early 1990’s: - Dean Hollenberg Committee attempts to improve conditions Successive Chairpersons report
Innovative recommendations, including the Smith Report – based on polling of the clinical faculty
Resulted in minor changesFOM responds to recommendations with litany of
constraints, but no constructive alternatives
SPH Clinical Teachers Association (CTA)
Spearheaded by Dr. Angus Rae in 1991 “A man without a stick can be bitten, even by a sheep”.
Gains achieved: UBC-SPH Affiliation Agreement changes
Terms of appointment to FM and SPH Removal of requirement for “Practice Plans” (Changes not with FoM agreement, but with pressure on Hospital
administration).
External Review FM Finances
April 1995: FoM recorded a debt of $5.6 million “...morale is in danger of diminishing
throughout the Faculty, but it is at a seriously low ebb amongst the clinical faculty who feel that they are not rewarded or recognized for what they do.. ”
CF not aware of report, but are pressured to form “Practice Plans” to support FoM
University Clinical Faculty Association (UCFA)
Formed in 1998, A voluntary association of about 500
clinical faculty, formed to negotiate conditions of work, remuneration and other issues, with the FOM
Infamous Cardiology Motion
June 1998 - All DoM Divisional Secretarial support discontinued.
Motion passed, widely supported by others: No further teaching of medical students unless
secretaries returned and discussion between Dean and Cardiology regarding future arrangements and mutual expectations.
Infamous Cardiology Motion
Possibility of wildfire withdrawal of teaching Dean Cairns convenes urgent meetings Task Force Committee (TASC) initiated
jointly by UCFA and the FoM Relationship to be defined Cardiology agrees to await report
TASC
Chair: Monique Bertrand Members: 5 CF (3 UCFA; 2 FOM); 3 FT;
Dean’s Administrative Assistant Facilitators: Qualstar Solutions Inc. Convened in December 1998: meetings
conducted through 1999
The TASC Agreement
“Mutual Responsibilities and Obligations for Clinical Faculty and Faculty of Medicine”
Submitted by Dean to Faculty Executive Unanimously agreed and passed October 1999 Dean instructed to commence implementation Signed by Dean and President of UCFA
The TASC Agreement
Outlined functional arrangements Scheduling; resources; inclusion & consultation Principle of appropriate remuneration
CF rights, including representation rights Detailed implementation plan with timelines
included
The TASC Agreement
“The Faculty of Medicine recognizes the right of the Clinical Faculty to have independent representation in its dealings with the University when defining the roles, responsibilities, rights, and rewards of Clinical Faculty members.”
The TASC Agreement
“Individual Clinical Faculty members will have the right to choose how they are to be represented. The Faculty of Medicine recognizes the right of Clinical Faculty members to form an association. If an individual Clinical Faculty member chooses to be represented by an association, the Faculty of Medicine recognizes the right of the association to be the sole representative of that Clinical Faculty member.”
The TASC Agreement
Was widely praised and anticipated to usher in a new harmonious and mutually respectful relationship between the FOM and CF.
Then………..
Chronology continued…
The months pass by – no movement regarding implementation of the TASC agreement.
April 2000: Cathy Cordell instructed to represent UCFA re negotiations for service contract.
Negotiations commence August 2000 Team: D. Smith; C. Thompson; J. Wade
Behind the Scenes
While negotiations proceed: Dean makes announcements and distributes
opposing documents. FOM expedites CASC process with Hospitals
and Government:Terms contrary to TASC AgreementOne sided in favor of FOMFOM – no obligations vs. CF obligations
Suspension of Student Teaching
January 2001: Negotiations break down
February 2001: UCFA organizes widespread suspension of teaching
March 2001: FOM agrees to mediation
Mediated Agreement
Mediator: Judith Korbin FOM team includes the Dean, a VP Human
resources, UBC August 2001: Final A/O Letter drafted –
FOM attempts to insert “unauthorized” footnotes
Mediated Agreement
Appointment/Offer Letter for Individual CF Terms of appointment Payment schedule, including teaching combined with patient care $80 per hour Clinical teaching:
Students - $ 24/hour Residents - $ 8/hour
Definition of “assigned” teaching Dispute resolution – commercial arbitration Teaching tracking project funded by FOM
June 2001: Approved at Faculty Executive
More of the Same
Months pass by, invoicing system in chaos Individual and group invoicing No system of tracking/responding No payments; no responses from FOM New Dean – Gavin Stuart
Dr. Brad Munt takes his teaching invoices before a commercial arbitrator
UBC lawyers argue that clinical teaching has no value
The Munt Affair
Arbitrator: Murray A. Clemens, Q.C. Counsel for Claimant and Respondents. April 2003: Arbitrator jointly appointed. October 2003: Arbitration award submitted UBC lawyers repeatedly slow the process
The Munt Affair
Summary of Arbitration: Munt’s teaching was “formally assigned” as
defined in agreement Teaching services are compensable at $8.00/hr
(“nominal”) Munt awarded costs of arbitration
FOM Response to Arbitration
Initial refusal to abide by decision. Munt “fired” and no longer assigned
teaching, but has “obligation” to teach residents who happen to appear on his service!
Dean unilaterally moves to re-define terms of A/O Letter; and teaching of residents is “declassified” as “Formally Assigned” and converted to “Obligation” of CF.
Faculty Meeting November 13th, 2002
Resolution to not support Medical School expansion unless: Government in writing commits to increase
residency positions. FOM must undertake study of current and future
human resources for clinical teaching. Clear implementation plan must be in place.
Seconded by PARBC
Faculty Meeting May 12th, 2004
Failure of FoM to enact motion November 2002: Resolution recommending that the University
Senate delay implementation of medical school expansion until detailed: Review of human resource requirement. Financial report addressing all aspects of expansion
presented to the Faculty of MedicineSeconded by PARBC
June 2004
Dean offers to pay all outstanding invoices
Clinical Faculty submit bills for $2.5 million
Dean refuses to payUCFA proceeds with commercial
arbitration
Interpretation & Summary
FOM has shown no sincere interest in resolving CF concerns – twenty-year record.
FOM responds only to threat of withdrawal of teaching (1998 and 2001).
The TASC Agreement has been betrayed. Negotiated A/O Letter – was never honored
and is now thrown out.
The Future
We must balance the teaching versus the research agenda.
We must continue to hold the Medical School accountable for appropriate financing of the teaching enterprise.
We have the authority to accomplish this thru the collegial governance structure of the Faculty of Medicine.
The Dean and Faculty Executive are responsible to us, not the other way around.
Representation
The UCFA has been formally accepted as a member of the Canadian Association of University Teachers
CAUT has a rich record of defending clinical faculty – eg. Nancy Oliveri
We will seek formal representation either thru the Faculty Association or the BCMA, to achieve an enforceable collective agreement.
Ontario – Global Contracts
A history of Practice Plans with “taxation” 1990 – Sick Kids – Department of Pediatrics Mid 1990’s – Queen’s University 2004 – OMA/Government $75 million to move
2,700 clinical faculty to global contracts $75 million to complete the move Autonomous governance structures Legal partnership agreements Cessation of Fee-for-Service
Is this the model we want to pursue?
Psychiatry – “A Hot Bed of Apathy”
We enjoy enlightened leadership – Thanasios Zis Integration with GFT staff and appreciation of
clinical faculty SESSIONS – payment has never been an issue Relatively well-paid clinical work
Stan Semrau Well represented
Val Gruson
Your Role
Hold the FOM and Dean accountable for funding, especially the expansion
Assert the role of excellent clinical teaching, recognized by appropriate remuneration, within the FOM
Support the UCFA by joining www.ucfa.ca
Attend FOM meetings and vote