Issue: BCMJ, vol. 55, No. 4, May 2013, Pages 185-186 Letters

I want to thank the BCMA most sincerely for the time they have given to improving the relationship between clinical faculty and the Faculty of Medicine. A key factor in the process is the letter of intent (LOI) which, although undated and with limited circulation (if any) to BCMA members at the time it was written, is an important document. It confirms the BCMA’s pledge to support its members who are now, or may in the fu­ture become, clinical faculty teachers/mentors in their quest for a just settlement with the Faculty of Medicine. It also confirms that both the BCMA and the Faculty of Medicine agree to recognize the Section of Clinical Faculty as participants in the process. This is great news—it has never before been recorded in an official document as far as I know. 

The LOI as it stands is not perfect, but it is a change for the better from pre­vious arrangements. With our represen­tative on the Clinical Faculty Working Committee we fully support the LOI process now taking place, while hoping for more changes in the future. However, there are items in the LOI with which I, as a founding member and past president of UCFA/SCF, would never have agreed to had I known of their existence earlier and been consulted. 

The first we heard of the LOI was at the Section of Clinical Faculty AGM on 5 May 2011 when the BCMA president announced that it was to be signed that day by the dean and himself. As there was no written copy of the LOI available before or after the meeting, it is not surprising that few, if any, of our members understood its importance. Indeed, a written copy was not seen until 10 months later on 26 March 2012 when the Section of Clinical Faculty president received one, seemingly by chance, in answer to a question asked of a senior member of a key BCMA committee. 

Why is this important? We, the Section of Clinical Faculty, have many times in the past stated we favor a referendum of clinical faculty members before accepting a new contract—indeed several senior members of the BCMA have supported this notion. Since a referendum is not mentioned in the LOI our members could rightly say we failed them when they learn we were party to the wording of the document, as some claim, but which we respectfully deny. 

Furthermore, the second paragraph of the LOI gives additional evidence that the Section of Clinical Faculty could not have taken part in its genesis. It implies that should the government run short of funds, which is quite possible, clinical faculty teachers/mentors could bear the brunt of the shortfall. No one else is mentioned, suggesting to some that the authors see patient care—the prime purpose of our profession—as being of secondary importance to other activities. I firmly believe this was not the authors’ intent, but no Section of Clinical Faculty board member would have endorsed a letter containing this comment. These two points may seem minor compared with the more important substance of the LOI and so they may be, but they do confirm that the Section of Clinical Faculty could not have read and endorsed the final version. 

That said, I am pleased to see that the relationship between BCMA and the Faculty of Medicine—between clinical practitioners and academics—is inching forward. The considerable potential for this relationship[1] will only be realized when there is transparency on the part of both parties in their relations with clinical faculty and their representatives: trans­parency that the above-mentioned wording in the LOI calls into question. 

I take no issue with those involved in the system, only with the system itself; systems instinctively resist change, but in the long run ancient Greek wisdom prevails: “Nothing endures but change.”
Do we have the courage to consider change, and to think outside the tent? 
—Angus Rae, MB, FRCPC


1.    Rae A. Clinical faculty proposal. BCMJ 2009;51:427-428.

Angus Rae, MB, FRCPC. Transparency. BCMJ, Vol. 55, No. 4, May, 2013, Page(s) 185-186 - Letters.

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