In 1998, 148 members of clinical faculty, those who provide over 60% of training for future doctors, formed the University Clinical Faculty Association (UCFA) to give a voice to these physicians who, unlike other groups in the vast health care industry, salaried teachers, nurses, technologists, researchers, and administrators, have neither a mutually agreed contract nor an independent dispute mechanism. 

This anomaly arose, not by design but failure to question an outmoded notion[1] and is inconsistent with the norms of modern society.

The formation of the UCFA/SCF was not a rebellion but a meeting of dedicated physician-teachers with a common interest in promoting medical education and the advance of the medical school, an essential determinant of which must be the satisfaction of these teachers, on whom the school so heavily depends, with their conditions of service. 

Since our inauguration the Faculty of Medicine has made several ad­vances aimed at improving the relationship with clinical faculty. In 2002 one of the UCFA board members, with our support, was appointed as chair of the newly formed Clinical Faculty Affairs Committee, answering to and advising the dean on clinical faculty matters. 

This committee, with the support of UCFA, has been able to obtain funds to compensate clinical faculty teachers/mentors who lose income as a result of taking learners. This is a positive step. There are others, in­cluding a contract between us which, although not perfect, will undoubtedly improve as time goes by to the benefit of all. 

At our inaugural meeting a proposal was put forward which we be­lieve is now worth debating openly by all participants in the expanding medical school. If together we think it has merit we should explore it further. 

The proposal is that clinical faculty consider forming “…An autonomous, self-governing Clinical Faculty Association, within the community of the University, dedicated to good clinical medicine, clinical research and teaching, and able to negotiate in good faith with the Faculty of Medicine the conditions under which members would join their salaried colleagues as equal partners in the common enterprise of training future doctors and other health care professionals…”

What might result from this proposal? 

• With acceptable terms of service the bulk of clinical faculty not yet doing so would join those now teaching in a harmonious partnership with colleagues in the Faculty of Medicine. 

• Most practising physicians enjoy teaching and realize the benefits both to learners and to themselves of the two-way exchange of information and experience. 

• With more mentors and fewer learners per mentor, learners would get more experience. 

• With the load on mentors thus reduced the inevitable loss of time from patient care and lengthening wait lists inherent in the presence of learners would be reversed. 

• Vital research faculty would have more time to pursue their important goals.

• There are hundreds of Canadian and other physicians who, having trained in prestigious schools overseas, cannot get into our system—with the increase in mentors they could more easily be absorbed for assessment and, if need be, remediation. 

• By spreading the load among more mentors, medical school enrollment could increase to absorb the hundreds of Canadians forced for lack of space to train overseas.

• Mentors would be responsible for the quality of their mentoring to the dean of medicine and for the quality of care to their patients and society at large. 

• The overall quality of medical practice would improve since this system has built-in CME for all participants—the Royal College grants CME credits for teaching. 

• The province would be turned into a medical school, an initiative which others might emulate, thus reversing the worsening shortage of doctors throughout the country.

• Dedicated mentoring takes time and clinical faculty should not be ex­pected to forfeit income and family time to do it well. This will cost money, but the overall savings from an improved system with more physicians would be immense.

• There would be an end to the disagreement and confrontation now pervasive within the teaching frat­ernity, and we could all, as respectful partners, get on with the job of producing the next generation of doctors. 

If after open debate this idea ap­pears worth pursuing, I believe there is the potential to become a world leader in medical education while enhancing the research excellence to which we aspire.

—Angus Rae, MB 
Vancouver

References

1. Rae A. Osler vindicated: the ghost of Flexner laid to rest. CMAJ 2001;164:1860-1861.