Provost's Response to the Report of the Task Force on Clinical Faculty

December 20, 2002

In January 2002, Provost Adel Sedra established the Task Force on Clinical Faculty, chaired by Dr. David Naylor, Vice-Provost, Relations with Health Care Institutions and Dr. Vivek Goel, Vice-Provost, Faculty. The Task Force was widely representative. It included colleagues from a wide range of clinical departments. Among its members were an elected president of a medical staff association, chair of a medical advisory committee, a physician-in-chief with expertise in health policy, a hospital chief executive, an ophthalmologist-educator, a physician-bioethicist, and a clinical department chair. The Task Force also included on-campus colleagues with appointments in the tenure stream in Medical Genetics and Microbiology, Law, and Economics.

This diverse group was asked to make recommendations as to how the relationship between clinical faculty and the University of Toronto might be optimized. Clinical appointments are critical to the University's ability to fulfil its academic mission. However, as the Task Force reported, clinical faculty differ fundamentally from University tenure-stream faculty in both their accountabilities and their income arrangements. Clinical faculty have triple accountability to the University, to their profession and its self-regulatory mechanisms, and to an affiliated hospital. They receive most of their income through practice plans, and the vast majority are self-employed.

Historically, the relationship between clinical faculty and the University has been ambiguous. The recommendations of this report clarify the issues that shape this relationship and provide an important new framework for collaboration among the University, the teaching hospitals and practice plans. The Report of the Task Force on Clinical Faculty represents a very significant achievement and I am grateful to the members of the Task Force for their hard work.

Overall, I endorse the recommendations put forward in this report. Because clinical faculty have accountability to both the University and an affiliated hospital, implementation of the recommendations will require creation of specific policies to govern the nature of clinical appointments, and revision to the affiliation agreements with each hospital.

University Appointment

As noted in the report, the Memorandum of Agreement governs the relationship between the University of Toronto and its faculty. It is the Memorandum of Agreement that delineates the minimum rights, privileges and benefits which the University grants to its academic staff. Central to the Memorandum is the protection of academic freedom. The Memorandum stipulates that there will be no change to basic policies and practices, commonly referred to as "frozen policies". Included in these frozen policies is the Policy and Procedures on Academic Appointments (PPAA). With regard to clinical faculty, there is a policy gap in the PPAA. The policies proposed in this report will fill this policy vacuum and clarify the terms of appointment for clinical faculty. The consultation of the Task Force makes it clear that clinical faculty wish to have policies to govern their University appointments that are specific to their own circumstances. Further, the recommendations of the Task Force report have already won support from elected representatives of medical staffs, medical advisory committees, and hospital executives. I have therefore advised the University of Toronto Faculty Association that policies for clinical faculty will be developed independent of the Memorandum of Agreement. As UTFA does not represent clinical faculty in their salary and benefits negotiations and does not admit clinical faculty as full members, this course of self-determination is the only legitimate path by which the University can strengthen and clarify its relationship with our clinical colleagues. Governance of the relationship for clinical faculty must involve a partnership between the University, the affiliated hospitals and the practice plans.

Among the most fundamental rights and responsibilities of all faculty including clinical faculty is academic freedom. The report notes that the University has a clear commitment to safeguarding the academic freedom of all individuals with University appointments, and requires co-operative mechanisms with the hospitals and practice plans to meet its obligation in this regard. Recommendation 3 and Recommendation 4 are designed to safeguard academic freedom in the clinical context. These recommendations have my unqualified support.

Hospital Appointment

Implementation of these recommendations will also require revision to the affiliation agreements with each hospital and alignment of practice plans with the principles contained in the report. Recommendation 2, for example, proposes that core principles for practice plans be developed that include distributed earnings to support the academic mission, the delineation of clinical and academic responsibilities, transparent processes for allocating resources within plans and multi-level dispute resolution mechanisms. In order to move forward expeditiously with implementation of these recommendations, I have asked Vice-Provost Naylor to begin the process of renegotiating the affiliation agreements to ensure that the core principles outlined in this report are implemented.

Provision of Benefits

Recommendation 1 proposes the development of a taxonomy for clinical faculty that identifies three categories of appointment: Full-Time Clinical Academic Appointment, Part-Time Clinical Academic Appointment, and Adjunct Clinical Academic Appointment. A principle that underlies the proposed taxonomy is that appointments should be based on job descriptions, not pay sources. Currently there are full-time clinical faculty doing essentially identical work, yet their eligibility for certain University perquisites varies arbitrarily depending on whether or not some or all of their salary is run through the University or through practice plans in affiliated institutions. The report notes that, over time, the differences between clinical faculty who are paid through these different sources has become increasingly more notional than real. I endorse this recommendation, and I support the proposal that full-time clinical academic faculty be eligible for education benefits and discounted Joint Memberships regardless of paymaster arrangements. I have asked the Dean's Office in the Faculty of Medicine to estimate the number of full-time clinical faculty who would be eligible for these benefits in order to estimate the approximate cost to the University of implementing this proposal.

Monitoring Policies for Clinical Faculty

Recommendation 5 proposes that a Clinical Relations Committee be established to review the policies and procedures for clinical faculty. The Clinical Relations Committee will also receive an annual report from the Clinical Academic Tribunal established under Recommendation 4. The membership of the Clinical Relations Committee will be broadly representative in order to safeguard the interests of clinical faculty. I agree with this recommendation. I have asked the involved Vice Provosts to consider how and when the functions of this Committee might be extended to include Part-Time Clinical Faculty and partially-affiliated hospitals.