Chair's Column: What has the University done for me lately?

Every now and then I am asked by faculty members about the value of being part of the University of Toronto. The hospital-based Department of Medicine practice plans are seen as the financial engines enabling what we do. What the U of T Department of Medicine contributes may not be clear.

In this Chair’s Column, I want to give you the facts about what monies the University Department of Medicine has and how they are used to support you. I have already shared this information with your PICs, who encouraged me to share it with you.

Annual Revenue to the Department of Medicine

In the current academic year, the annual revenue to the University DoM is approximately $13 million. These monies come from a variety of sources, but principally:

• Faculty of Medicine (our operating budget);
• Ontario Ministry of Health and Long-Term Care (MOHLTC) for residency training;
• Revenue from funded international medical trainees.

Keep in mind that, unlike other university Departments of Medicine in Ontario and elsewhere in Canada, revenue for clinical care and alternate funding plans from the MOHLTC flows directly to the hospitals and practice plans. I cannot comment on what proportion of practice plan income comes from these sources, but it would be useful to separate these out when considering who is funding what.

The overall funding to the Department has faced steady decline over the past five years. There are many reasons for this decline, but the two most significant are:

• Annual reductions in the operating budget from the Faculty of Medicine as a result of increases to university operating costs and tuition freezes or cuts. As for all clinical departments, we will continue to see a three per cent reduction per year. We have lost $750,000 in operating budget, or 8 per cent over the past five years; and,
• Fewer trainees from Saudi Arabia, leading to a reduction in funding of approximately $500,000.

Through our reputation and the hard work of our Advancement staff and faculty members, whose amazing work inspires donors, we have a substantial portfolio of endowments and trust funds. These generate approximately $3 million in interest income annually that supports research and education initiatives in every division.

Annual Expenses to the Department

Aligned with our mandate, the majority of our expenses relate to our responsibilities towards education and research.

We have approximately 1,000 trainees going through our residency and fellowship programs every year. The Department is accountable to PGME for all aspects of their training, including scheduling electives, the CARMS process, evaluation, providing end-of-training verification, remediation, etc.

With respect to research, our focus is on supporting the pipeline of physician-scientists. This extends to the Clinician-Scientist and Clinician-Educator Training Programs, to providing salary support for newly recruited clinician-scientists to enable them to get their research programs established, and later, to merit-based salary support for clinician-scientists who have come off salary support awards, like Canada Research Chairs.

Over the previous few years, there have been increasing demands placed on the Department – both centrally and across our hospitals and faculty – due to the introduction of Competence by Design (CBD) and the pending UGME and PGME accreditations. Of note, no new funding has been received to support implementation of CBD. As a result, we have necessarily reduced support for research. For example, we have accepted only two or three applicants per year into CSTP/CETP over the previous few years despite many highly-qualified applicants; similarly, we can fund only approximately 50 per cent of clinician-scientists who apply for merit awards after loss of external salary support.

Finally, we commit funds to support the well-being of our faculty, through acknowledgement of major milestones, such as Professors’ days, mentorship, workshops and events, and their career success, e.g. leadership training and coaching.

A brief summary of the annual expenses to the department is provided here:

• $4.5 million in salary support for staff. These are all the people who support recruitment (about 40 new faculty per year), CFAR (about 40 faculty per year), senior promotions (30 to 50 faculty per year and rising), communications (newsletters, announcements, social media, etc.), administration for grants held at the university, MSB lab oversight (9 clinical faculty have their labs at MSB), finances, training programs and over-arching education and research administration.
• $3 million annually to support divisional activities. Our faculty are distributed across 20 Specialty Divisions, from Allergy and Immunology to Rheumatology. Funds are allocated annually to each division based on its size (number of faculty and residents). They are managed by the DDD on behalf of the division alongside our Business Manager, Margaret Mah, and the DoM’s finance team. The DDDs work hard to supplement these funds with unrestricted educational grants from industry and philanthropic donations, working alongside our Senior Development Officer, Tyler Small. The monies are used by the divisions to fund fellowships, resident travel to meetings, social events, annual research and education days, city-wide grants and other activities.
• $300,000 to support education-specific initiatives, such as Core Medicine fees for ACLS and resident retreats, Undergraduate Medical Education, Master-Teacher Program, and others.
• $1 million annually to run the Clinician-Scientist and Clinician-Educator Training Programs. These programs provide tuition (about $11,000) and salary support ($75,000 per year for three years) to individuals undertaking graduate training. At any one time, we have 15 to 20 trainees in these programs. In addition to mentorship and financial support, we manage all grants and awards submitted and received by these individuals.
• $100,000 for faculty development activities and events. These include city-wide grant opportunities like research networks, annual events designed to build community and foster academic success and wellbeing, such Professor’s Days, Associate Professors’ Day, Annual Day, Faculty Orientation, Promotions and CFAR workshops, and other departmental activities.

$8.7 million annually goes to support our faculty members as follows:

• 128 faculty members receive stipends for leadership or other administrative departmental roles. These include:
  • Vice-Chairs, PICs and DDDs
  • CFAR and Senior Promotion Committee leads
  • CSTP and CETP Director
  • Quality Leads and Advisors
  • Leads for education: Core Internal Medicine and Specialty Program Directors (n=21), Leads for Fellowships (n=8), Education Scholarship, Master Teacher Program, Competency by Design, including 36 Academic Advisors, PGY4 Program, Teaching Effectiveness Committee (Senior Promotions), hospital site leads for Core Internal Medicine and Clerkships (n=17), Simulation, Academic Half Day Lead
• 20 faculty members are receiving clinician-scientist start up salary support of $40,000 each for five years;
• 30 faculty members are receiving clinician-scientist merit of $40,000 each for three years. Clinician-scientist merit is awarded by application to our Merit Review Committee and the competition is stiff – of approximately 20 applicants each year, we are able to provide support to eight to 10 of the most highly ranked;
• 38 faculty members hold a University Endowed Chair: The University DoM’s trusts and endowments provide interest to support six Divisional Chairs that support divisional activities (Cardiology, Respirology, Rheumatology, GIM, Geriatric Medicine and Palliative Medicine) and 13 individual awards to support faculty members’ research activities. We are working hard with advancement and our DDDs to ensure such support exists for ALL divisions and we very much welcome your help and support in identifying potential donors. A further 19 University-Hospital Chairs or Professorships provide support to additional faculty members:
  • Alexandra Yeo Chair in Benign Haematology
  • Banting and Best Diabetes Centre – Novo Nordisk Chair in Incretin Biology
  • Deborah Ivy Christiani Brill Chair in Neurology Research
  • Dr. Dexter Hung-Cho Man Chair in Cardiology
  • Dr. Luigi Casella Chair in Cardiology
  • Elisabeth Barford Early Career Professorship in Multiple Sclerosis Trust Fund
  • Elisabeth Hofmann Chair in Transitional Medical Research
  • Gabor Zellerman Chair in Nephrology Research
  • George, Margaret and Gary Hunt Family Chair in Geriatric Medicine
  • Godfrey S. Pettit Chair in Respiratory Medicine
  • Mary Trimmer Chair in Geriatric Medicine
  • Mr. Mak Pak Chiu and Mrs. Mak-Soo Lai Hing Chair in General Internal Medicine
  • Oreopoulos Baxter Chair in Nephrology Research
  • Pfizer Canada Chair in Rheumatology
  • Rose Family Chair in Palliative Medicine and Supportive Care
  • RTO ERO Chair in Geriatric Medicine
  • Sir John & Lady Eaton Chair of Medicine
  • Sun Life Financial Chair in Diabetes at UHN

These have almost exclusively come from donors who wish to contribute to the education and research of physicians in specific areas. As for divisional chairs, we are currently working hard to identify potential new donors, such as from among our alumni. Of note, unlike fundraising in the hospitals, which benefits from 'grateful' patients with close relationships with specific physicians or programs, we rely on philanthropy from folks who have a bigger vision, e.g. to foster innovation in clinical care and treatment that capitalizes on the full breadth of excellence of our department.

The bottom line here, however, is that with rare exceptions, monies from these endowments and trusts flow to the hospital departmental practice plans.

Other Ways in Which the Department of Medicine Supports You:

As University-affiliated teaching hospitals, you have the privilege of working alongside a truly outstanding group of University of Toronto undergraduate, undergraduate MD, postgraduate residents and fellows, and graduate students. Currently ranked 5th in clinical medicine world-wide, we are fortunate to attract the ‘best of the best’. While changes in curriculum at all levels has impacted the total number of trainees available to any one clinical service in any one hospital, I think we would all agree that we are lucky to have these trainees.

As a department, we are committed to faculty development and life-long learning. As an example, we provide, free of charge, the Master Teacher Program, led by Danny Panisko and Umberin Najeeb, to all incoming clinician teachers as well as the Co-Learning Curriculum in Quality Improvement and Patient Safety, led by Brian Wong, to residents and faculty to learn about QI. The CSTP and CETP programs have already been noted above.

Finally, as faculty members, the university Department is responsible for your academic career progression (recruitment, orientation, CFAR, promotion through the ranks, etc.). As I hope you are aware, we have invested heavily in mentorship and improving civility in the workplace, and are now embarking on a more fulsome strategy to advance inclusion and wellbeing under the leadership of our newest Vice-Chair, Dr. Lisa Richardson, and her portfolio of Culture and Inclusion.

We advocate for your happiness and success. Through the advocacy of Vice-Chair, Quality and Innovation, Dr. Kaveh Shojania, QI has now been fully embraced under the umbrella of Creative Professional Activities and the provincial impact of QI activities is understood as relevant. Through the advocacy of Vice-Chair, Education, Dr. Arno Kumagai, a curriculum in Person-Centered Care, led by Drs. Ayelet Kuper and Lisa Richardson, has been developed and implemented and is now fully incorporated into both the U of T undergraduate and post-graduate residency curricula. He has also championed fairness and transparency of policies regarding addresses complaints of trainees about faculty members and vice versa – this work has been embraced by PGME and UGME. Through the advocacy of Vice-Chair, Research, Dr. Michael Farkouh, almost 100% of our CSTP trainees have been successful in obtaining external funding to support their training, which is good for them and also good for us! Finally, as you are all aware, through the advocacy of former Vice-Chair, Mentorship, Equity and Diversity, Dr. Sharon Straus, now PIC at Unity Health/St. Michael’s, we have made major strides towards creating a department that equitable, diverse and inclusive.

Summary:

The department’s total budget of $13 million may appear modest in light of the size of our department, made up of more than 800 full-time faculty members and more than 1,000 trainees, and relative to annual revenues to the hospital practice plans. However, as noted above, it would be interesting to examine revenues to the practice plan in three categories: MOHLTC revenue for clinical services and AFP, hospital resources and university support. This might provide a more balanced view of who does what.

Over the past five years, the University Department’s funds have been reorganized to increase fairness and transparency in the allocation of funds. As you can see from above, a large proportion of our funds flow directly to Department members through the hospital practice plans to provide the human resource infrastructure to enable us to achieve our aims in our priority areas. The remaining funds support our training programs and sustain the administrative support required to keep us going.

Although the annual budget is relatively small, I believe we are doing a good job of ensuring that dollars are spent in alignment with our collective mission, vision and values. Could we do a better job with more funds? But of course! Which is why we are working with our colleagues in Advancement to launch a campaign to raise additional monies to support the outstanding work you do!

We vow to continue to be transparent about our revenues and expenditures so that no faculty member should have to ask, “What is the university doing for me?”

If you have questions, as always, direct them to me at g.hawker@utoronto.ca.