S.E.D. Shortt


Paying doctors: impact of a change in remuneration method at a canadian academic health centre


Almost a century ago, North American medical reformers argued that clinician scholars could be relied on to do their best academic work only if they were freed from reliance on entrepreneurial activity. Since that time Canadian medical schools have become increasingly reliant on medical fees to subsidize their academic mission. At present, clinical earnings no longer appear able to support medical education. This paper describes the early results from an innovation in physician payment at an Ontario academic health centre. Under the new system all faculty abandoned fee-for-service billing and were funded from a global clinical budget. This remuneration change had little impact on clinical service, education or research. However, the system has introduced unprecedented stability and accountability to the funding of medical education.