Paying Doctors: Impact of a Change in Remuneration Method at a Canadian Academic Health Centre

Abstract

Abstract: 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 article 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 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.