Qualitative Assessment of the Impact of Health Care Reform on the Availability of Clinicians for Preclinical Medical Instruction

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Purpose: Over the past 5 years, Calgary clinicians experienced the restructuring of health care delivery and a move to a presentation-based curriculum at the University of Calgary. Course coordinators have noted increased difficulty in recruiting clinical lecturers at the preclinical undergraduate level. This study was designed to evaluate the relative importance of factors that may influence the time clinicians spend teaching at this level. Summary: This descriptive survey was conducted within the University of Calgary, Faculty of Medicine, a teaching institution affiliated with the Calgary Regional Health Authority, which is responsible for the delivery of health care within the City of Calgary. Basic scientists, residents, and adjunct medical professionals were excluded from a list of lecturers for the academic year 1996-97, leaving a target population of 386. Respondents were stratified according to university appointment, specialty, type of medical training, and hours taught in the 1996-97 academic year. Dependent variables included the financial constraints, time constraints, health care reform, changes in the undergraduate medical education curriculum, and lack of recognition on availability for teaching. Written comments were also categorized and analyzed according to the same variables. A response rate of 79% (n = 305) was achieved. Of the respondents, 52% agreed that recent reform has made it more difficult to teach; full-time faculty were less likely to agree compared to non-full-time faculty (60% vs. 44%; nonparametric median test, c2 = 6.18, p =. 046). Twice as many family physicians reported that financial constraint was a factor (66%) when compared to other specialists, whereas relatively few full-time faculty noted it to be a concern (12%) when compared to major part-time (43%) and non-full-time/major part-time appointees (66%; c2 = 23.4, p <. 0001). Clinicians reporting the most teaching hours (more than 30) were most likely to describe an increase in teaching hours (61%). Nonfaculty members were less aware of the recent curricular changes (73%); however, more family physicians felt that these changes had a positive impact on willingness to teach (10%) compared to surgical (8%) and nonsurgical specialists (9%; c2 = 6.07, p =. 048). Forty-five percent of respondents agreed that they would be more willing to teach if offered some form of recognition. Two thirds of written comments suggested that recognition should be nonmonetary (e.g., faculty promotion, acknowledgment). Conclusions: The experience at the University of Calgary suggests that availability of teachers for preclinical undergraduate medical education has diminished as a result of health care reform. Family physicians have been affected the most, and the clinical environment will make it even more difficult to involve this important group of teachers in undergraduate medical education.