The independence and integrity of medical education and research in Canada are at risk because too many clinical faculty do not enjoy the same academic freedom and employment rights as their non-clinical colleagues, warns a report issued last month by a task force of medical experts established by CAUT.
The report, Defending Medicine: Clinical faculty and academic freedom, concludes that the freedom of clinical faculty to challenge prevailing orthodoxies or criticize decisions made in their institutions is increasingly vulnerable to pressure from outside interest groups, university administrators and corporate and government funders.
"This is a critical moment for clinical faculty," the report says. "Funding shortfalls have placed great strain on universities and health care institutions. Administrations have responded by building increasingly hierarchical management structures, structures that may produce narrow, immediate efficiencies, but place the future of academic medicine in danger. Pressure to produce clinical income takes time away from teaching and research. Incentives to create commercializable products push economic concerns, rather than scientific and ethical considerations, to the forefront. As room for independent thought, action and critical examination - the very things that advance the quest for greater human knowledge - disappears, universities and affiliated health care institutions are themselves diminished."
Derryck Smith, head of the division of child and adolescent psychiatry at the University of British Columbia and a coauthor of the report, said changes must be made to protect the health of Canadians.
"It's very important for researchers to be unfettered in their academic pursuits. In this case, it's particularly important because the outcomes affect the health of individual patients and populations," he said in an interview.
"The problem with clinical faculty is they are often caught in the vortex of three different systems - the university, the hospital and the research institute. If you then throw in the influence of the pharmaceutical industry, you have a potentially toxic mix of influence being brought to bear on individual faculty."
The task force says explicit protections of academic freedom for clinical faculty must be included in all employment contracts. Also, clinical faculty must have better access to fair and independent dispute-resolution procedures, including access to independent external arbitration for resolution of matters other than those covered by statutory prescription.
The task force also stresses that "clinical faculty should create effective representative organizations" to assist them in securing and defending their rights within universities, health care institutions and clinical funding plans.
The report was prepared by Philip Welch, a medical geneticist and retired professor of pediatrics at Dalhousie University; Carol Cass, chair of oncology at the University of Alberta and associate director of the Cross Cancer Institute; Gordon Guyatt, professor of clinical epidemiology and biostatistics and medicine at McMaster University; Alan Jackson, a neurologist and professor of medicine at Queen's University and an associate professor in the department of microbiology and immunology; and Derryck Smith, head of child and adolescent psychiatry at UBC and head of psychiatry at the Children's and Women's Health Centre of British Columbia.
The authors plan to visit all Canadian universities with faculties of medicine to talk with clinical faculty members about the issues. They will also be meeting with provincial medical societies and other groups that have an interest in the review.