1. NOSM postgraduate medical training:
creating sustainable funding for a
community-engaged distributed
education environment
Short Presentation
Muster Conference
October 30, 2014
Presenter: Jennifer Fawcett, Director, Postgraduate Education
Grace Vita, Director Finance and Risk
Dr. Catherine Cervin, Associate Dean Postgraduate Education
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2. Disclosure Slide
• Presenter:
Jennifer Fawcett
–Employee of
Northern Ontario
School of Medicine

3. Objectives
1. Describe the main points of a business
case for distributed postgraduate medical
education
2. Understand some of the lessons learned
about addressing the complexity of
medical education funding
3. Describe the importance of the study
undertaken to determine the economic
benefit of a new medical school.
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4. The Northern Ontario
School of Medicine:
Innovative Education and Research
for a Healthier North
Postgraduate Residency Programs: adaptable
generalists with advanced expertise needed for
the North

5. Residency Programs at NOSM

6. Note – Royal College of Physicians and Surgeons of Canada oversees and accredits
all non-Family Medicine Residency Programs.
College of Family Physicians of Canada accredits all Family Medicine
Residency Programs

7. Cost Drivers
7

8. Cost Drivers
Distributed Postgraduate Education in Northern
Ontario
• Part time stipendiary clinicians as teachers
and leaders
• Faculty site directors for each residency
program in each community
• Increasing need for educational expertise &
faculty development
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9. Cost Drivers
Distributed Education in Northern Ontario
• High travel costs
• Developing a research environment
• Resident wellness services
• Administration in a decentralized, interconnected
network
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10. Unpredictability in Resident Numbers
• Vacancies from start up years
• Transfers
• Remediation and extensions of training
• Extended leaves of absences: 5 to 6 per year
• Exiting programs early
• Choice to do R4 or subspecialty
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11. PGE Royal College Specialty
Program Costs
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12. Anesthesia Program increasing to only 10
PGE Residents per year
Anesthesia Residency Program Annual Costs
7 7
8
10
8
2013-14 2014-15 2015-16 2016-17 2017-18
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
-
Annual Cost (in CDN $)
Variable Costs 244,000 213,500 213,500 244,000 305,000
Fixed Costs 409,466 409,466 409,466 409,466 409,466
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13. Anesthesia Program Costs will never be covered
using the current MOH funding model
800,000
600,000
400,000
200,000
-
-200,000
-400,000
2013-14 2014-15 2015-16 2016-17 2017-18
Annual Program Costs
Anesthesia Program Costs vs. MOH Funding
8
8 7 7
10
13

14. PGE Family Medicine Program
Costs
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15. Accreditation Standards result in funding deficits
within Family Medicine
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0
-$1,000,000
-$2,000,000
Family Medicine Program Costs compared to MOH Funding
2013/14 2014/15 2015/16
15

16. $25,000
$20,000
$15,000
$10,000
$5,000
$0
-$5,000
Teaching Program
Salaries
Travel Supplies Educational
Activities
Funding Gaps Within MOH Budget Lines
Current TPA Funding Gap
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17. Summary of Sustainable
Funding Requirements
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18. Sustainable Funding for PGE Family
Medicine
PGE Family Medicine 2013/14 2014/15 2015/16 2016/17 2017/18
PGE Family Medicine Annual Cost
(000) $5,313 $5,313 $$5,313 $5,313 $5,313
NOSM Current TPA Funding Model
(000) $3,897 $3,897 $3,897 $3,897 $3,897
Deficit -$1,416 -$1,416, -$1,416, -$1,416 -$1,416
$43,300 per PGE Family Resident => Annual operating deficit.
Increase to $59,000 per PGE Family Residents is required
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19. Sustainable Funding for PGE Specialty
Medicine
PGE Specialty Medicine 2013/14 2014/15 2015/16 2016/17 2017/18
Number of PGE Specialty
Residents (000) 72 82 88 90 90
PGE Specialty Medicine Annual
Cost (000) $5,590 $5,895 $6,078 $6,139 $6,139
NOSM Current TPA Funding
Model (000) $3,658 $4,166 $4,470 $4,572 $4,572
Deficit -$1,932 -$1,729 -$1,607 -$1,567 -$1,567
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$50,800 per PGE RC Specialty Resident => Annual operating deficit.
Need a fixed + variable funding model $425,000 per program fixed + $30,500 variable

20. A new funding formula that recognizes the
fixed costs in a program is required
Average Fixed Program Cost $425,000
Variable Program Costs (per resident) $ 30,500
If fewer than 20 residents, the funding formula needs to include both a fixed
and variable component.
More than 20 residents current funding formula of $50,800 per resident
covers both fixed and variable costs.
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21. Sustainable Funding Strategies
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22. Principles for long term planning
• Community engagement
– Community input, grounded in the North
– Evidence for HHR needs in N. Ont
– Research benefits of learners (residents and others) in
Northern communities
• Educational excellence and innovation
– Capitalize on small residency programs – cross
program collaboration/innovation/integration
– Focus on resident well-being
– Sound educational structures
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23. Principles
• Work with MOHLTC and National Medical
Education Institutions
– MOHLTC review of funding provincially
– 1:1 for UME output
– NOSM input into accreditation standards (RC,
CFPC) related to Distributed Medical Education
environment
– Association of Faculties of Medicine (AFMC) 2012
Vision for the Future of Medical Education in
Canada (Postgraduate) aligns with NOSM’s vision
and mandate.
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24. Funding Strategies - seek new money
• Lobby Ontario Government for a fixed plus
variable cost formula
– Track our success for evidence to funders and engage
in economic impact studies
• Education innovation grant opportunities and
one-time curriculum development funding
• Work with Local Education Groups (LEGs) for
innovative approaches to supporting community
based residency programs
• Revenue from clinical fellowships
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25. Funding Strategies – optimize use of
funds
• Collaborate with hospitals (separate education funding)
• Review discretionary and variable costs for budget savings
• Maintain strong working relationships with the NOSM
Office of Finance
• Economize and maximize opportunities across small
programs (Curriculum Resource Support Team)
• ‘Whole School’ budget process and advocate for shared
educational support across the continuum of medical
education
• Budget Sub-Committee of the Postgraduate Education
Committee
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26. Practice Location of Graduates
Percentage of all NOSM PGE Graduates (since 2008) Practicing,
by Geographic Location N = 211
Location of Current Practice %
Northern Ontario Urban 47%
Northern Ontario Rural 22%
Northern Ontario Total 69%
Southern Ontario 28%
Out of Province 3%
TOTAL 100%

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Questions?