Defending Medicine: Clinical Faculty and Academic Freedom
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Defending Medicine: Clinical Faculty and Academic Freedom Report of the Canadian Association of University Teachers (CAUT) Task Force on Academic Freedom for Faculty at University-Affiliated Health Care Institutions November 2004 Table of Contents Page Executive Summary.................................................................................................................. 3 Section One - Introduction ....................................................................................................... 7 Section Two - Strengthening Academic Freedom Rules for Clinical Faculty.......................... 10 Section Three - Security of Appointment and Security of Income for Clinical Faculty........... 18 Section Four - Natural Justice for Clinical Faculty................................................................... 20 Section Five - Strengthening Clinical Faculty Representation.................................................. 24 Section Six - Conclusions and Recommendations.................................................................... 32 Appendix A - The CAUT Task Force on Academic Freedom for Faculty at University- Affiliated Health Care Institutions ........................................................................................... 35 Appendix B - Glossary of Terms.............................................................................................. 37 i Executive Summary The CAUT Task Force Clinical faculty in Canada do not enjoy the same academic freedom protection as other members of the professoriate. Prompted by this inequity, and the growing number of clinical faculty approaching the Canadian Association of University Teachers (CAUT) with concerns about institutional interference with their ability to conduct research, speak freely and share findings with patients and colleagues, CAUT established a task force to examine academic freedom at university-affiliated health care institutions. The task force was asked to review the state of academic freedom for clinical faculty across the country and to recommend how academic freedom could be best enhanced and protected. The members of the task force are Dr. Philip Welch (Chair), a medical geneticist and retired professor of pediatrics at Dalhousie University; Dr. Carol E. Cass, chair of oncology at the University of Alberta and associate director of the Cross Cancer Institute; Dr. Gordon Guyatt, professor of medicine at McMaster University; Dr. Alan C. Jackson, professor of medicine at Queen's University; and Dr. Derryck Smith, head of the division of child and adolescent psychiatry at the University of British Columbia and head of psychiatry at the Children's & Women's Health Centre of British Columbia. This report is the first step of the task force in fulfilling its mandate. Introduction Excellence in academic medicine depends upon a work environment characterized by intellectual curiosity, relentless critical inquiry, and a desire to improve clinical practice and advance scientific knowledge. Academic freedom is an essential component of such an environment but, for various structural and historical reasons, clinical faculty enjoy far less of its protection than other university faculty. Academic Freedom Academic freedom is the right of academic staff to teach, study, and publish regardless of prevailing opinion, prescribed doctrine, or institutional preferences. It includes the freedom to express critical opinion about workplace institutions and broad public issues. It also includes the freedom of academic staff to participate in representative academic bodies and the governance mechanisms that regulate the functions of their workplaces. It is sustained by security of appointment and income. Without academic freedom, the ability of clinical faculty to discover knowledge and to disseminate that knowledge to students, the scientific community, and society at large is diminished. By enabling faculty to engage in controversial research and critical inquiry, 1 academic freedom fosters the dynamic atmosphere required to advance human knowledge in health sciences and to protect the health and well-being of Canadians. Clinical Faculty The term “clinical faculty” is used in many ways across Canada. In this report, the term is used to refer to health sciences professionals, typically those with MD and/or PhD degrees, who hold simultaneous appointments at both a university and a teaching hospital or other health care institution. Membership spans the spectrum from full-time university professors to physicians in private practice who teach medical students on a part-time or occasional basis. Vulnerability of Clinical Faculty The work arrangements of clinical faculty differ from those of non-clinical academic staff in a number of important ways, differences that can compromise their academic freedom. First, the dual appointments (university and health care institution) that clinical faculty must typically maintain means they work under two sets of administrative rules—the collegial governance systems of universities and the hierarchical and increasingly “corporate” structures of health care institutions. As a result they must defend their academic freedom on two fronts—at universities, where its importance is acknowledged, and in health care institutions, where it is frequently poorly understood. Second, unlike non-clinical academic staff who typically derive the bulk of their income from the university payroll, clinical faculty income is allocated in a variety of ways and in various combinations: sometimes through a practice plan; sometimes through an alternative funding arrangement; sometimes as a direct university salary or contract payment; and sometimes as clinical earnings paid on a fee-for-service basis. Because interference with income is a powerful form of action against faculty members for exercising academic freedom, the diffuse nature of clinical faculty income creates particular vulnerabilities. Finally, many clinical faculty stand apart in that they are excluded by law, choice or tradition from the legal guarantees of academic freedom contained in collective agreements between universities and academic staff associations. With respect to health care institutions, clinical faculty, unlike almost all other groups in these institutions, typically have no collective agreements to protect their rights. This leaves many clinical faculty without effective representation and without access to the dispute resolution systems governed by natural justice that characterize collective bargaining relationships. Fostering Excellence Through the course of its work the task force was able to identify vulnerabilities common to clinical faculty across Canada. To address these vulnerabilities, the task force has formulated six recommendations to ensure that clinical faculty have the academic freedom vital to their work. 2 Recommendations The recommendations of this report—that universities and affiliated health care institutions make strong declarations of academic freedom rights, provide security of appointment and security of income, and allow access to dispute resolution systems characterized by natural justice; and that clinical faculty themselves form powerful representative organizations—will provide clinical faculty with the same academic freedom protections as other members of the professoriate and increase the ability of clinical faculty and the institutions where they work to advance the boundaries of human knowledge in health sciences and thereby protect the health and well-being of Canadians. Strengthen Academic Freedom Rules for Clinical Faculty The rules that govern the working lives of clinical faculty are set out in a variety of written instruments—mission statements, guidelines, policies, affiliation agreements, and employment contracts. A strong commitment to academic freedom in these documents is critically important for clinical faculty, both to establish a legal and policy basis for academic freedom rights and to foster a culture of institutional respect for academic freedom. 1. To ensure that academic freedom is a foundational principle of academic medicine, explicit references to, and protections of, academic freedom must be included in institutional mission statements, institutional policy, university-hospital affiliation agreements, funding plans, collective agreements, and employment contracts. Protect Security of Appointment and Security of Income for Clinical Faculty Termination of employment is a means of silencing critical opinion. The academic freedom of clinical faculty therefore depends upon security of position and security of income in respect to both universities and health care institutions. 2. To protect the academic freedom of clinical faculty (i) clinical faculty members must be eligible for tenure in respect of university appointments and university income (ii) decisions in respect of health care institution appointments and privileges must follow established rules (iii) health care institution appointments and privileges must be for renewable terms and can only be terminated or not renewed for just cause 3 (iv) health care institution rules must include protection for academic freedom, such that the exercise of academic freedom cannot be a justification for non-renewal, variance or termination of appointments and privileges (v) procedures must be established to ensure that allocations of clinical income are made according to clear procedures and protected against arbitrary or capricious decisions Ensure Access