UPEI and Health PEI release health system capacity report
UPEI and Health PEI have released the findings of the health system capacity report (the Spindle report).
The Spindle Strategy Group was engaged by UPEI and Health PEI to understand and catalogue the health care system’s capacity to successfully integrate medical learners; to identify any gaps in infrastructure, human resources, policies and programs, systems, and structures; and to devise an evidence-based roadmap including necessary investments and timelines to address those gaps.
Dr. Greg Keefe, Interim President and Vice-Chancellor, University of Prince Edward Island said, “We want to thank Spindle Strategy Group for their dedicated work on this project. The scope of the project was a health system capacity assessment for the future integration of future medical learners into the health system.” The Interim CEO of Health PEI, Corinne Rowswell commented, “As we move forward, we are mindful of the current state of health care on PEI and our duty to care for Islanders. We are working together with our partners to improve access to health care for all and recognize the significant value medical education provides to health-care systems.”
The Spindle report is a starting point. The report itself is based on a mathematical model that suggests an approach to integrate medical learners into our health care system. The report estimates up to 43 new physicians will be required over nine years; the model assumes these physicians will spend a minimum of 80 per cent of their time providing clinical care to Islanders and a maximum of 20 per cent of their time teaching.
What the report doesn’t factor in are the challenges of developing a medical school in a post-pandemic health-care system with a growing population that currently has gaps in access to care and service delivery that need to be addressed.
“Now the real work begins—the work of engaging fully with the health system, physician community, and other stakeholders to explore the options and possibilities both outlined in the report and no doubt more as UPEI, Health PEI, the government, and physicians work through how to do this together,” said Dr. Preston Smith, incoming inaugural Dean, UPEI Faculty of Medicine.
Smith, who grew up in Summerside, comes to UPEI after a lengthy career steering the direction of other medical faculties. He served as senior associate dean at Dalhousie’s faculty of medicine for five years, helping to establish the university’s family medicine residency program in PEI. He played a leadership role in the establishment of the Dalhousie faculty’s regional campus at the University of New Brunswick. He served as dean of the college of medicine at the University of Saskatchewan from 2014 until this year.
"I look forward to building our new UPEI Faculty of Medicine and working with all stakeholders on this transformative project for improved health care on PEI," added Smith.
Canada has seventeen medical schools across thirty-three campuses. All existing medical schools are expanding their seats. There are several new medical schools in development. Seventy-five per cent of medical school graduates indicate they want teaching opportunities as part of their career. UPEI and government’s support for the development of the UPEI Faculty of Medicine has ensured that PEI will no longer be the only jurisdiction in Canada without a medical school.
The detailed report can be accessed on the UPEI Faculty of Medicine web page at https://www.upei.ca/medicine/community-engagement.
UPEI and Health PEI Release Health System Capacity Report Highlights
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In the context of the health system, resourcing of the medical school relies on two key capacities: physicians and appropriate infrastructure.
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Physicians will be a key resource for the medical school as teachers, providing on-campus learning activities such as lectures and clinical skills workshops as well as supervising or precepting students in the field.
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The available physician resourcing for the medical school can be calculated by subtracting the new teaching and clinical backfill demands on physicians from the potential physician capacity to address these demands.
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By Year 9 of the medical school’s operations, it is estimated that at least 92 currently practicing physicians will have to be engaged by the university in medical education (spend 20% of their time teaching (note 1)) and 43 (note 2) new physicians will have to be hired into the health system and engaged by the university in medical education.
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Increasing engagement of currently practicing physicians in teaching will decrease reliance on new hires. Several strategies and enablers can be employed to increase historic recruitment rates and achieve hiring targets.
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Partnerships with out-of-province institutions will likely need to be forged to enhance the medical education experience, in particular for delivery of the PGME (residency) program.
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Infrastructure and space provisions are necessary for medical learners both within the health system and in the community. Addressing these physician and infrastructure needs of the medical school will require concurrent investments on the part of the Health System and the University.
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As a snapshot, in year 9 of the medical school’s operations, the baseline annual physician compensation (note 3) is estimated at ~$29.6M. Baseline annual resident compensation is estimated at $1.9M, for a total cost of ~$31.5M. Considering an inflation factor of 3% a year from the start of the medical school’s operations, these costs could be as high as ~$40M at this time point.
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High-level estimates provided by UPEI in consultation with various stakeholders including Health PEI, based on the specifications outlined in this report, estimate capital community infrastructure costs for the project to be $25,978,000.
Backgrounder:
In partnership with Memorial University of Newfoundland (MUN), the University of Prince Edward Island (UPEI) announced in October of 2021 its efforts to establish a Faculty of Medicine to deliver a medical education program for twenty undergraduate and twenty-one postgraduate (medical residents) learners.
In March of 2023, a joint Canada-PEI infrastructure announcement indicated that the first cohort of the program would start in 2026 (the earliest the joint program is expected to be accredited), with an earlier cohort beginning studies on PEI in 2025, under MUN’s CACMS (note 4) accreditation as a regional campus. This approach will provide PEI residents the opportunity to embark a medical education journey as soon as possible.
The joint UPEI/MUN medical education program will have a focus on training family physicians. By increasing the number of family physicians trained on PEI, the program aims to increase the number of doctors who will go on to practice in PEI. The medical school building will also house an on-site patient medical home, which is expected to provide services to approximately 10,000 patients.
For the program to successfully achieve its physician capacity building goals, it must integrate and dovetail with the provincial health-care system (Health PEI) from tip-to-tip. This involves integration of medical learners into hospital and community-based health-care settings across the Island as well as the provision of necessary supports to incorporate medical graduates into the PEI health-care workforce (including as future preceptors and faculty).
Of the seventeen medical schools operating across thirty-three campuses in Canada, none have undertaken a complex system capacity assessment prior to opening their medical schools. Since the first medical school opened in Canada in 1824, no medical school has closed, failed to integrate into, or caused harm to a health system.
Today Canada’s health-care systems are under tremendous strain, and not a day goes by that there is not a headline somewhere in the country about the physician shortage. Despite the challenges facing the health-care system across the country, all existing medical schools are currently expanding their seats; there are four new medical schools in development. Provinces cannot solve a labour shortage without adding more labour.
Such an impactful project does not come without significant challenges to be overcome and health system’s capacity to integrate medical learners is one of the challenges. For this reason, both UPEI and Health PEI took the unprecedented step of co-sponsoring the first-ever health system capacity report.
The Spindle Strategy Group was engaged by UPEI and Health PEI to understand and catalogue the health care system’s capacity to successfully integrate medical learners; to identify any gaps in infrastructure, human resources, policies and programs, systems, and structures; and to devise an evidence-based roadmap including necessary investments and timelines to address those gaps.
This was not a feasibility study. The work was a complex data-based assessment of the needs of both the health system and future medical school learners to inform a roadmap for the future integration of medical learners into the health system. It is a starting point to help inform realistic planning the health system and the new UPEI Faculty of Medicine now, and into the future.
[1] Time allocated for teaching is for the purposes of planning only and not intended to reflect the future reality of physician work patterns, which are anticipated to be varied and individualized. Additionally, physicians could spend some of their currently allocated teaching time on research, which would result in higher FTE demands.
[2] Could be pooled with greater health system hiring needs identified in the Health Intelligence Report
[3] Not including annual inflationary factor, benefits, continuing medical education, replacement costs, FFS billings, supplies, overhead and program support services
[4] Committee on Accreditation of Canadian Medical Schools (CACMS)
