The uncertain future of Canadian academic medicine

During the 1960's and 70's, academic medicine in Canada grew rapidly in size and scope and a number of research and clinical programs of the highest quality emerged. During the 1980's not only was this impetus not sustained, in some disciplines and regions there was likely a reversal of previous success. These adverse effects were produced by continued uncertainty and insufficiency of federal funding of research, underfunding of Canadian universities and of teaching hospitals, and by a decline within Canadian society of the images of both the physician and the teaching hospital with its technologically-based clinical and research programs. These negative influences were mitigated somewhat by the development during the 80's of more sources of research support from certain provincial governments and of a number of new biomedical research institutes and networks. The adverse influences of the 1980's will likely be perpetuated into the 1990's. Indeed an impending economic downturn and the return of constitutional disarray will worsen the climate for longterm growth in science and related health care research and technology. For Canadian academic medicine to survive these adverse influences, it must seek relationships and sources of support external to government. Most importantly however, it must strike new arrangements with provincial governments such that the imperatives of the academic health center and government become recognized in the planning process of the other party. For the academic health center this will mean involvement in government approaches to cost containment and health promotion; for provincial governments it will mean a commitment to health research and faculty renewal.(ABSTRACT TRUNCATED AT 250 WORDS)