Has the Alternative Funding Plan provided Queen's with increased flexibility?
Each of the four funding agreements with the government has differed with regard to flexibility available to the Alternative Funding Plan. The original contract fixed funding for five years. Increased subspecialization, increased patient demand, and other factors put tremendous pressure on SEAMO and its member organizations to increase staffing. Fixed funding meant increased staffing could only occur at the expense of levels of compensation, which was neither politically possible nor desirable. Modest increases did occur partly as a result of some enhancement funding at initiation of alternative funding, and partly through careful cash flow management (by using funding from vacancies).
The second funding agreement, the Amendment and Extension to the Agreement, provided a mechanism for requesting from the Ministry additional funds for new positions. This mechanism was both extremely cumbersome and time consuming and arguably provided little in return.
The third contract provided to SEAMO an envelope of funds and freedom to allocate these funds as it wished. Improvements to rates of compensation, new positions, and supporting infrastructure were funded from this envelope. This flexibility placed great responsibility on the organization to allocate its resources appropriately.
The current funding agreement again reduces significantly the flexibility available to the organization. While SEAMO can allocate its funds as it wishes, funding enhancements over the three years of the contract are linked either to penetration of the fee-for-service system through shadow billing, or guaranteed rate adjustments to mirror province-wide alternative payment plans.
For more information on this alternative funding plan see a article: Rosenbaum, P, Shortt SED, Walker DMC. Alternative Funding for Academic Medicine: Experience at a Canadian Health Sciences Center. Academic Medicine 2004;79:3.