The LEGS Evaluation Project
Project Brief – December 2014
Alternative Funding Plans (AFPs) in Ontario support physicians who provide clinical teaching to medical students and residents. AFPs are funded by the Ministry of Health and Long -term Care (MOHLTC), and have existed at Academic Health Science Centres (AHSCs) in Ontario since the 1990s. The first AFP for the clinical faculty of the Northern Ontario School of Medicine (NOSM) was signed in 2009, as a negotiated agreement between the MOHLTC, the Ontario Medical Association (OMA), NOSM, and the Physician Clinical Teachers Association (PCTA).
NOSM has a unique mandate to train physicians for rural and northern communities. Because of NOSM’s model of distributed medical education (DME) – with clinical learning sites in over 70 communities across northern Ontario – the NOSM AFP needed a different approach to supporting clinical faculty.
The LEGs Initiative is an innovative model of funding the academic activities of clinical faculty, tailored to northern Ontario and DME. AFPs at other AHSCs are largely centralized and implemented through existing administrative structures. In contrast,
the NOSM AFP is administered by an independent association, the Northern Ontario Academic Medicine Association (NOAMA), and implemented largely through the
Local Education Groups (LEGs) Initiative. LEGs are self -organized groups of
physicians with responsibility for academic deliverables and clinical teaching. LEGs
are funded to provide an organizational structure to support clinical faculty in NOSM’s partner communities.
Thirteen groups of physicians responded to the first call for LEG proposals in 2011; by the fall of 2013 there were 23 operational LEGs, with another 17
under development. Today, there are 35 operational LEGs, with others in the planning stage. Each LEG has its own governance agreement , educational program, objectives, and organizational structure. Four distinct organizational types have been recognized: Community (multi-specialty), Hospital Department, Family Health Team, and Pan-Northern.
AFPs are also intended to support the growth of an academic cultureamong physician
clinical faculty, and all NOSM AFP members are required to hold a faculty appointment at NOSM. More than half of NOSM’s clinical faculty have been appointed since 2009, reflecting a doubling of participation in the AFP, from 469 to 971 physicians. A
ll AFP members are eligible to apply for grant s through the AHSC AFP Innovation Fund and the Clinical Innovation Opportunities Fund. Unlike other AFPs, the NOSM AFP does not provide funding for clinical repair, so payments for clinical service delivery are separate from the AFP.
Although individual clinical faculty members can participate in the AFP without joining a LEG, LEGs are eligible to receive additional funding for administrative support, professional development, program development, and research development. Of
the 971 eligible physicians currently participating in the AFP, 627 (65%) have joined a LEG; many other potential LEG members await faculty appointments