Dean of Memorial's med school not ruling out tuition hikes to deal with deficits
'People will say to me that we are incredibly lean,' says Margaret Steele
The dean of Memorial University's faculty of medicine is not ruling out tuition hikes to end a pattern of annual deficits, while Newfoundland and Labrador's health minister says the "unfortunate" problem will be corrected "within this fiscal year."
"It's definitely something we would look at," Margaret Steele, who's been in charge of the medical school for five years, said when asked recently whether a fee increase is being considered to end a series of deficits of $4 million to $5 million annually in recent years.
It doesn't appear Health Minister John Haggie will oppose such a measure, noting that current tuition rates "are the cheapest outside of Quebec, across Canada."
"There are options and we need to look at as a suite of how we can approach remedying it," Haggie said.
Greene report highlights faculty overspending
The faculty of medicine was highlighted in last month's The Big Reset report from the premier's economic recovery team, led by former Royal Mail executive Moya Greene, who grew up in St. John's.
With the province in the midst of a fiscal crisis, Premier Andrew Furey assembled the team and gave them the task of helping establish a roadmap for economic recovery.
Not surprisingly, a faculty of the university that has received additional payments of nearly $20 million from the government over three years to cover operating deficits caught Greene's attention.
Greene noted that the faculty has "a separate administrative structure, including finance, faculty relations and information technology" from the rest of the university, and that "opportunities may exist" to lower costs by combining some of these functions with the broader university structure.
Haggie admitted there are "duplication of back-office functions" and he said efforts are underway to amalgamate some or all of those functions within either Eastern Health, the regional health authority, or the university.
"We're looking at how we can make sure that the money that is spent by Memorial goes on education and not duplication of administrative services," he said.
"We are aiming to get this all straight within the next fiscal year."
Accreditation must be maintained
The faculty receives about $55 million annually from the Department of Health and Community Services, but additional payments have become a pattern, with the faculty on track to post a $3.6-million deficit this year, according to the health minister.
But Haggie cautioned against any measures that will affect programming, or threaten the faculty's accreditation.
"It's a really crucial part of our health-care system. It provides new, fresh graduates and it does it in a very good way, so we just need to make it work from a financial point of view as well as a clinical point of view," he said.
The faculty has been training doctors in the province for more than five decades, and is one of 17 medical schools in the country.
The faculty has an enrolment of about 320 undergraduate students, some 300 residents training in health-care settings, and close to 300 graduate students.
There are 227 employees and 1,114 full-time and part-time faculty members, according to the faculty's annual report. Many are physicians practising in St. John's and other areas, who take on teaching roles as part of their practices.
One of the challenges, according to Greene, is that faculty can be reduced only through retirements, since collective agreements prohibit layoffs.
"This makes expenditure reductions difficult without impacting academic programming which may, in turn, impact accreditation," Greene wrote.
Growing the medical school
So why is the faculty unable to live within its budget?
The problem dates back more than a decade, when a province flush with oil revenues and burdened with a doctor shortage, especially in rural areas, decided to expand the medical school.
The faculty's government grant was increased by $12 million to expand the number of seats for undergraduate medicine from 60 to 80, which also resulted in a corresponding increase in the size of the residency program.
But when oil revenues started dropping and the province's fiscal situation worsened, the government came looking for cuts at the university. That $12 million has been eliminated, but the size of the school remains the same.
Over the years, the faculty has managed to trim some $8 million, but some work still needs to be done, said Steele.
Since her arrival, tuition rates at the faculty have more than doubled to $14,250, which generates an additional $2.6 million annually.
More than $2 million was cut with the elimination of 10 faculty and 19 staff positions through attrition.
Steele said some administrative units have been merged, but noted that separate administrative structures and services are sometimes required to meet certain accreditation standards.
She said funding requests are prioritized to areas that are critical for accreditation standards, and discretionary funding has dropped to one per cent.
Steele said negotiations are also underway in a bid to increase fees for the 10 seats available exclusively for medical students from New Brunswick.
"Relative to other faculties of medicine across the country, people will say to me that we are incredibly lean," said Steele.
However, she acknowledged there may be other revenue opportunities, such as higher tuition, and more cost-cutting options.
"We're open to that discussion and continue to work with both the university and the government," she said.