Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

J a n u a r y 2 0 0 9 Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

The Ontario government is asked to contribute to building a stable infrastructure of knowledge and dedication to make Ontario s Innovation Agenda a success and to improve health care for Ontarians. Ontario s academic hospitals and health research institutes seek to work with the Ontario government towards achieving this goal. We will do so within principles of collaboration and partnership and full accountability to the people of Ontario for results. Table of Contents 1 Executive Summary 2 Health Researchers, A Vital Resource 3 Measuring Up Against Our Peers 4 Ontario s Brain Gain and Drain: Migration Patterns of Health Researchers 5 Ontario s Current Salary Support Mechanisms 7 Bridging the Gap in Ontario

Executive Summary The Council of Academic Hospitals (CAHO) represents the 25 research and teaching hospitals in Ontario. Among these academic hospitals are many world-class health research institutes. Health research globally is at the cusp of unprecedented promise and opportunity. Ontario is playing a lead role in realizing the explosive potential of today s biomedical research. We are poised to radically improve what we know and how we are able to fight illness and disease. A successful health research enterprise at this level is dependent on having a secure cadre of the best and brightest health researchers. In turn, health researchers, a much sought-after commodity, are dependent on the supports that give them stability and security to work, to develop and to succeed. We have had success. The health research enterprise in Ontario s academic hospitals and universities is internationally renowned, with some of the world s most highly cited health researchers located in our research community. What is not commonly understood is that 80% of the innovative health research and graduate student training in Ontario belongs to researchers in our academic hospitals and their research institutes. The nidus of research excellence that we have achieved is internationally recognized and continues to function as our best recruitment instrument. It is no surprise that in recent years, we have experienced a net gain of leading health researchers into the province. Ontario is playing a pivotal role in the global health research revolution. However, Ontario is not unique in its quest to attract and retain the finest health researchers to its research enterprise. The global research market is aggressively competitive and others have recognized the importance of investing in a researcher base. If we do not provide stable and sustainable support comparable to other jurisdictions, we risk our leadership position. Current funding mechanisms in Ontario are not sustainable. At present, two thirds of the health researcher salary support we are able to provide at Ontario s hospital-based research institutes is dependent on fundraising efforts. The escalating costs of health care delivery have placed increasing demands on hospital foundations for clinical infrastructure and operational shortfalls. Coupled with the current global economic downturn, reliance on philanthropic support for the foundation of Ontario s evolving knowledge based health research economy is not a sustainable option. Most other Canadian provinces have established government-funded health research councils or foundations to provide strategic leadership and human and capital infrastructure support to their burgeoning research enterprises. These organizations allocate up to 70% of their funds to salaries and training. Ontario s investment in salaries and training pales by comparison. Consequently, in recent years, other provinces have become significant competitors in global recruitment of the best innovative minds, and indeed the destination for some of Ontario s finest researchers. Our capacity to recruit and retain is in jeopardy due to the lack of a strategic and collaborative provincial approach to investment in health research human resources. CAHO s Council of Ontario Research Directors (CORD) has identified the current salary support requirements at our research institutes and hospitals to be close to $100 million. i As academic hospitals and research institutes, we are committed to continuing to do our part in supporting our researchers. But we also look to the Ontario government to partner with us in order to ensure a stable and adequate base of funding. Ontario s academic hospitals, through CAHO, are eager to work with the Ontario government to develop a provincial funding approach that will begin to address the need for a stable base of funding and will thereby send the signal that Ontario understands the responsibility it faces as a world research and innovation leader. In return for financial support we will ensure accountability and success by targeting our shared investments, leveraging all other available resources and maximizing collaborations. Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

Researchers are the Engine in our Health Research Enterprise As the fourth largest biomedical research centre in North America, Ontario has 10,000 health researchers working within its academic hospitals. At present, we are dependent on fundraising to support our health researchers. We are not competitive in providing stable support to researchers and trainees. Other jurisdictions have moved ahead. The Ontario government must help to ensure a stable and adequate base of funding. Opportunity to leverage the Innovation Agenda. Health Researchers, A Vital Resource Ontario has been home to 77% of Canada s world first discoveries and medical breakthroughs since the late 19 th century, including the discovery of insulin, development of the first artificial kidney machine, and identification of the gene that causes colon cancer. ii This government understood the significance and potential of this track record and has launched an aggressive Innovation Agenda which marks a historic leap forward in fostering the province s research enterprise. Ontario may be risking its competitive edge. With incentives for industry-public sector partnerships and an unprecedented focus on developing new jobs, Ontario has sent a strong message we are serious about innovation. Today, our province is the fourth largest biomedical research jurisdiction in North America. iii Twenty-five academic hospitals and affiliated research institutes employ 10,000 researchers and generate $850 million of research activity annually. iv The additional spin-off benefits in terms of added generation of investment and new jobs are well-understood by this government and its commercial partners. While these figures are impressive, other jurisdictions are making steady strides and Ontario s competitiveness is being challenged, with its position at the vanguard of health research and innovation in jeopardy. Since launching its Health Research Foundation in 2001, British Columbia s share of national research awards has grown from less than 8% to more than 12%. v Ontario, by comparison, has been seeing a downward trend in terms of its share of national research funds. vi Talent is a key lever for competitive advantage in research. The expanding knowledge-based economy has heightened worldwide competition for talent. Successful innovation is thus dependent on our ability to attract and develop the best researchers in the world. COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

Measuring Up Against Our Peers Ontario is not unique in its quest to attract the finest researchers to its academic and research enterprise. Nations such as United States of America, Australia and the United Kingdom have strategies to cultivate health researchers and are targeting investments towards vii, viii, ix recruitment and retention. Closer to home, other Canadian provinces offer ongoing salary and training awards to health researchers (Tables 1 & 2). In 2006, the Alberta Heritage Foundation for Medical Research committed 70% of its $60 million annual research fund to salary and training awards. x Between 2001 and 2006, the Michael Smith Research Foundation in British Columbia allocated 63% of its funds on average to researcher salaries and training ($113 million through its Career Investigator and Research Trainee programs). xi, xii Quebec, Nova Scotia and Manitoba make similarly significant contributions to support health researchers. Table 1: Comparison of Health Researcher Salary and Training Investments across Canada During 2007/08, more than 250 investigators were supported through Alberta s Heritage Foundation for Medical Research. To receive AHFMR support, researchers must meet the highest standards of international excellence. Annual health Salary Training Province & Organization research funding awards awards AB Alberta Heritage Foundation for Medical Research $ 60M 55% 15% BC Michael Smith Research Foundation $ 32M -- 63% -- MB Manitoba Health Research Council $ 2.5M 40% NS Nova Scotia Health Research Foundation $ 3.8M 47% QC Fonds de la Recherche en Sante du Quebec $ 83M 23% 12% SK Saskatchewan Health Research Foundation $ 6M 12% ON Ministry of Research and Innovation $ 52M 7% Ministry of Health and Long-Term Care $ 76M 2% 1% Ontario Institute for Cancer Research (from MRI/MEDT) $ 18M 22% Ontario Government combined $ 146M 7% <1% Source: Manitoba Health Research Council (2006) In 2005, Ontario s Ministry of Health and Long-Term Care (MOHLTC) dedicated only 2% of its $76 million health research budget to salary awards and 1% to training awards, and the Ministry of Research and Innovation (MRI) allocated 7% of its $52 million health research investment to the Early Researcher Award program. The Ontario government s collective contribution to health researcher salaries and training through MOHLTC, MRI and the Ontario Institute for Cancer Research represented only 7% of its total investment in health research that year. Such a marked difference between Ontario and other provinces raises grave concern about losing our best researchers, both emerging and established, to other jurisdictions. Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

Ontario s Brain Gain and Drain: Migration Patterns of Health Researchers In 2008, the Council of Ontario Research Directors (CORD) examined health researcher migration to and from Ontario s health research institutes, reviewing profiles of 171 individuals classified as leading researchers or emerging stars (out of an estimated 2,000 principal investigators in the province). With its booming research enterprise, it is no surprise that in recent years, Ontario has experienced a net gain of leading health researchers into the province. 67% of new recruits to our health research institutes from outside Ontario (n = 91) have come from the United States, followed by 9% from Germany. Only 1% of recently recruited health researchers have come from Alberta and 4% have come from other provinces. Attracting the best is the first step in securing our standing. Keeping the best is as important. Excluding movement within the province, 36% of researchers who have left Ontario s health research institutes since 2005 (n = 47) have gone to the United States, and 40% have gone to other provinces, with Alberta being the most popular destination within Canada. An additional 10% moved to the United Kingdom and the remainder left in small numbers for other parts of Europe, Australia, and China. Attracting and recruiting researchers, as with many other specialized and highly sought-after professions, is much more expensive than retaining them. Attracting and recruiting researchers is much more expensive than retaining them. COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

Ontario s Current Salary Support Mechanisms Understanding current government contribution to researcher salaries compared to other provinces begs two questions: How are health researchers funded in Ontario? And is current funding adequate? To answer these questions, health researchers are classified into three broad categories: 1. University employees; 2. Active clinicians engaged in research at hospitals and affiliated research institutes; and 3. Non-clinical health researchers at hospitals and affiliated research institutes. University-employed researchers such as professors and members of their research teams represent 20% of the health research workforce in Ontario. xiii Their positions are generally permanent and tied to ongoing provincial government supported funding from the university. Exceptions include researchers hired on a short-term basis to carry out specific research projects, and post-doctoral fellows who are funded through a variety of sources secured by themselves and/or their faculty supervisors. Research institutes fund researcher salaries through the core budget funding they receive largely through fundraising. The remaining 80% of Ontario s health researchers are based at the province s academic hospitals and affiliated research institutes. These researchers account for: 80% of extramural health research funding (e.g. federal granting agencies); approximately 80% of the provision of medical research graduate education; and, 100% of clinician scientist training, province wide. Clinician researchers are also active in providing direct patient care to Ontarians. Ontario s hospital based research institutes have two major revenue streams: 1. Core budget 23% of funding, on average, is considered core budget. xiv Core budget funds are comprised mostly hospital foundation contributions but also include internal revenues such as parking as well as operating funds provided by MOHLTC and their university (Figure 1). 2. External research funds The other 77%, on average, are external research funds including: revenues from contract research; international, federal, and provincial research grants; funding from disease associations; and municipal and other external funds. Figure 1: Funding for Core Budgets of Health Research Institutes in Ontario Hospital foundation, 50% Internal revenues, 36% MOHLTC operating funds, 10% University, 4% Source: The Change Foundation (2003) Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

Ontario s Current Salary Support Mechanisms (continued) The vast majority of external research funding is through grants for research projects which generally do not permit researcher salaries as an eligible operating expense. Therefore, current salary support, as it is, is paid through the core budgets of research institutes. On average 60% of the core budgets of hospital research institutes are spent on researcher and administrator salaries and benefits. Some clinicians may be funded for protected research time by their hospital or through their practice plan in which case physicians are supporting their own colleagues through their individual clinical earnings. The Ontario government also now provides teaching and research support to academic physicians through the Academic Health Sciences Centre Alternate Funding Plan initiative which has helped a portion of the researcher group. Not surprisingly, research institute core budgets remain the largest source of health researcher salaries, covering 77% of the salary needs (Figure 2). Personnel awards such as the national Canada Research Chairs and MOHLTC s Career Scientist Awards are the second largest source of health researcher salaries. Such programs currently meet 15% of the salary requirements at research institutes. xv Current funding mechanisms for our hospital-based researchers are insecure and unstable. The escalating costs of health care delivery have placed material and increasing demands on hospital foundations for clinical infrastructure and operational shortfalls that force support away from researcher and training needs. The recent success of our provincial hospitalbased research enterprise in the Canada Foundation for Innovation Research Hospital Fund competition has further increased the pressure on hospital foundations. Ontario hospitals won $315 million of an available $426 million in awards. But this comes at a price as hospital foundations are now responsible for raising an additional 60% in matching funds for these awards as no funding support has come forward from our province. Figure 2: Sources of Salary Support for Ontario s Health Researchers Research institute core budget, 77% Personnel awards, 15% Funding for protected time, 4% 3 rd party: private plan, AFP, 1% University, 3% Source: The Change Foundation (2003) COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

Bridging the Gap in Ontario Reliance on philanthropic contribution to support the majority of the province s innovation engine for health research is neither sound nor sustainable. We cannot deny the pull effect of other provinces, notably Alberta and British Columbia, which offer stable salary support and clear career paths. 80% of our health researchers do not have stable and sustainable salary support. Based on a 2007 assessment we have identified that the current stable salary shortfall at our research institutes to be approximately $100 million. xvi To secure Ontario s leadership position and to support its knowledge economy, the Ontario government must contribute stable salary and training support for its health research agenda. Ontario s academic hospitals and health research institutes seek to work with the Ontario government towards achieving this goal. We will do so within principles of collaboration and partnership and full accountability to the people of Ontario for results. Table 2: Comparison of Salary and Training Awards for Health Researchers across Canada Duration Matched # of Awards Province & Annual of Award Funding Granted Organization Award Value ($) (years) Renewable? Required? Annually i AB Alberta Heritage Independent 135,000 230,000 7 x 53 Foundation Investigator for Medical Award Research BC Michael Smith Career 80,000 100,000 5 6 x 40 Foundation for Investigator Health Research Award MB Manitoba Health Manitoba 100,000 5 x x 3 Research Council Research Chair QC Fonds de la Research Scholar 39,007 88,469 4 96 Recherche en Sante du Quebec Clinical 23,407 53,082 4 x 30 Research Scholar National 30,000 4 x 54 Researcher Research Chairs 50,000 65,000 5 x n/a (with partner organizations) SK Saskatchewan New Investigator 40,000 2 x x 10 Health Research Establishment Foundation Grant Health Research 500,000 5 x 2 Team Grant ON Ministry of Career Scientist 70,000 5 x x 6 Health and Award Long-Term Care Ministry of Early 100,000 over 5 years x 64 Research and Researcher Innovation Awards ii Sources: various organizational websites and reports i Most recent published data ii Salary support for the awarded researcher is not an eligible expense. However, the award can be applied towards salaries of research associates and students. Supporting Health Researchers To Come To Ontario, To Stay, and To Succeed

i Discussions to date with the Ontario government, predicated on a preliminary assessment, have focused on a minimum base of $52 million in annual salary support. A 2007 CAHO survey of the 25 academic hospitals in Ontario determined approximately $100 million in researcher compensation being provided through overhead budgets not supported by the government. ii Association of Canadian Academic Healthcare Organizations (ACAHO). EUREKA! World s First Discoveries and Other Major Medical Breakthroughs in ACAHO Member Institutions. Accessible at: www.acaho.org, March 2008 iii Ontario Government. Ontario s Next Generation of Jobs Fund Quick Facts: Ontario s Next Generation Industries. 2008 iv Council of Academic Hospitals of Ontario (CAHO). Discovery Innovation Our Future. November 2006 v Michael Smith Foundation for Health Research. Our History. Accessible at : http://www.msfhr.org/sub-about-history.htm, 2008 vi On Management Health Group for the Manitoba Research Council. Health Research Funding in Manitoba: A Description and Comparison across Canada. May 2006 vii National Health Service (NHS). Best Research for Best Health: A new national health research strategy. 2006 viii National Institutes of Health (NIH). Training at NIH. Accessible at : http://www.nih.gov/training.htm, 2008 ix Australian Government National Health and Medical Research Council. Annual Report 2005: Investing in Australia s Health. 2006 x On Management Health Group for the Manitoba Research Council. Health Research Funding in Manitoba: A Description and Comparison across Canada. May 2006 xi Michael Smith Foundation for Health Research. Personnel Programs Review Research Trainee Program Background Information. March 2008 xii Michael Smith Foundation for Health Research. Personnel Programs Review Career Investigator Program Background Information. March 2008 xiii Association of Canadian Academic Healthcare Organizations (ACAHO). Research Funding Flow Survey. 2005 xiv Change Foundation. Council of Ontario Research Directors/Ontario Health Research Alliance Baseline Information Survey. 2003 xv Change Foundation. Council of Ontario Research Directors/Ontario Health Research Alliance Baseline Information Survey. 2003 COUNCIL OF ACADEMIC HOSPITALS OF ONTARIO

CAHO CORD Committee Members 2008-2009 David Hill (Co-Chair) Scientific Director Lawson Health Research Institute London Health Sciences Centre/ St. Joseph s Health Care London Geoff Fernie (Co-Chair) Toronto Rehabilitation Institute Larry Chambers President and Chief Scientist Élisabeth Bruyère Research Institute Bruyère Continuing Care Roger Deeley Associate Dean Research, Faculty of Health Sciences Queen s University Vice-President Research Development Kingston General Hospital Hugh Graham Executive Director Hotel Dieu Hosptial Kingston Gillian Hawker Physician-in-Chief Women s College Hospital Michael Julius Sunnybrook Health Sciences Centre David Kaplan Associate Chief of Family & Community Medicine North York General Hospital Colin Macarthur Bloorview Kids Rehab Alex Mackenzie Children s Hospital of Eastern Ontario Brian Malcomson Associate Vice President, Academic Affairs Montfort Hospital Randy McIntosh Associate Director Rotman Research Institute Baycrest Centre for Geriatric Care Ravi Menon Scientist Robarts Imaging Research Laboratories London Health Sciences Centre/ St. Joseph s Health Care London Zul Merali President and CEO Institute of Mental Health Research Royal Ottawa Health Care Group Chris Paige University Health Network Bruce Pollock Centre for Addiction and Mental Health John Puxty Chief of Staff Providence Care Ian Rodger and Academic St. Joseph s Healthcare Hamilton Janet Rossant Chief of Research The Hospital for Sick Children Arthur Slutsky St. Michael s Hospital Duncan Stewart CEO and Scientific Director Ottawa Health Research Institute The Ottawa Hospital James Woodgett Director Samuel Lunenfeld Research Institute Mount Sinai Hospital Salim Yusuf and Chief Scientific Officer Hamilton Health Sciences

The CAHO office is located at: 200 Front Street West, Suite 2501 Toronto, Ontario Canada M5V 3L1 416-205-1336 Visit our website: www.caho-hospitals.com Members Council of Academic Hospitals of Ontario Children s Hospital of Eastern Ontario Ottawa, ON Hôpital Regional de Sudbury Sudbury Regional Hospital Sudbury, ON Bruyére Continuing Care Ottawa, ON The Ottawa Hospital Ottawa, ON University Health Network Royal Ottawa Health Care Group Ottawa, ON London Health Sciences Centre London, ON Mount Sinai Hospital Providence Care Kingston, ON Hamilton Health Sciences Hamilton, ON Kingston General Hospital Kingston, ON St. Michael s Hospital Centre for Addiction & Mental Health St. Joseph s Health Care, London London, ON The Hospital for Sick Children Toronto Rehabilitation Institute Hotel Dieu Hospital Kingston Kingston, ON Baycrest Centre for Geriatric Care Bloorview Kids Rehab North York General Hospital Thunder Bay Regional Health Sciences Centre Thunder Bay, ON St. Joseph s Healthcare Hamilton Hamilton, ON Sunnybrook Health Sciences Centre Hôpital Montfort Ottawa, ON The New Women s College Hospital