I have been getting emails soliciting my option about the Government of Ontario’s decision to make the Northern Ontario School of Medicine (NOSM) a stand-alone university.  This is a big issue in Northern Ontario, with many people getting upset over what I think amounts to very little.  But perhaps we should rewind to the beginning.

NOSM is a fairly unique medical school.  It was created in the mid-2000s to deal with a persistent shortage of doctors in Northern Ontario.  In market economies, the problem of keeping up the supply of doctors to rural areas is almost universal: either give extra cash to practitioners – pay them more for not living in the big city, forgive their student loans, etc – or give more scholarships to students from rural areas in the hope they might want to go back there (communist governments had a third option, which was simply to assign people to remote regions, but this is pretty rare nowadays).  The solution offered by NOSM was different – set up a medical school in the North, for the North, and more specifically, for students from the North.

Makes sense, right?  Well, the problem was that in North America, medical schools are normally attached to major research universities.  This is in large part a consequence of a 1910 report on Medical Education in the United States and Canada – even back then we were a Common Higher Education Area – conducted by the Carnegie Foundation.  Before then, pretty much anyone could set up a medical school and so the term “MD” didn’t mean very much.  Programs varied in length, content, and certainly in terms of quality control.  Its author, Abraham Flexner, was of German extraction and leaned towards a German model of medical education, or at least those American universities closest to it, like Johns Hopkins.  What that meant was that medical schools had to have stringent entrance criteria, tight connections to hospitals for clinical training and significant research capacities.  This meant a lot of medical schools had to close – half either merged or closed in the subsequent two decades – and more to the point it meant that medical universities were permanently tied to institutions with significant research facilities in the life sciences.  And neither of Northern Ontario’s universities really met that description.

So instead a different kind of medical school was created: one which de-emphasized biomedical discovery in favour of community-engaged research, and one which therefore did not need the same  links to major biomedical research facilities.  Then, the new school could be placed in a Northern Ontario university, although in the end the government ended up putting it in two of them, splitting the facilities between Lakehead in Thunder Bay and Laurentian in Sudbury.  It’s not clear to me if this was a compromise born of regional politics or a necessity in order to have access to enough clinical placements in hospitals.  And it wasn’t an easy beginning – getting faculty in a single spot to get on the same page about anything is hard enough – having two faculties separated by a thousand kilometres didn’t make it any easier.  But it was a success, maybe beyond anyone’s dreams.

The legal arrangement was that NOSM offered all the courses and largely managed its own affairs (you have to squint really hard when reading NOSM publications to spot the links to Lakehead and Laurentian).  But it wasn’t a degree-granting institution: that was the reason for which Lakehead and Laurentian were kept in the arrangement.  And because they were the degree-granting bodies, Laurentian and Lakehead also acted as the fronts for applications to the granting councils: research money flowed through their accounts on the way to NOSM.  So when Laurentian ran into financial problems, it impacted NOSM, as a not-inconsequential sum of research money was among the restricted funds that went AWOL there.   There were, shall we say, some tensions in the arrangement.

But nobody – and I mean nobody – saw what was coming next, which was that the provincial government decided to simply cut NOSM loose from both Lakehead and Laurentian and make it an independent university on its own.  This move seems to have been made quite suddenly – the drafting of the legislation has more than a touch of the dog-ate-my-homework about it (“there shall be a Board of Governors”, but all the details are going to be delivered via regulations, ditto the Senate – it all suggests that the legal department may not have had more than about 48 hours notice).  And this has set off all sorts of alarm bells around the region.

The first alarm bell is from Laurentian and Lakehead, who are not unnaturally peeved that they are about to lose the prestige they gained from an association from a medical school.  The second alarm bell is from the city of Thunder Bay, which for some reason seems to suspect that NOSM’s independence possibly presages the university upping sticks and centralizing its affairs in Sudbury.  This seems implausible: even if the university wanted to centralize – and it has been pretty clear that it does not – it’s not like there’s any money available to expand spaces in Sudbury and even if that weren’t true, I am pretty sure a government getting slammed for ignoring education in the North would absolutely put the kibosh on a new university trying to abandon Thunder Bay.

The third alarm bell is one I am hearing less from the North than I am from elsewhere in the province.  And maybe it’s not so much an alarm bell as it is puzzlement: is a stand-alone medical university even possible?  The answer is that of course it is, but we have been so conditioned by the Flexner Report and subsequent developments to see medical faculties as being inseparable from research universities. 

And yet, outside North America this is not really all that unique.   Germany has a few medical universities (e.g. Hannover): in Romania, Poland and Russia it is more common for medical schools to be stand-alone entities than it is for them to be part of a “regular” multi-faculty institution.  It’s also largely true of China and Vietnam, and similar institutions are spread over Indonesia, Malaysia and India. 

Stand-alone medical universities – heck, single-faculty universities writ-large – are in fact common the world over.  And when you think about it, why not?  We in North America have no problem dealing with Fine Arts schools.  Why not have more such institutions?  After all, Nova Scotia has stand alone schools for Education and Engineering into the 1990s and an ag school until about a decade ago.  They were eliminated for reasons of financial expediency rather than anything else, but it’s not clear that similar considerations will damn NOSM.

In any event: NOSM’s birth as an independent institution might be out of the blue and bears all the planning process hallmarks of a provincial government that brought us thousands of unnecessary COVID deaths.  But there’s nothing inherently scary or improper about it.  It’s been de facto independent pretty much from the start, and it will continue to do just fine on its own.  It might, conceivably, cost a little bit more as a stand-alone institution, and if the provincial government doesn’t understand this then that is a problem.  But on the whole, this seems a pretty benign story.