Faculty of Medicine Retreat

April 2, 2014

Check against delivery.

Thank you Dean Whiteside for that kind introduction. More importantly, thank you for nearly a decade of sterling service as Dean of the Faculty of Medicine and Vice Provost, Relations with Health Care Institutions.

There will be many opportunities to recognize Cathy’s extraordinary leadership properly and to celebrate her accomplishments appropriately… but for the moment, ladies and gentlemen, could I ask you please to join me in a round of grateful applause.

Thank you. I am delighted to be here and honoured to speak. This exercise is so important, as are the key questions driving your deliberations today.

Over the next twenty or so minutes, I would like to share two key messages with you. The second message – about partnership – will comprise the lion’s share of my remarks.

But my first message is this: Thank you. Thank you for your leadership… for your scholarship, mentorship, and clinical expertise… for your commitment to research, and research-intensive education… for your dedication to your students, your colleagues, your patients, your hospitals, your University, and your extended communities.

Recent news from UHN underscores this last point. Dr. BobBell’s appointment as Deputy Minister of Health and Long Term Care is wonderful news for the region and the Province.

It also exemplifies the significant collective impact the Faculty of Medicine and our partner hospitals have on every aspect of healthcare, health policy, research, and education, not just in Toronto, Ontario, and Canada – but globally.¬

As everyone knows well, so many of the challenges we face in the 21st century respect no borders, whether physical, geographical, or socio-economic. Everything from pandemics and public health to demographics and development are increasingly global problems.

Responding to these challenges is a noble and, crucially, a collective enterprise.

I am struck, looking out at this gathering, that many of the next discoveries in basic science, each with far-reaching and entirely unpredictable repercussions… many of the next advances in clinical practice, many innovations in education… and so many of tomorrow’s leaders in all of these fields… have their roots in this room today.

It is a truly inspiring thought.

So my first and most important message this morning is thank you for everything you do, individually and together, on behalf of our remarkable academic community.

My second message picks up from my first message and takes me back to my installation address — it is hard to believe that was already five months ago…

In that address I identified a number of headwinds facing our community and institutions and I proposed three strategies to respond to them:

  1. Leveraging our location, for the mutual benefit of our institutions and our region,
  2. Advancing and deepening international collaboration, and
  3. Re-examining or re-inventing undergraduate education.

I am not going to revisit these themes in any detail here. Instead, I want to focus on a concept fundamental to each of them: Partnership. Indeed, I would suggest that partnership and excellence are the two key engines in the drive to fulfill our potential, just as they are the cornerstones of integration, innovation, and impact.

So let me spend the balance of these remarks reflecting on the nature of our partnerships and how I see them evolving.

Let’s start with the partnerships closest to home: within our huge, diverse, and deep academic community.

The University of Toronto is an enormous physical operation. Let me try to give you a sense of the scale.

There are some 260 buildings and 1.7m gross square metres of built environment, across three campuses – if you converted that floor space into parking spots, they would stretch end-to-end from Toronto to Montreal and beyond. All of this sits on something like 7m square metres of real estate. And that doesn’t count our partner hospitals and institutions.

On top of this, we have about 1,000 graduate, undergraduate, and professional programs. There are 44 libraries – the third largest academic library system in North America. Most importantly, we host some 82,000 students and about 18,000 faculty, staff, and librarians – added all up, that’s about the population of St. John’s NF.

Not surprisingly, this is fertile ground for collaboration and partnership. Indeed, collaborations abound and are remarkably successful, as Cathy’s remarks have already demonstrated. Of the past decade’s 500 most highly-cited publications with an author from our academic community, more than 40% included authors from multiple departments or institutions within our community.

Indeed, such is the strength, breadth, and depth of the University of Toronto community that wonderfully inventive interdisciplinary collaboration thrives.

To take just one ‘only at U of T’ example of creative convergence: Prof Lorna MacDonald teaches performance, opera, and vocal pedagogy in the Faculty of Music. She also collaborates with the clinicians at Hospital for Sick Children’s Cochlear Implant Research Laboratory on laryngology, speech-language pathology, and paediatric voice and hearing care.

Or consider Dr. Stanley Zlotkin, Chief of Global Child Health at Sick Kids. He is Professor of Nutritional Sciences and Paediatrics and works with colleagues in the Munk School of Global Affairs, the Faculty of Applied Science and Engineering, and the Rotman School of Management on technological and organizational solutions to global health problems.

This phenomenon of intense, local, inter-institutional collaboration is striking; and it gives rise to some important questions. In particular: How can our community foster and enable further collaboration so that we more fully leverage our location in one of the world’s great concentrations of biomedical expertise? How do we understand the responsibilities and privileges of membership in our extended academic federation? These are important questions requiring ongoing discussions.

But one thing is clear: In responding to these challenges, Simcoe Hall should not be a barrier, as I know – from experience! – it is sometimes perceived to be. I hope familiarity with and respect for our community are two of my most important qualifications for the job of President, as they were for my predecessor.

I have deliberately dedicated much time and energy, since being named as the next President of U of T, to getting to know members of this community… from the Faculty of Medicine, the hospitals, TAHSN. In this light, Simcoe Hall has (or should have) the critical role of an honest broker and facilitator.

As we broaden our view to our local municipal and provincial communities, the University’s social obligations and mandates come into even sharper focus. The University of Toronto is a publicly assisted institution, funded in part by the people of Toronto, Ontario, and Canada. We receive our primary missions from them: advanced research and education.

The same is true – with particular, institution-specific considerations – for the University’s partner hospitals. In a very real sense, our institutions work in partnership with our communities.

These constituencies rightly expect excellence. And they receive it. Here are two proof points among many: The University of Toronto is Canada’s only university consistently ranked among the top 20 or 25 universities in the world. And U of T ranks behind only Harvard in total research output worldwide.

These rankings speak to excellence in advanced research. We also respond with equal distinction to our mandate to help educate the people of Ontario. For example, the proportion of Ontario’s medical practitioners educated in the University of Toronto and our partner hospitals is remarkable: U of T trains over half the practicing specialist physicians and one-third of the family physicians in Ontario… Half of Ontario’s speech therapists… More than half of the dentists… Three quarters of the province’s pharmacists…

The list goes on.

I suggest that the University of Toronto and our partner hospitals form a collaborative cluster that combines research excellence with accessible education in a way that few institutions in the world can match.

The hospitals, of course, have the added responsibility of helping to meet the clinical and public health needs of the city and the province. These are acute challenges. I understand that a recent study of the Toronto Central LHIN indicated that more than 35% of patients from the Bay Street Corridor, University, and Kensington-Chinatown neighbourhoods reported having no primary care physician.

Similarly, almost 40% of visits to emergency departments from Regent Park residents are for non-urgent care. These are striking data points and evidence of one of this century’s greatest tests of public health: Urbanization and all of its attendant characteristics.

There are countless ways we are responding to this test. Excellence in basic research is the most obvious. But it bears stressing that this is not so obvious in all circles – especially in the context of a seemingly growing emphasis on fettered and focused research funding among the granting councils.

Moreover, advances in health sciences (and even health policy) are not accidents. They are the direct result of decades of fundamental research. A great example is the discovery of stem cells by Till and McCulloch in the early 1960’s. This basic research is meticulously confirmed, revised, rethought, and reapplied over generations. In a very real sense we are part of an intergenerational partnership.

Fortunately, our academic community is brilliant at fundamental research.

We are also brilliant at the other end of the partnership spectrum. One small but compelling example of this is the extraordinary student-led, largely student-funded group called IMAGINE. As many here will know, IMAGINE is an inter-professional, student-run community health partnership aimed at promoting and providing health care to the core neighbourhoods of downtown Toronto. And when I say “inter-professional”, I mean it: the team has roots in a host of our Divisions, including Medicine, Pharmacy, Dentistry, Social Work, Nursing, and Public Health.

Yet there is an essential tension at the heart of our partnership with the city and the province. Our political leaders deserve praise for protecting funding for education and health from the sharpest cuts in a period of budget austerity and restraint. But there just isn’t sufficient money to sustain or build upon what we have already achieved together.

That would be troubling enough. But it is aggravated by poor or short-sighted policy decisions. Ontario has the lowest per-student funding of any province in Canada. It is also weakly differentiated and insensitive to geographic variability in costs.

Spending on infrastructure or deferred maintenance is regarded in some quarters as a cost rather than an essential investment in long-term prosperity. And utterly sensible pension solvency legislation would save our institutions millions of dollars… tomorrow.

In addressing these tensions, our partnership serves us well. Advocacy with a single voice is powerful. This is especially true when governments of every stripe seem strained to rise above retail politics or populism. For a good example of this, let me turn to the national landscape.

After more than two years of coordinated advocacy efforts from across the post-secondary education and advanced research sector, the 2014 Federal Budget created the Canada First Research Excellence Fund.

Quoting from the Budget:

“Economic Action Plan 2014 proposes to create the Canada First Research Excellence Fund with $1.5 billion in funding over the next decade to help Canadian post-secondary institutions excel globally in research areas that create long-term economic advantages for Canada.”

The most important part of this announcement was the Government’s commitment to award the funding on the basis of excellence and tri-council funding performance.

I think it is worth noting that the Excellence Fund will go a long way to helping redress some of the perverse incentives in the Indirect Costs Program. Let me spend just a moment elaborating.

As will be familiar to everyone in the room this morning, the Federal Indirect Costs Program was designed to help institutions meet the costs of providing researchers with adequate space and with a wide variety of support services – light, heat, cleaning, legal, and so on. Bizarrely – and in total contrast with our peer jurisdictions – these so-called indirect costs are covered in Canada at a rate inversely proportional to the amount of research an institution performs. Consequently, the program punishes excellence in research. It has been a constant thorn in our collective side – and the subject of frustrating advocacy for over a decade.

The trouble has always been that it’s a tough sell in Ottawa. Frankly, it doesn’t make a good “announceable”. And it flies in the face of deeply engrained regional politics in this country. Faced with this, we took an orthogonal approach to our advocacy.

The new Canada First Research Excellence Fund represents a sea change. Because it will be explicitly based on excellence and success in peer-reviewed Tri-Council funding competitions – and not the inverse – it rights the balance that the Indirect Costs Program had upended. The Indirect Costs Program is still in place, but this new Excellence Fund is an extremely positive first step forward. It is a huge win for the University of Toronto community and the cause of higher education and advanced research in Canada. And it was the product of a nation-wide partnership with other U15 universities, led from Toronto, with the AUCC latterly joining in.

Ultimately, I think our collective advocacy persuaded the highest levels of the federal government that the University of Toronto, the research hospitals in the Toronto region, and a select number of our peers across the country are vital national resources and must be strengthened and promoted as such.

As a matter of fact, these same institutions represent Canada’s resources for the world and a vital conduit through which the world connects to Canada. When one reflects on partnerships that extend beyond Canada’s borders, partnerships among institutions of advanced education and research should be top of mind. Consider: The University of Toronto community dramatically out-publishes and out-collaborates every other institution and academic cluster in Canada. In 2012 alone, authors with a U of T affiliation produced over 14,000 publications and collaborated with over 8,000 distinct institutions in hundreds of municipalities around the world.

These are extraordinary numbers. According to Thomson Reuters no institution in Canada even comes close – UBC was second to U of T with a little over 8000 total publications.

Furthermore, lest the quality be lost in the sheer quantity, note our share of the past decade’s most highly-cited publications from Canadian universities:

  • 41% across all fields,
  • 36% in surgery,
  • 30% in social work,
  • 42% in oncology,
  • 33% in neuroscience,
  • 34% in general and internal medicine

The list goes on and on. We punch way above our weight: Research from the University of Toronto has a disproportionate impact on the world.

Similarly, when the best universities in the world want to collaborate, they seek out the University of Toronto community. A 2012 study reported in Nature found that, “Exceptional research groups share ideas, resources and outcomes.” No surprise.

But the exclusivity of exceptional research groups is striking: The most frequent international partners of the University of Cambridge, are the Max Planck Institutes, MIT, Harvard, CalTech, Berkeley, the University of Heidelberg, and two U of Ts: Tokyo and Toronto. Harvard’s most frequent international partners are Imperial College London, University College London, the Max Planck Institutes, the Karolinska Institute, the University of Cambridge, the University of Geneva, and the University of Toronto.

The report’s author correctly notes that: “Excellence seeks excellence”. In fact, everyone seeks excellence. Institutions are lining up to partner with our Faculty of Medicine and the region’s academic hospitals. Our international partnerships are flourishing – from every corner of the globe: from United States and Europe… to China, India, and Brazil… to Africa and the Middle East.

It is obvious why all of this matters. The Toronto region’s institutions of advanced research and education form a vital bi-directional gateway to Canada’s global partners.

To tie all of these various threads together, at whatever scale we focus our gaze – from the institutional through the municipal, provincial, and national, to the international – partnerships drive integration, innovation, and impact. Indeed, partnership is a fundamental precept in helping us fulfill and increase our potential.

Let me conclude with an observation and an appeal. First, the observation.

The University of Toronto’s ability to excel at partnerships has helped define this institution for nearly 200 years. The successful collaboration with our partner hospitals to create the Toronto Academic Health Science Network and, more recently, its extension throughout the Toronto Region among our community-affiliates, is nothing less than remarkable. We have achieved international recognition among the best academic health science centres in the world.

Against this background, the Presidency of the University of Toronto is a daunting and humbling responsibility. However, my confidence in our collective future has grown with each passing day. My optimism is informed by our history of partnership and excellence and it is strengthened by the outstanding people I have the privilege of working with and for – not least among them, everyone in the room this morning.

And finally, the appeal. I think we need to do a better job of celebrating our partnerships – of recognizing and paying tribute to what we have achieved together.

In that same spirit, I call upon us to renew and reinvigorate our partnerships – and when we do, we will take another step towards achieving our potential, and we will have that much more to celebrate tomorrow.

Thank you for your kind attention. I hope I have left enough time for a few questions!