One Hundred Twenty Years of Canadian Academic Medicine: How Michael Porter Became the New Abraham Flexner

One hundred and twenty years after the Flexner report purged for-profit practices from academic medicine in North America, a new era of commercialization, or an era of “de-Flexnerization”, is under way. High cost structures in academic medical centres and limits on funding support seem to have triggered academic medical institutions to engage in a variety of for-profit revenue-generative practices, many targeting the global community. This new commercialization seems in tension with Abraham Flexner’s findings that an over dependence on for-profit practices is linked with poor health care outcomes and poorly trained physicians. Using the Toronto academic health science centre as a case study, this dissertation employs Foucauldian theories of discourse and space to make visible the shifts in the economic and management logics of the leadership of a Canadian academic health science centre over 120 years that have made this new commerciality possible. A new management framework for Canadian academic medicine is identified, “The Discourses of Management”. Specific attention is given to Canadian academic medicine’s journey from the “local” to the “global”. More specifically, this thesis documents a change in the global space from being a space of reputational formation to being a space of wealth creation, or more accurately, a rhetorical space of wealth creation. That is to say, this thesis argues that the global space instead of functioning as an actual space of material resource accumulation is in actuality functioning as an imaginary space where wealth may be created but in actuality is not. The emergence of health care as a policy field, health care as a sector of the economy, and academic health science centres as a new overarching institution are documented in a 120-year history. Evidence is presented that the academic health science centres may be emerging in Toronto as a more tangible overarching governing body for the Toronto’s academic hospitals and its faculty of medicine.Ph.D