Variations in monetary distribution among Ontario's Alternative Funding Agreement workload model hospitals.
OBJECTIVE
Alternative Funding Agreements (AFAs) were in place in 41 hospital emergency departments (EDs) in Ontario at the time of this survey (May to August 2005). Each of these 41 hospitals works with its own internal administrative model. The primary objective of this paper was to document the administrative models used in these Ontario EDs. The secondary objective was to inform current and future AFA EDs of the potential models.


METHODS
Telephone surveys were conducted with a member of each of the 41 AFA workload model hospitals.


RESULTS
All hospitals provided at least 1 emergency physician to answer the questionnaire. Although most AFA hospitals divide the AFA fund pool on an hourly basis, there is impressive variation on premium values awarded for day, evening, weekend and night shifts. Other variations included holdback of funds for bonuses, distribution of non-OHIP (Ontario Health Insurance Plan) dollars, on-call allowances, and different pay scales for the general practitioners and locums working in some departments.


CONCLUSIONS
Allowing flexibility in distribution of AFA dollars to physicians in each group has helped make this program more acceptable. Many issues unrelated to funding remain to be resolved in order to stabilize ED recruitment and retention as well as improve work satisfaction. Further research on these latter topics is required to develop a fair and equitable funding arrangement that supports and enhances physician coverage in EDs across Canada.
Whyne
Mitchell
M
Emergency AFA Group, Royal Victoria Hospital, Barrie, Ontario, Canada.
Whyne
Garrett
G
Rowe
Brian H
BH
D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D018803:Models, Economic; D017146:Models, Organizational; D009864:Ontario; D010561:Personnel Staffing and Scheduling; D012456:Salaries and Fringe Benefits; D011795:Surveys and Questionnaires; D016526:Workload