Alternate funding plans have made their mark on academic departments of paediatrics in Canada.

An Alternate Funding Plan (AFP) was introduced at the Hospital for Sick Children in 1990 as the fee-for-service model was incapable of meeting the academic mandate of the Department of Pediatrics. The plan was challenged by some members of the Ontario Medical Association and community paediatricians as inefficient, too costly, and possibly a challenge to the fee-for-service system. At present, 28 years later, there are nine productive Department of Pediatrics AFPs across Canada. The current state of the AFPs and possible future direction of the program are discussed.