The CMA: Something needs to change

Issue: BCMJ, vol. 64, No. 6, July August 2022, Page 246 Editorials

Being just 3 months younger than Canada, the Canadian Medical Association (CMA) is one of our country’s oldest societies. The association’s first president, Sir Charles Tupper, was a founding father and the first and last physician–prime minister.

Unlike provincial associations, the CMA is not involved in remunerative negotiations. It is free to critique government policies that clash with the needs of patients and health workers without fear of reprisals from its de facto employer.

About 15 years ago, I was elected CMA president. The CMA staff I encountered were extremely impressive and knowledgeable. They and the elected delegates welcomed and supported me in my mission to create a better system for all. My years there were hectic, productive, and filled with optimism.

Canadian doctors lack the political influence that doctors in Britain enjoy. I attended the British Medical Association’s 2008 annual meeting in my birth town of Liverpool. Tom Sackville had been a junior health minister under Margaret Thatcher. He revealed that the Iron Lady feared confrontation with doctors, remarking, “She fearlessly took on Gorbachev and the Red Army and asserted her will over Ronald Reagan; she decimated the power of the British trade unions; she ordered the British Navy, with heir to the throne Prince Andrew on board, to the South Atlantic to engage Argentina in war. She drew the line at waging battle against the BMA.”

There is no such fear of the CMA by our government.

Governments avoid controversial policy issues. That’s why decisions on abortion, same-sex marriage, assisted dying, prisoners’ rights, safe-injection sites, and medicare have ended up in the courts.

A 2007 independent study on the costs of waiting for care revealed the economic cost of waiting across just four provinces was $14.8 billion. Long wait times impose both medical and monetary harms on patients and the economy. The calculations did not include waiting from GP to specialist consultation, nor the long-term costs of chronic irreversible harms, drug addiction, and depression. Other studies estimated that mental illness cost our economy $51 billion in just 1 year. We pay to prevent patients from being treated, and shorter wait lists would actually save money. Preventive medicine should not mean preventing patients from being treated.

We also advocated for wait-time guarantees and patient-focused (activity-based) funding (both will soon be policy in Quebec).

Dr Barry Turchen presented a study at the CMA using BC’s Freedom of Information and Protection of Privacy Act (despite government opposition). He found that administrative costs in BC’s system were 16%, representing 6 to 7 times what was claimed, and over 3 times that of US public Medicare. An earlier report by Commissioner Judi Korbin had pointed out that 80% of all new health care jobs in BC were in middle management.

During my tenure, Dr John Haggie (CMA president, 2011), put forward a motion at the CMA asking that Canada’s Auditors General investigate such costs. They did not respond. Dr Haggie later became Newfoundland and Labrador’s Minister of Health and, so far, has not ordered such a review in his province.

My time at the CMA taught me a great deal about the health disparities between different communities in Canada. We did succeed in pressuring governments to train more health workers in Canada. That was too little and too late.

Last year I surveyed former CMA leaders on their thoughts on the state of our system and how the CMA was performing. Almost all respondents opined that the CMA had lost influence with doctors and government. It was not reaching out to its grassroots membership and was enjoying its new status as a very wealthy entity after the sale of MD Financial Management to Scotiabank for almost $3 billion.

The following CMA policy preceded my tenure: “When timely access to care cannot be provided in the public health care system the patient should be able to utilize private health insurance to reimburse the cost of care obtained in the private sector.”

Yet the CMA refused to participate in a constitutional case aimed at making its own policies on health insurance and freedom to practise matters of government policy. Its membership among practising physicians has dropped and, sadly, given the CMA’s historical roots in Quebec, the Quebec affiliate has disbanded. Doctors of BC has ended compulsory membership.

For what I believe was the first time in its long history, the CMA recently suspended a member, denying them the chance to stand in a democratic election for nominee as president-elect. The courts overturned the suspension and awarded substantial costs against the CMA. The CMA’s action appears to demonstrate a lack of concern for the democratic process and members’ assets. Its $3 billion windfall means it does not need to consider its members, nor does it need their annual dues to remain viable.

Our 1926 BCMA president, Dr J.H. MacDermot, warned: “Our noble tradition that no sick person of any age, sex, race, or religion whatsoever, shall ever suffer for need of medical care . . . should be based on our willingness to give. . . . It should not be exploited: nor should it be assumed as a God-given right. Least of all should it be a right-of-way for needy and penurious governmental and administrative bodies.”

Dr MacDermot’s warning has become a reality. Patients and their doctors are now controlled and dominated by the state.

I am concerned about the CMA’s lack of action and support for doctors, their patients, and the democratic process. Something needs to change, and I see some hope in light of the current impressive elected presidential line. But they need democratic grassroots support and input. Let’s give them what they need.
—Brian Day, MB


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Brian Day, MB. The CMA: Something needs to change. BCMJ, Vol. 64, No. 6, July, August, 2022, Page(s) 246 - Editorials.

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Dr. Chris Sedergreen says: reply

The humiliating defeat of the Canadian Medical Association in the Supreme Court of BC is about as clear a statement as it is possible to make that the Canadian Medical Association (CMA) is a failed entity, and that it’s present form should be dismantled.

‘Humiliating defeat’ you ask? Well, you could certainly be forgiven for not knowing about it, since the CMA, the CMA Journal, and the CMA web site have been deathly silent about it. The bottom line here is that a dark shadow has been cast over the CMA elected officials by this legal judgement; and for this the only honourable thing for them to do is to resign.

But looking at the wider perspective, how many physicians and surgeons from coast to coast to coast think the CMA is of the slightest value to them whatsoever? I believe that very few doctors have any time for the CMA at all, and if it disappeared in a puff of smoke no one would notice a difference.

If we were to ask ourselves “do we need a Canadian Medical Association?”, there would probably be a long pause before a positive answer was proposed. So for the sake of the exercise, let’s ask ourselves what we would want a newly invented Canadian Medical Association to look like?

First and foremost it should serve as a critical examiner of, and respondent and contributor to Canadian federal government health care policy. It should do this solely on the basis of informed physician comment from every corner of this vast country of ours, and not merely an elite group in Ottawa or other major metropolitan centre.

Never, to my knowledge, has the CMA painstakingly canvassed the needs and aspirations of practitioners from coast to coast. (Contrast this with the Professional Institute of Public Service and ) which annually canvasses each of it’s approximately 60,000 members with a multi-page questionnaire regarding their hopes and expectations).

Next the CMA should serve as an effective communication conduit between individual provincial medical professional associations; as well as with international medical professional associations; and should keep members informed about what is occurring in the medical professional world around them. Our CMA has done none of this.

The CMA should also be a trusted and reliable means of communication between the profession and Canadian citizens. Such communication should be in both directions, so that citizens have a chance to tell us what they think of us. (Again it is axiomatic that the CMA must express the known majority held medical opinions).

Communication is separate from advocacy. It is to be expected that we should advocate for ourselves at a political level; but we should also be forthright in advocating loudly for the best medical care for our patients. The CMA should NOT advocate for narrow special interest groups unless there is a very specific medical need. To do so risks creating divisions in society. The CMA should advocate for the highest standards of medical care and denounce those that fall short.

The CMA should be the defining resource for what ‘Professional Standards’ means. (This should not be left the Colleges of Physicians and Surgeons). Ethical conduct and ‘best practises’ should not be defined by an ivory tower group, but through free and frank discussion of the members.
A re-invented CMA would be involved actively in providing high quality continuing medical education across the country to doctors; as well as seeking to educate the public how they might best live healthy lives. We used to do that. The BCMA led the world in cervical cancer screening in the 1960s by means of the Pap test. Ontario physicians led the way in promoting smoking cessation. There’s still much work to be done.

Dr Darren Jakubec says: reply

I have only practiced in Canada.
I have a hard time fathoming the specifics of how the Canadian system's CMA could better match the influential British one. I assume being at the table when negotiations occur. Can someone provide more specifics?

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