From the outside, The Canadian Medical Association looks like a monarchy. It presides over the major ceremonies at provincial and territorial associations. But the CMA has grown tired and a bit embarrassed by old formalities.
After 152 years, the CMA has almost transformed into a New Thing.
Reform started some time ago with reorganization and throwing out robes and royal parades.
Committees followed.
Then motions. And board members.
The CMA almost succeeded in throwing out general council.
By every indication, the CMA wants to throw out the medical profession too.
Crisis at OMA Council
On May 5th at OMA spring council in Ottawa, Dr. Gigi Osler, CMA President, gave her annual address.
At first, no one came up to ask questions. Almost three hundred people sat in silence: a rare event in medical politics.
The Chair encouraged council members. This is your chance. Speak up. Ask questions.
Then they came. A few at first, then lines of courageous doctors formed at the microphones and shared what they thought of the CMA.
You do not care about us.
The CMA has lost its focus on representing physicians.
The CMA board chair told us that the CMA wants to align with groups and individuals who care about what the CMA cares about. If you do not support what the CMA cares about, that’s ok. You do not have to work with us.
Dr. Osler handled it well.
But I suspect the comments cut deeply. Caring for doctors seemed to be one of the reasons Dr. Osler got involved. It must sting for the CMA to say — in official messages to the OMA, on numerous occasions, with passion — that the CMA only wants to align with people who align with it, to heck with the rest of you.
Speaking for Doctors?
Without surprise, the CMA is bleeding members. It used to have 89,000 out of just over 100,000 doctors in Canada. Last I heard, membership had plummeted to 69,000 and continues to drop.
How long before it shrinks to only 20% of working physicians, like the American Medical Association?
Could the CMA become the Canadian Healthcare Association?
I do not blame the CMA for losing heart and getting frustrated at trying to please all Canadian doctors.
In politics, those who hate you speak up while one in a thousand happy ones lets you know. It has ever been thus and will ever be so.
The CMA President still presides over the installation of the PTMA Presidents. Association bylaws dictate that the national office must pass the chain of office. But the national office has told the PTMAs they are no longer as interested in chains, offices, doctors, or even medical politics for that matter.
The CMA loves to chat with government about healthcare, but details about policy and politics — stuff that actually impacts doctors’ lives — not so much.
Secret of CMA Credibility
Will the CMA correct its course? Or will it double down on a dumb decision and work to show why giving the impression it had dumped doctors was a good decision in the first place?
Engorged with cash from the sale of the MD Management investment company, CMA does not need doctors anymore. It does not need members.
The CEO need not panic every time a few dozen members cancel memberships in protest.
This is great for the CMA. Except for one thing: The CMA never really needed money in the first place. Money from dues was only a proxy for credibility.
Voluntary memberships from 89,000 doctors offered the best reason for politicians to listen to the CMA. Without that, the CMA is just another wealthy endowment: a big hat with no cattle.
CMA staff has taken note. They updated their website and feature physician issues more prominently in recent messages.
But the CMA still faces a crisis with regular working doctors. CMA credibility rests on members. If the CMA does not mend support soon, a new national association will take its place; one that leaves no doubt about who it represents.
“The CMA Humpty Dumpty sat on the wall,
Humpty Dumpty had a great fall, All the King’s horses and all the King’s men,
Couldn’t put Humpty back again.”
It’s what the CMA hierarchy with its SJWarriors care about that matters, not what the individual members of the medical profession care about.
The CMA “diverted” monies generated by generations of MDs to spend on its own ideological dreams that are not in the interest of the members that it purported to represent.
Time for the increasingly abused and disrespected medical profession to create a new representative organization to represent its own interests before its too late, as other entities gnaw away at it like rodents …the era of the governmental widgetization of the profession with Paps in aisle 9 at the pharmacy is not far away.
Thanks Andris
Very interesting comment, as usual. I do worry that the CMA agenda does not reflect the pulse of regular working doctors. It also feels like the disrespect for physicians has been blamed on physicians, thus the trend towards issues that do not help physicians directly.
Thanks again!
PS I made the correction you mentioned d/t spell check.
The CMA is in denial of just how angry the MD population is. I quit paying dues the day after they sold out MDM. They have been betraying the interests of physicians for over a decade. They keep sending me e-mails and updates as if I was still a member. Now they are hounding me to re-new. I won’t. Their reported numbers are likely false because of this time of denial. I feel sad that a great person like Gigi Osler has to preside over this disaster that was the doing of others who clearly espouse the socialist manifesto instead of acting in its paying members interest.
Thanks Ernest. I think many other docs agree with you. Gigi has been very popular and has a real heart for helping doctors.
I do not know if it is possible for an organization to recreate the hunger required to be a truly representative organization when they can live perfectly well without any member dues. We shall see.
Great points.
For me, it comes down to relevance. The things that impact me as a physician are provincial not federal. I will pay dues only when my federal interests are validated. The biggest Federal issue right now in my opinion is the Canada Health Act. It is an act in name only where provinces point to specifics to justify their own ideologies but ignore other aspects that aren’t momentarily relevant. I do not see the CMA fighting to create a unified Federal ideology. It is long past time to reform the Canada Health act and until a paradigm shifting adjustment that is uniformly and federally enforced is in place, the CMA has no relevance to me
Great points about the CHA, Rob. You might be interested to know that the CMA is currently working on a review of the CHA. I think that’s good news. Having said that, I worry that they will call for a one-size-fits-all approach that is centrally mandated but without any central responsibility.
As a purely financial piece of legislation, the CHA speaks more about what cannot be done than about any promises to produce anything.
Thanks so much for taking time to read and comment!
Cheers
The GST is a Federal matter…the CMA gazes at its navel.
The selectiveness of provinces as to which parts of the CHA they would choose to respect and which they would choose to ignore is a Federal matter and which caused the CMA to navel gaze again….$2. 6 Billion could have financed an excellent assault on forcing the Feds and the Provinces to respect the CHA, with its provisions to respect the rights of the medical profession,in its entirety…or to scrap it….at present the CHA resembles the proverbial Norwegian blue parrot of Monty Python fame …we are all being reassured that it is not dead, merely napping after a long flight…nailed to its perch because it is so vigorous.
Ha! Great how you brought in the blue parrot. Too funny.
I agree. The CHA simply reaffirmed the 5 principles we saw in the HIDSA (1957) and the MCA (1966)…but it added access. The whole point of writing up the CHA was to stamp out user fees at hospitals (because provinces were underfunding hospitals) and balanced billing by doctors (because provinces were underfunding physicians’ fees). The CHA set the rules the stipulate when the federal government is allowed to release its (now called) Canada Health Transfers to the provinces. But we point to the CHA as though it controlled healthcare. It is actually only a finance law, but through the power of the transfer payments forces provinces to play along or forgo funding.
Federal government health issues vs national issues is an interesting nuance point to reflect on.
CMA is the national voice of physicians and yet it has no dedicated file or point person for representing the unique needs and issues of federal physicians or federal patients.
As a previous federally employed doctor, my issues and patients were federal and not provincial.
Between the military, first nations and Inuit health branch and corrections the federal government and its federally employed physicians are responsible for the primary health care to a larger patient population then several of our provinces but do it without physician or patient voice organized representation in any provincial or national medical associations.
Why wouldn’t it be a natural fit for CMA to fulfill a “federal government physician medical association” function equivalent ?
If it’s not CMA’s role to be standing up in support of federal physicians and federal patients and their unique vulnerabilities and needs, especially in a federal election year, who’s role within the Canadian medical profession is it?
Great comment, Karen!
We forget about our federal colleagues. You are abandoned by both the provincial and national associations. Must be lonely.
Thanks so much for reading and posting a comment!
Cheers
Wonderful post Shawn,
It is a brilliant idea, to create an association that really represents doctors and I wish you well in your endeavor.
I think that the CMA is jealous of organizations like the College of Physicians and Surgeons of Ontario and the College des Médecins du Québec.
These last provincial bodies are only representative of doctors in the same way that the old Soviet Writer’s Guild was representative of authors and journalists in the Soviet Union. They have an obvious conflict of interest that can only be reconciled by faith in the idea that the government, indeed, is the true voice of the worker. From the moment one suspects that the interests of government and workers (doctors in this case) are not identical, the problem becomes impossible to ignore.
The CMA, on the other hand, has no other raison d’être, beyond the representation of doctors and their interests. But that, apparently, is not enough. CMA (or a certain sort of individual who would be attracted to medical politics at that level), would like to run with the big dogs, be real players, write health policy. But that, naturally, is something that is done by arbitrating competing interests. In assuming such a role CMA has to abandon doctors, just like the provincial governing bodies. But whereas these actually have a real regulating role, CMA does not. It is pathetic really. Unless their ultimate goal is to become some kind of pan-Canadian CPSO policing medicine across the nation.
I am not a doctor myself, however, my very peculiar path in life has put me constantly in their company, beginning with my father, and older brother. I well remember the debates in the sixties around public healthcare. The idea was, that the government would insure doctors’ services and hospital expenses. Period. The government would only pay the bills without attempting to influence service delivery. Above all : never would the government presume to interfere in any way in the patient-doctor relation and especially would remain far from any medical matters whatsoever.
Fast forward fifty years : The Supreme Court of Canada decided to decriminalize doctor assisted suicide and (largely because of the terms of a provincial law already passed in Quebec, Bill 52, 2015) active euthanasia.
So far so good. But HOW, we must ask, did that simple idea (that doctors would no longer go to jail for killing a patient) become leveraged into a state mandated universal access, with euthanasia practiced in virtually all institutions, and even dissenting doctors facing possible legal repercussions if they do not provide “effective referrals” for that to which they object on principle, both for medical and ethical reasons ? See CPSO policy, Court affirmation of same, and heated commentary thereon.
The reason of course, is that government has broken the terms of the original public health bargain. The have indeed presumed to define the nature of medical care : literally ; textually ; in the Quebec law, euthanasia has been defined as medical “treatment” to which all eligible patients have an unconditional right, regardless of individual doctor or institutional sentiment. Worse still ( if that be possible), other provinces (notably Ontario and BC, which with Quebec amount to over 70% of Canadian population) have subsequently followed suit, without even the legal basis claimed in Quebec, with organizations like CPSO simply assuming this extraordinary change (from medically unthinkable to legally mandated) had become settled policy (and with the agreement of the courts as noted).
(cont’d below)
Thanks for this, Gordon. You are right: Medical care has been redefined.
Good comment…the enforced collectivization of the health care system “from above” is well under way…those not in government approved collective teams will be increasingly treated as Kulaks , suffering the same fate, no matter how superior their effectiveness and productivity.
The function of Soviet unions was to transmit orders from the politburo to the factory floor or to the collectives…MEDSTANTRUD was the trade union of Soviet “medical help providers”…MDs were thrown in the pot with the sanitary workers…all obeyed without question the orders from above, no matter how crazy, with informers denouncing their quota of “saboteurs and wreckers” to the authorities to gain extra rations and minor privileges.
The Canadian medical representative organizations increasingly serve the interests of their masters and not of those members toiling at the coal face .
Rule #1 in Single Payer healthcare: Never speak out against the payer.
We need a “bottom up” representative organization as opposed to the top down “ we know best” representative organizations that we have at present that collaborate with the powers that be.
The Swiss have a system where no law passed in Berne becomes law until a referendum is held across the country to support it…I gather that the Swiss have referenda every two weeks or so which reject 80% of the laws passed by the political class.
Can you imagine if Canada had the same system where 80% of the laws churned out by the Federal government ( or Provincial/ municipal governments for that matter) were rejected by the Canadian voters….Switzerland, with few natural resources other than hydro, became one of the richest countries in the world as a consequence.
A bottom up representative medical organization would put any of their major decisions , such as the selling of MDM for $2.6 billion, to the membership for a vote…one suspects that the membership of the CMA would have rejected the deal.
The “ we know best” hierarchies, such as ours in medicine, would fight to the death any real bottom up restructurization.
With the internet, we benefit from awesome powers of communication that earlier generations of “concerned citizens” would have given their eye teeth for. The bench is very deep. And Shawn’s blog is an important node in that network.
Gordon Friesen
http://www.euthanasiediscussion.net/
The CMA continues to weaken physician finances through their promotion of MD Financial and the ongoing affinity agreement. MDF is now lavishing money on event sponsorships with the hopes of roping the next cohort of physicians into their high fee mutual funds. Physician personal finance is the best road to autonomy and wellness. As long as MDF is being promoted by the CMA they aren’t acting in the best interest of physicians. CMA is now a public policy endowment. The membership is irrelevant.
Well put. “Physician personal finance is the best road to autonomy and wellness.”
Thanks for reading and posting a comment!