Recently, I was fortunate to attend the Global Symposium on the Role of Physicians and National Medical Associations in Addressing Health Equity and the Social Determinants of Health held in London, England. The meeting was organized by the Canadian, British and World Medical Associations and had, among other goals, an agenda to assist public health pioneer Sir Michael Marmot in making such issues central to his upcoming role as president of the World Medical Association.
Among the attendees was Canadian Medical Association president Dr. Chris Simpson. I sat down with Dr. Simpson to explore the stories, the evidence and the politics that come into play when doctors are actors for social change.
Ryan Meili: I'm curious about your experience as a physician and your relationship to the CMA. What changes have you seen in the organization?
Chris Simpson: One incredible turning point, which has certainly influenced my involvement with the CMA, was Jeff Turnbull's presidency. I don't think people fully appreciate yet how fundamentally that changed the organization in a way that I think is really progressive. I believe really strongly that if we just simply reflect back to our membership what we think they already think and know, that's not even remotely leadership. This isn’t to say that CMA does not have a proud history – because it does. Nor is it saying we haven’t had great presidents, because we have. But the consistency we have seen over the past few years in moving ahead with a progressive agenda is what has changed.
In five short years, it's turned around completely where we're actually actively bringing along the membership– we’re talking about things that are important to society and we’re no longer afraid to take risks. It's become a very progressive organization because, although we've got 1300 policies dating back to about 1921, I think the heart of the organization is definitely in a very progressive space. I've been pleasantly surprised that the membership is very happy with that change of direction. And I think it's affected the type of people who are seeking the presidency too. People who hold a different view about the role of private investment and so on who used to have quite a strong voice in the organization are now much less influential.
That may be good or that may be bad, but it's certainly reflective of the type of people that are being attracted to leadership positions in the CMA; the committees, the board, in elected positions -- they've been, on the whole, more progressive and equity-minded individuals, in my opinion. There is room, of course, for all views in the CMA, but the balance we have now more accurately reflects the distribution of views of our membership, I believe.
There are two ways a medical association can see itself: As advocating for its members almost uniquely vs. seeing health as our primary goal & a healthy society. What do you see is the value of that conversation?
I think it's critical. I don't know if you noticed the sign on the wall somewhere here at the British Medical Association; it says something to the effect of “We put doctors at the center of everything we do”. We recently went through a rebranding of our mission and values. I argued very strongly that we needed to leap from being doctor-centred to being very explicitly patient-centred and we kind of landed on “Helping doctors help patients” which is fair enough, but it's sort of that middle ground.
I think our legitimacy in society, which is really going to be the only way we're ever going to be truly effective as change agents, is going to be determined by whether or not people truly believe that they are our first priority.
I think our legitimacy in society, which is really going to be the only way we're ever going to be truly effective as change agents, is going to be determined by whether or not people truly believe that they are our first priority. Not just individual patients, but society at large. The CMA is well on its way to getting there. And we're partially helped by the fact that all of the negotiation stuff is at the provincial level (unlike in some countries), so we're a little more free to be in that patient advocacy space instead of doctor advocacy/negotiation. They shouldn't be mutually exclusive, but physician pay can be a polarizing issue during stressful times. And as important as these issues are, it sometimes serves to distract from the advocacy piece.
Take the recent dispute between the OMA and the provincial government, for example. The OMA has laid out a compelling case for why the government’s imposed solution will reverse several years of funding and structural reforms designed to get better care for patients; work done between the OMA and government as a partnership. This most recent dispute reverses a lot of that good work and the OMA rightly points this out. But the issue has been reduced to soundbites in the press about a dispute over physician’s pay when it’s not really that at all. We support our Provincial and Territorial Medical Associations one hundred percent but our mandate to pursue advocacy is largely unencumbered by the thorny issues surrounding physician pay, and that gives us a different kind of platform from which to pursue our advocacy agenda.
Photo by Phallin Ooi
Our core work is advocacy, and the other thing that's really helped us, is that we've spun off this new co-organization – Newco - the products and services stuff, and MD Financial Management. Those two entities (though they're wholly owned by the CMA) now have their own boards, their own CEOs. So now the CMA is all about patients, the public, and the profession’s role in the service of patients and the public. We can be very much in that space. It's a very comfortable spot to be in.
Since the Turnbull presidency, the CMA has really started to own an advocacy mandate. We’re feeling more and more comfortable in our own skin in that role with every passing year. You can feel it. Even at the board level -- the things they're proud of are the ones where CMA has really been out in front on an issue and helped shape society’s discussion. The recent and still ongoing national conversation on end-of-life care is a great example.
One of the things that I've been seeing happen lately is a series of articles suggesting that public health professionals are commenting on the economy when they shouldn't, and that we should stick to our needles. You talked about that legitimacy of physician voice. Should we stick to our needles, or is there a role for us to be talking beyond healthcare, to the causes of ill health and the causes of the causes?
I see it a little differently than has been expressed by others. I think we need to earn the right to be in that space. We earn the right from the people we serve. So if we have expertise, and our hearts are in the right place, then civic Canada will confer the legitimacy we need to speak from that perspective.
I think we are truly servants, public servants, and we need to earn that trust. I see it less as a matter of should we or shouldn’t we but rather can we earn the right to speak on these broader issues. I think we have to do a lot of hard work to really belong there – to be authentic advocates for patients and the public. I think we're well on our way, though. Essentially, whatever affects the health of Canadians should concern us. Things like the economy and tax policy and public policy in general certainly qualify as health influencers, so those of us who feel strongly about this and who have expertise can make their case to Canadians that they can help lead the discussion. Canadians will return that authenticity with their trust.
There definitely is some past baggage to overcome and some existing problems within the profession to overcome, but I think that's something the public will want from us if we approach it – as you say – consistently and legitimately.
And it has to be about coming at it from an altruistic perspective. Yes, we can see the link to our core business – the practice of medicine - but I think there's also a more general leadership role in society that - whether we have deserved it or not - we've been given historically. It's a trust. Even the right to self-regulate is a huge privilege that we have and with that comes the responsibility to do it well.
I love to see physicians with placards – being not only advocates but activists. That’s the kind of leadership that demonstrates tangibly to the people we serve that we are with them and that we will work alongside them to achieve the change our country needs
If you think about history - physicians and their organizations have been brought along reluctantly on too many issues of progressive social change. But now we have an opportunity to provide leadership to support and develop a progressive and healthy society and further cement the trust that Canadians place in us as a profession. The stuff we're talking about here today – the role of physicians and their organizations in addressing the social determinants of health, actually has us a bit out in front of general society.
We had the refugee actions in the last few years. It was the 50th anniversary of Medicare - physicians were out with placards - and this time in support of universal healthcare for all instead of against it.
I'm sure you know the story of how Tommy Douglas came to really believe in Medicare - was his own experience as a kid. He received what he regarded at the time as a charitable donation of services by a doctor and in many ways, I think that kind of sensibility in the profession shares a lot of commonality with some of the core principles of most of the world’s great religions; the sense that we have a responsibility to advocate for people who are less well advantaged. That sense of duty to society’s most vulnerable people is deeply-rooted in our profession. Somehow, along the way, though, we've taken the privilege we've been given and we've perhaps not always lived up to the responsibility – at a societal level - that goes with it.
This is really all about bringing that duty and that responsibility to a whole new level. I love to see physicians with placards – being not only advocates but activists. That’s the kind of leadership that demonstrates tangibly to the people we serve that we are with them and that we will work alongside them to achieve the change our country needs.
I think we know what the right thing to do is, we just have to have the bravery and put the hard work in to make it happen.
Missed the first part of this interview? Read it here.
Ryan Meili is an expert advisor with EvidenceNetwork.ca, a practicing family physician in Saskatoon, and founder of Upstream: Institute for A Healthy Society.
Chris Simpson serves as president of the Canadian Medical Association and his primary non-clinical professional interest is health policy — particularly access to care, wait times and medical fitness to drive.
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