Monika Dutt practices Public Health and Family Medicine in Nova Scotia and Newfoundland & Labrador.
Amy Tan is a palliative care & family physician in Victoria and a Clinical Associate Professor at UBC.
Rita McCracken is a family physician in Vancouver and an Assistant Professor at UBC.
It is increasingly recognized that leadership in health care and medical organizations can influence systemic barriers in health. We had hoped that Canadian physicians would be among the first to take a hard look at our own professional culture and come together with solutions to dismantle the systemic racism colonialism and oppression in health care that have been exemplified in the tragic deaths of Joyce Echequan and Brian Sinclair and the disproportionate impact of the COVID-19 pandemic on the health of racialized people in Canada. Indeed, the Canadian Medical Association stepped forward and consulted communities and members and, on August 22, 2021, proposed three changes to its own governance structure, specifically designed to improve diverse representation and inclusion of historically underrepresented groups on their Board. Investments such as the proposed changes have been shown to improve outcomes not only for the physicians involved, but also for patients. Changing leadership is not the only step needed to change long-standing cultural norms – but it is an essential step that will create a ripple effect.
Sadly, the proposed changes did not pass. Instead, the CMA’s Annual General Meeting (AGM) was interrupted repeatedly by a group of physicians, who claimed that the proposed governance changes were a challenge to “democracy”. In a recent BCMJ article, many of the physicians who opposed the changes stated, “We do not need to sacrifice democracy to achieve diversity.” In addition to being a flawed argument, the optics of this argument are challenging. A small group of physicians, mostly men, mostly white, from a single province derails a national process that could allow more diverse voices to be heard, by saying that the dominant voices must be heard. The dismissal of the proposed changes leaves Canada’s national physician body squarely where it was before: in the past and with the barriers to historically underrepresented voices firmly in place.
We are three female physicians, each with different lived experiences of not being included in the medical profession. We celebrated the inclusive, thoughtful, expert process that the CMA board used to design a new set of tools that would allow our, and many other voices to be heard. Then we watched a few voices use the existing meeting rules and structures, to distract from those who spoke in favour of the changes, including many from traditionally marginalized backgrounds. In the end, the proposed changes were not passed and the status quo was retained. We are disappointed, but not surprised.
What happened at the AGM is a perfect example of what underrepresented physicians go through every day. They must perform to an impossible standard within the system, one that was designed to exclude them, and graciously accept unjust outcomes. This is in fact the definition of systemic discrimination, and is already acknowledged to be a problem in Canadian medicine.
Many have been working for years to shift the power imbalances that exist in medical leadership in a way that ultimately benefit the various communities we all work in. What played out at the AGM was an indication of the extensive work that needs to happen for physicians – and our patients – to overcome barriers due to sexism, racism, ableism, and cis-heteronormativity. These barriers have existed for as long as the CMA has existed; in fact they are the foundation of most institutions. Social change needs bravery, transparency and a new set of rules that will be more equitable, just and inclusive.
We urge everyone to email your CMA delegate and tell them that you are ready for change. Insist they use the lessons they already learned from consulting with under-represented groups and experts. Tell them that justice, equity, diversity and inclusion must not be only at the forefront of any governance changes, but also integrated throughout CMA activities and expectations of its members. Just as our patients deserve equitable and safe care, all physicians deserve true belonging within our profession.
I have a dissenting view. If the goal is that all physicians deserve true belonging in our profession, and and every member has an equal vote ,than that seems fair.I read the article in the BCMJ written written by the” mostly white, mostly men” dissenters. They present their case with without resorting worrying about the ” optics”
of sex or skin color . They don’t mention their identity markers ( We are three female physicians…)as that is irrelevant in assessing if their arguments have merit or not . Also, the authors of this commentary fail to state what exactly they are proposing to replace a ” one member , one vote” system.I assume they would propose that a number of leadership positions would be appointed based on identity markers. How would they be appointed? by who? Respectfully, I believe the dissenting group is correct .
I support the piece written by Drs. Dutt, McCracken, and Tan. The components of effective advocacy for social change are well known and one is the active support of members of the status quo group. As a male, mid-career specialist physician, I regularly extend my support to EDI perspectives and initiatives and will continue to look for opportunities to do so. The view promoted by Dr. Satenstein sounds like meritocracy and equality of opportunity. First of all, medical leadership needs diversity of life experience. So here’s a call to add that line to every hiring schema! Second of all, as our hospital department’s hiring lead, I can assure you that pragmatically there is no such thing as true meritocracy or equality of opportunity in the hiring process. Candidates show up at your door via socially-determined paths. You interpret their skills and attributes through socially-determined assumptions. You have little idea who will turn out to be your most valuable department members and why.
It’s equity we are after, the broad recognition that arbitrary systemic society-wide factors contribute significantly to the successes and failures of individuals — many of our most valuable colleagues have overcome barriers that are invisible to some. So let’s step up our game, status quo physicians!
I respectfully dissent from your dissenting view and believe the opinion of these esteemed authors should be lifted up. The culture is not comfortable for many and I feel those dissenting are reacted to their own discomfort…but we should be uncomfortable with the current culture…we should step back and then step up. We should always strive to be better. The dissenters are not “correct” (or incorrect for that matter) but they are privileged. And with great privilege comes greater responsibility…or something like that…I can never remember the specifics of that quote
Love this thoughtful commentary, very disappointed in the CMA on this issue. I will endeavour to look up my CMA delegate!
Hi Alan! Thanks for taking the time to make a comment on our blog. Just wanted to clarify that the CMA have shown transparent leadership on making EDI advances real. However, their process was disrupted by a small group of members who claimed the process was “in democratic”. Letting your CMA delegate know you are ready for change and approve their proposed actions is what we are encouraging people to communicate. Also! There is an online meeting tonight, Sept 9, 2021 that you could attend (info on the CMA website).
Excellent points. Thank you to the authors for writing this.