Picture of Monika Dutt, Amy Tan and Rita McCrackenMonika 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.