It was an unusually heated CMA election, or "Smackdown
in Charlottetown," as some papers have dubbed the August
22 vote. Doctors stormed out and protesters braved downpours
to loudly air their concerns. Everyone knows which of
the two maverick Vancouver doctors duking it out for
the association's leadership won, but the debate is
far from over. What will private healthcare advocate
(and CMA establishment golden boy) Brian Day's win over
medicare defender Jack Burak mean for you?
Orthopedic surgeon and private
clinic owner Dr Brian Day is the CMA's President-Elect.
He was the BC Medical Association's choice and is well-known
in the medical community as an outspoken advocate for
a greater private sector role in healthcare (his nickname
in some circles is "Dr Profit"). His challenger, Dr
Jack Burak, encouraged by pro-public health colleagues,
defied the BC vote and tradition, taking his fight to
Charlottetown. Physicians remain divided on the outcome.
Dr Day's win prompted outrage in
some quarters. "Sadly, the CMA has shown itself to be
out of touch with the evidence, the values of Canadians,
and, we believe, with the views of its members," said
Dr Danielle Martin, an FP and chair of the group Canadian
Doctors for Medicare. Others, like Doctors Nova Scotia
president Dr Rhonda Church, were happy to see Dr Day
elected. "I believe he'll be a strong advocate for change
that's going to be in the best interest of our patients,"
she told the Halifax Chronicle Herald. On the
floor, the division was tangible, with roughly half
the delegates giving Dr Day a standing ovation.
BIG
BUSINESS, MEAGRE CARE
Others worry about the implications of Dr Day's victory.
"I would rather, as a working doctor, argue with big
government than big business," says Dr Shyamala Dakshinamurti,
a neonatal pediatrician and professor at the University
of Manitoba. "This is ultimately the choice we're facing."
A stint practising in Chicago left her with a lasting,
negative impression of profit-driven care. "I have clear
memories of dodging the insurance company accountants
as they combed my patients' charts looking for anyone
whose coverage they could disallow," she recalls. "Having
to negotiate this with someone whose interest was not
the patient but only their bills always left me with
a sick taste in my mouth."
Since his victory, Dr Day has been
busy building bridges with sceptics like Dr Dakshinamurti.
He's managed to win over the young doctors at the Professional
Association of Interns and Residents of Ontario (PAIRO).
PAIRO is an ardent supporter of medicare, yet the group
says it's ready to work with Dr Day. "I think initially
we were a bit concerned only because we know that the
CMA has always been in support of publicly funded medicine
and medicare and I think that Dr Day's position —
at least prior to his election — has always been
very pro-private care," explains PAIRO executive board
member Dr Sacha Bhatia. "However, it seems that since
he's been elected, Dr Day has been quite conciliatory
with respect to this. He recently came out in his website
and his acceptance speech saying "My support for a universal
system that delivers quick access to comprehensive care
is unequivocal."
However it should be noted that
Dr Bhatia and PAIRO supported the renegade Dr Burak
in the race. "There were some people who said he shouldn't
have done it but I think it was well within his rights
and within the electoral process of the CMA — and
there have been precedents for this" he says, citing
Dr Albert Schumacher's successful challenge a few years
ago.
Dr Bhatia thinks airing the candidates'
opposing philosophies is ultimately good for Canadian
healthcare. "I think, at the end of the day, it was
a very good thing for the CMA election debate to focus
primarily on this issue because this issue is going
to be one of the biggest issues at least for the next
few years facing medicare. Previously there was just
a lot of dancing around this issue at the CMA."
TWO
CAMPS
Dr Bhatia and his colleagues at PAIRO acknowledge that
this is a hotly debated topic among MDs. "Are people
passionate about this issue? Absolutely," he says. "It's
an issue doctors get passionate about because they see
it on a personal level every day. We live it!"
Dr Dakshinamurti agrees. "Of course
the physicians are divided, as the country is divided,"
she says. "It is indeed a hot button issue, as one's
prior experiences tend to result in strong views. This
is an issue that requires debate within as well as without
the profession."
"However, I think that there is
way more common ground on this issue than differences,"
adds Dr Bhatia. "Everyone recognizes the status quo
is unacceptable and everyone recognizes that patient
care and the public good must come first."
He notes the debate is really about
choosing between two paths with the same destination.
"I think it's critical that nobody — and that includes
Dr Day — is saying that universal healthcare is
a bad thing."
IS
THE CHA CTD?
However, much of the media coverage of Dr Day's victory
alluded to it, along with last year's Supreme Court
ruling in Quebec, as another nail in the Canada Health
Act's coffin. This line of thinking seems to ignore
two important points — first that the CMA doesn't
have the power to enact healthcare policies, and second:
no one person has complete control over the association's
positions. Dr Dakshinamurti cautions against reading
too much into Dr Day's election. "I think the relevance
of the positions stated by the CMA has to be taken in
context of the fact that at least as many physicians
in Canada oppose its views as support it."
"Right now all political parties
— including the ruling Conservatives — still
favour upholding the Canada Health Act," agrees Dr Bhatia.
"And in any attempt to introduce private care in Canada
— like Ralph Klein's proposals in Alberta —
the public has shown it has very little tolerance for
such reforms."
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