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Canadian Medical Association

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Canadian Medical Association
AbbreviationCMA
Formation1867
TypeOrganizations based in Canada with royal patronage
Legal statusactive
PurposeAdvocacy on national health and medical matters
HeadquartersOttawa, Ontario, Canada
Region served
Canada
Membership
Less than 70,000 physicians and physicians in training
Official language
English, French
President
Dr. Sandy Buchman (2019-2020)
President-Elect
Dr. Ann Collins (2020-2021)
WebsiteCMA

The Canadian Medical Association (CMA) is a national, voluntary association of physicians and medical learners that advocates on national health matters. Its new strategic plan identifies its primary mandate: driving positive change in health care by advocating on key health issues facing doctors and their patients.[1]

The Canadian Medical Association Journal (often abbreviated as CMAJ) is a peer-reviewed general medical journal that publishes original clinical research, commentaries, analyses and reviews of clinical topics, health news, and clinical-practice updates.

Membership

The CMA has over 75,000 members[2] and is the largest association of medical doctors in Canada. Its membership includes physicians and medical learners. The CMA represents Canadian physicians from medical school through to residency, medical practice and retirement.

History

The CMA's origins may rest with Dr. Joseph Painchaud and other Quebec physicians who in 1844 hoped to find ways to help physicians and, after their deaths, their widows and orphans.[3] There were false starts in attempts to form an association, but soon after confederation, practising physicians were successful in developing a national body.

The CMA's first president was Sir Charles Tupper,[4] the Nova Scotia Premier who led that province into confederation and later became Prime Minister of Canada. The foundation of the CMA was strongly rooted in its Scottish origins as the first three presidents of the CMA graduated from the Edinburgh Medical School.[5]

Among the CMA's founding principles in 1867 was to "improve public health and prevent disease and disability," a purpose which remains today.[citation needed]

The CMA Code of Ethics has been around in one form or another since 1868. As recently as 2015 this document was considered by the CMA to be "arguably the most important document produced by the CMA. It has a long and distinguished history of providing ethical guidance to Canada’s physicians. Focus areas include decision-making, consent, privacy, confidentiality, research and physician responsibilities. The code is updated every 5-6 years and has a major revision approximately every 20 years. Changes must be approved by CMA General Council."[6]

The fledgling association faced a lot of growing pains in its first 25 years as meeting attendance was small. There was even a notice of motion in 1894 to disband it.[3]

The Montreal Medical Journal was taken over in 1911 to become the CMA Journal.[3]

In 1921, the CMA re-organized with the appointment of its first permanent general-secretary, Dr. T.C. Routley. The association also became more financially stable by raising funds with a bond issue.[3]

Over the years, the CMA and its physician members have contributed to improved health and safety of Canadians. They have advocated on behalf of patients and educated the public to limit the effects of outbreaks, such as the 1918 Spanish flu, SARS in 2002 and the H1N1 influenza pandemic in 2009–2010.[7]

The CMA was instrumental in advancing awareness and treatment of cancer and formed the Canadian Cancer Society (CCS). The association provided most of the funds for the early years of the CCS based on interest generated from public donations made to a fund honouring King George V's silver jubilee.[8]

Since the 1950s, the CMA has warned the public about tobacco use. It successfully fought against promotional tobacco marketing and for new laws that curbed smoking and other tobacco consumption among Canadians.

The CMA played an important role in medical assistance in dying (MAID) legislation, calling it one of the most complex and ethically challenging issues facing Canadian physicians. The CMA supports its members in exercising their freedom of conscience - both for those who chose to provide or participate in physician assisted suicide and those who do not.

The CMA also played a central role in the creation of the Registered Retirement Savings Plan in 1957 as a tool to provide its members financial security in retirement.[9] MD Financial Management MD Financial Management was developed in 1969 to provide financial services to physicians and their families. It was sold in 2018 to Scotiabank and the sale includes a 10-year collaboration agreement.[10]

In 2018, the CMA ended its membership in the World Medical Association (WMA) to protest the plagiarism found in the speech of the WMA's incoming president.[11][12]

Advocacy

As a national association of physicians and medical learners, the CMA often advocates on key health issues that matter to Canadians and its members. In developing its positions, it seeks input through town hall meetings, surveys its members and reviews relevant scientific research. It also seeks input from provincial and territorial medical associations and from its more than 60 affiliate, associate and stakeholder organizations.[13]

2019 federal elections

In the 2019 federal election, the CMA is working to make health and health care a key election issue. The CMA's campaign focuses on six priority issues that were validated through extensive consultation earlier in the year:

  • Access to care: A high-performing health care system that all Canadians can access depends on a robust primary care system and a sustainable health workforce.
  • Seniors care: The current Canadian health care system is failing to meet the needs of the aging population. The CMA is advocating for a national plan to address all aspects of seniors care, including long-term, palliative and home care.
  • Virtual care: Digital innovations have been widely adopted and improve many aspects of Canadians’ lives, except in the public health care system – a model that has not significantly evolved in decades.
  • Climate change and Health: The health impacts of climate change facing Canadians are real and will worsen.
  • Pharmacare: Canada is the only country in the world with universal health care that does not also include prescription medications as part of its public health plan.
  • Youth mental health: Timely and affordable access to mental health care and addiction services are long overdue for youth.

Physician assisted suicide

In 2015, the Supreme Court of Canada, in a unanimous decision, struck down the Criminal Code's absolute prohibition on physician-assisted death.[14] As a result, the CMA developed foundational principles for medical aid in dying[15] to guide discussions with its members and with the federal government on ensuring patient dignity and upholding the rights of both patients and physicians. Consultations included submissions and presentations to the federal External Panel on Options for a Legislative Response to Carter v. Canada,[16] the House of Commons Standing Committee on Justice and Human Rights[17] and Health Canada.[18]

The CMA continues to work with government to address outstanding issues including medically assisted dying for mature minors and those who have mental illness as the sole underlying medical condition.

Public mobilization campaign

In 2015 the CMA embarked on its first major public mobilization efforts. With a federal election happening that year, the CMA saw an opportunity to align with the public on an issue that mattered to both the public and physicians. Hence, Demand a Plan was born.

Demand a Plan is a public campaign spearheaded by the CMA with the aim of having all levels of government work together to develop a comprehensive national seniors strategy. Over 74,000 people have signed up in support of the campaign.[19]

The Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities, in a report in March 2018,[20] adopted many of the recommendations made the previous year by the CMA on ways to better serve seniors with improvements to housing, income security and quality of life.[21]

The success of Demand a Plan brought on a new era of public mobilization at the CMA. Recognizing that there are many more issues that need to be rallied around, the CMA launched a second public mobilization platform called CMA Health Advocates. This platform is designed to bring Canadians together around a shared goal: improving health care. It enables them to engage and connect with their local politicians to share their health and health care stories. During the 2019 federal election, the CMA Health Advocates platform will be tracking each party's platform promises and creating opportunities for the public and its members to show their support.

Choosing Wisely Canada

Choosing Wisely Canada was launched by Dr. Wendy Levinson in 2014 in partnership with the CMA to help physicians and patients reduce unnecessary tests, treatments and procedures, and ensure high-quality care.[22] Central to the campaign are lists developed by more than 45 specialty societies to encourage critical thinking that will avoid unnecessary and potentially harmful tests and procedures.[23] The federal government's Advisory Panel on Healthcare Innovation urged governments in all jurisdictions to support the initiative.[24]

Drugs: Pharmacare, opioids and cannabis

The CMA continues to advocate that Canadians should have access to medically necessary pharmaceuticals that are safe, effective, available when and where needed and reasonably priced.[25]

The CMA is an active member of the Pan-Canadian Collaborative on Education for Improved Opioid Prescribing, which is chaired by the College of Family Physicians of Canada.[26] The CMA's position is that opioids are important for managing pain, but prescribing them must be based on evidence and include careful assessment and monitoring.[27] The CMA endorsed the collaborative's clinical guideline for opioids,[28] initially published by CMAJ and updated in 2017 by the Michael G. DeGroote National Pain Centre.[29]

The CMA identified potential risks of cannabis use and has addressed them in submissions to House of Commons standing committees.[30][31][32] Following the introduction of the Cannabis Act, the association provided guidance to the federal government on a regulatory framework to protect children and youth.[33]

Health and technology

Advances in technology could bridge the physical divide between doctors and patients, thereby reducing wait times[34] and health care costs. Technologies such as virtual reality, artificial intelligence and robotics hold significant promise for patients and physicians, particularly for a country like Canada with its large land base and numerous remote communities.[35]

In early 2019, the CMA launched a Virtual Care Task Force alongside the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada to explore the barriers affecting the effective implementation of virtual care in the Canadian health system. Recommendations are expected in early 2020.

Physician health and wellness

Physician health and wellness has become a key priority of the CMA. In 2018, a national snapshot report released by the CMA showed that while physicians report high resiliency, they also experience high levels of burnout and depression, particularly residents and women.[36]

To help respond to this growing issue, the CMA has implemented a physician health and wellness department led by Dr. Caroline Gérin-Lajoie. An environmental scan is underway to further identify key issues and possible solutions.

Provincial and territorial medical associations

Corporate structure

The size of the elected board of directors is transitioning to 19. The board includes physician, resident and student representatives. It is the executive authority of the CMA, meets four times a year and is responsible for policy direction.

In 2018, the association launched the CMA Patient Voice, a group of 12 individuals that provide a patient's perspective to the CMA's work.

A health summit attended by a wide spectrum of medical and health professionals as well as patient representatives[37] is held annually to disseminate new research, information and innovations, and to debate issues facing the medical community and users of medical services.

A public annual general meeting is held to review financial statements and other CMA business matters. As well, the association holds an annual General Council meeting of its members to discuss policy matters.

Companies

The CMA's subsidiary company Joule was created on Sept. 1, 2014. It delivers continuing education to doctors, resources for accessing medical information online, clinical information resources and summaries of the latest clinical evidence. CMAJ is published by Joule. Joule's grant program funds CMA member innovations that hold promise in the advancement of health care.[38]

The CMA Foundation was launched in 2017 to support charities furthering health care.[39]

CMA Awards

Each year the CMA invites nominations for the CMA Awards. The awards are presented at the annual meeting in August:

  • Owen Adams Award of Honour, the highest award the CMA can bestow to a non-physician
  • Medal of Service, awarded to a CMA member making exceptional contributions to the advancement of health care
  • F.N.G. Starr Award, the highest CMA award to a member; recognizes lifetime achievement
  • May Cohen Award for Women Mentors, awarded to a woman physician and CMA member demonstrating leadership in grassroots advocacy
  • Sir Charles Tupper Award for Political Action, awarded to a CMA member demonstrating leadership in grassroots advocacy
  • Awards for Young Leaders, awarded to up to six CMA members (two students, two residents and two early career physicians) for dedication, leadership and commitment in one of these areas: political, clinical, educational, research and community service
  • Dr. William Marsden Award in Medical Ethics and Professionalism, awarded to a member for advancing excellence in medical ethics or professionalism in Canada
  • John McCrae Memorial Medal, awarded for exemplary service to current or former clinical health services personnel with the Canadian Armed Forces
  • Dr. Brian Brodie Medical Learner Leadership Award, given to a student and a resident who demonstrate exemplary leadership

See also

References

  1. ^ "CMA 2020". Archived from the original on 2018-11-07. Retrieved 2018-11-07.
  2. ^ "About the CMA".
  3. ^ a b c d Howell, W.B. (1936). "Men and Books, a review of H.E. MacDermot's History of the Canadian Medical Association, 1867-1921". CMAJ. 34 (3): 300–331. PMC 1561548.
  4. ^ "Sir Charles Tupper Award for Political Action". Archived from the original on 2018-11-08. Retrieved 2018-11-07.
  5. ^ "Past presidents of the CMA since 1867". Archived from the original on 2016-12-23. Retrieved 2018-11-07.
  6. ^ "CMA Code of Ethics". 8872147 Canada Inc. Archived from the original on 19 February 2015.
  7. ^ "Second Reading of Bill S-248, An Act Respecting National Physicians' Day". 2018-04-19.
  8. ^ "Our history". Canadian Cancer Society.
  9. ^ "Our history". MD Financial Management.
  10. ^ "Scotiabank completes acquisition of MD Financial Management and begins 10-year collaboration with the Canadian Medical Association".
  11. ^ "Canadian Medical Association (CMA) resigns from the World Medical Association (WMA)". Archived from the original on 2018-10-09. Retrieved 2018-10-09.
  12. ^ "Canadian Medical Association Resignation". World Medical Association.
  13. ^ "Affiliates, associated societies and observer organizations". Archived from the original on 2018-11-08. Retrieved 2018-11-07.
  14. ^ "Supreme Court Judgments Carter v. Canada".
  15. ^ "Principles-based approach to assisted dying in Canada" (PDF).
  16. ^ "CMA submission to the federal external panel on options for a legislative response to Carter, vs. Canada" (PDF).
  17. ^ "CMA Submission: Supporting the enactment of Bill C-14, Medical Assistance in Dying" (PDF).
  18. ^ "Federal monitoring of Medical Assistance in Dying Regulations" (PDF).
  19. ^ "Demand a Plan".
  20. ^ "Advancing Inclusion and Quality of Life for Seniors".
  21. ^ "CMA submission to the House of Commons Standing Committee on Human Resources, Skills and Social Development and the Status of Persons with Disabilities" (PDF).
  22. ^ Levinson W, Huynh T. Engaging physicians and patients in conversations about unnecessary tests and procedures: Choosing Wisely Canada. CMAJ. 2014 Mar 18;186(5):325-6.
  23. ^ Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA; Choosing Wisely International Working Group. 'Choosing Wisely': a growing international campaign. BMJ Qual Saf. 2015 Feb;24(2):167-74
  24. ^ "Report of the Advisory Panel on Healthcare Innovation: "Unleashing Innovation: Excellent Healthcare for Canada"" (PDF).
  25. ^ "Pharmaceutical Issues". Archived from the original on 2018-11-08. Retrieved 2018-11-07.
  26. ^ "What is being done to address the opioid crisis?". Canadian Centre on Substance Use and Addiction. Archived from the original on 2018-11-08. Retrieved 2018-11-07.
  27. ^ "Opioids and the CMA".
  28. ^ "The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain".
  29. ^ "What is being done to..." Archived from the original on 2018-11-08. Retrieved 2018-11-07.
  30. ^ "Submission to the House of Commons Standing Committee on Health" (PDF).
  31. ^ "The health and social effects of nonmedical cannabis use". World Health Organization.
  32. ^ Crean, R.D.; Crane, N.A.; Mason, B.J. (2011). "An evidence based review of acute and long-term effects of cannabis use on executive cognitive function". J Addict Med. 5 (1): 1–8. doi:10.1097/ADM.0b013e31820c23fa. PMC 3037578. PMID 21321675.
  33. ^ "CMA Submission: The Cannabis Act, Submission to the House of Commons Standing Committee on Health" (PDF).
  34. ^ "Time to Close the Gap: Report on Wait Times in Canada (2014)".
  35. ^ Beaulieu, Yanick; Kohll, Sonny. "Virtual Care Allows Physicians to Reach Canadians Outside of the Usual Spaces".
  36. ^ "CMA National Physician Health Survey: A Snapshot" (PDF). p. 2.
  37. ^ "Patients get floor at Canadian Medical Association inaugural health summit in Winnipeg". CBC.
  38. ^ https://joulecma.ca/
  39. ^ "The CMA Foundation Celebrates Its One-Year Anniversary". Archived from the original on 2018-11-08. Retrieved 2018-11-08.
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