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Last chance for democracy at CMA

We, the undersigned physician leaders, are speaking here to represent perspectives which are shared by many practising doctors. The CMA is set to make a change that will make it undemocratic. Pure democracy is the way to go for president and board positions.

Our profession has come to a watershed. This is the decisive time for Canadian physicians to either accept a back seat in looking after Canadian physicians and managing Canadian Healthcare, or come forward to exert our knowledge, experience and leadership.

Our association—dedicated to the interests of Canadian physicians and Canadians’ health—is about to exit stage left. 

This year at the Canadian Medical Association (CMA) annual summit AGM and the (proposed final) General Council doctors have their last chance to exercise democracy in medicine. The board’s proposed bylaw changes will effectively abandon the last vestiges of participatory democracy that exist within our 154-year-old member organization.

graphical user interface, website
The CMA: a 154-year-old member organization.

The CMA has, in recent history, been a feudal structure where leaders are chosen through the virtual fiefdoms of their provincial & territorial medical associations (PTMA). 

This has usually happened with no reference to CMA member-physicians, but rather on the basis of what appears to be sinecure, where usually “whipped” council delegates are well paid and equally pampered to show up to ensure the continuation of the patriarchy.  

There is one provincial exception: In British Columbia democratic, province-wide elections have been held for both the CMA president since the 1970s, as well as for CMA directors, wherein both equity and diversity have been fairly and widely represented1

All other CMA directors across the country have otherwise continued to be appointed uncontested at General Council having been nominated by their PTMA with neither transparency nor open province-wide, democratic elections. 

Presidents of the Doctors of BC during the same period—similarly elected by the full province—are reflective of rural, urban and metro origin and have also met the test of equity, diversity and inclusion2 (EDI). These physicians include Drs. Charles Webb, Trina Larsen Soles, Alan Ruddiman, Eric Cadesky, Kathleen Ross, Matthew Chow, and incoming president Ramneek Dosanjh: B.C. presidents have been four men and three women, each in turn manifesting B.C.’s diversity. 

For decades past, with provincial- or territorial-wide elections, CMA presidents reflected Canadian physicians’ respect for demonstrated leadership as well as the diversity of gender and racial representation. Notably, Dr. Alika Lafontaine will be the first CMA president-elect of Indigenous origin3.

Over the past decade the CMA leadership has had five women and six men (two of whom also openly identifying as GLBTQI2S+), two BIPOC individuals and two from Royal College or CFPC rather than a PTMA.  

Regrettably, the track record on EDI for CMA board directors sent by other PTMAs has been so ashamedly lopsided as to not bear further analysis or judgment.

All CMA members can vote on this

On Sunday Aug. 22 the CMA will have a virtual AGM where all members can log-in and attend and vote online. If you are a lapsed or dormant member, you must join or renew your membership by Aug. 16 at 8 pm ET. You can register for the AGM here.   

The CMA board
It is clearly apparent that to adequately address the important issues of equity, diversity and inclusion, it is not the CMA presidential chain that needs to be fixed. It is the CMA board.

Nonetheless CMA—apparently ignoring this reality—is instead moving to have our president elected on a nationwide ballot of all members. While seemingly laudable, this is in fact misguided—presenting difficulty and uncertainty for members from other PTMAs.

CMA members will soon, if these motions are passed, be invited only to “affirm” or “ratify” the candidates for board directors set forth by the new CMA Leadership and Diversity Committee that is proposed to replace the current internal and external Nominating Committees.

And in what appears to be a well-planned distraction, these bylaw proposals conflate the good momentum toward EDI with denying the popular voting rights of members. This is a total affront to participatory democracy. 

The truth is the real power of the CMA rests with their board. Therefore, it is the CMA directors that should, from a well-prepared and represented EDI slate, be elected by CMA members in secret ballot either within their own provinces—just as has been the practice in British Columbia—or perhaps by a national ballot.

Proposed disenfranchisement 
The biggest irony in this is that what is being proposed is the almost-complete disenfranchisement of the whole membership—including the very colleagues we are trying to bring back into the fold as future legitimately elected leaders of our national association.

If CMA members see these proposed changes as being as badly advised as do we, it is now time to speak up! 

The choices are simple but stark: Put a stop to the removal of all CMA democracy at the upcoming virtual Aug. 22 AGM or otherwise forever hold our peace.

If doctors want CMA to survive as our premier national organization and regain our national influence and support of Canadian healthcare, they either need to show up virtually at this year’s AGM and put things straight, or by default accept an ineffective plutocracy.

If that happens, Canadian doctors, despite all we have built since Canada’s federation and the birth of CMA in 1867, may lamentably need to look elsewhere to fill the void in effectively advocating for and upholding the ideals and values of both the profession and the people of Canada.

Our unanimous appeal is for all Canada’s doctors to show up virtually as a force to be reckoned with at our upcoming annual general meeting of the CMA.

We, the undersigned physician leaders, are speaking here to represent perspectives which are shared by many practising doctors. While we do not represent the views of any one medical or political organization, we do speak as one in our deep concerns as longtime members of the CMA.

Let’s unite to send a strong message to the current board and to the CMA, through the democratic power that we, the physicians of Canada, hold at our AGM.

We must insist and resolve that we elect our best people to be provincial and territorial directors in a one-member-one-vote manner from a well-supported and represented EDI slate; or, alarmingly, risk having the control of our 154-year-old collective national organization, our CMA, irrevocably removed by the current board and administration of our association.


Dr. Granger Avery is a past-president of the CMA. Dr. Arun Garg is a past-president of the British Columbia Medical Association (BCMA, the earlier name for Doctors of BC) and was previously a CMA board director. Dr. Derryck Smith is a Vancouver-based psychiatrist and a past-president of the BCMA and a past CMA board member. Dr. Ian Gillespie was president of the BCMA in 2010/11. Dr William (Bill) Cavers was president of Doctors of BC in 2014/15. Dr. Charles Webb is a GP-anesthetist, a past-president at Doctors of BC, president of the Vancouver Medical Association and recently completed three years as a democratically elected director at CMA. Dr. Alan Ruddiman was president of Doctors of BC in 2016/17. Dr. Eric Cadesky is a primary and residential care doctor in Vancouver and was the 2018/19 president of Doctors of BC. Dr. Kathleen Ross is a past-president of Doctors of BC. Dr. Ramneek Dosanjh is the incoming president of Doctors of BC. Dr. Jeff Dresselhuis is family physician and the immediate past-chair of Doctors of BC. Dr. Richard Merchant is an anesthesiologist and the president of the Westminster Medical Association.


1. Directors from B.C. to CMA: four men and two women and one BIPOC since the start of an open vote in B.C. over the last five years: Drs. Nasir Jetha, Shelley Ross, Carol Williams, Robin Saunders, Charles Webb and Nigel Walton. 

2. Recent Doctors of BC presidents / president-elect: four men and three women including two BIPOC candidates: Drs. Charles Webb, Alan Ruddiman, Trina Larson Soles, Eric Cadesky, Kathleen Ross, Matthew Chow and Ramneek Dosanjh (president-elect).

3. Recent presidents / president-elect at CMA: five women and six men (two also openly identifying as GLBTQI2S+), two BIPOC individuals, and two past presidents from the Royal College or CCFP rather than PTMAs: Dr. Anna Reid, Hugo Francescutti, Chris Simpson, Cindy Forbes, Laurent Marcoux, Granger Avery, Gigi Osler, Sandy Buchman, Ann Collins, Kathleen Smart and Alika Lafontaine.

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