Unity is not unanimity: Finding medicine’s collective voice

Put ten physicians in a room and you may hear 12 opinions.That is not evidence of a divided profession. It is evidence of an educated one.Physicians are trained to question, challenge and reconsider. We compare evidence, test assumptions and consult colleagues because no individual—regardless of experience—has all the answers. Different specialties, communities, generations and models of practice also expose us to very different parts of the health system.A rural family physician, an urban subspecialist, a hospital-based physician and a new graduate trying to establish a practice may all be describing the same health system, but they are seeing it from different positions.Disagreement is not a defect in medicine. It is part of our professional discipline.But there is an important difference between disagreement and disintegration.A profession can contain many perspectives and remain united. It can also create the appearance of unity by suppressing the disagreements that most need to be heard.The challenge is not to make every physician agree. That would be impossible and undesirable. The challenge is whether we can disagree honestly, decide legitimately and still act together when our shared responsibilities require it.Unity is not conformity Unanimity means everyone agrees.Unity means that different views have been heard, the process for reaching a decision is credible and, even when we disagree with the result, we remain connected to the larger professional community whose future we share.Unity does not require silence from the minority. It does not place leaders beyond criticism. Nor does it ask physicians to surrender independent judgment or support every position taken by a medical organization.It requires something more difficult.It asks us to distinguish between disagreeing with a decision and rejecting the legitimacy of every collective process. It asks the majority not to treat a favourable vote as permission to disregard those who lost. It asks the minority to continue contributing without being silenced or dismissed as disloyal.Most importantly, unity requires us to know what we are trying to preserve together.Physicians will continue to disagree about payment models, scopes of practice, private delivery, technology, workforce policy, regulation and the organization of care. But surely we can identify a common floor.Patients should receive timely, high-quality care. Clinical decisions should remain grounded in evidence and patient need. Physicians should have the time, people, infrastructure and information required to practise safely. Professional autonomy must be accompanied by accountability. The medical workforce must be sustainable. Physicians must have a meaningful role in decisions affecting patient care.We do not need one policy answer to every question. We need agreement on the principles that cannot be lost while we debate the answers.What happens when unity is absent?When physicians no longer recognize their common interests, fragmentation does not leave a neutral space. Someone else fills it.We begin negotiating against one anotherFamily physicians, specialists, hospital-based physicians, community physicians, rural doctors and academic physicians all experience different pressures. Those differences deserve representation.When every constituency presents its concerns as separate from—or in competition with—the interests of every other group, governments can negotiate around the profession rather than with it.One group may receive a temporary solution while another absorbs the cost. A narrow investment may relieve an immediate pressure without addressing the structural problem. Physicians begin fighting over portions of an inadequate solution rather than asking who determined the size and shape of that solution in the first place.Scarcity makes this especially dangerous. Every group understandably wants to protect its own patients, practices and members. But if each believes it can advance only when another loses, the profession becomes easier to divide and less able to influence the health system as a whole.The loudest voice can become the collective voiceWhen representative organizations are weak or distrusted, governments, journalists and the public may turn to whichever individual or online group offers the clearest—or most provocative—message.That voice may be raising a legitimate warning. It may represent an important minority view. But it does not necessarily represent the profession.Without trusted ways to hear and bring together physician perspectives, it becomes difficult to distinguish among a warning signal, a constituency position and a claim to speak for everyone.The result is not necessarily more democracy. It is often more confusion.Patients hear conflict rather than purposePhysicians may understand the distinction among a compensation concern, a workforce crisis, a practice-sustainability problem and a patient-safety issue. The public may simply hear that doctors are fighting.This does not mean physicians should avoid discussing compensation or working conditions. Both directly affect whether medical services can be sustained. But we must explain the connection.“This is bad for doctors” may be true. It is rarely enough.Our positions must also explain what is at stake for patients, communities and the future of care.Power does not remain vacantThe experience of the United States offers a warning about what can happen when individual physicians and small practices lack sufficient collective capacity to withstand larger economic forces. The proportion of American physicians working in private practice fell from 60.1% in 2012 to 42.2% in 2024. The American Medical Association points to pressures including inadequate payment, costly resources and burdensome administrative requirements.Many factors contributed to this shift, and the Canadian context is different. But the broader lesson matters.Power does not remain vacant. When physicians cannot build sufficient collective capacity, authority migrates elsewhere.It migrates to governments, hospitals, insurers, investors, technology companies and other corporate entities. Independence without collective infrastructure can become isolation.What history can teach usInternational examples must be approached carefully. The legal, political and professional structures governing physicians vary substantially among countries. The value of these examples is not that we should copy their tactics. It is that they show what strengthens or weakens collective professional action.Saskatchewan: solidarity requires public legitimacyWhen Saskatchewan introduced universal medical insurance in 1962, most of the province’s physicians withdrew their services for 23 days. The dispute reflected deep tensions among public access to care, government involvement in healthcare and physicians’ professional independence. It ended through negotiation and helped shape the development of Canadian medicare.The episode demonstrates two truths.First, organized physicians had substantial negotiating power. Government could not simply proceed as though the medical profession did not matter.Second, professional solidarity was not enough to reverse a policy with significant democratic and public support.The lesson is not that physician unity failed. It is that professional unity is not self-validating. We must be able to demonstrate that what we seek is not only good for physicians but defensible for patients and the public.It is possible for physicians to be united and still fail to persuade. Unity must be joined to evidence, ethics and public purpose.England: a mandate, an organization and a decisionThe British Medical Association operates within a very different legal and employment environment from Canadian medicine. Its relevance here is not its trade-union status or its use of industrial action, neither of which is being proposed as a model for Ontario. The lesson is organizational.In July 2026, resident doctors in England voted on a negotiated government offer concerning pay and jobs. The result was exceptionally close: 52.9% voted in favour and 47.1% voted against, with 57% of eligible voters participating.That did not mean the process had failed.Members were able to assess the proposal themselves. Those who opposed it remained entitled to their concerns. Those who supported it provided the mandate to proceed.That is unity without unanimity.The transferable lesson for Canadian medicine is that effective collective representation requires clearly stated objectives, meaningful member engagement, disciplined negotiation, transparent communication, accountable leadership and a legitimate method for determining whether an outcome is acceptable.Unity is not created by announcing that physicians are united. It is created by giving them a credible process through which they can decide and act together.Ontario’s responsibilityOntario physicians already have significant mechanisms for collective representation, including province-wide negotiation, binding dispute resolution and public advocacy. The 2024-28 Physician Services Agreement, for example, includes an arbitration framework through which unresolved compensation matters can be decided.Those mechanisms carry significant responsibility.Ontario physician advocacy cannot be built around a real or perceived threat to patient care. Its strength must instead come from a credible member mandate, disciplined negotiation, evidence, transparency, public trust and the willingness to remain together after difficult decisions.This is not an argument that the OMA should become a trade union. A conventional labour model applies most naturally to employees bargaining with an identifiable employer and would not describe the circumstances of most Ontario physicians, who remain independent practitioners, practice owners, partners or contractors.Nor should physicians have to surrender independent practice or professional autonomy to gain an effective collective voice.In Ontario, where physicians who are not OMA members must still pay amounts equivalent to OMA dues and assessments, the obligation to earn trust through fairness, responsiveness and results is even greater.Mandatory financial support may create structural representation. It does not automatically create moral authority.Canadian unity cannot end at a provincial borderHealthcare delivery may be organized provincially and territorially, but many of the forces reshaping medicine are national.Physician supply and mobility, administrative burden, health information systems, artificial intelligence, virtual care, medical education and workforce sustainability do not stop at provincial boundaries.A province can attempt to solve its shortage by recruiting physicians from another province. That may change the location of the shortage without increasing the national supply.A successful model of care may emerge in one jurisdiction, yet every other province can spend years rebuilding similar work if there is no effective way to share and scale it.This is why Canada needs both strong provincial and territorial medical associations and a strong Canadian Medical Association.Provincial and territorial associations bring local knowledge, member relationships, negotiating experience and a direct understanding of how policy affects practices. The CMA can convene the profession around issues that no jurisdiction can solve alone.Canada’s medical associations have already advanced shared priorities that include physician-led team-based care, pan-Canadian licensure, reduced administrative burden, virtual care, improved pathways for internationally trained physicians and a national health-workforce strategy.That collaboration should not be occasional or ceremonial.The CMA must be prepared to convene, listen and lead nationally. Provincial and territorial associations must bring their members’ realities to that table, identify common ground and lend their collective strength to issues that extend beyond their own borders.This does not mean every association must take the same position on every matter. It means recognizing when a problem cannot be solved one province at a time.Our health systems may be provincial and territorial. The forces reshaping medicine are national and global.Pluralism enriches representation. Fragmentation weakens it.Unity cannot be commandedMedical organizations do not create unity by suppressing criticism.They do not create it by dismissing dissatisfied physicians as uninformed or disruptive. They do not create it by consulting members only after a decision has effectively been made. And they do not create it by treating an election victory as permanent permission to govern without continued engagement.Unity must be built through fair process.That means seeking dissent early enough for it to influence the outcome. It means explaining how evidence was weighed and competing interests were balanced. It means acknowledging uncertainty and being clear about who made a decision and who is accountable for implementing it.It also means resisting the temptation to treat every disagreement as an existential conflict.A mature profession must distinguish among a negotiable preference, a constituency concern, a serious warning signal and a threat to a foundational principle. Leadership is partly the work of making those distinctions.What constructive unity asks of usConstructive unity begins with a common floor rather than a common ceiling.Physicians should remain free to propose different solutions while staying committed to essential principles. Minority positions must be recorded accurately and answered substantively, not caricatured so they can be dismissed. Members should understand who has authority, how it was obtained and how it can be reviewed.Not every lost vote is a betrayal, and not every criticism is an attack.Unity also requires mutual obligation.Family physicians must be willing to defend the infrastructure needed for complex specialty care. Specialists must recognize that a health system cannot function without strong, longitudinal primary care. Urban physicians must understand rural and remote realities. Established physicians must make room for those entering a very different profession from the one we inherited.Provincial and territorial associations must contribute to national solutions. The CMA must ensure national advocacy remains grounded in the different realities experienced across the country.And every significant physician position must be explainable in terms of its implications for patients, communities and the sustainability of care.The difficult test of unity is not whether we agree. It is whether we can continue to work together when we do not.Finding our voiceMedicine has always contained strong personalities, competing schools of thought and legitimate differences in experience.That diversity is not something to eliminate. It is one of our strengths.But the pressures reshaping healthcare are larger than any individual physician, specialty, association or province. Governments are reorganizing care. Corporations are acquiring practices. New technologies are changing clinical work. Patients are waiting longer. Physicians are increasingly exhausted, and many are questioning whether the professional life they entered remains sustainable.We will not meet those forces by pretending to agree. Nor will we meet them by retreating into smaller and smaller camps.Unity asks something more difficult of us.It asks us to listen without surrendering judgment. To criticize without destroying trust. To stand with colleagues whose immediate problems may not be our own. To build provincial and territorial strength while recognizing the need for national leadership and coordination through the CMA.And, when a fair decision has been reached, to preserve enough confidence in one another to move forward together.We do not need one opinion. We need a profession capable of holding many opinions - and still finding its voice.Dr. Cathy Faulds is a palliative care physician in London, Ont. and a past head of the board of the Ontario Medical Association. This item originally appeared on her Substack.

Unity is not unanimity: Finding medicine’s collective voice

Register for free access or login.

Related Topics