Canadian physicians need better CMA representation

It was with some dismay, particularly as an orthopedic surgeon, when last fall I heard Dr. Louis Francescutti, the incoming president of the Canadian Medical Association (CMA), interviewed on the CBC radio program White Coat, Black Art with Dr. Brian Goldman. The topic of the program, which aired on Oct. 1, 2012, was unemployed doctors.1 In the interview, Dr. Francescutti opines on the unemployment problem in orthopedics and other specialties; the potential inadequacies of older doctors who haven’t kept their skills up to date; the lack of need for specialists, nurses or surgeons; and, among other things, an impression of a pathway to start an alternative medical system with Canadian students who train overseas and want to come back to Canada. To quote the interview,1 in response to the question of how to fix physician unemployment Dr. Francescutti said, “Do we need doctors and do we need nurses? I mean those are guilds that served us well, you know, 150 years ago, but are they serving us well today?” He added, “So if you have, for example, a cardiovascular surgeon that’s doing 4-, 5-, 600 cases a year, are they a surgeon? Or are they a technician?” In response to an earlier question related to the lack of jobs available, he responded, “One other question that nobody talks about is, well, what about older physicians? Maybe it’s time for them to retire? Well, they can’t retire. Because with the financial crisis of 2008, a lot of them are broke.” At the time the interview took place (January 2012), Dr. Francescutti was the president of the Royal College of Pysicians and Surgeons of Canada (October 2010–October 2012); in August 2012 he was named president-elect of the CMA.

The Canadian Orthopaedic Association (COA) executive wrote to the Royal College after the interview aired in October 2012 to express dissatisfaction with Dr. Francescutti’s comments and the perception that he was speaking for physicians. The COA was not the only group to complain. The Royal College did not publicly admonish the interview; however, on Oct. 26, 2012, they issued a media release on employment issues,2 and the topic of physician unemployment was the subject of the November Message from the CEO.3 The COA also wrote to the CMA executive, who acknowledged the concerns and reiterated its committment to finding a long-term, lasting solution to the serious challenges faced by Canadian residents.

I write this editorial as an interested specialist in Canada, not as a member of the COA executive. Dr. Francescutti’s comments on White Coat, Black Art were out of touch with the ongoing education efforts and employment issue resolution initiatives of the Royal College — the organization for which he was president at the time of the interview. It really sounds like Dr. Francescutti is not representing the Royal College ideals of medical education, lifelong learning and sound health policy and is not speaking for physicians or health care in general.

Dr. Francescutti has obviously spoken his mind in public regarding this subject in a way that did not represent the ideals of the Royal College. He was president of that organization when he spoke and was so far from the base tenets of the organization the reader may wonder how in the future can we trust him to represent the ideals of the CMA and, more broadly, physicians and health care in Canada. He may claim that he was opening the subject for debate or playing the devil’s advocate or some other such reason. However, there is a difference between provoking discussion and completely overthrowing the efforts of organizations that advocate for physicians and health care in general.