Ben Diepeveen discusses the Canadian Medical Association’s troubles framing its opposition to federal tax reform as an issue of patient welfare.

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With his proposal to tighten restrictions on the use of private corporations for personal tax relief, federal Finance Minister Bill Morneau has forced Canada’s doctors to once again confront a perennial problem: How do medical associations reconcile their dual role as advocates for their physician members and advocates for patient welfare?

Whenever doctors feel financially threatened, their associations try to paint physician interests as perfectly consistent with good patient care, thereby maintaining their reputation as advocates for the public good. It’s often a difficult pitch, considering the privileged financial position in which most doctors find themselves; Canadians aren’t always eager to take the side of folks already bringing in an average gross payment of $339, 000 in public money. This time around, their task is proving even more challenging than usual.

When first confronted with Morneau’s proposal, medical associations tried to stick to the usual script. In an interview with the Globe and Mail, Dr. Granger Avery, who was at that time president of the Canadian Medical Association, argued that his organization was worried that patients would suffer if doctors left Canada due to an unreasonable tax burden. In addition, the Canadian Medical Association’s website has a letter template that they encourage doctors to use and send to their Member of Parliament, which also emphasizes the risk to patients. Doctors aren’t just worried about their paycheques, you see – they’re worried about what will happen to their patients when too many of them get fed up and leave the country.

This argument suffered two major setbacks over the past few weeks. First, at the Canadian Medical Association convention in late August, a good number of delegates took to the microphones to support Morneau’s proposed changes. These doctors acknowledged physicians’ status as high earners, and called on the Canadian Medical Association to advocate moving toward a system of salaries and benefits for physicians rather than forcing them to rely on incorporation to fund maternity leave and retirement. One doctor even asked if the Canadian Medical Association was being disingenuous in framing its objections around patient welfare. After enduring many such interjections, Ontario Medical Association President Dr. Shawn Whatley tweeted in frustration that “Delegates to #CMA150 should REPRESENT docs, not their own personal biases. We’re here to support doctors so that Docs can care for patients.” Undeterred, this past week many of those same physicians signed an open letter to Bill Morneau further articulating their position. “We need adequate tax revenues to fund social programs such as affordable housing, pharmacare, social assistance, legal aid, and the healthcare system itself,” they explain. “These programs directly impact the health of our patients.”

The Canadian Medical Association’s patient safety argument was further weakened when the Canadian Nurses Association announced its support for Morneau’s tax proposal on September 5^th, 2017. Like the Canadian Medical Association, the Canadian Nurses Association claims to lobby in part for the public interest and the preservation of a strong healthcare system. The nurses are directly contradicting their coworkers here, but this is not that unusual. They haven’t exactly been reliable allies for physicians over the years, and have often undermined doctors’ efforts to frame themselves as natural guardians of patient interests. This time around their dissent is particularly salient, as, unlike physicians, very few nurses will personally feel the effect of changes to tax rules surrounding incorporation. In this case, the Canadian Nurses Association might have a bit more credibility to speak to any potential impact on patient welfare.

With dissenting voices emerging from within the medical profession itself as well as nursing, medical associations’ initial ‘patient welfare’ argument is getting flimsier by the day. The Canadian Medical Association and its provincial chapters are left with openly lobbying for the financial interests of their membership, and aligning themselves with other groups representing small business owners. Maybe the Canadian Medical Association expects too much of itself, and the public expects too much of doctors. We don’t presume traditional unions to sacrifice the good of their membership for the public good, after all. However, we should at least expect doctors’ organizations to be honest about their motivations, and not to cloak an obvious financial matter in the language of patient welfare. When they do, medical associations discredit themselves in the eyes of their colleagues and the general public.

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Ben Diepeveen is a Ph.D. Candidate in the School of Political Studies at the University of Ottawa. @Diepeben