Canadian Medical Association Journal 1996; 155: 451-453
© 1996 Nancy Robb
As a past president of the Medical Society of Nova Scotia (MSNS) and former chair of the CMA board, she witnessed issues such as health care reform firsthand from both a regional and national perspective.
So what goals will the third woman to head the Canadian Medical Association pursue when she begins her 1-year term this August? To a large extent, she says, her goals will depend on the CMA's needs and the issues it will face in the coming year. "My goals must be in balance with what the CMA Board of Directors sees as the priorities and issues of the year, and the most significant priority right now is health care reform."
Dr. Kazimirski is sitting in the living room of the Falmouth, NS, home she shares with her husband and partner in practice, Mark, their dog and a copper Persian cat, who settled on her lap for much of our interview. Their two grown sons are frequent visitors. The home is just down the hill from the white farmhouse where her father, a retired mining engineer, was born, and where she spent summers as a girl. Born in Sudbury, Ont., Dr. Kazimirski studied medicine at the University of Ottawa, then interned at the Montreal General Hospital. She returned to Falmouth for good in 1971, when doctors in nearby Windsor invited her and Mark to open a practice.
Dr. Kazimirski will bring a solid medical-political background to the CMA's top post. Besides being a former head of the MSNS and past chair of the CMA, she recently chaired an MSNS task force that examined medical-services delivery under provincial reform, and she still sits on her health region's Board of Directors.
Like most Canadian physicians, she has experienced the initial effects of health reform and change: bed shortages, and the elimination of obstetrics at her community hospital.
She knows those are but a taste of the challenges and changes confronting the CMA and its members across the country. "Physicians are increasingly frustrated at not being able to access diagnostic facilities and treatment facilities, at not being able to get people into hospital," she says. "We are finding that the tools we're used to working with literally are being taken away from us, and our ability to deal with medical problems is increasingly being hampered."
That, "coupled with the dramatic and rapid change that's going on in the health care system, which is restructuring and realignment more than actual reform, has destabilized the profession considerably," she continues.
"Many people are at a point in their lives or their career where they need more security than the Canadian system can offer at this time. Others are challenged by the opportunity for change and renewal and are moving ahead, digging in and taking leadership roles."
Dr. Kazimirski thinks the exodus of well-trained Canadian doctors to the US and other parts of the world spells "disaster" for Canadian health care. "We should be able to provide a professional environment that supports practice, and that's what we're losing -- a professional environment that supports practice," she says. "It has significant implications, not only in terms of numbers, but [also] in the mix of specialists versus family physicians."
Reform also has implications for medical education. While Dr. Kazimirski applauds organized medicine's involvement in physician-resource planning and the development of rural-incentive programs, she says the "migration" of rural family physicians, along with the loss or changing roles of community hospitals, limits training opportunities for future doctors already hit with licensing and mobility restrictions.
"If we want to send people to rural areas, we have to provide them with rural training," says Dr. Kazimirski, a preceptor in family medicine at Dalhousie University and a member of Nova Scotia's Physician Resource Advisory Committee. "It means a different level of exposure for [residents] when they don't get the community-based hospital [experience]."
For patients, all of this fallout translates into reduced access to quality health care. "We recognize the fiscal realities," Dr. Kazimirski said. "Unfortunately, the principles of health care reform -- these include the movement from the hospital to community care and more emphasis on health-promotion and disease-prevention strategies -- haven't been incorporated into the reform that is under way. We're still dealing with the basic dollars-and-cents and restructuring, and unfortunately have made changes without putting in place the infrastructure that will allow, for instance, for the movement from hospital to home."
Nor, she adds, have governments incorporated ways to evaluate change. "We have some sense of how much money we're saving, but we have no idea where this is taking us."
Dr. Kazimirski predicts that may soon change, thanks to mounting pressure not only from the medical community but also the public. She is heartened by the results of a recent CMA public opinion poll in which Canadians highlighted their concerns about deteriorating access and quality, and called for "prioritization of urgent services" and "a reallocation of government monies" to health care.
"The time is right for a very public debate about what people want their system to be, what problems they're having, and how reform is moving ahead," she says, noting the federal government's National Forum on Health may help perform that function. "I still firmly believe that in the end all the players want the same thing: to sustain and improve the Canadian health care system. Our health care system is very much a part of what defines us as Canadian."
A supporter of the basic tenets of reform, she cites a few "early strides," such as federal funding for centres of excellence in women's health and the recently announced Health Services Research Fund, which will help determine "what to preserve and what to change" in the health care system. "Physicians have always said, 'Why create a new system? Think instead about building on the best of what we have and changing only what we need to change.' "
Dr. Kazimirski, a strong supporter of the CMA leadership conferences that help physicians deal with change, knows that adapting to any new order won't be easy. For doctors, it means "accepting the reality of health care reform," developing new skills and learning to work in teams with other health care professionals.
But they shouldn't despair. "I think the challenges in the system are significant, but I also think there are wonderful opportunities in medicine," says Dr. Kazimirski, whose two sons, Marc and Luc, hope to follow in their parents' footsteps. "I am proud to be a physician -- medicine is a noble profession."
She sees a window of opportunity for doctors to help ensure that medicine stays on course. "Getting involved in provincial or territorial medical associations is going to be very important, so that the unique experience of physicians, which is gained from that one-on-one patient contact, can be part of the decision making," she says. "My message to all physicians is simple: whatever interests you or draws you, get involved. Don't let others design your future."
Her own involvement in organized medicine had modest beginnings at MSNS branch meetings. "I found them fascinating and interesting," recalls Dr. Kazimirski, who has also served on the education and discipline committees of the Provincial Medical Board of Nova Scotia. "They were dealing with a side of my life and my practice that I didn't have any real knowledge about."
But Dr. Kazimirski, also a member of the MRC executive and chair of the Atlantic Research Centre for Mental Retardation, knows only too well how hard it is to juggle family responsibilities, private practice, medical politics and special interests.
For the past 2 months, as she's been preparing to assume the CMA's top post from Winnipeg pediatrician Jack Armstrong, she's been on the road, attending meetings and touching base with physicians across the country. She admits that she likes to take time to indulge her passions for cooking and gardening -- the Kazimirskis have several flower beds, a large vegetable garden, a raspberry farm and a greenhouse filled with basil -- and to catch up on her practice. "I am away from my practice more now because of CMA work," she says. "I miss it, but will get caught up once my term as president is over."
As CMA president, she plans to tap her interests in research and women's health and to endorse initiatives such as leadership conferences that draw women into the medical-political fold. Even now, as she travels across the country, she makes "an effort to meet with women physicians" or attend functions on women's health issues. In the weeks following our interview, for example, she was to speak at a conference on women's health in Toronto, then at an international conference on women's health in Ottawa.
Dr. Kazimirski stresses that she intends to be an effective spokesperson for all doctors. "I'm unbelievably honoured to be the next CMA president," she says, "and I'm asking for the support of the medical community and all my colleagues."