Canadian Medical Association Journal 1996; 155: 984
The good news was that even though delegates were clearly unhappy with many recommendations related to governance of the association, they appeared interested in increasing the voice given residents and medical students within the CMA -- so interested, in fact, that they extended the deadline set by Speaker Doug Perry specifically to discuss how to increase representation of trainees.
The bad news was they couldn't agree how many votes should go to trainees or how delegates would be selected. After considerable debate, the matter -- like much of the rest of the report -- was referred back to the Board of Directors.
Dr. David Keegan, president of the Canadian Association of Internes and Residents (CAIR), was disappointed but philosophical about the outcome. "Obviously we would have liked the matter settled this year, and now it looks like we will have to wait 1, 2 or more years for it to happen," he said. "We do appreciate, though, that the Committee on Structure tried to increase our representation and that there seemed to be support for it."
Currently, medical residents are represented by CAIR and the Féderation des médecins résidents du Québec (FMRQ); undergraduates are represented by the Canadian Federation of Medical Students (CFMS) and the Féderation des associations d'étudiants en médecine du Québec. Only CAIR, a CMA-affiliated society, has a vote at General Council. It also has observer status on the Board of Directors.
The Committee on Structure had recommended that each of Canada's 16 medical schools send one postgraduate resident and one undergraduate medical student to vote at General Council. Each of these 32 voting members would have to be CMA members and would be chosen through their respective organizations.
Some delegates were worried that if trainees voted as a bloc they would have more votes than any single provincial division. One physician suggested that divisional interest in the CMA would wane if students were given too much clout.
Keegan was disturbed that the debate seemed to turn on whether trainees should be given enough representation to create a caucus. "What's the point of giving students a voice if you don't want them to use it?" he said. "Residents should be able to speak through their own duly elected democratic body. We don't feel shortchanged with the current system, but if the CMA decides to increase the number of votes we have at General Council, it should be through the mechanism chosen by the trainees themselves."
Dr. Robert Woollard, chair of the Council on Medical Education, spoke in favour of increased trainee representation. "I don't feel threatened by 32 students having a vote in a General Council of 270," he said. "They would give good counsel. This does not open the floodgates to some nefarious power; it opens the door to the future of the profession."
Dr. David Jones, chair of the CMA's Advisory Committee on Benefits, Services and Membership, pointed out that trainees represent 7% -- and potentially could represent 13% -- of CMA membership. The number of student members has grown substantially in the last 2 years; currently the CMA has about 3000 student members, almost half of the total medical student population.
Stephen Crummey of St. John's, the CFMS vice-president for finance, said medical students welcome the CMA's effort to include more students, whose voice needs to be heard on issues such as discrimination against new graduates and unfair restrictions on practice. Ultimately, he said, students would like to have voting privileges.
Dr. Sonia Brisson, a McGill University resident and member of the FMRQ, pointed out that both students and residents had been included in the Quebec caucus at the 1996 General Council, giving them a voice -- albeit within the provincial division. This measure was commended by other delegations, which promised they would take similar steps in the future.