Looking back and looking ahead as the CMA turns 130
John Bennett, MB, BS
CMAJ 1997;157:938-9
[ en bref ]
Obstetrician-gynecologist John Bennett, the CMA's former associate secretary general, is author of History of the Canadian Medical Association 195494 [catalogue / review]. This article is based on information found in that book and the 2 other volumes dealing with CMA history.
© Canadian Medical Association (text and abstract/résumé)
In brief
The handful of "medical men" who founded the CMA 130 years ago this month could not have predicted the changes their association would witness. In this article Dr. John Bennett discusses some of these changes and considers some of the issues that may lie ahead.
En bref
Les quelques «hommes de médecine» qui ont fondé l'AMC il y a 130 ans ce mois-ci n'auraient pu prédire les changements dont leur association a été témoin. Dans cet article, le Dr John Bennett discute de certains des changements et aborde certaines des grandes questions à venir.
The CMA may be celebrating its 130th anniversary this month, but the seed for the association was actually planted in 1844, 23 years before the official birth. On Nov. 8, 1844, Dr. Joseph Painchaud of Quebec sent a letter signed by 20 Quebec physicians to the Montreal Medical Gazette. It outlined a plan for the formation of a "Medical Fund or Association" and in the following years many physicians from Quebec and Ontario met to discuss the topic. Unfortunately, no common ground was found. It was later recorded that the attempt to form an association was "strangled wantonly in its very birth, and strange to say, by the very men who had for some months watched over its development with apparent solicitude."
In 1849 the dormant seed was stimulated by Dr. Francis Badgley of the Montreal Medico-Chirurgical Society, who proposed the formation of a BritishAmerican Medical and Surgical Association. Once again there was plenty of rhetoric, but an organizational meeting that had been planned for Kingston, Ont., in 1851 never took place.
The British North America Act of 1867 presented yet another opportunity to form a national association and once again the lead was taken by physicians from Quebec. The efforts and contributions of Dr. William Marsden and Dr. R.H. Russell of the Quebec Medical Society led to the society's call for a "Convention of Medical Delegates from Universities, Colleges, Schools, Medical Societies, etc., in the Dominion of Canada, to meet at the City of Quebec on the second Wednesday in October, 1867, for the purpose of adopting some concerted action on the subject of medical legislation, in conformity with this report, and for the formation of a Canadian Medical Association."
The call brought 164 physicians to Laval University's Grand Hall on Oct. 9, 1867, where the following motion, moved by Dr. W.S. Harding of New Brunswick and seconded by Marsden, received unanimous approval: "That it is expedient for the medical profession of the Dominion of Canada to form a Medical Association, to be named the Canadian Medical Association." By late afternoon a slate of officers had been presented and approved, with Dr. Charles Tupper being acclaimed president. The seed that had been planted 23 years earlier had finally found fertile ground. Growth could begin.
Initially the association's main concerns were to establish a standard for medical education, along with a uniform system of licensure for a new country. It also created a Code of Medical Ethics based on the American Medical Association's code of 1847. Among the physicians who served as general secretary and whose names still occupy a special place at the CMA were Dr. William Osler (18824) and Dr. F.N.G. Starr (18931901).
By 1921 the CMA had run into financial trouble: it had a debt of $9350 and an overdraft of $3800. It was proposed that a bond issue be floated among members to raise $20 000; the bonds would offer 5% annual interest for 10 years. During the 1921 annual meeting in Halifax, Dr. J.S. McEachern stated: "This is not the time to even think of disbanding. This is the time to think of moving forward." By 1923 the association was solvent, showing a credit balance of $7000. Five years later, when the annual meeting was held in Charlottetown, the bond issue -- it had raised $15 800 -- had been paid off.
In 1923 Dr. T.C. Routley was named general secretary and moved the CMA's administrative arm to premises shared with the Ontario Medical Association at 184 College St., Toronto. The rent was $1 per year, split equally between the 2 associations.
From that point the CMA continued to grow. The 1942 annual meeting in Toronto attracted 2330 members and the topics discussed ranged from the British Commonwealth Medical Conference scheduled for Saskatoon in 1949 to the federal government's announcements of health grants, prepaid medical plans and the formation of a Section of General Practice. In 1949 the Newfoundland Medical Association was welcomed into the CMA fold.
By the 1950s the CMA had become a force majeure in federal and provincial politics: it first dipped its toes gingerly into that sea, and then took a headlong plunge. In the centennial year, General Council approved a move of the CMA office from Toronto to Ottawa; it was completed in 1969. The relocation meant the CMA was no longer removed from the politics and policies of the federal government, and it finally had a chance to become the Canada-wide "voice of organized medicine."
The crisis that followed Saskatchewan's imposition of medicare in the early 1960s gave Canada's physicians one of the clearest signs that passivity and noninvolvement in the politics of health care was an invitation to disaster. The "Saskatchewan crisis" became the first of many opportunities for the association, which had been regarded as a club by some and simply ineffectual by others, to show that it was neither an anachronism nor a toothless tiger. By the 1980s one federal minister had described it as "one of the strongest, if not the strongest, trade union in Canada." The CMA's high profile was confirmed during the annual meeting in Victoria in August, when coverage of the meeting dominated the front pages of Canada's major newspapers and included a live broadcast on CBC Newsworld.
The second half of this century has seen major changes in the way the association operates. Staff now total 450, including some 340 employees at MD Management Ltd., its rapidly expanding financial subsidiary. The headquarters remains at 1867 Alta Vista Dr. in Ottawa, adjacent to several of the city's major hospitals and other national health care organizations.
What will the CMA be like 20 years from now when it marks its sesquicentennial? Some predictions are easy to make. Women will be playing a much larger role in its operations, and MD Management is likely to remain a financial powerhouse. The CMA's financial wing, launched with $20 000 in seed money 40 years ago, has grown into one of the country's major financial-management companies, with assets worth more than $9 billion under administration. No other medical association in the world has come close to matching its success.
The CMA's Publications Department has also witnessed staggering growth. In 1910 the CMA absorbed the Montreal Medical Journal, and published the first issue of CMAJ in 1911. In the last 10 years the CMA has become a publishing powerhouse, producing 14 different medical journals and newsletters and more than 8000 periodical pages per year. It has also expanded into the consumer market: a cookbook that will be published next year will mark one of the largest deals in Canadian publishing history. In 1995 the CMA became the first national medical organization in the world to develop its own Internet site; CMA Online now averages well over 100 000 Web page accesses per month.
As we look ahead, it might help to recall the CMA's original Plan of Organization and Bylaws, which is as solid today as 130 years ago. According to the plan, the CMA "must tend to advance medical knowledge, and elevate the standard of medical education, besides directing and controlling public opinion in regard to the duties and responsibilities of [physicians]; and serve to excite emulation as well as harmony in the profession."
That advice is well worth heeding 130 years later.
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