The CMA is dead. Long live the CMA

“WTF is going on?” “Do you know Robert’s Rules?” “How can anyone be against EDI?” Judging by the texts blowing up my phone, the 154th Annual General Meeting (AGM) of the Canadian Medical Association (CMA) will be one long-remember for many things. It will be remembered as the meeting that reinforced that virtual technology is a tool, for better or for worse. Just as in clinical medicine, virtual meetings work best in the context of existing relationships based on trust and respect. And those were sorely needed given the importance of the debates surrounding governance changes and equity, diversity, and inclusion (EDI.) The meeting’s chosen platform did not allow members to talk to or even identify each other, so discussion on all sides veered into social media where echo chambers are known to entrench positions and worsen outrage rather than promote dialogue. Never minding the expected technical glitches, it was messy. If it was messy then it was also democratic—except when it wasn’t. Some will say that democracy won the day since a motion was defeated that would have ended any chance for CMA members to elect their own board members and instead left it to a small Leadership and Diversity Search Committee whose choices would be ratified at the next AGM. They will point out that defeating an antidemocratic motion is not akin to maintaining the status quo and that there is much the CMA can do to promote EDI. Others will point out that any intentional action on EDI is progress and that these changes would in any case be reassessed in three years. They will also correctly point out that the meeting was delayed on several occasions due to procedural questions involving Roberts’ Rules and the inherent inequity of using such a traditional system. All of these arguments have their merits and there was a clear general consensus at the meeting that EDI is a shared value; unfortunately this commonality was mostly lost due to the virtual setting and the overtly stated preference of meeting “efficiency.” Other things happened, such as bylaw amendments on national elections for the CMA president-elect position and general housekeeping items that were defeated. Dr. Sandy Buchman, now the CMA past-past-president, barely got into his report of the nominations committee before the meeting cut off abruptly, more than an hour after it was supposed to have ended. All of this meant that the acceptance of the nominating committee was swift with little time to reflect on the monumental ratification of Dr. Alika Lafontaine as the CMA’s first Indigenous president-elect. Read: Smart choice: New CMA president calls for changes to the culture of medicine At this point we were more than four slogging hours into the meeting and we needed uplift. And with Dr. Katharine Smart scheduled to give her inauguration speech as the new CMA President, there was no doubt in my mind that her energy and vision was just the antidote we needed. Except that the meeting abruptly ended when the platform booted me out. Some frantic texting informed me that others had the same problem. And like that, the meeting was over. No inaugural speech. No wrap up. No word on the next steps. Although it may seem that after voting there were winners and losers, it feels like everyone lost. EDI was pushed to the side in a debate of going fast or going far. The profession did not come together and rather seemed more polarized. Those who have earned their time in the sun had it set prematurely on them. So we are left with two paths forward. The first involves continued division and splintering of our professional into interest groups that act with good intentions but are limited in their scope and influence. Without common values to unite us, the CMA will be an efficient corporate entity flush with finances but lacking legitimacy from its members. The second and preferred path is to learn from what happened. CMA members or at least the 300 plus members that gave most of their Sunday to attend the AGM—said that we want to be involved and be heard. We want an organization that takes the time to know us and understand our needs. We want platforms to come together and discuss, to get to know each other. General Council had it flaws and could have been more inclusive, but gathering together with family and friends led to debate that was respectful and as a profession we moved forward on complex issues like medical assistance in dying, drug reform, and climate change. For safety this may take the form of more virtual forums or Health Summits. And, delta willing, perhaps next year we will even be able safely gather in Edmonton to personally witness Dr. Lafontaine’s inauguration and hear Dr. Smart’s valedictory speech. The medical community needs healing. We need policies that equitably uplift rather than create new barriers. We need new structures that promote mentorship, value diversity, and include voices not traditionally heard. We can choose efficiency or we can take the time to really listen to each other. After surviving more than four hours of an exhausting virtual meeting, those are the things I would really like to remember. Dr. Eric Cadesky is a primary care doctor in Vancouver.

The CMA is dead. Long live the CMA

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