There has never been an election like it in the long, mostly staid history of the Canadian Medical Association.
Almost always, CMA presidents are nominated early and approved by acclamation. This time, not only is there a contest, it has become increasingly bitter, complete with electioneering, whisper campaigns and hard feelings.
Much is at stake. Many believe the choice by delegates next week at the CMA's annual general meeting in Charlottetown could have a profound impact on the future of Canada's health-care system.
Two Vancouver doctors with radically different health-care philosophies — family physician Jack Burak and private-clinic operator Brian Day — are vying for the CMA'S top job, effective in 2007.
Dr. Day, universally acknowledged as a superb orthopedic surgeon, is a widely known, outspoken advocate of expanding the role of private, for-profit clinics in Canada to cure the system's perceived ills, particularly surgical waiting lists.
Dr. Burak, on the other hand, believes strongly in strengthening publicly funded health care by making necessary changes to the system without allowing private-sector competition.
According to University of Toronto health-policy analyst Raisa Deber, the CMA has traditionally been “an extremely progressive voice” on behalf of Canada's public health-care system.
But choosing Dr. Day as president of the influential organization that purports to speak for the country's 62,000 doctors would jeopardize that, Prof. Deber said.
“He has been quite negative about medicare, and if he sticks with those views, then that will be quite a significant change for the CMA.”
Emotions are running high in the candidate doctors' home province, where Dr. Day is the official nominee of the B.C. Medical Association.
After an avalanche of angry e-mails — for and against the two physicians — poured into the BCMA last month, president Margaret MacDiarmid wrote to all members, urging them to cool it.
“It is important during this turbulent time we remain respectful of each other,” her letter said. “It is possible to disagree with one another and be passionate about our beliefs without resorting to personal attacks.”
Dr. Day, who runs the country's largest private health-care facility, won the BCMA nomination last February in a close, five-way race. Dr. Burak finished second.
Normally, the winner would have been given a free ride, given that it is B.C.'s turn to provide the CMA presidency. But Dr. Burak, a past president of the BCMA, upset the applecart by deciding to renew his challenge at the CMA convention.
“I think Dr. Day's been hurt by the way this has unfolded,” said Dr. MacDiarmid of the BCMA, which is providing $10,000 for his campaign.
“They are saying many things about him that are not true. We have no qualms about backing him.”
Dr. Day said private competition will eliminate waiting lists, the way it has in many European countries. “Anyone who continues to suffer at the hands of our current system knows it is not working well. It is time we fixed it.”
Robert Woollard, head of the family-practice department at the University of British Columbia and a director of Canadian Doctors for Medicare, is one of the doctors who urged Dr. Burak to run.
“Dr. Day represents a distressingly narrow view of a complex issue,” said Dr. Woollard, a veteran of many CMA committees.
“Far from going to hell in a hand basket, Canada's health-care system is quite commendable. I know doctors feel beleaguered but the crisis is not such that we have to throw the baby out with the bathwater.”
Dr. Burak, meanwhile, said he is far from relishing the contest. “My own medical association has dumped me in favour of someone who has done little for the organization. It's not fun.”
But too many doctors urged him to run for him to say no, he said.
“If we collectively elect Brian Day, it's hard to imagine that the Canadian public will not see that as the doctors of Canada giving up on our public health-care system in favour of allowing an expansion of private, for-profit medicine,” he said.
The CMA annual general meeting, with about 260 delegates from across Canada, begins on Sunday. The vote for president takes place Tuesday morning.
