September 06, 2006

Canada's doctors choose a new leader in health care can he bring the system into the 21st century.

For-profit clinic founder is CMA's new president-elect
Laura Eggertson
BC physicians have elected the medical director of a private, for-profit clinic as the president-elect of the CMA.

"[W]e have the potential to design the best health system in the world." Photo by: Cambie Surgery Centre
Pending ratification at the CMA General Council in August, Dr. Brian Day, founder of the Cambie Surgery Centre in Vancouver, will serve as CMA president 2007–2008. The CMA presidency rotates among all the provinces, and members of each provincial medical association vote on the position when their turn arrives.
In 1996, Day, an orthopedic surgeon, founded the Cambie Centre, which treats patients willing to pay out-of-pocket, or those who are covered by third-party insurance or government plans, such as the Workers' Compensation Board or the RCMP. Those organizations pay for the clinic's services to avoid waits in the public system.
Day ran on a platform that included the need for doctors to have a greater say in reforming the health care system, and chastised governments for their "bullying" behaviour.
"We and our patients have suffered at the hand of governments. For 20 years they have tried to fix the system and failed. Now it is our turn," Day states on his Web site ( "The exclusion of market forces has allowed increased demands for services to coincide with decreased practice revenue for physicians."
Day has previously stated that private health care should complement, but not replace, the public system. But Day was not a one-issue candidate, he told CMAJ in an interview.
"I think people voted for me because they support change. There's a lot of discontent with the way the government has allowed the massive shortage of family doctors to occur," he said.
The president of the BC Medical Association was one of 6 candidates who ran in the CMA election. Dr. Michael Golbey says he believes the surgeon won the election because "it just reflects the frustration that doctors in BC have in getting care for their patients."
"He comes along with a different way of looking at things and people just latched on to that," says Golbey.
Day is a well-respected figure in the medical profession who has spoken to audiences around the world and has been "extremely persuasive," says Golbey.
Day's position is "different" from what CMA's General Council has said over the years, and the president of the CMA is bound by what's decided at General Council, Golbey pointed out.
"He will absolutely bring a different perspective to the CMA."
However, "Dr. Day's solutions will not provide the relief that the Canadian public seeks," stated Dr. Sacha Bhatia, spokesperson for the New Health Professionals Network (NHPN), which represented 25 000 new health professionals. "On the contrary, they will only serve to make profits for some health care entepreneurs and bring some richer patients to the front of the line while decreasing access to health care for the majority of Canadians."
The fact that Day got only 17% of the total vote in BC "suggests that his ideological message does not have overwhelming resonance," stated the NHPN.
Day says that given Quebec's white paper calling for private health insurance for elective surgeries, Alberta's plan to introduce a "Third Way" and the BC Throne Speech calling for an update to the Canada Health Act, Canada is at a "pivotal moment" with respect to medicare.
"There is no question that reform is coming and we have the potential to design the best health system in the world," he says. "It's not a question of debating the pros and cons. It's more about taking the best from what we can learn about systems that work and also learning from the mistakes that other people have made."
Doctors should not only be at the table for that discussion, "we should be at the head of the table," Day adds. "Governments need more help from doctors than they've asked for or have taken in the past."
In a submission to Senator Michael Kirby's committee on health care in 2001, Day recommended repealing the Canada Health Act. "The Canada Health Act achieves the reverse of what it was set out to do. In fact, the people from lower social economic groups, people who do not have the ability to pick up the telephone and make a phone call, people who do not know how to wheel their way around the system are the ones who suffer in a system like this," he said at the time.
Asked if he still supports that view, Day responded that while there is nothing in the Act that is bad, "it has to be updated."