Getting practical about the naive dreamers

The founders of the CFPC and the profession of family medicine in Canada were optimists, believers, and aspirational. The organization’s first purpose from incorporation in 1968 was to promote the highest quality of medical care for the people of Canada.¹ Family medicine is the best of Canadian health care. But the profession—and its professional home—are at risk.

When I first became Executive Director and Chief Executive Officer, I wondered if the CFPC’s founders were so naive they couldn’t imagine or foresee a world where members would not want to belong to the CFPC or pay increasing dues. Didn’t they anticipate the future risks of asking members to approve fee increases? Governments don’t ask citizens about their willingness to pay taxes, particularly if the benefits are not immediately tangible or directly relevant to them. Maybe that’s just it. The founders didn’t want fee increases to be obligatory like taxes—they hoped members would be enthused to support family medicine because of its indispensable role in the lives of patients and in health care.

For decades, family physicians have provided more than 50% of the health care in Canada, had the best patient outcomes, and been cost-effective service providers.² However, governments and our negotiators have undervalued family doctors and left primary care with just 5% of the overall health care budget.³ I suspect the founders could not anticipate this incongruity. I’m reminded of Mark Twain’s quote “Truth is stranger than fiction, but it is because Fiction is obliged to stick to possibilities; Truth isn’t.”⁴ The natural consequence of being both the most valuable and consistently undervalued is that members lose faith. The system is failing them and their professional home, leaving members to ask, “Why has the CFPC not done more?” Our recent survey of membership shows little faith in the profession and consequently, diminished faith in their professional home.

We’re in a difficult time in history for the profession and its professional home. Were the founders naive dreamers or did they make sure the membership has power? I think a little of both. Members have voted against fee increases for 8 years, requiring the College to reflect on our value proposition to membership. In the past few years, the CFPC has become more fiscally responsible (cutting costs and staff by 10% to 15%) and is prioritizing member value. As the only national voice of family medicine, we’ve also strengthened our advocacy. Now is the time to maximize this effort. The founders made this a core purpose: “To enlighten and direct public opinion in Canada in relation to family medicine.”⁵ Family medicine is the cornerstone of Canada’s health care system, and our value is finally now being recognized by politicians, the media, and most importantly, the public. Rarely does a week pass without news stories of lineups to have a family doctor, politicians promising to address the lack of family doctors, or similar.

The CFPC is moving away from asking for fee increases without linkages to specific activities. At the same time, the CFPC needs financial stability to maintain its core functions—such as standard setting—and the slow but essential tasks—such as advocacy. To that end, the CFPC will be integrating cost-of-living adjustments to all its products and fees to account for inflation. Getting members’ approval for inflation increases will provide the CFPC with financial stability for core functions. Limiting regular increases to inflation will ensure members maintain control of and responsibility for CFPC fee increases for specific functions.

At this time in history, when our country is recognizing the importance of each Canadian having a family physician, it is time for us to shore up the professional home while remaining accountable to members. The CFPC’s founders were aspirational and brilliant, and I, perhaps naively, think this is exactly what they would dream.

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