Background

Equity and diversity in medicine are the subject of an important, ongoing discussion for medical professionals and patients. Greater equity and diversity in the medical workforce will improve system adaptation and patient care, but many barriers need to be addressed for the profession to move forward.

To better understand and address these barriers, the CMA launched a conversation with CMA members and stakeholders on equity and diversity in medicine in January 2019.

Members and stakeholders were encouraged to ponder questions such as:

  • In your opinion, what are the most prominent issues or challenges related to equity and diversity facing the medical profession?
  • What actions or solutions, big or small, might lead us toward a more equitable and diverse future for the medical profession?
  • How can an increasingly diverse profession positively affect patients?
  • What role should the CMA play in improving equity and diversity to support you as a member?

Since receiving and reviewing feedback, the CMA has developed a draft policy on equity and diversity in medicine to promote increased equity and diversity in medicine and to foster a more collaborative and respectful professional culture. By developing this policy, the CMA aims to identify a set of guiding principles and commitments to achieve these goals. It provides support for the view that improving circumstances and opportunities for physicians and learners is essential in creating a more equitable and sustainable culture and practice of medicine.

    PDF                        PDF          

Defining equity and diversity

Equity refers to the treatment of people that recognizes and accommodates their differences. Equity relates to the opportunities of any given person, with their own identity, culture and characteristics, to create and sustain a career or to receive medical care without discrimination, harassment or cultural- or characteristic-related negative bias.

Diversity includes those (observable and non-observable) characteristics that are constructed — and sometimes chosen — by individuals, groups and societies to identify themselves (e.g., age, culture, language, gender, sexuality, health, cognitive abilities, socioeconomic status) in different contexts and that may describe them in relation to others in those contexts. It describes them in relation to other people (e.g., age, socioeconomic status, geographic location, health).

Feedback options

The consultation period for reviewing the draft policy closed on Nov. 18, 2019. Thank you to all stakeholders who shared their thoughts. 

  • Thank you for this first draft. It is a good document which requires some clarification, additions and changes in the next version.

    • In the second document on “Background to the Policy”, I believe that the section on Physician Leadership could deal with leadership and leadership development more specifically. The section mainly deals with academic data only. In addition, I suggest to not limit that section to gender bias, as the evidence shows that both male and female physician leaders are biased against by peers for having “gone to the dark side”. Publications by Spurgeon and others have addressed that issue that, until today, remains rampant.
    • For the “Main Policy”, please accept following thoughts:
      1. Under Rationale: last sentence of second paragraph requires clarification (unless I am the only one who needs clarification to avoid multiple interpretations).
      2. Overall reflection on the Recommendations, I wonder, what is it the CMA can do to action some if not all of these recommendations? What support can CMA offer to make some of the recommendations actionable?
      3. Why is the sentence at the bottom of recommendation #3 formatted as an orphan sentence?
      4. Recommendation #5 iv: while I support the statement in principle, one has to be very careful in the execution of that recommendation, in that equity should exist in access to resources, training and hiring processes, which might not necessarily translate in equity in the outcome. Off course, this comment does not apply in general and only pertains to certain situations.
      5. Educational recommendation 1 iv: while absolutely essential, time will have to be found in already overloaded curricula. As an example, leadership development has been on the radar of medical school curricula for years, and argument continues to be made that there is (too) little time. Having said that, this is an important recommendation.

    Happy to talk on the phone if my words are unclear or can be misinterpreted. Many thanks for doing this important work and allowing to submit comments

    John(y) Van Aerde, MD, PhD, FRCPC

    Executive Medical Director

    Canadian Society of Physician Leaders

  • Having reviewed the policy and background several times , I commend the CMA for their initiative and efforts. I support this policy. The politically correct pendulum is swinging with  much force these days,,, perhaps too much but these issues do need to be dealt with and equalized and addressed within ,,especially our profession which is seen as a leader in this country.   I think that it also opens many doors where some , likely small, amounts of  the 2.6 $ could effectively be applied to strengthen our morale  as a profession and to improve and maintain quality patient care. Motivational education to help understand and change harassment issues  for just one example.  Page 4, Item 3,,,, "Humility is the key"  is a potent statement. Our past and present president have shown strength and leadership with humility and we as a profession should strive to learn from their example. I respect all of my colleagues comments and note that the $$ issue is prevalent on our minds. I have every faith that our CMA will chose wisely in dealing with this issue.

  • I agree. Equality of opportunity = yes. Equality of outcome = no. 

  • This is important work, worthy of using part of the money obtained from the sale of MD Management. This discussion reminds me of a statement I heard on radio, and which I can only paraphrase: "If one is accustomed to privilege, even equality can seem like oppression." I was fortunate to hear a marvelous indigenous MD speak about her experiences. She told a story about talking at a school, and hearing one of the indigenous children say to another, "There she is – that's the doctor" to which the other child replied, "She can't be a doctor. Indians aren't doctors." Often, it's only when we see ourselves in others that we believe it could be us.

    Our trainees, particularly women, are still bullied and harassed during their training, with no obvious route to change. I had hoped it had changed since my training. Marilou McPhedran spoke at our University (with almost none of the administration present) and said she sees no reason to believe things have changed or will change because the system is set up to prevent change. So, this work is even more important to try to develop a culture which doesn’t allow discrimination and harassment and encourages equality. We must realize that it is not a zero-sum game: when we improve conditions for others, we all benefit socially, and importantly, financially.

    Unfortunately, documents like this often contain too much Newspeak and jargon, which inhibits acceptance. Perhaps the CMA can develop documents inapproachable language.

  • I'm all for diversity and equity and think all comments from people who don't think we have a problem with this should be ignored because they ignore good evidence.  I'd rather see the CMA doing more to protect the entire profession from outside forces though.  The denigration of the profession is harming patient care, so pro doctor is pro patient and can easily be phrased that way if we can afford some PR.