CEO's CFP columns

Clarity in the centre of the storm

Michael Allan
Canadian Family Physician October 2024; 70 (10) 672; https://www.cfp.ca/content/70/10/672

This is my second column as your Executive Director and Chief Executive Officer, but the first focusing on my new role. I know what you are thinking: “How bad are things at the College if they’ve hired Mike Allan?” I asked myself the same question! In truth, my hire is a reflection of our board’s commitment to members. The board requested nominations from you, the members, and targeted family physicians known to members. Of course, the board needed experience in leadership, administration, et cetera for the Executive Director and Chief Executive Officer role but, most of all, the person needed to be grounded in family medicine.

What does that mean? Years ago, at the end of a Friday after seeing patients for 8 hours, I was settling into paperwork (ie, chart notes, laboratory results, referrals, and forms), the unavoidable and least enjoyable part of each day. Staff had mostly packed up, but the last person there popped her head into my office and asked if I could take a phone call. The call was from an emergency doctor in a different province. He was seeing one of my patients who was almost certainly having a myocardial infarction. The emergency doctor asked if I could reassure my patient so treatment could proceed.

I did just that, including saying at one point, “You have to let this man save your life.” After brief closure with the emergency doctor, I went back to the drudgery of paperwork for the next 2 to 3 hours. Intermittently, I tried to recall what I had done to make this patient overly dependent on me, but then I remembered all the things I had helped her and her family through over time. I got a little closer to appreciating the profound role we play in patients’ lives and the immense trust they place in us. While driving home, I came to a place of acceptance—to try not to foster dependence, but also to be grateful for the opportunity to make a difference.

I realize there is a lot to do at the College. Goodness, there is a lot to do. What is worse is that it is all very important. We are in crisis in family medicine in Canada, and we should not let a good crisis go to waste. For the past few decades we have been saying, to almost anyone who would listen, but in particular to politicians and leaders with influence, family physicians provide the most care in Canada and our profession produces the best health outcomes.

If that portion was heard, what was certainly never acted on was the idea that family physicians have been grossly undercompensated in type and manner. The problem was we were speaking in facts. Reflecting on government and policy choices, a good friend once said, “The facts, while interesting, are irrelevant.” While the value of family medicine is indisputable, a thousand variables including election cycles and competing opportunity costs act like a hurricane on the best efforts of planning. Now, as we reach the centre of that storm, we begin to see real change for family physicians.

We are seeing improvement in compensation and in other areas such as administrative burden. Still, many issues remain. One challenge is the numerous groups the College serves and interacts with, starting with you, our members, as well as patients, provincial Chapters of the College, residents, medical students, universities, partner organizations, governments, and the list goes on, perhaps limited only by imagination.

Despite the wide array of partners and affiliates we have, sometimes each with different and conflicting priorities, there is one thing we can all get behind: We all want to see family medicine prosper. We want our profession to get the kind of care to which we have dedicated our lives. The kind where all Canadians and partners value the profession of family medicine the way our patients value each of us.

A keen, but slow, learner’s journey

Michael Allan
Canadian Family Physician September 2024; 70 (9) 600; https://www.cfp.ca/content/70/9/600

This is my first column as Executive Director and Chief Executive Officer of the CFPC. In writing it, I considered talking about my new role or the state of the College, but that will come next month. Those things are important, but September is a time when formal recognition of the National Day for Truth and Reconciliation in Canada reminds each of us to pause and reflect on the experiences and histories of Indigenous communities in Canada.

Family medicine allows us many career opportunities, teaching being one of them. We often talk about how as teachers we also learn from our students. I know many students will roll their eyes or sigh at this comment.

In 2008 I was given the opportunity to run a community medicine course that put me in front of 120 students on a regular basis. One day I was emulating television host Phil Donahue, running around the large lecture hall to facilitate students speaking to and hearing from one another. Our discussion at the time was about intervening when we felt children’s safety was at risk, the role of social services, and the awful decisions around removing a child from a home and their parents. It is a weighty conversation that most of us in family medicine have dealt with, but there in the classroom it was about to get even more serious. A student commented on their perception that Indigenous children were more likely to be separated from their families than other children. One Indigenous student bravely responded by reminding the class that many Indigenous parents had been stolen from their homes as children just because they were Indigenous and were then forced to grow up in residential schools. These children—and their parents—were systematically robbed of many things, but a key one was the ability to pass on parenting skills, often learned as you grow up in your home with your parents’ and family’s love and guidance. The strength and power of the student’s words quickly turned the discussion into an amazing educational experience for everyone, including their teacher.

Within medicine I have been called an iconoclast (which I had to look up). In my youth I demonstrated or rallied to support social justice causes such as anticonflict efforts, human rights, and environmental preservation. Yet after that class in 2008, I went home shocked and humbled about how little I knew about residential schools and the campaign of cultural disruption waged on Indigenous people. A friend of mine who worked regularly with Indigenous peoples explained how an Elder once told him, “When they came for my kids, I learned that I could be there when they took my kids or go to jail and not be there when they took my kids.” For anyone with loved ones, especially children, ponder the horror of that choice.

These individuals’ stories are powerful. As I revisited them, I was struck once again by the realization of how much I do not know. However, by listening to others, hearing their stories, reflecting on what I have learned, and being honest about where I am, maybe I can do better. I am embarrassed to this day about how little I knew about the residential school system when it was in operation, but the truth is I know or understand so little about the experiences and lives of others. By accepting this, allowing ourselves to learn, and not hiding or running from our discomfort, we will position ourselves on a better path. At a conference in June I heard Anishinaabe Grandmother Kim Wheatley from the Shawanaga First Nation in Ontario explain that reconciliation is the wrong word to use in this context, because Indigenous people have nothing to reconcile for and, of course, she is right. And I am still learning.