Physicians have a moral and ethical responsibility to do more for Canada's most vulnerable populations, including Indigenous peoples and those with addiction and mental-health issues, the federal Health Minister says.
"Because you are a doctor, society has granted you power and privilege, respect and responsibility. There is no better use of that power than to advocate on behalf of those who do not have the same opportunities," Dr. Jane Philpott told delegates to the Canadian Medical Association's 150th annual meeting.
She said it is important for physicians to care for individual patients, but it is not sufficient, so professional associations such as the CMA should use their influence to promote improving the health of the population as a whole.
Dr. Philpott praised health workers who, "at great personal expense," care for the marginalized and lobby politicians such as herself to "address gaps in health systems."
Similarly, she lauded those on the front lines of the opioids crisis.
"There's an incredible cadre of doctors to whom we are deeply indebted – those of you who have taken an interest in caring for people with addiction and high-risk drug use," Dr. Philpott said.
"Your passion for justice and your determination to push the boundaries of health systems – because you care so much – is an inspiration to me."
The Health Minister said the opioids crisis is an "unprecedented national public-health emergency," one that claimed 2,458 lives in 2016, and will result in even more deaths this year.
"This challenge requires unified response from all levels of government, and all of society, including health professionals," Dr. Philpott said.
She added one important role the profession can play is to help change attitudes.
"Doctors have a huge role, including promoting awareness that social inequity and unresolved trauma are often at the root of high-risk drug use. This includes homelessness, poverty, violence and sexual abuse.
"Addiction is not a crime, nor a mark of moral failure. It is a health issue."
Similarly, the Health Minister said physicians can play a role in reconciliation with Indigenous peoples by acknowledging that "First Nations, Inuit and Métis peoples have suffered from both negligence and systemic discrimination when it comes to health care," and by working to change that, including by "growing a robust Indigenous health work force."
While Dr. Philpott's speech on inequality and social justice was warmly received, the talk quickly turned to other concerns during the question period.
Gigi Osler, a Winnipeg surgeon, said that while physicians care deeply about patients, they are also concerned about making a living and angry about the impact of planned tax reforms that could be costly for doctors. Dr. Philpott said the "concerns of physicians are being taken into consideration." But she also said many criticisms of the reforms are misplaced and urged doctors to read the Finance Department proposal. That outraged many physicians. "I take umbrage at being told by the minister that we can't read," said Brad Fritz, a Vancouver doctor.
Many physicians worry that changes to the tax rules for professional corporations will make it difficult to save for retirement and impossible to finance maternity and sick leave, and warned that this will hurt patient care as doctors look to work elsewhere.
But some delegates said doctors should not be defending an unfair tax regime just because it benefits them personally.
"It's a bad system," Hasan Sheikh of Toronto said. "If our issue is pensions, maternity leave and so on, let's address those."
Nitasha Puri of Vancouver said that physicians are privileged, financially and otherwise, and they should be using their influence to advocate for all Canadians who do not have decent wages, pensions and benefits, rather than trying to maintain their tax breaks and wealth.
The Canadian Medical Association represents 85,000 physicians, residents and medical students.