Medicine as a Career II To Join Or Not To Join

I started this blog in February of this year with the intent that it could help fill a gap in mentoring of medical residents and students. That gap was in place in part because of a failure on my part at least to fulfill expectations and commitments made going back a couple of years within the Department of Psychiatry within the University of BC. However, if this venture is going to be successful, I probably need to be more committed to regular meaningful postings. As I mentioned to a resident whom I was speaking with last week, this process ideally also needs readers because, to be effective in mentoring, this has to be a 2-way conversation. This has nothing to do with my simply wanting to post something to boost my own image.

To facilitate this, I thought I had sent the link to my blog to both graduate and undergraduate colleagues, particularly selecting names from some of the correspondence about mentoring. However, judging from the lack of "statistics" at the website, it is not clear that anyone has yet read any of my postings. I will have to be a little more crass in trying to "promote" this blog if my aim of facilitating some conversation between colleagues and learners is going to be fulfilled. Getting questions and feedback should be a good way of stimulating more reflection and input on my part.

Be all of that as it may, I want to write today about another aspect of the practice of medicine that does not relate directly to academic learning. This has to do with joining professional bodies, professional associations and other related organizations.

Naturally, to practice, one has to have a license, which is only obtained through our national provincial licensing and regulating colleges, such as the College of Physicians and Surgeons of BC in the case of our province. Likewise, to practice as a specialist, one has to be a member of the college of specialists, a fellow of the Royal College of Physicians and Surgeons. This includes the College of Family Physicians for doctors in that area, of which I was once a member myself. Yes, for those of you who did not know before, I completed the residency for Family Medicine in 1978 in Manitoba and practiced that branch of medicine for 12 years in a rural setting and an urban one in that province before re-training as a psychiatrist there.

However, beyond the 2 agencies mentioned above, joining becomes voluntary. That being said, there is one other national organization with provincial arms that, although one may choose not to officially join, still tends to extract certain fees from all practitioners. I refer to the national and provincial Medical Associations. It can be noted at this point that in some cases these associations no longer identify themselves with the use of that word, BC being a case in point. Following the lead of several other provinces going back a number of years already, we are now no longer the British Columbia Medical Association but Doctors of BC. The rationale that these bodies use for supporting attempts to collect fees from all practitioners is that they are the agencies with whom the provincial paying departments of health negotiate levels of payments which benefit all physicians in a given province. Therefore, even non-members of these bodies benefit, so it is considered reasonable that they contribute something for the work of the Association in obtaining benefits that they also share.

My wife always accuses me of being a joiner. In thinking about writing this I reflected on why that might be. I think it goes right back to how I was shaped growing up. In the first place, I grew up as a member of a small community in which most people knew of one another. This certainly facilitates a sense of belonging and identification with a larger body than just one's family. At the same time, and I now consider myself fortunate in that regard, I also became quite conscious over time that I was also the part of extended families. Finally, I was brought up in a community of faith where I also subsequently learned that, at least in our interpretation of our beliefs, we were meant to be, indeed created to be, parts of a community, not just individual cogs in a universal wheel. So, growing up and intrinsically developing a sense of belonging also meant that I came to understand and appreciate the value of the larger group. One aspect of this is mutual support. Another aspect is that the group can often be more effective in accomplishing certain things than an individual. So, I keep on wanting to belong.

I think moreover that there is also a degree of professional responsibility and integrity in identifying with one's colleagues by joining bodies where we are united, at least by membership, if not necessarily in many other ways. As a result, I keep up my membership in the Canadian Medical Association and its provincial chapter. As some of you may already experienced or be learning, besides certain professional benefits, the CMA/BCMA= Doctors of BC also provide financial services that I have found invaluable over the years. These organizations have in their wisdom developed a corporation whose sole responsibility is our financial betterment. Because we thus pay their salaries, they can go about their work without the aggressiveness that private financial planners and brokers must use to a greater degree. As the organization has grown over time, there is also the accumulated experience and wisdom of many individuals across the country as well as with advisers that have been utilized over time. For many years, M.D. Management, which is only one of the names it has utilized over time, was recognized in the upper ranks of reliability and returned when it came to mutual fund and retirement (RRSP) investment. They do also provide advice and help on insurance, but I found this out somewhat late for my optimal benefit only when I sought the advice of my financial planner because of something I had read about insurance for Long-Term Care. That is naturally something most of us probably don't think about until we get older, at which time the premiums become pretty high.

As a psychiatrist, I have also maintained my membership in the Canadian Psychiatric Association. Since I specialize in working with Children and Adolescents, I am also a member of the Canadian Academy of Child and Adolescent Psychiatrists, as well as the American Academy of Child and Adolescent Psychiatry. Besides the benefits of working together on professional pursuits, facilitating conversations about practice and research, particularly in conjunction with annual scientific sessions, these organizations also publish journals in our field, which are worth reading. Along the same lines, I have tended to maintain membership in the psychiatric section of Doctors of BC.

As a teaching position, linked to UBC and its Faculty Of Medicine, and beneath that the Department of Psychiatry, there is also the Clinical Faculty Association that can be joined to help work out issues with the University and faculty, particularly when it comes to conditions of work and payment.

Beyond these examples, most "joining" becomes more voluntary and related to particular professional and related interests. For example, partly because of my own faith heritage, I have long been a member of what used to be called International Physicians for Prevention of Nuclear War (IPPNW), which has now for some years functioned under the broader name of Physicians for Global Survival (PGS). As such, I sometimes like to brag that I am the winner of the Nobel prize because in 1991, IPPNW did receive the Nobel Prize for peace! Again, partly reflecting my rural upbringing with its closer ties to the land (my mother's family were farmers) I care about the environment and so joining Canadian Association of Physicians for the Environment (CAPE) also seemed a natural. Finally, having mentioned my faith several times, I am also a long-time member, as I alluded to in the previous posting about my medical school training, of the Christian Medical and Dental Society of Canada, which is again part of an international body. Reflecting even more closely my own denominational background, I've also long been a reasonably active member of the Mennonite Health Care Fellowship, which used to be called a Mennonite Medical Association, but changed its name once it opened its membership to other healthcare professionals besides physicians.

Belonging to all of these bodies has been an enriching experience in terms of getting to know other physicians and sometimes even their families. It broadens one's horizons as to what is possible within and with our profession as it relates to the world around us. But of course, it also comes at a considerable financial cost. All the fees for joining the mandatory bodies as well as a reasonable number of elective ones can easily run upwards of $5000 a year, and I haven't even mentioned medical protection.

Liability insurance against malpractice is another important facet of our profession. We are fortunate in Canada, with our tendency to be more favorable to things socialist, in that we have a long-established and very effective, helpful and supportive, mutually-structured body that provides these services for us, the Canadian Medical Protective Association. They also provide a lot of good educational services that relate to our practices. Being as it is a mutual association, the insurance costs for us are only a fraction of what they are in our neighbor country to the south with its independent capitalistic bent, but also because of the higher level of lawsuits that are brought against physicians there.

So, I think it is evident that my advice to most of my younger colleagues and learners would be to seriously consider not only joining these associations, but becoming actively involved in them. Only by doing so do we continue to make them useful and beneficial to us and our communities at large.