Equilibrium: National and Provincial Roles in Canadian Radiology

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Those who cannot learn from history are doomed to repeat it.

George Santayana, The Life of Reason

It is not only healthy but customary and desirable for associations to review their governance structure periodically to ensure that it is effective in meeting the needs of members. The Canadian Association of Radiologists (CAR) has undergone 3 such reviews in the late 20th and early 21st centuries. The first was conducted in the late 1980s under the leadership of Dr Ian Sutherland, the second 10 years later under that of Dr Brian Lentle, and the latest in 2007, led by Dr David Vickar. Each of these reviews led to administrative changes that were designed ultimately to serve the Association's constituents—Canadian radiologists, and, by extension, the Canadian public.

The major impetus for the Lentle review, conducted by an accounting-management firm in 1998, was the steadily declining membership in the CAR, which threatened its fiscal viability. It had become apparent that the Association was not providing the political leadership needed to rectify problems such as insufficient and outdated diagnostic imaging equipment in Canada. Before this review the link between the provincial radiology associations and the CAR had been through the provincial divisional councillors. There were 4 councillors from each of the provinces of Quebec and Ontario, and 1 from each of the other 8 provinces; all of the councillors held seats on the CAR Council. An important outcome of the 1998 review was the recognition that not all divisional councillors were able to speak with authority on behalf of the provincial radiologists that they were intended to represent. This led to the creation of the Presidents' Forum (PF), a think-tank made up of the presidents of the 10 provincial radiology associations. This body met twice yearly at the time of the CAR Council meetings and replaced the divisional councillors on the CAR council. The PF elected its own representative who served as an official member of the CAR Executive Committee. Whatever its shortcomings, this new relationship created a formal link between the national and provincial radiological associations, and it ensured that the officers and administration at the national association had direct communication with the leaders of radiology in the provinces.

The governance model that was adopted by the CAR at the annual meeting in St. John's, Newfoundland, in 2007 eliminated the PF and returned to a model that resembles the old system of divisional councillors. The thinking behind this change seems to be that the CAR, as a national association, needs to be able to set its agenda without undue influence from the provincial societies. We recognize that there are issues that fall within the natural jurisdiction of the CAR. Two of the most important of these are national accreditation programs and the iteration of national guidelines and national standards of radiology practice. Conversely certain issues fall within provincial jurisdiction—matters relating to fee negotiations are an obvious example. However, it is unrealistic to assume that there is always such a clear-cut dichotomy between issues of national and provincial responsibility and importance. Many of the items that the CAR may be called on to deal with require that it receive expert advice from and cooperation with the provincial associations. The PF was created precisely for this purpose and it needs to be resurrected in some form that is compatible with the CAR's new governance structure. Failure to recognize the essential linkage between CAR and its provincial counterparts runs the real risk of dooming the CAR once again to appearing irrelevant to the majority Canadian radiologists. In these perplexing economic times that result might equally translate into members choosing to withdraw their financial support for the Association and a return to the fiscal exigency that hampered it in the late 1990s. Both a strong radiology profession and exemplary patient care require a strong and balanced interplay of provincial and national interests and strengths.