The Doctor's Dilemma—Circa 1975

SIR ARTHUR CHETWYND:

Distinguished guests, ladies and gentlemen: There is a story about a pretty young girl, after undergoing an appendectomy, asking, "Doctor, will the scar show?"--and the doctor replying, "Not if you're careful!"

Our speaker today, Dr. Bette Stephenson, is President of the Canadian Medical Association, and like all good presidents I have observed (speaking metaphorically, of course) seems prepared to expose some scars to the public.

It is quite often customary for the president of an association (perhaps even the Empire Club) to be a one-person lobby for their organization. Dr. Stephenson, from what I have observed and read of her since she came so prominently into the public eye, has castigated her peers and governments alike, when she felt they deserved it--and has done so in a very telling way. If she is a lobbyist at all, she seems to be a lobbyist for her own conscience--an altogether admirable ideal!

It would be impossible, in the time allotted to me, to do justice to all of those things already written into the record of our speaker's still relatively short lifetime. Born in Aurora, obviously a brilliant student, she graduated in Medicine from the University of Toronto before attaining her twenty-second birthday. Following internships at Women's College Hospital and Toronto Western Hospital, she has served as a "general practitioner and a family physician" from her base in Willowdale since 1948.

She is married to Dr. G. Allan Pengelly (for practical purposes she has continued to use her professional, premarriage name of Dr. Bette Stephenson), and has six children-four boys and two girls . . . zero population!

In addition to her busy home and professional life, our speaker has found time to make a contribution in what is usually referred to as the larger world. A year has not gone by without finding her identified in a very active way with an important area of service in medicine, education, teaching, welfare and, of course, in many, many aspects and facets of the Canadian Medical Association and its interfaces with its numerous publics. In recognition, she was awarded Canada's Centennial Medal in 1967.

There is a story about a preacher who had a brother, a medical doctor whom he very much resembled. A gentleman met the latter one day and said, "You preached a fine sermon on Sunday, Doctor", to which he replied, "I am not the brother that preaches. I am the one that practises."

Our speaker today is that unique person who in her lifetime has combined practising and preaching in what seems to be a rather effective prescription. Ladies and gentlemen, speaking on the subject of "The Doctor's Dilemma-Circa 1975", it is with very great pleasure and honour that I introduce to you the President of the Canadian Medical Association, Dr. Bette Stephenson.

DR. STEPHENSON:

Mr. Chairman, Mr. Minister, honoured guests, ladies and gentlemen: Sir William Osler, who died more than fifty-five years ago, is undoubtedly still Canada's most famous and most quoted physician. May I read one brief paragraph of his to illustrate why? "Though a little one, the master word looms large in meaning. It is the open sesame to every portal, the great equalizer in the world, the true philosopher's stone, which transmutes all the base metal of humanity into gold . . . and the master word is . . . work."

Ladies and gentlemen, for those of you who have been wondering how or why this fifty-year-old female was elected the first woman president in the one hundred and seven year history of the Canadian Medical Association, I think that is the answer.

Having been born, raised, and educated, and having worked all of my professional life in the Toronto area, the influence, the renown of the Empire Club and its prestigious membership has been very well known to me for many years. Thus my ego was appropriately massaged when I received the invitation to address you today. Therefore I thank you sincerely for the honour and for the privilege of speaking to you, but I confess that I, too, have wondered why. I thought perhaps there might be two reasons, and the first reason I thought of was that perhaps my occasional somewhat extensive exposure in the mass media had whetted your curiosity, since one has to admit that a woman president of a major national organization such as the Canadian Medical Association is still somewhat unusual. It is also possible that you were led to believe that the reputed conservative caution of that august association, the CMA, had been replaced either by reckless abandon or unusual prognosticatory capability.

About the former conjecture, time alone will tell. As to the latter, I must tell you that not even the omniscient members of the Canadian Medical Association were aware in 1973 that 1975 would be declared International Women's Year. Because I have neither time nor sympathy for the uncharitable truculence and the frenetically dehumanizing activities of the too visible and too vocal proponents of socalled "women's liberation", I have rejected the thought that this traditionally andro-centric organization extended its hospitality as a token gesture to that United Nations declaration, because like most Canadian women, I know who I am--a woman, a wife and a mother. I am also a doctor, a general practitioner, or family physician if you prefer, who happens to be the president of my profession's national association, and as far as my profession is concerned, the fact that I am a female is totally irrelevant.

Having disposed of that first possibility, I concluded that your invitation was probably prompted by a real interest on the part of our society in the role and policies of the most dedicated of its public servants, the doctors, and perhaps some slight curiosity about the individual who is privileged to represent at this time the Canadian medical profession.

So be it.

In spite of the opinion voiced by some of my critics, both within and outside the medical profession, I do not open my mouth simply to shift feet. However, neither do I believe that any woman, including the president of the Canadian Medical Association, should travel through life voicing platitudinous nothings, avoiding the real gut issues of our time simply because they happen to be controversial or because they require the use of some unvarnished English. As a result, from time to time, I am quite correctly accused of sounding something less than ladylike.

No, I am not intimidated by men. Indeed I find them attractive and extremely interesting in more ways than one or two. My lack of sympathy with what I consider the lunatic fringe of the women's liberation movement is no doubt the result of my own personal experience. I have never felt that I required liberating. I was born and raised in a liberated family, my husband tells me that he has never felt constrained to curb that liberation, nor has his masculinity or position as a husband and father ever been compromised or threatened by my status. He too, happens to be a doctor, a very superior family physician. I can count on the fingers of one hand the number of occasions in my professional life that I have been aware of any sexual discrimination on the part of my professional colleagues. I wish I could say the same thing with respect to patients. I suspect that there are within this audience a number who would have no concern at all about their wives seeing a male obstetrician but who would have some fairly serious reservations about asking me to examine their prostate glands. The hang up, gentlemen, is yours--not mine. I am simply a physician.

There is one other major fact of professional medical life which denies any element of sexual discrimination. If I were to deliver your wife's baby next week the OHIP benefit for my services would be $148.50, exactly the same amount that my husband would receive. If, however, your wife were to be delivered by Dr. Elizabeth Wylie, the female specialist in obstetrics and gynaecology, who delivered all six of my children, she would receive $180, $31.50 more than my husband, not because she is a female, but because she has taken additional training, possesses greater expertise and much more experience in obstetrics than either he or I. In short, gentlemen and ladies, there is no sexual discrimination in the fee schedule of the Ontario Medical Association, and through the president of my provincial association, Dr. Manning Mador, I thank my colleagues for this just and equitable recognition.

It's true, the report in the November 23rd issue of Weekend Magazine was entirely correct. I do deal with stress, that is, I get relief from it, by scrubbing my kitchen, but that does not mean that I consider it my responsibility or my place, my role, to scrub the kitchen simply because I happen to be a woman, a wife or a mother.

I must tell you that I am not a white Anglo-Saxon, Protestant, racial bigot who hates Chinese. In fact, one of the most exciting, pleasant, and enjoyable trips of my life, one of the experiences that I'm sure I'll remember longest, was to the People's Republic of China with the Canadian Medical Delegation. I found the Chinese in China, the Chinese in Hong Kong and the Chinese Canadians who I meet here in Toronto almost daily, among the most interesting, the most industrious and the most friendly of people. Frankly, the colour of their skin just doesn't matter. Nevertheless, I do not withdraw one step from the issues I raised regarding the first year medical student enrolment at my Alma Mater, the University of Toronto. Notwithstanding the avalanche of letters to the Editors of The Toronto Star, The Globe and Mail, and The Varsity, I maintain that the people of Canada and the people of Ontario have a right to the answers to the three questions I posed.

I would remind you that Canada needs approximately 2,500 newly licensed physicians each year to meet the medical requirements of the Canadian people. It is the position of the Canadian Medical Association that, as a developed country and as a country accepting its responsibilities to its own citizens, Canada should meet its own physician manpower requirements itself. Basically, we believe that it is entirely inappropriate for Canada to create a vacuum through constant underproduction of Canadian medical manpower, which results in the enticement of large numbers of foreign-trained physicians to practise in this country. In many instances the native lands concerned, the Caribbean islands, India, Pakistan, parts of both eastern and western Europe, suffer desperate medical manpower shortage problems far more serious than ours. Such countries cannot afford to lose such highly trained professionals to Canada in terms of either their personnel needs or their economic status. It would, I think, be sufficiently disturbing to acknowledge that such a situation was the result of the accidental juxtaposition of unpredictable national and international developments. It is, therefore, painfully close to a national disgrace to learn that there is evidence that this government policy was knowingly established on the basis of philosophy documented as background material for the 1966 revision of Canada's Immigration Act. For the sake of developing nations, surely we cannot permit this drain of a valuable resource to continue. Indeed there is, I believe, real justification for the point of view that we in Canada have an obligation to produce more physicians than we require ourselves in order to help meet the needs of less fortunate countries.

Furthermore, for the sake of Canada and its citizens, we must surely take serious stock of this policy.

From the flood of supportive mail, it is all too evident that the deliberate strictures on universities and faculties of medicine, inherent in that governmental policy, have been in large part responsible for depriving a significant number of Canadian citizens of the opportunity to study medicine in Canada. I would point out to you that last year our sixteen Canadian medical schools received in excess of three thousand applications for first year medicine from students with the required academic qualifications. From this group we have been able to choose fewer than 1,700 students.

In short, there are more than twelve hundred academically qualified candidates unable to obtain entry to Canada's medical schools every year and a sizable number of that group are Canadian citizens, the children of tax-paying Canadian citizens, who have been denied admission to Canadian medical schools, to some degree at least, in favour of students who are either foreign or of landed immigrant status.

Gentlemen, the statements which I made--that 25% of the first year medical students at the University of Toronto were of Chinese origin, and that the majority of those were from Hong Kong and had been granted landed immigrant status by the Department of Immigration, have been verified in the Legislature of this province by the Minister of University Affairs.

I regret very much my use of the facts regarding Chinese students at the University of Toronto as an example, only because the example has tended to obscure the real issues, and the real issues are the answers to those three questions:

1. Are the admission policies of Canadian medical schools sufficiently closely related to the needs and the expectations of Canadian society?
2. Do Canadian government immigration policies regarding foreign students impinge in any way upon opportunities for qualified Canadian students?
3. Are all Canadian citizens aware of the proportion of their taxes directed toward the education of Canadian-born and foreign-born university students? Further, if they are aware, do they consider the proportions realistic and desirable?

By raising these questions, I have subjected both the Canadian Medical Association and myself to considerable criticism and a great deal of abuse. By raising the issue again, I am sure I will no doubt stimulate further rhetoric. But the questions are still unanswered and the problems remain unsolved, and that whole area of medical manpower is but one example of the doctor's dilemma-circa, 1975.

Unlike the original author of that titillating title, I cannot present to you with acid wit and perspicacity a scintillating satirical Shavian study of contemporary society. That is beyond my capability. But as a physician, I do want to share with you some of our concerns about some of the problems which confront all of us in this decade.

For most physicians it is an interesting paradox that at a time when our professional potential for valuable human service has reached previously undreamed of pinnacles, the profession is subjected to continuous, carping criticism, in no area more so than that of physician remuneration--money. I, for one, am intrigued, indeed perturbed, with the generally held, usually erroneous, almost always ambivalent, opinions of the public regarding the medical profession and money. When closely questioned, most patients offer the highly personal opinion "My doctor is a great guy, he probably makes a bundle of money, but when I consider the hours and the way he works, the training and experience he needs, the job and responsibility he has to carry, I think he earns every nickel of it."

However, when it comes to the activities of the medical profession in general, we are described, as one singularly undistinguished political opportunist put it, "as a money grubbing, overpaid, demanding cartel-if not a group of rapacious thieves!" He's entitled to his opinion.

However, when a union announces that it needs a 20% or 25% increase, that demand is described as simply keeping pace with inflation. When Dr. Mador indicated a need for a 10% to 15% increase in the profession's fee schedule in this province to maintain pace with inflation, it was described as "yet another OHIP rip-off".

This occurs in spite of the fact that the average Canadian gets considerably more where it really counts, that is in his net disposable income, from a 15% salary raise than a doctor will ever take home from a 15% increase in the schedule of fees. But let's be honest about it. At least a part of this public reaction is the result of very human human nature. The average physician in Canada is well paid for his services and the average citizen of Canada knows that fact extremely well. At present, the doctor's net earnings, after he has paid the cost of his practice, before income tax, are close to $45,000 a year. That medicine is the highest earning profession in this country is widely publicized by government, to some degree naturally since the majority of medical bills are now paid by government. But could I just remind you of a few facts.

1. The average physician has approximately nine years of post high school education.
2. The average physician is approximately twenty-eight or twenty-nine years of age before he begins to produce any major earnings, and his life expectancy and the number of years of earnings are considerably fewer than those of the average Canadian.
3. The average physician is self-employed with all the problems and hazards that that status entails. He has no company-paid-for pension, no sick leave, no insurance programme, and none of the other normal fringe benefits. He has to pay for those himself.
4. The average Canadian physician carries a very heavy workload and considerable responsibility. A 55-60 hour work week, or even longer, is not the exception, it is the norm. Decisions that have life and death ramifications are not made more easily by physicians than by you, but they do occur more frequently.
5. There are a few scoundrels in our profession-as is the case in any other profession, but in medicine they are the exception. There is no massive medical care insurance rip-off in this country, particularly not in this province. Contrary to so-called common knowledge, government financing of Medicare in Ontario did not result in massive increases in physician's incomes. Well over 90% of the residents of this province had medical care insurance on a voluntary basis before universal government insurance was introduced. The fact is, and I have some figures to prove it, that physicians have not taken advantage of Medicare, either to increase the frequency of their fee revision or to introduce exhorbitant fee schedule increases.

For years it was the practice of the Ontario Medical Association, just as it is the practice of other provincial medical associations, to revise their fee schedules every two years. Here in Ontario the fee schedule increase on April 1st, 1967, was 10% . On the same date in 1969, again 10%. In spite of the Machiavellian nature of its format, federal medical care insurance was introduced to the Province of Ontario on October 1st, 1969. There was no fee increase in 1970. In 1971, heeding the recommendation of the CMA and requests of the ill-fated Prices and Incomes Commission, established in late 1969 by the federal government as a method of confronting and inhibiting the then-present inflationary trends, the Ontario Medical Association fee schedule was increased by only 4.5%, and this amount was applied only to the lower earning groups within the profession, such as family physicians and paediatricians.

You may be interested to know that of all societal groups and professions, the medical profession was the first and one of the few segments of Canadian society which accepted the responsibility urged by the Prices and Incomes Commission and revised their schedules entirely within the suggested PIC guidelines.

There were no increases in either 1972 or 1973, but in 1974 there was an increase of 7.75% which was negotiated with the provincial government. The remainder of that agreement calls for a 4% increase in 1975.

You will note that the figures I mentioned are gross payment increases, not salary or net income increases, which brings me to the point.

With this audience I am sure that there is no need for me to define nor to delineate the obvious differences between gross payments, costs of practice, net income (before income tax) or that most important of all figures, disposable income. You all know very well that the figure that really counts is the one on the lower right hand corner of the balance sheet, the net disposable income.

For Canadian physicians, the route to the net disposable income is a little more stringent than it is for most Canadian citizens. For the average Canadian physician does not enjoy all of the privileges granted to other citizens. The Canadian physician is prohibited by law from incorporating, therefore he must pay income tax on the higher personal income tax rate, never on the lower corporation tax rate. Thus, most physicians in Canada are in the 50% income tax bracket. Official government figures show that in 1972 the average Canadian doctor received about $68,000 in payments from the insuring agencies. After paying the costs of practice, the physician had approximately $41,200 left because the costs of practice are about 40%. However, for many specialties such as radiology, they may be as high as 75% to 80%. When he had paid his income tax, the average Canadian physician in 1972 had approximately $26,800 left in disposable income.

Now, when you read that a physician was paid x thousand dollars by OHIP, remember that this is the gross payment, or if the payments from Medicare are going to go up by y points, this is y percent of the gross payments. It certainly does not mean that the physician's disposable or even his net income will rise by anything like that amount. Indeed, according to Statistics Canada, over the past six years, the disposable income of the average Canadian, that is the per capita disposable income increase in this country, rose something like this:

In 1969 by 8.7%.
In 1970 by 6.1 %.
In 1971 by 10.1%.
In 1972 by 12.2%.
In 1973 by 13.8%.

For the same years, the physician's disposable income increased as follows:

In 1969 by 6.5%, 2% less than the average Canadian.
In 1970 by 6.1 %, exactly the same as the average Canadian.
In 1971 by 6.7%, almost 4% less.

In 1972, instead of rising by 12.2% as it did for the average Canadian, the doctor's disposable income increased only by 6.2%.

And for 1973 we anticipate that the increase for the average Canadian physician will be below 6% as compared to a 13.8 % rise for the average Canadian.

My reference source, ladies and gentlemen, is the Eleventh Annual Report of the Economic Council of Canada, and my point is not to suggest that physicians are poorly paid, but to state most emphatically that where it really counts, in disposable income, the physician in Canada has not fared nearly as well as the body public has been led to believe, and while we cannot yet produce all of the statistics to prove it, we know that our costs of practice have increased sharply during 1974. Office rents and the costs of medical materials have soared. Added to that, governments have seen fit to increase nursing and other salaries in hospitals by 30% to 40%, and when that happens our staff costs go up right along with them. Many clinics and individual physicians anticipate that the cost of practice in 1974 will exceed 50% of their gross income.

A few weeks ago, Dr. Mador announced that the Ontario Medical Association would ask government to consider re-opening the profession's two-year agreement. I mentioned that during the 1973-1974 negotiation with the provincial government, the profession had agreed to accept a 4% increase in fees in 1975. Dr. Mador announced at that time that if the profession were to keep pace with inflation, it would require an increase of the order of 10% to 15%.

But let me give you a final figure to remember.

For the average Canadian physician to realize a 10% increase in his disposable income during the year 1975, a figure which is less than two-thirds of that predicted for the average Canadian citizen, and which with inflation will probably leave the physician with less real purchasing power, the fee schedule will have to be increased by 14%. I put it to you that no other segment of Canadian society has matched the degree of economic responsibility demonstrated by Canadian doctors. I am a member of the Ontario Medical Association and the medical profession of this country, and I am proud of the economic responsibility that my provincial division and my profession have exhibited in the past decade. A few weeks ago I called upon the profession to continue to exercise that economic responsibility with respect to its requests for payment schedule revisions from government. The editor of this country's leading commercial medical newspaper flatly stated in an editorial that I would receive no Brownie points from my colleagues for that statement Perhaps not. I certainly won't receive them from the rednecks, and we have a few of those. But I have no doubt that while continuing to work to ensure that its members are fairly treated by society, my profession will continue to act responsibly in revising its schedules of fees and in its negotiations with its respective governments. Medical fee increases are coming. They are indicated and they are warranted, but they will be economically responsible. There will be no demand for 50% or 60% increases.

With your permission I shall now turn to an even more thorny horn of the doctor's dilemma, the problems of conception control and abortion. During the year 1973, at least 43,000 abortions and probably closer to 50,000, were carried out on Canadian women. In British Columbia, for every four children born, one fetus was aborted.

I hope that those figures will give you reason for pause, for they illustrate the dismal failure of our totally inadequate educational and family planning programmes. In many large Canadian hospitals, the excessive caseload has made the role of the legally-required therapeutic abortion committee well-nigh impossible. Thoughtful and concerned physicians continue to serve on these committees on a voluntary basis because it is the only way in which the needs of their patients, the needs of society, and the demands of the law can be met. They continue to perform a time-consuming, thankless task in the face of widespread criticism and the only slightly veiled threats of legal action against them by the Federal Minister of Justice. Why? Because they recognize that the job must be done-it is a responsibility which has been delegated to the medical profession by society and by the Criminal Code, which the Minister of Justice is responsible for enforcing. The members of therapeutic abortion committees in hospitals are striving to discharge that responsibility to the best of their abilities.

On the other hand, in many parts of Canada, valid, medically indicated therapeutic abortions which are permitted by law are not available in local hospitals, because, for the governing bodies of hospitals, the law is permissive. No hospital is required to establish a therapeutic abortion committee. Therefore, there is tremendous variation and marked regional inequitability of the availability of the legislated service.

The medical profession of Canada, the Canadian Medical Association, has publicly accepted its share of the responsibility for the inadequacies of the law related to abortion. The Criminal Code was revised in 1969, largely in keeping with recommendations submitted by the Canadian Medical Association. Within the brief span of eighteen months, however, the drastic change in public attitudes and the rapidly escalating demand for abortions, forced the profession to recognize those inadequacies. We have, and continue to recommend, major changes in the law, but to no avail. The Federal Government has consistently refused the long-promised parliamentary review and the frequently promised parliamentary debate on abortion. In lieu of examining the law for possible revisions, the Minister of Justice, Otto Lang (and I regret that his actions make it impossible for me to use the title Honourable) berates the medical profession and has the unprecedented audacity to usurp the privileges of the courts by providing his personal interpretation of the law. He indicates what, in his opinion, the 1969 parliament intended and directs hospital authorities to adhere to that interpretation. As if that were not enough, the government of which Mr. Lang is a member, has not seen fit to provide either the public or the profession with so much as a ball-park definition of such key terms as the word "health" which are enshrined within the legislation. As a final straw, the Minister threatens hospital therapeutic abortion committees and encourages provincial Attorneys-General to do likewise, simply for doing the best job that they can do with parliament's totally inadequate legislation.

I shall not subject you to further abuse on this subject, other than to say that the Canadian Medical Association has protested this most improper behaviour by the Minister of Justice, to the highest levels in the country.

As with many medical, social and socio-medical problems, the key to the door of solutions is prevention; in this case, prevention of unwanted pregnancies by responsible family planning. It is patently obvious that family planning-conception control programmes in Canada are far from adequate. It is my opinion that the guilt for the impotence of such programmes as we have must be shared by many, including the medical profession of this country. In recent months, however, the Canadian Medical Association has made representations to the federal Department of National Health and Welfare and to its provincial counterparts, calling for a concerted, comprehensive, national family planning programme, encompassing family life education at all levels, widespread dissemination of accurate information, and the provision of accessible and available professional assistance. It is not our suggestion that the federal government has primary responsibility in this area. In fact, the provincial governments, in all probability, should bear a larger degree of the governmental burden, but the people of this country have every right to expect their federal government to provide more leadership in the establishment of family planning programmes than has been evident to this date. The 43,000-plus abortions carried out in Canada in 1973 provide the most damning possible evidence of Canadian public ignorance of, and apathy to, conception control. Ignorance fostered by inadequate and inappropriate education, whether provided by home, school, or church, and by the meagre and inequitably distributed family planning counselling services. The responsibility for this unhappy situation must rest with the federal and provincial departments of health and the medical profession. In my opinion, there has been a gross failure on the part of all three of these bodies to fulfill their obligations to the people of Canada.

We have available to us in 1975 a number of effective methods for control of conception. Oral contraceptives, in spite of the mass media, when treated with the respect merited by any drug, are not only safe, they are, when properly prescribed and properly taken, 100% effective. We suffer, you see, not from the lack of effective weapons, but from a gross neglect of the nurture of intellectual, ethical and emotional awareness of the need for responsible utilization and the development of effective methods of distribution. It is my personal opinion that it will be only through effective programmes of family life education and family planning that we shall be able to create and foster that one truly vital necessity for prevention of unwanted pregnancy, that is a fully developed sense of individual, personal, sexual responsibility in all of our citizens-male as well as female.

The medical profession of this country is concerned that a matter as significant as family planning, one so closely related to medicine and health services, is in fact administered at the federal level by the Department of Welfare. The same holds true with respect to several provinces where, if they exist, family planning programmes fall under the jurisdiction of the departments of welfare or social services. If counselling for rational family planning, if the prescription of oral contraceptives, the insertion of inter-uterine devices, and the prescription of other contraceptive methods is not a health matter, I ask you, what is?

In the opinion of the Canadian Medical Association, this country desperately needs a comprehensive, national family planning programme, involving all levels and all segments of society with real leadership provided by the federal and provincial governments and by the medical profession. To that end, on November 28th I requested an opportunity to address the federal-provincial Health Minister's conference on this subject when it meets next Tuesday and Wednesday. Yesterday I was informed that the request was denied.

I can only hope that someone who is permitted to attend that august meeting will motivate our Ministers of Health to stimulate government activity to meet this desperate, this shamefully unmet need.

In the problematical area of conception control and abortion, I suggest to you that my profession has been acting in a responsible manner. The major decisions regarding such matters must remain with our elected representatives, with parliament and with provincial legislatures. While I have not had the opportunity to study in depth the Ontario Health Department's recently announced family planning programme, I am delighted to hear that they are taking an initiative. I seriously doubt that the programme will be as extensive as I think it should be, but it certainly would appear to be a step in the right direction. Now, if only we can persuade the other provinces and the federal government to follow suit!

Ladies and gentlemen, I have touched upon only three of the many horns which constitute the dilemma of Canadian doctors in 1975. I have neglected completely such important issues as the maintenance of physician competence in the face of the most rapid medical scientific advance in history; I have neglected the role of physicians in improving our health care system; I have neglected the moral and ethical responsibility of physicians in the burgeoning fields of genetic engineering and organ transplantation, to name only three more.

It is, however, my sincere hope that from the necessarily cursory examination of those areas on which we have spent a little time, you may be more aware of both the breadth of concern and the degree of responsibility which Canadian physicians and their organizations bring to their continuing consideration of the problems of our society and to their labours to improve the present and future human condition.

Ladies and gentlemen, the master word for Canadian physicians is still "work". But I can assure you that it would be impossible for them to follow that Oslerian precept, to survive the stress of difficult dilemmae, were they not deeply embued with, and very highly motivated by, that one vital human emotion which, for more than two thousand years, they have shared with the patients they serve. I mean, of course, that much maligned, often misused, frequently misunderstood, other four-letter Anglo-Saxon word spelled "L-O-V-E".

Dr. Stephenson was thanked on behalf of The Empire Club of Canada by Maj. Gen. Bruce J. Legge, Past President of the Club.