Dear colleagues,

Health care in Canada is evolving at a rapid pace. Over the years, the Royal College has contributed to public debate on key national issues. We keep you abreast of these activities as they occur.

However, the evolving challenges facing our health system and the diversity of requests received each year has also prompted us to think more deeply about the Royal College’s advocacy role.

Strong leadership is essential to our health system

Advocacy, done well, can bring about appropriate and lasting change that, in our case, can help enhance a health system, support better patient care, and advance specialty medical education and practice.

This work’s importance continues to grow. In recent years, the Royal College has provided leadership and expertise to national issues such as physician employment, Indigenous health and Early Childhood Development in Canada.

However, effective advocacy does not happen overnight. It is a long-term approach to problem solving that requires sustained effort, careful attention to organization, thoughtful research and analysis, and dedicated resources to succeed. Advocacy can take many forms and the Royal College’s leadership must align with Fellows’ vision.

How to best advocate for a stronger health system

With these realities in mind, we undertook an extensive investigation in early 2015 to answer three overarching questions:

  1. What should the Royal College advocate about?
  2. What image should the Royal College portray in its advocacy role; how should it position itself?
  3. What process should the Royal College follow; how should it advocate?

The Royal College’s by-laws instruct the organization to “contribute to the formulation of sound health and public policy”. Our legal mandate requires us to “encourage, assist and promote the study of quantitative and qualitative aspects of specialized health care”. The CanMEDS Framework also calls upon physicians to act as health advocates. So the foundation is there.

We also reviewed all pertinent legislation that affects our role in advocacy. Rules vary by jurisdiction and governments define lobbying under strict terms. For example, the federal government interprets lobbying as an activity carried out by an organization where 20 per cent or more of an individual or group’s full-time work is spent communicating with elected officials or civil servants.

For perspective, we also consulted with three sister organizations, 50 Regional Advisory Committee (RAC) members and 14 National Specialty Societies (NSS). All supported our roles as advocates and leaders, and advised us to focus generally on pan-Canadian issues. In general, they called for the Royal College to adopt the stance of “expert” rather than that of “activist” in its advocacy.

Your views on our advocacy role

Finally, we designed an online survey that solicited input from more than 2,400 Fellows, asking what the Royal College should advocate about, what image it should portray in its advocacy role, and how the Royal College should advocate.

Encouragingly, the messages from Fellows aligned closely with Council’s view, as well as the input from RACs and NSSs. More specifically, here is your feedback on what image the Royal College should portray in its advocacy role:

Graph of the number and percent of Fellows choosing what image the Royal College should portray in its advocacy role

At the same time, Fellows spoke loudly about the Royal College protecting its reputation as an evidence-based organization. More than 70 percent of respondents felt that our advocacy should involve a major effort developing data and evidence to inform public policy. More than 60 percent said we should make a major effort to advocate to federal-provincial-territorial governments and that we should work to influence government policy and decisions.

Refining the vision

At its June 18-19, 2015 meeting, Council built on feedback from Fellows affirming the role of the Royal College as a knowledge expert and thought leader. It also addressed the type of issues to be generally addressed in advocacy, putting public interest first and supporting high quality health care.

At its next meeting in October, Council will approve the advocacy guidebook, providing an effective roadmap for the coming years. This will include a commitment to keep Fellows abreast of advocacy efforts.

In the meantime, I’d welcome your input on our work so far and directions for the future.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer