History

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Introduction

Following preliminary organizational work lead by Fred Freedman and Gordon Guyatt the MRG formally organized in May, 1979, around three basic principles formulated by John Marshall and Philip Berger and incorporated in a constitution:

The universal access of every person to high quality, appropriate health care must be guaranteed. The health care system must be administered in a manner which precludes any monetary or other deterrent to equal care.
Health care workers, including physicians, should seek out and recognize the social, economic, occupational, and environmental causes of disease, and be directly involved in their eradication. The health care system should be structured in a manner in which the equally valuable contribution of all health workers is recognized.
Both the public and health care workers should have a direct say in resource allocation and in determining the setting in which health care is provided.

Before the MRG

In the autumn of 1978 two members of the house staff at the Toronto Western Hospital, Fred Freedman and Gordon Guyatt, began talking about their alienation from the established medical organizations and the need they perceived for an alternative. The idea for an organization that would represent progressive, socially conscious physicians grew out of their discussions. They circulated a letter describing their idea to other members of the house staff at the Toronto Western, and were pleasantly surprised when ten to fifteen of their colleagues expressed an interest. The group, supplemented by a few house staff members from other Toronto hospitals, began to meet on a regular basis. They hammered out a preliminary position and sought support through a mailing to over 5,000 Toronto physicians and an advertisement in the Canadian Medical Association Journal. Only a handful of replies were received, and almost half were hostile to the point of being vituperative. However, the mailing attracted a few practising physicians, including John Marshall and Cynthia Carver, into the fold. It was decided that a “convention” was required to determine whether there was sufficient interest for the group to make a go of it. Held at Hart House in May, 1979, and chaired by John Marshall, the convention was attended by almost sixty people, still mainly medical students and house staff members. Those present agreed on a set of basic principles, and the response left no doubt that the idea of a Medical Reform Group was feasible. A committee, led by John Marshall, Jake Onrot, and Philip Berger, undertook to draft a constitution for the new organization.
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Formation of the MRG

In October, 1979, over 60 young physicians and medical students, largely from Toronto and Hamilton but also from other parts of the province, met in the Hart House Debates Room to ratify the constitution. The structure of the group, with a provincial steering committee, local chapters, and working groups meeting around specific issues, was adopted. The conflict around the issue of whether the group should be restricted to physicians and medical students was highlighted. Pragmatic considerations led to a consensus that the MRG be primarily a physicians’ group. The wording of the three basic principles was modified, but their content was confirmed. They are as follows:

  1. The universal access of every person to high quality, appropriate health care must be guaranteed. The health care system must be administered in a manner which precludes any monetary or other deterrent to equal care.
  2. Health care workers, including physicians, should seek out and recognize the social, economic, occupational, and environmental causes of disease, and be directly involved in their eradication.
  3. The health care system should be structured in a manner in which the equally valuable contribution of all health workers is recognized. Both the public and health care workers should have a direct say in resource allocation and in determining the setting in which health care is provided.

The constitution as amended was passed unanimously with, as is described in the minutes of the meeting, “much cheering.” Another notable aspect of this meeting was the establishment of the MRG tradition to back up our positions with a solid understanding of available evidence. The group distributed a fact sheet on the effects of extra billing, citing the experience of user fees in Saskatchewan and the work of economists Barer, Evans, and Stoddart. Prior to this meeting the MRG had made no public statements, largely because of reluctance of group members to risk subsequent personal reprisals. The first steering committee, which included John Marshall, Cynthia Carver, Debbie Copes, Nick Kates, Barbara Lent and Jake Onrot (who was responsible for putting together the first MRG newsletters), was willing to put aside these fears and speak publicly for the group. As a result, on November 1, 1979, a bold faced headline on the front page of the Toronto star announced “125 MDs Break Ranks with the OMA.”