MONTREAL — Canadian and Israeli doctors have formally agreed to work together in areas of common interest, including lobbying for reciprocity in postgraduate training programs and speciality certification, and sharing expertise in emergency preparedness and the integration of foreign doctors.

The Canadian Medical Association (CMA) and Israel Medical Association (IMA) signed a 10-point letter of agreement during the CMA’s annual general meeting in Montreal last week that strengthens their bilateral relations and expresses a desire for further collaboration, including in the international arena.

In addition to exchanging information on professional issues, the points of agreement include one of a political nature. The CMA and IMA state that they will act jointly to try to persuade the Arab countries to increase their level of involvement in the World Medical Association (WMA).

IMA president Dr. Yoram Blachar, one of the signatories of the agreement with outgoing CMA president Dr. Brian Day, is the incoming WMA president. While three Arab countries – Egypt, Kuwait and Tunisia – are nominally WMA members, they are not active, Blachar said, and he has pledged that reaching out to these and other Arab countries will be a priority of his term of office, which begins in October.

The WMA, founded in 1947, is the umbrella organization of 85 national medical associations, representing nine million physicians.

This is only the second formal agreement with another national medical association (the other being the United States) that the CMA has entered into, said its secretary general and CEO William Tholl, who is also a signatory along with Leah Wapner, IMA secretary-general. It’s the first such bilateral agreement to which the IMA is party.

“There have been many efforts over the years to bring in the Arab countries,” Tholl said. “The CMA has historically acted as a broker in the world, including that part of the world.”

There is no overt Arab boycott because of Israel’s membership in the WMA. Tholl thinks the Arab absence may have more to do with culture; African nations are also not well represented on the WMA.

The CMA-IMA agreement builds on an already existing good relationship between the two bodies, as well as personal relationships between members, Tholl and Blachar said.

The CMA has 68,000 members, representing about 85 per cent of the medical profession in Canada, Tholl said.

“The CMA and IMA share a long list of common values, including a commitment to excellence in patient care, a determination to protect the interests of physicians and a desire to dialogue with other organizations on issues of common interest,” the agreement begins.

The two associations say they will work jointly to make it possible for medical graduates from Canada and Israel to pursue postgraduate training in the other country, whether in clinical care or research, as well as for specialists to be recognized in each country.

The two associations think they can learn from each other in how to handle disasters, whether natural or man made. “For example, the CMA has been through the SARS experience while the IMA has much experience in planning for mass trauma casualties and natural disaster planning,” the agreement reads.

The CMA is especially interested in knowing more about how Israel was able to absorb so many foreign physicians, mainly from the former Soviet Union, in such a short space of time.

Between 1989 and 1994, about 12,000 doctors immigrated to Israel from the FSU, doubling the number of physicians already in the country, Blachar said. The great majority had to be retrained to meet Israeli standards, as well as learn a new language and adjust to a new culture, but most did so successfully.

In this area, the CMA and IMA have committed themselves to working through the WMA on strategies to assess the quality of medical education and clinical knowledge of doctors from developing countries.

The health and well-being of doctors themselves is another mutual concern. The CMA and IMA may develop programs such as a telephone hotline for physicians training or working in the other country, or formulating policies aimed at protecting doctors, such as from violent patients.

They expect to collaborate on health policy issues such as the regulation of  medical professionalism, and to work with the medical school deans in each country on ethics instruction.

They will work with their respective governments to “improve the lines of communication at the federal or other appropriate political level,” on such issues as medical waiting times, public health and safety and interprofessionalism.

“This agreement will also provide an opportunity for ministers and others to showcase the collaboration between the two countries,” the agreement states.

Under the agreement, IMA and CMA representatives will meet at least once a year, alternating between the two countries, beginning in Israel later this year or in early 2009.

Blachar, a 67-year-old pediatrician who spent a two-year fellowship at the Montreal Children’s Hospital, was previously head of the WMA council for two terms.

Although Israel has one of the best ratios of doctors per population in the world, that is changing, Blachar said, and may have a shortage of doctors in the near future. Many doctors are retiring and the population continues to increase.

“Israel may soon have a ratio below the OECD average of 2.5 per 1,000 population and is already in need of anesthesiologists, critical-care specialists and general surgeons,” he said.