“I love the variety of the work. I love that it is cradle to grave. I love that you could do work outside the office.”
Suzanne Strasberg is a Canadian primary care clinician with extensive experience in national medical leadership and board governance.
Dr Suzanne Strasberg was chair of board of the Canadian Medical Association (CMA) and previously served as board chair for MD Financial Holdings Inc. a post she held for four years, has served as a board member with the CMA, and as board chair, board director and president of the Ontario Medical Association. She was a founding member of the Coalition of Family Physicians of Ontario.
She was a family doctor in Toronto as a member of the Jane Finch Family Health Team. Her clinical interests include pediatrics, adolescent medicine, gynecology and palliative care. She was provincial primary care lead at Cancer Care Ontario from 2012 to 2018. She qualified in medicine from the University of Toronto and ICD.D from the Rotman School of Management at the University of Toronto
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Hello, I’m Domhnall MacAuley, and welcome to this MedicsVoices conversation, where we talk to the key opinion leaders in health and medicine around the world. Today we are in Canada and I’m talking to Suzanne Strasburg who is Chair of the Board of Directors of the Canadian Medical Association, which is very high profile role. But let’s take you back to the very beginning. Let’s take the back to what inspired you, because your parents were medical.
Suzanne Strasberg: My father was Professor of Surgery at the University of Toronto and, Washington University in Saint Louis, and my mom was a registered nurse who worked at Women’s College Hospital. She worked on the floor for years, then did clinical trials, and was a diabetes education nurse.
DMacA: Was medicine always written in the stars?
SS: No, I thought I was going to be the first female judge in the Court of Canada. When I was young, my parents had a lawyer friend who was very influential, he was a Queen’s Counsel, and took me downtown to Osgoode Hall and showed me around. But then when I was about 14 or 15, my mom said, you know, I think you really want to be a doctor.
That really stuck with me and I decided I did want to be a doctor. And, I’ve loved every second of being a family doctor and being a physician. Its been an honour and a privilege and I did whatever I could to try and convince my daughter to go into medicine too. But, she had her own mind, much to my chagrin, and chose to do a PhD in chemistry. Science, but not medicine.
DMacA: Tell us about medical school. Coming from the background, with your father a professor of surgery, did medical school influence you in the direction of family medicine?
SS: Well, actually, I was in a program to be a plastic surgeon, and I had done two years of research with a woman who was quite inspirational, Susan McKinnon. She was involved in one of the first peripheral nerve transplants. I did two years in her lab but I was trying to get pregnant and couldn’t get pregnant. And my dad always said to me, do surgery only if it’s the only thing that’ll make you happy. It was the only thing that made him happy. But it wasn’t the only thing that made me happy. So, I decided, with my husband, that I wasn’t going to pursue that career where I would be 33 or 34 years old when I finished. I went back to Toronto from Saint Louis and started a practice with someone I was introduced to and have had a fantastic career in family medicine, working in a fairly indigent practice in an area of Toronto called Jane and Finch and loved every second of it. The patients were just wonderful and it was a real privilege to be able to work there.
DMacA: You’ve talked about your practice, but you had another interesting partner who, I believe is your sister.
SS: That’s true. She was also in family medicine. I left the practice about two years ago, moved from Toronto and she, together with one of the associates in my office, took over running the practice. And they’re running a practice now with a total of nine physicians and about 18,000 patients and still in the same location in Jane and Finch. And, it was really great to work with Jessica.
DMacA: Tell us a little bit about your own experience in family medicine and what interested you.
SS: I like the idea of being able to look after generations of the same family and, certainly in my practice, I sometimes had the opportunity to look after four generations of the same family. I love the variety of the work. I love that it is cradle to grave. I love that you could do work outside the office. You could work in ‘emerg’, which I did. I was a clinical associate, working on the floors at SickKids in Toronto. When I started, I did surgical assisting. You could reinvent yourself all the time and you weren’t doing the same thing all the time. And I love the interactions with patients where you are able to establish long term, really important relationships. Even to this day, my sister will say to me, I saw one of your patients, and they said to say hello. It was really great.
DMacA: And, you’ve had an interest in cancer care…
SS: That’s one of the things that family medicine allowed. I had a bit of a career outside my main clinical career as a family doctor. I was the provincial lead for Cancer Care Ontario and I did that for about six years. The Province was divided up into 14 regions and there was a regional lead and there were also Aboriginal health cancer leads. We all worked together trying to advance the health of the people who lived in Ontario. And I had an opportunity to work on the program that moved us from screening using fecal occult blood tests to fecal immuno chemical tests. I had the opportunity to be part of the development of the high risk lung cancer screening program, part of the work that moved us from doing traditional cytology pap smears to HPV testing, and work with mammography. I have quite a history of cancer in my family; my mother had breast cancer; my sister, who I mentioned earlier, had breast cancer at 35. For sure we have a gene that’s as yet undiscovered. So, I had quite a bit of interest in that work, and it was challenging. I got to work with really smart people and that was a great opportunity.
DMacA: You were clearly very immersed in clinical care and the care of your patients, and then you took another diversion because you became involved in medical politics. Tell us how that began and how that developed.
SS: That started because in about 1996 they decided that, because of deficits in the provincial budget, they would claw back 10% of all physician billings. That made me unhappy. So I, along with Rochelle Schwartz and Sharla Lichtman and a number of other people met, in a small room at North York General Hospital and we decided to start a group called the Coalition of Family Physicians. We all put in $100 each to establish the group and I went and opened the bank account and got the letters patent. I was the secretary because I opened the bank account and for a while I was doing the ledgers by hand. I was always out by a few pennies here and there and eventually we got enough money from physicians around the province, at $100 each, to get a bookkeeper. I have to give so much credit to Rochelle and Sharla. They took so much time away from the practice. And, they were very inspiring. A lot of people joined and a lot of people gave up their time. We would meet in people’s basements once every two weeks, we would send out newsletters, print them out, lick the envelopes stamps on a Sunday night and mail them the next day. Eventually one of the physicians got the fax numbers for doctors in the province and he was able to send faxes 24 hours a day to get our information out. And then around 2003, we decided it was better to try and get inside the Ontario Medical Association because they had all the money. We ran three board directors in the Toronto area. There were three spots, eight people ran, and we came one, two, three. So that was really the start of my medical political career.
DMacA: Tell us how that progressed because you became chair of the Ontario Medical Association.
SS: I joined the board and there were a lot of very interesting issues at that time around primary care reform so I got involved in that. One of the main primary care models, which still exists today, is something called a family health organization, or we call it a FHO, and it’s a capitaation model with a small mix of fee for service. I was one of the co-chairs with the ministry developing that along with some other directors at the OMA that had significant experience and who were very valuable in terms of their expertise. After two years I decided to run for the executive and I was elected by my peers on the board. Once you got on to the executive you rotated through various positions – becoming secretary, then treasurer, then chair of the board. Then you become president elect, the president, and then the past president. And you finally stepped off the board. I was the chair for a year and it was a great experience because it was very challenging. We had a board of, I think, 25 people. In those days you had large boards and it took some learning to be able to manage a board of that size and to listen to people and still get through your agenda and get the issues dealt with in a timely way.
“…selling the wealth management company… really helped establish the CMA as an organization that will live on in perpetuity and be able to move forward in areas that we might not have, change the focus a little so that the focus is about the profession, about health, about health care, and about the health system.”
DMacA: After the Ontario Medical Association, you got involved with the wider Canadian Medical Association.
SS: After the Ontario Medical Association, I was chair of the PTMA Forum. (Provincial and Territorial Medical Associations) Three times a year the CMA would bring together the presidents and CEOs of the 12 provincial medical associations and the two territorial medical associations and we would talk about issues of common interest. And I chaired that.
Before I was on the CMA board, I also chaired an organisation that looked at the interface between public and private medicine and, at the time we had a president, a man named Brian Day, who felt very strongly that the Canadian health care system was not providing the care in a timely way so we looked at that. Once I finished as the PTMA chair, I joined MD Financial which was a wholly owned subsidiary of the Canadian Medical Association. It started as a small mail and mutual fund company, I think in the ‘60s. I sat on that board for a few years, and then I became the chair of the board, and in 2019, we sold it to Scotiabank for $3 billion which, at that time, was the largest wealth management company outside the five big banks in Canada. That was also a really very interesting experience. The board was made up of half physicians and half people who really knew about running a wealth management company. Working with the CEO, Brian Peters, was a really outstanding opportunity and the executive leadership team was excellent. I learned a lot there.
DMacA: MD financial was an enormous financial organization, and many of our audience wouldn’t have a feel for this type of arrangement because it’s so different to other medical societies. So, just give us a little bit of background of what MD financial did for doctors.
SS: At the beginning, as I said, if you were a member of the Canadian Medical Association, you had an opportunity to purchase what we would consider traditional mutual funds. They had a whole range of different offerings. They had a priority lens on learners, helping them understand debt and helping them get a line of credit at really good rates so that they could afford to pay for medical school. They ran seminars on how to establish a practice, a little bit about billing, although billing is different in every province.
There were different ways you could invest and they had advisors. Most of the time I was there, you would have had an advisor who helped you understand what your risk tolerance was, what your goals for retirement were, and they were not commission based, they were paid a salary. So, there was never any conflict in terms of the advice that they provided to the physician- it was always 100% in the best interest of the physician, which would have been very different. Later on they had some specific offerings for clients that had a bit more money than when they started out and they began to offer things that you might not be able to get access to, such as Blackrock and private equity offerings. When we sold it to Scotia we had about a $50 billion in assets under management. It was a big wealth management firm.
DMacA: It’s an eye watering amount of money at a time when many medical associations are scraping resources together. CMA must be one of the wealthiest after that sale?
SS: Absolutely. I think we are probably the wealthiest ‘not for profit’ in Canada. And the CEO at the time, Tim Smith, by having the insight to look at selling the wealth management company at a time when there was a lot of fintech coming in, banks investing a lot, and the CMA couldn’t do that, really helped establish the CMA as an organization that will live on in perpetuity and be able to move forward in areas that we might not have, change the focus a little so that the focus is about the profession, about health, about health care, and about the health system.
DMacA: Before we move on to your role as chair, let’s talk about the extra qualification you undertook to become a director.
SS: I did that quite late. You don’t have to take but it seems to be a gold standard, at least in Canada, to get your Independent Corporate Director (ICD) designation. That’s done through the Rotman School of Management at the University of Toronto. It comprises four two-day meetings, educational seminars over a year, it’s quite interactive. It includes everything from governance, regulatory issues, IT, cybersecurity. And then you go through a lot of cases and issues that have come up and, what they call, ‘director dilemmas’ such as a case of wrongdoing by the CEO or someone on the board, or something someone had said and how that was managed, the outcome, and what you would do in that situation or what you would recommend. There were a lot of really great speakers and the group was very diverse. Some were from management, some were from boards of directors, some were neither but wanted the education for a variety of reasons. When I was there we had an MP from the Liberal Government. So it was quite interesting.
“It’s been challenging and difficult at some times but mostly rewarding. And again, I got to work with a fantastic CEO and executive leadership team, great people around the board table…it was a very nice experience. It’s almost over now. I’m done on August 21st.”
DMacA: Let’s move on a little and tell us about the process of becoming the chair of the board of directors of CMA.
SS: A call went out and any of the members of the CMA could apply. At the time, there were about 75,000 members. The CMA hired a search committee, people put in their applications in and there was a short list. People from the company would call and ask you questions and if they thought that you were qualified, they shortlisted you. I got shortlisted and there was an interview. I was actually sailing in the Caribbean with my husband at the time and flew back- that was something he wanted to kill me for, and still remembers! But I flew back, had an interview, and the interview went well. And, by the time I landed back in Saint Vincent I had a call from the chair of the search committee who said I had got the position. I was pretty happy about that. It’s been challenging and difficult at some times but mostly rewarding. And again, I got to work with a fantastic CEO and executive leadership team, great people around the board table, which was also quite challenging as it was a large board of 18 people, and the board changes over by about a quarter to a third every year.
So, every year you’re having to bring people up to speed which is a bit of a challenge, especially when you’re developing and implementing on a strategic plan, because people are coming in at different times. But, again, it was a very nice experience. It’s almost over now. I’m done on August 21st.
DMacA: For most members of CMA, the role of chair of the board of directors is quite distinct so give them a little flavour of the types of challenges that you face.
SS: The spokesperson of the organization is the President so they deal with speaking to the press and they have an online presence through social media. They would deal with the crises of the day, things around, for example, the pandemic or access to care or physician burnout. My job is to represent the board, to be the interface between the board and the CEO, who is our only employee, to make sure that the board gets the materials that they need in order to make informed decisions and discharge their fiduciary responsibilities in a timely way, make sure they have enough information, the right information, and, feel like they’ve had an opportunity to talk and express their views and come to a decision that they’re comfortable with. I have a number of responsibilities. I sit on the Finance Committee, the Human Resources Committee, and the Governance Committee of course but, my main responsibility I would say, was to help develop and implement on our strategic plan which we call Impact 2040. And I did that in conjunction with the board, but with management and specifically, a woman named Allison Seymour, who was the executive lead, and her team.
“I think I came in at the right time. I had a fantastic practice with a great partner and outstanding patients. And I found a lot of joy in medicine.”
Suzanne, setting the spinnaker…
DMacA: You set me up nicely for me for my next question because, as you said, you are coming to the end of your tenure. The obvious question is, what are you going to do next?
SS: Not too much. I think almost 30 years in medical politics is enough. I would love to sit on another board if I had an opportunity, but I’m not sure that I have the skill set outside of medical organizations to sit on another board. I’m going to continue to do locums for a couple of days a week in the Niagara region when I’m in Ontario. In the winter my husband and I go skiing in British Columbia, and we have a boat share on a sailboat for three weeks in the Caribbean, which I think we will probably keep for at least one more year. I have a daughter who’s at school in California, so we will go out and see her and my parents are both alive, elderly, and living in Toronto. And I want to spend some time with them and my siblings, who I’m close to in Toronto.
DMacA: So for my final question, let me bring you back to that 14 year old prospective law student, what would she think of your career?
SS: I think she would have thought that I made the absolutely right choice. There are a lot of physicians who are having some difficulties, wo are feeling burnt out, who are feeling underappreciated. Personally, I never felt that, and although I understand why they feel it, I never did. I was fortunate to take advantage of all the opportunities that the Ontario Medical Association negotiated for Family Physicians. I think I came in at the right time. I had a fantastic practice with a great partner and outstanding patients. And I found a lot of joy in medicine. So I think she would have thought I made the right decision.
DMacA: Thank you very much for taking us through what’s been an incredible journey through all those different roles. Thank you very much for your inspiration and for sharing so much of that with us today.
