The Canadian Medical Association (CMA; ) is a national, voluntary association of physicians and medical learners that advocates on national health matters. Its primary mandate is to drive positive change in health care by advocating on key health issues facing doctors and their patients. The Canadian Medical Association Journal (often abbreviated as CMAJ) is a peer-reviewed general medical journal that publishes original clinical research, commentaries, analyses and reviews of clinical topics, health news, and clinical-practice updates. Membership The CMA has over 75,000 members and is the largest association of medical doctors in Canada. Its membership includes physicians and medical learners. The CMA represents Canadian physicians from medical school through to residency, medical practice and retirement. History The CMA's origins may rest with Dr. Joseph Painchaud and other Quebec physicians who in 1844 hoped to find ways to help physicians and, after their deaths, their widows and orphans. There were false starts in attempts to form an association, but soon after confederation, practicing physicians were successful in developing a national body. The CMA's first president was Sir Charles Tupper, the Nova Scotia Premier who led that province into confederation and later became Prime Minister of Canada. The foundation of the CMA was strongly rooted in its Scottish origins as the first three presidents of the CMA graduated from the Edinburgh Medical School. Among the CMA's founding principles in 1867 was to "improve public health and prevent disease and disability," a purpose which remains today. The CMA Code of Ethics has been around in one form or another since 1868. As recently as 2015 this document was considered by the CMA to be "arguably the most important document produced by the CMA. It has a long and distinguished history of providing ethical guidance to Canada’s physicians. Focus areas include decision-making, consent, privacy, confidentiality, research and physician responsibilities. The code is updated every 5-6 years and has a major revision approximately every 20 years. Changes must be approved by CMA General Council." The fledgling association faced a lot of growing pains in its first 25 years as meeting attendance was small. There was even a notice of motion in 1894 to disband it. The Montreal Medical Journal was taken over in 1911 to become the CMA Journal. In 1921, the CMA re-organized with the appointment of its first permanent general-secretary, Dr. T.C. Routley. The association also became more financially stable by raising funds