Home About the CMPA 2024 CMPA Annual Meeting Minutes of the 2023 CMPA Annual Meeting [Draft]

Minutes of the 2023 CMPA Annual Meeting [Draft]

Montréal, Québec., with virtual participation—August 14, 2023

Welcome and opening address

The 119th Annual Meeting of the Canadian Medical Protective Association (CMPA) was held beginning at 3:45 p.m. ET on Monday, August 14, 2023, in the Montréal ABC room of Le Westin Montréal, 270 Saint-Antoine Street West, Montréal, Québec. Videoconference participation was also available. The meeting was conducted in English and in French and simultaneous interpretation was available for all attendees. The meeting was recorded as a webcast and will be available through the Annual Meeting page of the CMPA website. There were an estimated 268 physician-members present, with 78 participating in person and 190 virtually.

Call to order

The Chief Executive Officer (CEO), Dr. Lisa Calder from Ottawa, Ontario, read the notice of the 2023 Annual Meeting of the Canadian Medical Protective Association and declared the meeting to be duly constituted.

Land acknowledgement

The CEO welcomed revered community leader and knowledge holder, Elder Amelia Tekwatonti McGregor. A Mohawk from the Bear Clan, Kahnawà:ke Territory, she is a founding member of the Kahnawà:ke Schools’ Diabetes Prevention Program and was recently recognized by McGill University with an honourary doctorate for her vital contributions to health promotion, community education, and to the expanding fields of Indigenous research methodology. Elder McGregor began the meeting with an opening address to creation, offered in her language.

The President, Dr. Jean-Hugues Brossard from Montréal, Québec, thanked Elder McGregor and recognized Tiohtià:ke/Montréal as unceded and unsurrendered Indigenous lands known as a gathering place for many First Nations, and the Kanien’kehá:ka Nation as custodians of the lands and waters on which the Annual Meeting participants were gathered. As an organization, he indicated the Association recognizes all first peoples who were here before us, those who live with us now and the seven generations to come. He also acknowledged that the CMPA offices located in Ottawa are on the unceded, unsurrendered territory of the Anishinaabeg Algonquin nation whose presence reaches back to time immemorial. He noted the Association honours and pays its respects to these lands and to all First Nations, Inuit, and Métis peoples throughout Turtle Island.

Introduction

The CEO reminded meeting participants that, as per the CMPA By-law, only active members who were present in-person could vote. She also noted only active members could pose questions. She referred meeting participants to the handouts available on their seats, or for virtual attendees, by clicking on the ‘Supporting materials’ link on their screen.

The President introduced several of his colleagues, many of whom would be presenting during the meeting:

  • Dr. Armand Aalamian, Executive Director, Learning
  • Mr. Domenic Crolla of Gowling WLG, General Counsel
  • Dr. Michael Curry, Council member and Chair of the CMPA Audit Committee
  • Dr. Pamela Eisener-Parsche, Executive Director, Member Experience
  • Mr. Cory Garbolinsky, Executive Director, Financial Services and Chief Financial Officer (CFO)
  • Mrs. Christine Holstead, Executive Director, Strategy and Operations
  • Ms. Leah Keith, Executive Director, People and Culture
  • Dr. Birinder Singh of Toronto, Ontario, 1st Vice-President
  • Mr. Chantz Strong, Executive Director, Research and Analytics and Chief Privacy Officer
  • Dr. W. Todd Watkins, Associate CEO

He also acknowledged the presence of two former presidents of the CMPA, Drs. Debra Boyce, Peter Fraser; all CMPA Council; and two former CEOs, Drs. John Gray and Douglas Bell.

Appointment of scrutineers

Dr. Brossard indicated Drs. Steven Bellemare of Ottawa, Ontario and Debra Boyce of Peterborough, Ontario were prepared to act as scrutineers in the event a vote should be required. Absent any opposition, the President identified the membership’s consensus to accept the proposed scrutineers.

Approval of the minutes of the 2022 CMPA Annual Meeting

The minutes of the 2022 Annual Meeting, held in person with virtual participation available, had been posted on the CMPA website.

A motion to approve the minutes of the 2022 Annual Meeting, held in person with virtual participation available, was moved by Dr. Susan Chafe of Edmonton, Alberta, seconded by Dr. Gerard Craigen of Toronto, Ontario, and carried.

A year in review

Dr. Calder observed how the CMPA brought value to the healthcare system through yet another challenging year. She reflected on how physicians, patients, and providers continued to face COVID-19, a toxic drug crisis, and significant resource restrictions, including the healthcare human resource crisis. Members faced new medico-legal risks in almost every area of practice as the healthcare system experienced strain. Through these difficult times, the CMPA focused on being there for them with compassionate support, modernizing the Association, and doing so collaboratively.

Support and assistance

The President asserted that in 2022, the CMPA was there for its members with peer support. The Association received over 29,000 requests for assistance and partook in over 49,000 interactions with its members. It provided expert guidance and ethical defence in over 5,000 College matters, close to 2,000 hospital matters, and 760 new legal actions, as well as a significant number of additional existing legal actions and threats, all while continuing to provide just-in-time advice on key issues like the healthcare human resources crisis. 93% of members surveyed agreed that speaking with a physician advisor has a positive impact on their practice. The CMPA has the trust of its members.

Physician wellness

Dr. Brossard reported, in speaking to members each day, the Association knows physician burnout rates are at an all-time high. Physician wellness can directly affect the safety of medical care and increase medico-legal risk. In 2022, the CMPA hired additional physician advisors to strengthen its capacity to help and continued to educate staff and lawyers to support distressed members. 71% of members surveyed report a decrease in extreme stress, which supports the safety of their care.

Patient compensation

The CEO indicated another essential role of the CMPA is to provide timely and appropriate compensation to patients, on behalf of members, when the care provided is found to be negligent. In 2022, $279 million dollars was paid in compensation to patients. Over the past 10 years, a total of approximately $2.3 billion dollars was paid in patient compensation, or an average of $229 million dollars per year. One of the Association’s main priorities, preventing patient harm from occurring, is advanced through member education, advice, and support. However, when it is proven that harm has occurred as a result of negligence (or fault in Québec), both members and their patients can be confident that the CMPA is here to provide compensation. To ensure the funds are in place to do this, the Association takes a number of steps, including investing prudently.

Financial position

Dr. Calder informed meeting participants that the performance of the CMPA’s investment portfolio impacts its financial position, which is a major factor in setting membership fees each year. While carefully managed, the Association’s investments are not immune to the volatility of the financial markets and 2022 saw one of the poorest market performances in recent history. Like many portfolios, the CMPA’s returns were less than expected. Although the Association strives to maintain long-term fee stability over time, its ability to do so depends in part on the performance of its investments. In addition, its financial position and membership fees are impacted by medico-legal costs, which fluctuate from year to year; 2022 saw an increase in medico-legal costs in many regions, which include compensation to patients. Higher medico-legal costs and lower investment returns led to a decrease in the CMPA’s overall financial position.

The CEO elaborated that the Association takes a long-term view of its finances. Each year, the CMPA sets its membership fees to support the financial sustainability of the organization and keep fees as low as possible. The Association adjusts and responds to changes and trends in the investment markets and medico-legal environments appropriately. Ultimately, its aim is to ensure it has the funds to support members and compensate patients today, tomorrow, and well into the future.

Equity, diversity, and inclusion

Dr. Calder described equity, diversity, and inclusion (EDI) as vital to healthcare. When members and patients experience racism and inequities, this significantly affects physicians, threatens patient safety, and creates medico-legal risk. As an organization that protects physicians and promotes safe medical care, the CMPA has a responsibility to address this risk and help mitigate bias and inequity in the services it provides. As part of its ongoing journey, last year, the Association launched its EDI Strategy to support this work, and recently included EDI as a key component of its Strategic Plan. Throughout 2022, the CMPA’s Council members and leadership team were provided comprehensive EDI and anti-bias training. To support reconciliation, the Association consulted with Indigenous leaders and stakeholders, exploring culturally sensitive approaches to resolution of concerns arising from medical care. The CMPA is also exploring restorative approaches to healthcare harm in the medico-legal environment and is in the process of hiring a Strategic Lead, EDI who will help strengthen the organization’s EDI activities. She reported looking forward to the Association’s continuing its work and strengthening its ability to provide members with a fair, equitable, and inclusive support.

Modernizing governance practices

The President recalled, during the 2022 Annual Meeting, a motion was passed for the CMPA to review its governance processes. The Association’s Council had already begun working with the management team to examine its governance model and this work has also been identified as a key area of focus in its new Strategic Plan. Knowing there is a need to adapt to a world that is changing, to continue to meet the needs of CMPA members and deal with challenges that arise, a modern and agile governance model is required. Now mid-way through a two-year review process to update the governance model, the Association is considering all aspects of governance, including size, composition, the role of Council and the makeup and focus of its committees. Working with the expert governance consulting firm Watson Advisors, the CMPA has developed a robust business case to modernize its model, and has completed an extensive environmental scan to examine models for stakeholder and medical malpractice organizations from across Canada, the United Kingdom, Australia and the United States. The Association has conducted eleven regular Governance Committee meetings and nine Council engagements on the matter.

Dr. Brossard added, beginning this fall, all members will be surveyed by email to provide feedback on the CMPA’s current governance process and on what they believe should change. While the unique nature of the CMPA will not make changing its governance model easy or rapid, the Association has committed to outlining a plan for members to vote upon during the 2024 Annual Meeting and is on track to make this happen.

Advocacy and collaboration

The President explained part of the CMPA’s role is to advocate for system enhancements that allow our members to focus on safe medical care. With governments contemplating significant changes to the healthcare system, the Association’s voice is an important part of this conversation. In 2022, the CMPA partnered with stakeholders to shape policy on issues impacting patients, physicians, and the medical liability system, with a focus on virtual care and medical assistance in dying. 397 meetings were held with stakeholders and 38 submissions were forwarded to governments and medical regulatory authorities, advocating for changes to improve the practice environments of physicians and the safety of care. The Association knows that when it collaborates with healthcare organizations, it is helping to build a stronger healthcare system, and that is the way of the future.

Safe medical care

The CEO described the CMPA as one of Canada’s largest providers of medical continuing professional development that, in 2022, delivered evidence-informed education as a benefit of membership. The Association’s educational products range from fundamental medico-legal concepts to targeted offerings to help members in specific specialties practise safely; it also offers personalized educational advice to members who are facing recurrent medico-legal events. Last year, the CMPA delivered fundamental medico-legal education to residents at all 17 faculties of medicine in Canada through its CMPA Patient Safety Primer workshop. With the wind down of its subsidiary Saegis, five learning resources were transferred into the CMPA’s education portfolio, reinforcing its commitment to learning. The Association continues to modernize the delivery of its learning products to provide members with relevant and easy to access learning resources to help enhance the safety, reliability, and quality of healthcare.

Research and insights

Dr. Calder reported, further towards its goal of modernization, in 2022, the CMPA used its medico-legal data in new ways and enhanced how it shares research and insights with members and stakeholders. The Association created 66 analytical reports in response to member requests for medico-legal information, supporting patient safety research and knowledge sharing. To enhance patient safety, the CMPA created a new product called “know your risk”, which allows physicians to visit its website and see the main drivers of medico-legal risk for their type of work, and directs physicians to pursue learning opportunities, including workshops, eLearning activities, or a Good Practice resource. The Association also published peer-reviewed articles on medico-legal topics relevant to its members; its research into Diagnostic Delays in Sepsis was published in Critical Care and received significant media pick-up, with articles appearing in La Presse Canadienne, La Presse, Profession Santé, and Le Devoir. In sharing research, the CMPA aims to help members enhance the safety of their care and reduce the risk of harmful events.

2022 Report of the Audit Committee

Dr. Michael Curry, Chair of the Audit Committee, reported that the firm of KPMG audited the CMPA 2022 financial statements and, in an unmodified opinion, attested the statements properly present the results of operations in 2022 and the financial position of the Association as at December 31, 2022.

2022 Financial Report

Financial model

In walking meeting participants through the CMPA’s unique financial model that supports its long-term financial horizon, and in summarizing its 2022 financial performance, Mr. Cory Garbolinsky, Chief Financial Officer (CFO), reported the CMPA has a responsibility to maintain sufficient funds to support its more than 109,000 members and, on their behalf, compensate patients proven to have been harmed by negligent care today, tomorrow, and well into the future. He outlined the key principles that drive the Association’s financial model, as follows:

  • Principle 1: The CMPA’s occurrence-based protection provides physicians with eligibility for assistance any time in the future, as long as they were members when the care was provided. As a result, the Association must hold funds to support members and compensate patients for up to four decades from the time the care was delivered.
  • Principle 2: Members pay the expected cost of their protection through their yearly membership fees. In 2022, the Association collected the fees required for the estimated cost of protection for all occurrences taking place in that same year, even though they may not become apparent for up to the next four decades.
  • Principle 3: The CMPA does not seek to generate a profit; its financial goal is to hold at least $1 of assets for every $1 of liability to appropriately compensate patients and their families.
  • Principle 4: The CMPA’s financial model is self-correcting. Upon its actual year-end results differing from its estimated results, as a not-for-profit organization, the Association is not permitted to pay dividends to its members, but it may increase or decrease membership fees from year to year to address the difference.

The CFO explained the inter-connectedness of the various parts of the CMPA’s financial model. Its net asset position, or the difference between its total assets and total estimated liabilities, is a key factor in determining the membership fees in any given year. Membership fees are used to pay the medico-legal costs of supporting the Association’s more than 109,000 members, and compensating patients on their behalf. The changing trends in medico-legal costs shape the size of the assets needed for future and outstanding claims. The provision is the amount of money needed to appropriately compensate injured patients and manage future legal and administrative expenses. Equipped with a diversified investment portfolio, the CMPA aims to earn income to ensure it can appropriately compensate patients and fund future medico-legal expenses.

Funded position

The CFO reported, as of December 31, 2022, the CMPA’s net asset position decreased by $560 million from 2021 to $1.1 billion. This decline was in part by design, as the Association significantly reduced membership fees in 2022 to lower its net asset position, which was higher than ideal in 2021. The decline was also a result of an unplanned loss in the CMPA’s investment portfolio, caused by an overall decline in global financial markets.

Membership fees

Mr. Garbolinsky recalled fee reductions were $99.5 million in 2021, $200 million in 2022, and $362.5 million in the current year; this makes for a total of $662 million in membership fee reductions since 2021. He noted membership fees of $416.6 million were collected in 2022. Through prudent adjustments to membership fees, the Association aims to stabilize its membership fee structure over time. While the CMPA strives to maintain long-term fee stability, its ability to do this is in part determined by the performance of its investments, which are managed carefully but subject to market fluctuations.

Medico-legal costs

The CFO explained that the CMPA collects membershipfees to pay medico-legal costs such as compensation to injured patients, legal and expert fees, safe medical care education programs, and the costs to run the Association. Having described compensation to patients as the CMPA’s single largest expense, he reported that in 2022, the Association paid $279 million to patients injured as a result of proven negligent medical care. While the total compensation amount varies from year to year, the CMPA has paid a total of $2.29 billion dollars in patient compensation over the last ten years, or an average of $229 million per year; the legal costs over this same ten-year period were $1.8 billion. Having noted that compensation to patients is not equal across the Association’s four fee regions, he reported that while Ontario represents 40% of the CMPA’s members, this fee region has the highest legal fees and compensation amounts awarded to patients, and represents more than 50% of the Association’s annual costs. These regional cost differences lead to members paying different fees in different regions. Each region is independent and there is no subsidization between the regions. Similar to members in Ontario paying higher fees than their colleagues in other fee regions, members in Québec pay the lowest fees in the country due to lower medico-legal costs in that region.

Provision for outstanding claims

The CFO described the provision for outstanding claims as the sum of all of the expected future medico-legal costs resulting from the care delivered by members up to and including 2022. For care delivered in 2022, the CMPA must ensure it has funds available to cover any expense related to care in that year for up to four decades. As of December 31, 2022, the estimate for all outstanding and future claims was $4.0 billion, an increase of $36 million from 2021 based on updated cost-trends. Approximately two thirds of this $4.0 billion provision is for compensation to patients. This provision for outstanding claims was subject to a peer review by Ernst and Young, whose independent calculation strongly aligned with that of the Association, and was also audited as part of KPMG’s external audit of the CMPA’s financial statements. 

Investments

Mr. Garbolinsky reported the CMPA’s investment portfolio is modelled closely on the estimated payment pattern of future and outstanding claims, and is targeted to match or exceed a 5% investment return over the long term. While the Association achieved exceptional returns on its investment portfolio over the past ten years, earning a 7.96% compound annual return, this same portfolio had a net value of $5.4 billion in 2022, a decline of $485 million from 2021, which can be attributed to an overall decline in the financial markets and fee reductions in 2022. The CMPA’s positive financial position will help weather the volatile financial markets, fluctuating medico-legal case volumes and costs, and the recent high inflation environment. The Association continues to invest responsibly to maintain an appropriate financial position that ensures timely and appropriate compensation to patients on behalf of members, protection and support to physicians, and safe medical care learning and research to support patient safety. Should the financial market volatility continue, the CMPA’s financial position may be further impacted, which could lead to future increases in membership fees. 

Having noted the full report of the Association’s 2022 financial performance was available on the CMPA website, the CFO summarized three key takeaways:

  • The Association’s occurrence-based protection allows it to operate with a long-term financial horizon of up to four decades, and to protect members and compensate patients today, tomorrow, and well into the future.
  • Fee increases or decreases are the primary tool used by the CMPA to manage its overall net asset position.
  • The Association’s positive net asset position in 2022 should provide confidence to members and their patients that it is there for them when needed.

2024 Membership fee requirements

The CEO indicated each year, the CMPA sets membership fees to support its financial sustainability while striving to keep fees as low as possible. Membership fees in each of the Association’s four fee regions are set in accordance with the estimated medico-legal costs per region and the region’s financial position. These medico-legal costs are calculated annually and include the estimated costs to compensate patients and support members for the next four decades. Each region’s cost trends combined with the CMPA’s overall investment performance influence its financial position. If the cost trends rise above its estimates, the region’s financial position is negatively impacted, and vice versa. The Association is committed to containing growth in medical liability protection costs and aims to support relative, long-term membership fee stability. 

Dr. Calder added, while the CMPA closed 2022 in a positive financial position, it was lower than anticipated, due in part to lower investment returns and increased medico-legal costs, which include compensation to patients. To ensure that the Association has sufficient funds to support its more than 109,000 members and compensate patients on their behalf, most 2024 membership fees will increase from their significantly reduced levels in 2023. The exception is Québec, where membership fees will remain the same. She reminded meeting participants that membership fees were reduced by 45-90% last year, depending on the fee region, as a result of the fee credits that were applied due to the CMPA’s very strong 2021 financial position.

The CEO further reported, in response to the regional cost differences across the country, the Association’s four fee regions allow for an equitable allocation of costs. They are British Columbia and Alberta; Ontario; Québec; and Saskatchewan, Manitoba, Atlantic provinces, and the Territories. Given each region is independent and there is no subsidization between them, if one region is in a positive or negative funding position, this does not impact the others. Depending on the financial position of a fee region, fee credits or debits are applied. The total cost per region is the amount to be collected in each region, and the average fee per member constitutes the total cost per region divided by the number of members in that region. This aggregate fee is only an average, an illustrative number that does not represent the fee that an individual member pays. When determining individual member fees, the CMPA first calculates the total cost for the region, and uses this as the foundation to determine regional fees based on the type of work.

2024 Aggregate fee requirement for the British Columbia and Alberta region

After several years of significant fee reductions and recent lower investment returns, the financial position of the region is now at an appropriate level, with the 2024 average fee per member now in line with the estimated cost of protection, which is $5,071. The total fees collected from this region will increase from $99.3 million to $148 million in 2024 due to the removal of these fee credits. All members in the region will see an increase in their 2024 membership fees (the 2023 aggregate fee per member was $1,701 after having been reduced by $3,138). A graphical depiction of the region’s five-year trend demonstrates that while the average fee per member is more than last year, it remains less than in 2019 and 2020.

2024 Aggregate fee requirement for the Ontario region

The cost of providing medical liability protection in Ontario in 2024 is forecast to be an average of $6,853 per member. While this cost has been relatively stable year over year, it is trending upwards. Because the Ontario region is much closer to a deficit position compared to last year, the aggregate fee per member is being increased by $434 to $7,287. 2024 membership fees in the region will see an increase (the 2023 aggregate fee per member was $3,198 after having been reduced by $3,448). The total fees collected from this region will increase from $185.8 million to $325 million due to the change in the financial position of the region and removal of fee credits. A graphical depiction of the region’s five-year trend demonstrates that the 2024 average fee is close to what it was in 2021, and less than in 2019 and 2020.

2024 Aggregate fee requirement for the Québec region

The total fees collected from this region will remain constant at $5 million and the cost of providing medical liability protection in Québec in 2024 is forecast to be, on a per member basis, $3,998. Given it currently has the strongest financial position of all fee regions and its medico-legal costs have not weakened its financial position, the CMPA is offering a fee credit of $3,774 in this region, resulting in a $224 average fee per member in 2024 (the 2023 aggregate fee per member was $227 after having been reduced by $3,526). A graphical depiction of the region’s five-year trend demonstrates that this represents a 1.5% decrease from 2023, and the fee is by far the lowest of all the fee regions. This fee is also significantly less than previous years (ie., in 2019, the average fee requirement in Québec was $2,387 dollars).

2024 Aggregate fee requirement for the Saskatchewan, Manitoba, Atlantic Provinces and the Territories region

The total fees collected from this region will increase from $5.2 million to $10 million, the cost of providing medical liability protection in the Saskatchewan, Manitoba, Atlantic Provinces and the Territories region in 2024 is forecast to be, on a per member basis, $3,703. Given this region is in a positive financial position and the CMPA is not expecting a significant rise in medico-legal costs, the CMPA is offering a fee credit of $3,008 in this region, resulting in a $695 average fee per member in 2024 (the 2023 aggregate fee per member was $344 after having been reduced by $3,219). A graphical depiction of the region’s five-year trend demonstrates that while this is an increase from 2023, it is significantly lower than it was in previous years.

2024 Type of work (TOW) fees

Speaking to a summary slide, the CEO demonstrated that there are significant regional differences in protection costs, with Ontario being the most expensive region. The CMPA is committed to charging only those fees required to provide effective medico-legal protection through a sustainable model which gives members confidence that assistance will be available to them in the event of a medico-legal difficulty. The Association will continue to modernize and enhance its member services to maximize the value it delivers to physicians.

Having shared the average fees per member, Dr. Calder presented a practical example of the actual membership fees that family physicians practising in type of work code 35 will pay in 2024, which is the CMPA’s largest type of work code. She noted the full listing of 2024 membership fees was available on the CMPA’s website. Members’ will be provided an email notification in the fall when the individual annual fee invoices will be available online through the secure member portal on the Association’s website.

The CEO offered the Association’s financial sustainability as an assurance that it will continue to be there for its members and to compensate patients on their behalf, today, tomorrow, and well into the future.

2023 Election results

Dr. Calder announced, each year, approximately one-third of the CMPA’s Council positions are scheduled for nomination and election. This year, nine Council positions were up for nomination and election in seven areas, and voting occurred in Alberta and Ontario. Candidates in the remaining Areas were elected by acclamation. She presented the 2023 Council election results and congratulated and welcomed new members of Council, as follows:

  • In Alberta, Dr. Wayne Rosen was re-elected.
  • In British Columbia and Yukon, new councillor Dr. Jugpal S. Arneja was elected by acclamation.
  • In Newfoundland and Labrador, new councillor Dr. Paula Cashin was elected by acclamation.
  • In Nova Scotia, new councillor Dr. Heather Scott was elected by acclamation.
  • In Ontario, Dr. Katy Shufelt (2nd Vice-President) was re-elected, and Dr. Birinder Singh (1st Vice-President) was elected by acclamation.
  • In Prince Edward Island, new councillor Dr. Jill Cunniffe was elected by acclamation.
  • In Québec, Dr. François Mercier and new councillor Dr. Nicole Damestoy were both elected by acclamation.

The CEO welcomed the diversity of and extended thanks to all the candidates in the 2023 election. She acknowledged the following members who would be departing Council, and thanked them for their commitment to the Association and to its members during their tenure as CMPA councillors:

  • Dr. Alfred Bent from Nova Scotia
  • Dr. Patrick C. Bergin from Prince Edward Island
  • Dr. Alexander Barron from Ontario
  • Dr. Michael Cohen, Past President, from Newfoundland and Labrador
  • Dr. Victor Huckell from British Columbia and Yukon, and
  • Dr. Claude Mercier from Québec

The President also expressed his thanks to the departing councillors and welcomed new Council members.

Other business and questions

The President welcomed only active members to pose questions or share comments on additional business, and offered the reminder that those who did would be identified in the meeting minute. Given the hybrid participation format of the meeting, he indicated questions received both online and from the floor would be addressed, and delegated facilitation of the questions to the Associate CEO and the Executive Director, Member Experience. Like-minded comments or questions were grouped for efficiency of response following their having been put forward by the following members:

Dr. Muna Chowdhury, a family/general practitioner from Halifax, Nova Scotia
Dr. Eno Chude, a resident from Kamloops, British Columbia
Dr. Shannon Fraser, a general surgeon from Hampstead, Québec
Dr. François Mercier (CMPA Councillor), a family/general practitioner from Verdun, Québec
Dr. Hamid Nasser, a surgical consultant from Cambridge, Ontario
Dr. France Proulx, a psychiatrist from Montréal, Québec
Dr. Wayne Rosen (CMPA Councillor), a general surgeon from Calgary, Alberta

Of the discussion that ensued, the following points were salient:

  • Thanks and appreciation were offered for the fact that the Annual Meeting was held in French.
  • While its sources of revenue primarily include membership fees and returns from its investment portfolio, the Association also holds a one-third investment in and shares the net income of Salus Global along with the Healthcare Insurance Reciprocal of Canada and the Society of Obstetricians and Gynaecologists of Canada.
  • For each of the CMPA’s four regions, the member fees are spread among the various types of work based on their associated risk and the costs for the region. There are seven risk groups and the cost of each is analyzed annually per region, following which the fees are adjusted. A further analysis of the patterns of change over time may lead to the identification of trends. The structure of the risk groups is also reconsidered every two to three years to ensure it remains appropriate. Types of work may be redistributed among the risk groups depending on the changes observed during this exercise.
  • To a question regarding the difference between Québec fees and those in the other three (3) fee regions, it was clarified that this province’s cost of protection was not the lowest this year, rather, its more than favourable financial position required the CMPA to decrease member fees as a means to pulse back the region’s excess of assets. The province experiences a lower frequency and severity in civil litigation and, while its regulatory authority is conversely more active than others in the country, the manner in which regulatory matters are addressed between hospitals and the College differs from other regions. Nevertheless, the Association remains engaged with Québec stakeholders regarding current affairs, and offers many of its learning resources in French to members in the province.
  • In an effort to ensure a deep understanding of member needs, for a number of years, the CMPA has been recruiting physician advisors in a manner that welcomes diversity in terms of practice location, practice environment and practice type or medical discipline. The Association now has a representation of physician advisors who, between them, have practiced in every province in the country. The CMPA continues to strive for the success it has experienced in increasing representation in this same pool from the perspective of race, gender, gender identity, LGBTQ community membership and ability.
  • To advocate for international medical graduates to transition more easily and in a timely manner into the Canadian healthcare system, the Association, and particularly its physician advisors who are in direct contact with these physicians, continues to seek to understand the complexities and diversity that exist within the group so as to address them in a culturally sensitive and appropriate manner. In performing a needs assessment to gain an understanding of what might be helpful, preliminary results indicate the many resources already available are not currently being used in an effective manner given the absence of coordination. The CMPA aims to identify partners with whom it may collaborate to better respond to the needs of this community.
  • Although the upcoming changes to the Association’s governance model may impact governance costs, these represent a small percentage (3-5%) of its overall costs. While still uncertain what the changes will be or how costs will be impacted, the likelihood of them trending downward is good given Council is not expected to expand or increase the number of its committees. The CMPA’s new hybrid approach to meeting participation, whereas most are held virtually and more important meetings continue to seek in-person attendance, has significantly mitigated governance costs. The Association also scrutinizes operational costs in general given their impact on members.
  • The CMPA recently created the Strategic Engagement and Advocacy department to enable a purposeful approach to associated efforts. The number of its submissions has increased, its ability to work with partners has been enhanced, and its advocacy has improved across the country to governments, medical associations and federations, specialty societies and particularly regulatory authorities who provide consultation opportunities on a variety of issues related to their policies. Upon identifying medico-legal risk or safety implications in healthcare, the CMPA seeks to enhance input into the clarity around certain legislation, including that on medical assistance in dying, allowing healthcare workers registered in other provinces/territories to immediately begin working in Ontario, moving healthcare into public private partnerships, changes in scopes of practice, the creation of a Crown corporation to oversee the Québec health system, etc. The Association also often provides clarity on assumptions that physicians will bear the medico-legal risk for other healthcare providers.
  • While restricted resources and working within systems that are not functioning the way they should creates risk, the recurring theme in medico-legal cases that continually leads to complaints to hospitals, regulatory authorities and in civil legal cases is around communication. Known to be additionally impacted by stress, because communication will continue to be an issue as the healthcare system struggles, it is important for members to take associated education programs in an effort to mitigate this medico-legal risk.
  • The medico-legal environment is dynamic and changing faster than ever. While the number of cases remains stable, both damages and the costs of defense are increasing. The CMPA aims to continue to improve the quality of defence, but a variety of drivers are yet evolving, creating many unknowns, such as the impact of inflation or virtual care moving forward, of the pandemic on medico-legal costs, of collaborative care on medico-legal risk, and of artificial intelligence on the profession. In this period of uncertainty, there are signs that the medico-legal environment is undergoing stress in response to these drivers. Although the legal system takes time to respond to social change, signs of its effects are now being seen in the decisions received from the courts. Severity has increased, as have dollars per case and civil litigation in a number of Canadian jurisdictions. Novel theories of liability presented by plaintiffs’ counsel and occasionally accepted by courts are concerning given medico-legal principles generally have been thought to adapt well over time. Legal norms may be changing. There is real evidence outside Canada of significant increases in damages and new theories of liability, some of which may move into our country.
  • To a question regarding CMPA assistance for Québec physicians who have migrated to the private sector, it was clarified that, provided a physician is a member of the Association on the date a medico-legal occurrence arises, protection will be made available regardless of whether the physician was practising in the public or private healthcare environment. If the physician was working in a private clinic, and the clinic in question was also named in an action, the availability of protection would be dependant on whether or not the structure of said clinic meets the principles of CMPA assistance to clinics, which are available on the Association’s website.

Looking to the future

The CEO reported the CMPA has taken significant strides to modernize and its ability to be nimble and adapt to change has enabled continued support to its members, their patients and the healthcare system. She recalled that in 2023, the Association released a new Strategic Plan that will guide its course for the next three years. This Strategic Plan will position the CMPA to confidently face further challenges that may be in store. Its three guiding actions, to support, strengthen, and adapt, will allow the Association to advance key initiatives, such as:

  • Creating an even better member experience by making its services more accessible, meaningful, and simple to use.
  • Enhancing its learning resources, strengthening its use of data to drive safe medical care, and
  • Applying equity, diversity, and inclusion principles to all of its services and developing a better understanding of its members’ experiences of equity, diversity and inclusion.

She reiterated that the CMPA will soon be reaching out to members for valuable input on modernizing its governance structure. The long-term success of the Association rests on the proper functioning of its governing body, CMPA Council.

Adjournment

There being no further business, at 5:15 p.m. ET, the President declared the meeting adjourned, and indicated he looked forward to meeting again during the 2024 Annual Meeting in Halifax, Nova Scotia.