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2022 Annual
Report

President, CEO & Leadership

President and CEO message

CMPA Council, Leadership team and Strategic Plan

Council

The CMPA is governed by an elected Council of 31 practising physicians who, together with CMPA management, foster the long-term success of the Association.


Meet Council >>

Leadership team

Members of the CMPA leadership team bring unique and diverse skills that help us assist and support members, and contribute to safe medical care across the healthcare system.


Meet the team >>

2019-2022
Strategic Plan

The CMPA’s commitment to support our members and employees, strengthen our foundation, and adapt to a changing healthcare environment.


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CMPA's mission and vision

Mission

To protect the professional integrity of physicians and promote safe medical care in Canada.

Vision

The CMPA is valued as an essential component of the Canadian healthcare system.

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Supporting physicians & patients

As an essential component of the Canadian healthcare system, we empower better healthcare by assisting physicians, contributing to safe medical care, and supporting the medical liability system.

Assisting physicians
Contributing to safe medical care
Supporting the medical liability system

Assisting physicians

Advice and medico-legal assistance

2022 saw severe challenges to the healthcare system. Through difficult times, we provided compassionate support to Canadian physicians facing high levels of stress and complex medico-legal issues.

How our advice and medico-legal assistance made an impact in 2022:
  • We received over 29,000 unique requests for medico-legal assistance from members (of which 21,149 were requests for advice and 8,194 were new medico-legal cases).
  • We engaged with members over 49,000 times on the phone and online, providing peer support and expert guidance to help physicians navigate medico-legal challenges.
  • We provided medico-legal support in 942 legal cases (such as civil-legal matters), and we supported 5,069 College matters and 1,859 hospital matters.
  • To support members in a rapidly evolving healthcare environment, we provided timely COVID-19 medico-legal advice and shared information about providing abortion services to US residents following the overturn of Roe v. Wade.

93% of members surveyed agreed that the knowledge gained from speaking with a physician advisor would make a positive impact on their practice.

Physician wellness

Peer support provided by CMPA physician advisors significantly assisted members in managing the stress and anxiety that can accompany a medico-legal concern, helping them provide safe medical care.

How we supported physician wellness in 2022:
  • To help us better address member distress related to medico-legal events, we created a Physician Wellness Strategy.
  • We collaborated with healthcare organizations across the country to bolster physician wellness at the individual and institutional levels, and supported the work of other organizations promoting physician wellness.
  • Key engagements included work with Doctors of Nova Scotia, Doctors of British Columbia, Healthcare Excellence Canada, the Québec Physicians’ Health Program, the Alberta Medical Association, and the Ontario Medical Association.

71% of members experiencing extreme stress who called for assistance noted a significant reduction in stress after speaking with us.

Equity, diversity, and inclusion (EDI)

Equity, diversity, and inclusion (EDI) are crucial to safe medical care and physician wellbeing. Advancing EDI is directly tied to our mission. We have a responsibility to help mitigate bias and inequity in the services we provide to members.

How we advanced EDI in 2022:
  • We launched our 2022-2025 EDI Strategy, which outlines our commitment to provide members with fair and equitable support in an inclusive environment.
  • We consulted with a range of stakeholders — including the University of British Columbia Okanagan, Dalhousie University, the College of Physicians and Surgeons of Manitoba, and the Federation of Medical Regulatory Authorities of Canada — to better understand alternative dispute resolution in situations of discrimination and to explore restorative justice approaches in the medico-legal environment.
  • We continued to provide CMPA Council members and our leadership team with comprehensive EDI and anti-bias training, helping them better understand the experiences and needs of members and employees.

We strive to be an organization where members and employees are valued for their diverse experiences and perspectives.

Organizational resilience

To keep supporting our members with high quality services, we invested in our people and infrastructure – creating a robust employee well-being plan and flexible work model, and initiating proactive recruitment activities.

How we enhanced organizational resilience in 2022:
  • We launched a holistic employee well-being plan for all staff.
  • We incorporated wellness initiatives into the day-to-day work of our physician advisors, lowering employee stress and fostering connection. This ensures our physician advisors are ready to help our members address challenging medico-legal events.
  • Following extensive consultations, we launched a flexible work model across the organization.
  • We focused on recruitment and reprioritizing our operations to improve our organizational capacity and employee wellness, while continuing to meet the needs of our members.
  • We evaluated our legal services model to assess how it was bringing value to members. The comprehensive review found that our delivery of legal services was efficient, effective, and sustainable. Opportunities for enhancement included the creation of a Legal Services Oversight Committee and a robust internal data strategy to better serve our members.

The health and wellness of our employees is one of our top priorities.

Contributing to Safe Medical Care

Safe medical care learning

As one of Canada’s largest providers of continuing professional development in healthcare, we delivered evidence-informed education to enhance the safety, reliability, and quality of healthcare in Canada.

How our learning offerings made an impact in 2022:
  • We delivered 306 events and workshops to over 15,000 attendees, including Prepped for Practice, delivering fundamental medico-legal education to residents at all 17 faculties of medicine in Canada.
  • Our self-directed learning products were accessed nearly 160,000 times.
  • We advanced equity, diversity, and inclusion in our digital learning offerings by adding new accessibility features and diverse and inclusive images to our 15 Electronic Learning Activities.
  • Following the wind down of our subsidiary, Saegis, we transferred a number of Saegis learning products to the CMPA’s educational portfolio, expanding the learning offerings available to members as a benefit of membership.

82% of members agree that the CMPA is a key partner in promoting safe medical care.

Research and insights

In 2022, we leveraged our medico-legal data in new ways and enhanced how we share research and insights with members and stakeholders.

How we leveraged research and insights to enhance patient safety in 2022:
  • We developed a data strategy to improve stakeholder and member access to our medico-legal data, and to improve operations and decision-making.
  • Under this strategy we launched several internal pilots using advanced tools—such as machine learning—to make better use of our data.
  • We created 66 analytical reports in response to member requests for medico-legal information, supporting patient safety research and knowledge sharing.
  • To enhance the safety of medical care, we created Know your risk reports that provide specific medico-legal data by specialty.
  • We published 5 peer-reviewed articles on medico-legal topics relevant to our members.

Our research and insights support patient safety and help prevent harm from happening in the first place.

Supporting the medical liability system

Compensating patients

We are a not-for-profit mutual defense organization. An important part of our role in the Canadian healthcare system is to provide, on behalf of our members, timely and appropriate compensation to patients, if the care provided is found to be negligent (fault in Quebec).

How we ensured appropriate compensation to patients in 2022:
  • We paid $279 million in compensation to patients on behalf of members proven harmed by negligent medical care, helping to support patients’ short and long-term care needs.
  • We closed 2022 in a strong financial position despite many challenges in the economy and financial markets. Members and patients should feel assured that we are here for them when needed, now and in the future.

On behalf of our members, we have paid a total of $1.25 billion in patient compensation over the past 5 years.

Advocacy and collaboration

We partnered with stakeholders to shape policy on key issues impacting patients, physicians, and the medical liability system. Virtual care was the main focus of our 2022 engagement and advocacy efforts.

How we advocated and collaborated to support members in 2022:
  • We published a policy paper, Integrating Virtual Care in Practice, setting out key medico-legal considerations for the use and expansion of virtual care.
  • We advised federal and provincial bodies — including the governments of Quebec and Saskatchewan, the Federation of Medical Regulatory Authorities, the Canadian Institutes of Health Research, and HealthLink BC — on virtual care standards and regulations.
  • We continued to provide input into federal and provincial medical assistance in dying (MAID) guidelines, and Parliament’s Special Joint Committee on MAID.
  • We held 397 meetings with stakeholders and sent 38 submissions to governments and medical regulatory authorities, providing our perspective on key issues and advocating for changes to improve the practice environments of physicians and the safety of care.

Collaborating with healthcare organizations across the country helps build a stronger healthcare system.


Top 6 ways CMPA benefits physicians and patients

  1. Mutual medical defence organization – assisting and prevention, not insurance
  2. Protection: Today, tomorrow, into retirement and beyond
  3. Compensation to patients
  4. More than medico-legal protection - Accredited, data-informed, learning, and evidence-based research
  5. Compassionate physician-to-physician support in English and French, on the phone and online
  6. Medico-legal assistance

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A year in numbers

Our members

In 2022, the CMPA had 107,839 Canadian physician members

Type of work

Family Medicine Specialists 37% 
Royal College Specialists 50% 
Residents 13% 
Other* 0.1% 

Region

BC/AB 26% 
SMAT** 13% 
ON 40% 
QC 20% 

Age

40 and under 38% 
41-59 41% 
60 and over 21% 

Note:
*Other: This category consists of two types of members: those who are currently working in another country and those who have renewed their membership to support COVID care activities.



Our services

Advice

In 2022, the CMPA engaged with members 49,599 times on the phone and online.

21,149

Advice calls provided to members

BC/AB 4,861
SMAT** 2,104
ON 10,109
QC 4,075

719

COVID-19 advice calls

BC/AB 146
SMAT** 70
ON 388
QC 109
Unknown 6




Education

306

Continuing professional development educational events and workshops

BC/AB 32
SMAT** 18
ON 212
QC 43
Outside Canada 1

15,816

Continuing professional development attendees

BC/AB 1,990
SMAT** 778
ON 6,350
QC 6,348
Other 350





  • 2022
    BC/AB
    SMAT**
    ON
    QC
    New medico-legal cases





    Legal actions - served1
    670
    130
    81
    388
    71
    Legal actions - not served2
    272
    52
    24
    77
    119
    College (medical regulatory authority) matters
    5,069
    1,414
    851
    1,838
    966
    Hospital matters
    1,859
    453
    162
    520
    724
    Paying agency matters
    176
    13
    24
    33
    106
    Other3
    148
    39
    18
    69
    22






    Resolved legal actions





    Judgment for plaintiff
    8
    2
    0
    4
    2
    Judgment for physician
    26
    4
    7
    6
    9
    Settled with plaintiff
    313
    82
    26
    127
    78
    Dismissed/discontinued/abandoned
    638
    164
    65
    283
    126

    Notes:

    1. Legal actions – served: means legal action was commenced against a member.
    2. Legal actions – not served: means legal action was threatened. Note: threats may result in a settlement or progress to Legal action – served.
    3. Other: includes human rights complaints, inquests, privacy investigations, and criminal matters.

  • 2022
    2021
    2020
    2019
    2018
    New advice contacts





    Advice to members
    21,149
    24,291
    23,702
    22,967
    22,622
    New medico-legal cases





    Legal actions1

    -
    732
    854
    900
    Legal actions - served2
    670
    632
    -
    -
    -
    Legal actions - not served3
    272
    326
    -
    -
    -
    Threats1
    0
    9
    791
    958
    895
    College (medical regulatory authority) matters
    5,069
    4,844
    4,183
    4,827
    5,628
    Hospital matters
    1,859
    2,011
    1,773
    2,129
    1,955
    Paying agency matters
    176
    206
    293
    598
    236
    Other4
    148
    178
    176
    144
    146
    Total new medico-legal cases
    8,194
    8,206
    7,948
    9,510
    9,760
    Resolved legal actions





    Judgment for plaintiff
    8
    11
    8
    5
    8
    Judgment for physician
    26
    30
    29
    47
    53
    Settled with plaintiff
    313
    343
    259
    285
    276
    Dismissed/discontinued/abandoned
    638
    574
    349
    438
    441
    Total resolved legal actions
    985
    958
    645
    775
    778

    Notes:

    1. The CMPA migrated to a new client management system in 2021, which classifies medico-legal cases differently. Reclassification of medico-legal cases will be observed, such as legal actions now classified as served and not served.
    2. Legal actions – served: means legal action was commenced against a member.
    3. Legal actions – not served: means legal action was threatened. Note: threats may result in a settlement or progress to Legal action – served.
    4. Other: includes human rights complaints, inquests, privacy investigations, and criminal matters.

** Saskatchewan, Manitoba, Atlantic provinces and Territories

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Financial performance

2022 Audited Financial Statements [PDF] Opens in new window

Our financial responsibility

The CMPA has a responsibility to maintain adequate funding to support member physicians and compensate patients on behalf of members when negligence (fault in Québec) has been proven – now and beyond the member’s retirement.

Accordingly, our financial planning horizon is long.

As a not-for-profit mutual medical defense organization, we collect membership fees from physicians each year. On behalf of members, we use our funds to compensate patients proven to be harmed by negligent medical care (fault in Québec), to support members facing medico-legal difficulties, and to advance safe medical care.

Members pay the full cost of their protection through their fees. In 2022, we collected fees necessary to protect our members and compensate patients today, tomorrow, and well into the future for all occurrences taking place in 2022.

We strive to ensure the fees we collect are used efficiently and appropriately, and we are committed to limiting growth in medical liability protection costs. One of our goals is to maintain relative fee stability, but this is in part determined by the performance of our carefully managed investments. As appropriate, we may lower membership fees when we are in a strong financial position and prudently raise fees when needed.

Over the past 10 years, we have achieved exceptional returns on our investment portfolio -- earning a 7.96% compound annual return. This strong investment performance has contributed to our positive financial position and has allowed us to reduce fees over the past 4 years.

We continue to invest responsibly to maintain a stable financial position that ensures timely and appropriate compensation to patients on behalf of our members, protection and support to physicians, and safe medical care learning and research to support patient safety.

For more information, read our consolidated financial statements and Independent Auditors’ Report.

Compensating patients

On behalf of our members, we provide timely and appropriate compensation for patients proven to have been injured as a result of negligent medical care (fault in Québec). Compensation to patients and the cost of legal services are our largest expenses each year.

We paid a total of $2.29 billion in patient compensation on behalf of our members over the last ten years, or an average of $229 million per year.

The following graph highlights patient compensation by region.

Compensation to patients by region

2013 - British Columbia/Alberta: 65,095,579.74; Ontario: 97,052,890.01; Québec: 18,033,153.26; Saskatchewan/Manitoba/Atlantic and Territories: 13,316,638.03; Total: 193,498,261.04; |
2014 - British Columbia/Alberta: 45,122,483.61; Ontario: 161,320,246.61; Québec: 26,163,466.73; Saskatchewan/Manitoba/Atlantic and Territories: 4,288,617.68; Total: 236,894,814.63; |
2015 - British Columbia/Alberta: 34,446,374.23; Ontario: 122,660,468.06; Québec: 18,222,304.73; Saskatchewan/Manitoba/Atlantic and Territories: 19,480,332.72; Total: 194,809,479.74; |
2016 - British Columbia/Alberta: 50,375,512.83; Ontario: 83,832,405.49; Québec: 19,512,531.11; Saskatchewan/Manitoba/Atlantic and Territories: 17,964,540.84; Total: 171,684,990.27; |
2017 - British Columbia/Alberta: 34,875,714.64; Ontario: 162,391,086.79; Québec: 33,241,679.20; Saskatchewan/Manitoba/Atlantic and Territories: 19,972,610.92; Total: 250,481,091.55; |
2018 - British Columbia/Alberta: 64,962,377.44; Ontario: 144,823,869.34; Québec: 19,793,981.14; Saskatchewan/Manitoba/Atlantic and Territories: 30,537,734.07; Total: 260,117,961.99; |
2019 - British Columbia/Alberta: 36,057,340.09; Ontario: 156,356,720.28; Québec: 16,806,950.42; Saskatchewan/Manitoba/Atlantic and Territories: 14,176,574.04; Total: 223,397,584.83; |
2020 - British Columbia/Alberta: 53,020,743.88; Ontario: 112,084,663.76; Québec: 22,886,340.74; Saskatchewan/Manitoba/Atlantic and Territories: 18,006,544.67; Total: 205,998,293.05; |
2021 - British Columbia/Alberta: 78,058,205.40; Ontario: 157,282,315.72; Québec: 20,821,379.86; Saskatchewan/Manitoba/Atlantic and Territories: 20,079,610.47; Total: 276,241,511.45; |
2022 - British Columbia/Alberta: 80,360,288.16; Ontario: 166,395,822.83; Québec: 17,448,368.62; Saskatchewan/Manitoba/Atlantic and Territories: 15,143,882.35; Total: 279,348,361.96;
  •   British Columbia/Alberta
  •   Ontario
  •   Québec
  •   Saskatchewan/Manitoba/Atlantic and Territories
  •   Total
2013
British Columbia/Alberta 65,095,579.74
Ontario 97,052,890.01
Québec 18,033,153.26
Saskatchewan/Manitoba/Atlantic and Territories 13,316,638.03
Total 193,498,261.04
2014
British Columbia/Alberta 45,122,483.61
Ontario 161,320,246.61
Québec 26,163,466.73
Saskatchewan/Manitoba/Atlantic and Territories 4,288,617.68
Total 236,894,814.63
2015
British Columbia/Alberta 34,446,374.23
Ontario 122,660,468.06
Québec 18,222,304.73
Saskatchewan/Manitoba/Atlantic and Territories 19,480,332.72
Total 194,809,479.74
2016
British Columbia/Alberta 50,375,512.83
Ontario 83,832,405.49
Québec 19,512,531.11
Saskatchewan/Manitoba/Atlantic and Territories 17,964,540.84
Total 171,684,990.27
2017
British Columbia/Alberta 34,875,714.64
Ontario 162,391,086.79
Québec 33,241,679.20
Saskatchewan/Manitoba/Atlantic and Territories 19,972,610.92
Total 250,481,091.55
2018
British Columbia/Alberta 64,962,377.44
Ontario 144,823,869.34
Québec 19,793,981.14
Saskatchewan/Manitoba/Atlantic and Territories 30,537,734.07
Total 260,117,961.99
2019
British Columbia/Alberta 36,057,340.09
Ontario 156,356,720.28
Québec 16,806,950.42
Saskatchewan/Manitoba/Atlantic and Territories 14,176,574.04
Total 223,397,584.83
2020
British Columbia/Alberta 53,020,743.88
Ontario 112,084,663.76
Québec 22,886,340.74
Saskatchewan/Manitoba/Atlantic and Territories 18,006,544.67
Total 205,998,293.05
2021
British Columbia/Alberta 78,058,205.40
Ontario 157,282,315.72
Québec 20,821,379.86
Saskatchewan/Manitoba/Atlantic and Territories 20,079,610.47
Total 276,241,511.45
2022
British Columbia/Alberta 80,360,288.16
Ontario 166,395,822.83
Québec 17,448,368.62
Saskatchewan/Manitoba/Atlantic and Territories 15,143,882.35
Total 279,348,361.96

In 2022, on behalf of our members, we paid $279 million in compensation to patients harmed as a result of negligent medical care (fault in Québec). This is $50 million more than our ten-year average (2013-2022).

Read more about compensating patients

Patient compensation costs on behalf of members vary greatly from year to year. Contributing factors include case duration, the number of cases settled, and the medico-legal outcomes of cases.

In 2022, the $279 million in payments to patients was $3.1 million more than in 2021. When compared to years prior, this increase was driven largely by an increase in the number of cases greater than $5 million which contributed to higher average value per case. As compared to the ten-year average, the 2022 average payment per case was higher by 41%.

Insurance protection against unexpected costs

Since there is volatility in outstanding claims and compensation to patients, we have insurance to help protect us from unexpected costs for medico-legal occurrences prior to December 31, 2022. These policies will help us continue to compensate patients and support members even if there is an unexpected increase in medico-legal expenses.

Our investment portfolio

We have a diversified investment portfolio that earns income to ensure we can appropriately compensate patients on behalf of members and fund future medico-legal expenses to support our members.

In 2022, the investment portfolio had a net value of $5.4 billion.

This is a decline of $485 million from 2021. This decline can be attributed to a $315 million investment loss caused by an overall decline in financial markets, as well as significant fee reductions in 2022. The decline in the investment portfolio is the main factor behind the decrease in the Association’s financial position (more on this below).

Read more about our investment portfolio

The performance objectives of our investment portfolio are to:

  • Match or exceed an investment return of 5% over the long-term to appropriately compensate patients harmed by negligent care (fault in Québec) and to reduce membership fees.
  • Achieve positive value-added returns (over a passive benchmark return) after deducting management fees.

Our investment portfolio consists of both public and private assets. We value our private assets conservatively at the lower of original cost or market value. At the end of 2022, we estimated that the fair value of our private assets exceeded their original cost by $825 million. At fair value, our investment portfolio value was $6.3 billion in 2022.

Supporting physicians and patients long-term

Membership fees collected in 2022 fund patient compensation and the medico-legal costs of our members well into the future for care provided in 2022.

This long-term horizon demonstrates our commitment to protecting members and their patients long after members retire. This is known as occurrence-based protection. Members are eligible for assistance (and patients are eligible for compensation if harmed by negligent medical care) any time in the future if the physician was a CMPA member at the time the care occurred. For example, a retired member could be eligible for assistance related to the care they provided early in their career.

We must hold adequate funds to compensate patients and support physicians with medico-legal cases for up to 4 decades from the time care was provided.

Our net asset position

Our net asset position is the difference between our assets (things that bring money to the CMPA) and estimated liabilities (things that cost the CMPA money). It provides a point-in-time measurement that indicates whether we have the required resources to meet our financial obligations, including compensating patients over the next 4 decades.

This amount fluctuates from one year to the next, depending on factors such as investment returns and compensation to patients. We strive to maintain a reasonable net asset position and take a measured approach to temporary shortages or excesses. To manage our financial position over time, we increase or decrease membership fees as needed.

The Association’s net asset position as of December 31, 2022, was $1.1 billion, a decrease of $560 million from 2021. This decline was the result of fee reductions and a loss in our investment portfolio in 2022.

While the net asset position has decreased since 2021, it remains higher than ideal. The CMPA will leverage this surplus to lower membership fees in 2023, as appropriate. All the while, we will continue to appropriately compensate patients that have been harmed as a result of negligent medical care (fault in Québec).

Planning for future compensation and physician support

We look ahead to ensure we have adequate finances to appropriately compensate patients harmed by negligent care (fault in Quebec) and manage legal and administrative expenses well into the future.

As of December 31, 2022, the estimate for all accumulated outstanding claims was $4.0 billion, an increase of $36 million from December 31, 2021.

Membership fee requirements

Through prudent adjustments to membership fees, we aim to stabilize our membership fee structure over time. We strive to maintain relative fee stability, but our ability to do this is determined in part by the performance of our investments, which are managed carefully but subject to market fluctuations.

CMPA members pay the expected cost of protection for the year in which the care was provided. If the actual costs of protection are different from the predicted values, future fees may be adjusted (increased or decreased) to address the difference.

When we are in a strong financial position (e.g., our investment returns outperform our long-term expectations) we typically reduce membership fees.

Our recent strong returns on investments have allowed us to reduce membership fees. Fee reductions were $99.5 million in 2021, $200 million in 2022, and will be $362.5 million in 2023. This is a $662 million reduction in membership fees since 2021.

If our financial position normalizes (i.e., decreases from the highs we have seen in recent years), a future increase in membership fees is likely.

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