2026 CMPA Annual Meeting (complete)
Dr. Birinder Singh: Hello everyone! Welcome. I’m Dr. Birinder Singh, President of the Canadian Medical Protective Association. Welcome to our 122nd Annual Meeting. Our meeting is being delivered virtually and in person, from Calgary, Alberta. This is a special year for us, as we’re celebrating our 125th anniversary. That’s 125 years of supporting Canadian physicians and helping them practise safely.
Today, we are excited to have over 160 members with us in Calgary and online from across Canada. Much of today’s meeting will be delivered in English, but everyone has access to simultaneous interpretation. If you’re in person, use the headsets provided, and those online can select the appropriate language.
Thank you all for being here. Let’s get started. Lisa, I’ll turn things over to you.
Dr. Lisa Calder: Thanks, Birinder, and welcome everybody. I’m Dr. Lisa Calder, the CEO of the CMPA. Since we have quorum, I’ll officially call this meeting to order.
To begin our meeting, it is my honour to welcome Elder Charlie Crowchild. Elder Charlie Crowchild was born and raised on the Tsuut’ina Nation and has dedicated his life to his community, serving through leadership, hard work, language, and cultural knowledge. Charlie is a respected Elder and a fluent speaker of the Tsuut’ina language. He continues to play an important role in preserving and sharing the teachings, values, and traditions of the Tsuut’ina Nation for future generations. I had the opportunity to speak with Charlie earlier and he's a remarkable individual. We are so fortunate to have him here. And I'm very grateful to welcome him to the floor to open our meeting. Elder Crowchild.
[Applause]
Elder Charlie Crowchild: Good afternoon everybody. It’s such a pleasure for me to do this and it’s an honor for me to be up here to speak to all of you doctors and visitors here. I really, really appreciate that.
With that, I’m going to say a prayer in my language and my son here will do a welcome song. It’s so important because in our culture, in our customs, usually with the prayer comes a song, like the Anglican, the Catholic, they have their song... their hymns, with their prayers. So ours is a little bit different in our culture and our heritage.
With that, I’m very honored, I’m very thankful to be here and I really, really appreciate that. David here went around the room to bless the room and bless the people up here.
And with that, I’m going to say a prayer in my language. So, if you don’t mind, just say a prayer for yourselves. Pray, say a prayer for your family.
[Tsuut’ina language]
David Meguinis: Good afternoon ladies and gentlemen. I’m here as a Helper with our Elder here, this song I’m gonna sing is... it’s like a doctor going in a medical room, and... you have to wear gloves to cut somebody open! I’m them gloves.
So that’s why I’m here, it’s to help our Elder, and he’s my father. He took me in as my father passed at 104 years old. So these songs, I grew up with. There are all different nationalities or traditions, Cree, Blackfoot, Stoney, different tribes have different meanings. This is a song when you put up a tepee and you open that door and you welcome people. This is like your tepee, right here, with your people that are online and whatnot. It’s a massive tepee that you work together and... for the people, no matter what color you are and whatnot.
[Singing and drum beating]
Elder Crowchild: Your tepee is open now.
[Applause]
Dr. Calder: Elder Crowchild, I just wanted to give you this tobacco and this gift, and to express our appreciation for sharing your wisdom with us today.
Elder Crowchild: Great.
Dr. Calder: Thank you.
Elder Crowchild: Thank you so much.
Dr. Jenn D’Mello: Thank you Elder Crowchild. Hi everyone, I’m Dr. Jenn D’Mello, a CMPA Councillor from Calgary. The CMPA acknowledges and gives gratitude to the many First Nations, Métis, and Inuit from across Turtle Island who have lived in and cared for these lands for generations. With respect, we acknowledge the ancestral territory of the peoples of Treaty 7 who call Calgary home, which includes:
the Blackfoot Confederacy, comprised of the Siksika, the Piikani, and the Kainai First Nations; the Tsuut’ina First Nation; and the Stoney Nakoda Nations, including Chiniki, Bearspaw, and Goodstoney First Nations.
The city of Calgary is also home to the Métis Nation within Alberta, including Nose Hill Métis District 5 and Elbow Métis District 6. This area, where the Bow and Elbow Rivers meet, has always been a major gathering place for Treaty 7 First Nations. Treaty 7 was intended by First Nations leaders to detail how settlers and Indigenous people could coexist peacefully together and help all people inhabiting these lands thrive.
This is not what happened once the treaty was signed, and to reconcile that we all have an ongoing responsibility to uphold the intent of the treaty that gives us this land and resources we use to our benefit.
I would also like to acknowledge that the CMPA offices, located in Ottawa, are on the unceded, unsurrendered Territory of the Anishinaabe Algonquin Nation, whose presence there reaches back to time immemorial. that can better support the diverse needs and experiences of our members.
Dr. Calder: Thank you, Jenn. Before we continue, just a quick few notes for you.
Under the CMPA By-law, only active members can vote and ask questions.
If you’re joining us online, you can vote directly on your screen. If you’re here in person, you can use this little keypad. It looks kind of like a BlackBerry.
If you’d like to ask a question, online participants can use the Messaging tab and select Ask a question.
For those of you in the room, please proceed to one of the microphones that you see here, and introduce yourself by your name and province or territory. Please note that if you ask a question, you will be identified in the meeting minutes.
And finally, if you need assistance, we do have technical support available to you, both in the room and online.
Dr. Singh: We’re joined today by members of our leadership team, Council, and general counsel. We’re also pleased to welcome former leaders of the CMPA, including former Presidents, Drs. Debra Boyce, Michael Cohen, Jean-Joseph Condé, and Peter Fraser, as well as former CEO, Dr. Doug Bell. Thank you all for attending.
In advance of voting, we have identified 2 scrutineers: Dr. Marcia Clark and Dr. Gordon Giddings. If you wish to object to the scrutineers, please let us know now using the Ask a question button online or by using one of the mics in the room.
We’ll pause briefly to allow objections to be noted. As there are no objections, Dr. Clark and Dr. Giddings are appointed scrutineers of the voting.
I’d now like to seek approval of the 2025 Annual Meeting minutes, which are on the CMPA website. Members attending in person, please raise your hand to move or second the motion. Members online can move or second the motion by clicking the Messaging tab and selecting Move or Second from the drop-down menu.
So we have online moved by Dr. Pravin Batohi and seconded by Melanie Willows.
No changes to the minutes as proposed have been received. Members will now vote to approve the minutes.
The motion will come up on screen for our members joining us online. We’ll now pause for voting.
Just standing by for the results now.
Alright, the approval of the minutes has passed. The resolution carried. So thank you everyone who participated. Over to you, Lisa.
Dr. Calder: Thanks Birinder. We want to take the opportunity to look back at what we've accomplished over the past year. It's been a year of significant momentum and change, and through it all, we remained focused on our members. And our members noticed. Our member satisfaction rate remained consistently above 90%, which is a very strong result for any service-based organization, and especially so when you think about the ongoing turbulence in the environment.
Providing trusted medico-legal support is at the heart of what we do. And this past year, members turned to us with more frequent and complex medico-legal concerns. Even with the increased demand, we continued to deliver expert, empathetic, peer-to-peer advice and assistance. 93% of survey respondents agreed that the CMPA provides credible medico-legal advice and 97% said their interactions with us took place in a safe, non-judgmental, and supportive environment.
These results reflect that members feel heard, respected, and supported when they need us.
Dr. Singh: Medico-legal issues can take a real personal toll, so we continued to expand our supports for member wellness. Last year we introduced the Wellness Support Program for members experiencing elevated distress related to medico-legal issues. Early feedback is encouraging, with members reporting they’re better able to manage stress, navigate medico-legal challenges, and return to work sooner.
In 2025 we also introduced the Physician Well-Being Index in both English and French, with access to resources tailored by province and territory. Thousands of members have used the tool to check in on their wellness, on their well-being, compare their results with peers, and to access resources. It also helps us better understand wellness trends and shape future supports for you, our members.
Dr. Calder: So let’s look at how we‘re modernizing the member experience through innovative solutions. One example is the Member Support Program, which we launched several years ago. And it was designed to provide tailored support to members who are experiencing a high or increasing amount of medico-legal issues. What our data shows us is that this program, which started as a pilot project, is now effective and impactful. And it's a strong example of evidence-informed innovation that is member-centred, and it's designed to make a real difference.
Another important way that we support our members and contribute to the healthcare system is through patient compensation. When a patient has been proven harmed by negligent care, CMPA provides compensation on behalf of the member. Our role in compensating patients is critical, both to the healthcare system and to Canadian physicians. So when negligence has been proven, members can have the confidence that they will not be personally responsible for compensating patients.
Dr. Singh: Let’s turn now to how we’re strengthening our work through equity, diversity, and inclusion.
Over the past year, we continued embedding EDI principles into the way we support our members. I’m proud to share that 100% of our physician advisors completed San’yas Indigenous-specific anti-racism training, strengthening our frontline teams’ understanding of anti-Indigenous racism.
We also offered employees learning on inclusive language, anti-Black racism, Pride and allyship, and Truth and Reconciliation.
Beyond learning, we continued to advance our goal of restorative approaches to justice. This work has been described by Indigenous physician leaders as meaningful reconciliation in action.
While we recognize there’s more to be done, we’re seeing positive signs that we’re moving towards a more inclusive organization that can better support members from all backgrounds and experiences.
Dr. Calder: Advocacy and collaboration were also key areas of focus for us in 2025. Across the healthcare system, we brought a medico-legal lens and perspective to issues that matter to our members and to safe medical care. We contributed to national conversations about the safe implementation of AI-based tools in healthcare.
And in 2025, we engaged with 17 AI stakeholders and working groups across Canada, and this included organizations and governments in BC, Ontario, and Québec.
In Alberta, we have acknowledged the many challenges that are impacting physicians in this province, and we've worked closely with stakeholders such as the AMA and the CPSA to support our members during turbulent healthcare changes.
One specific example is our submission to the AMA regarding the Triage Liaison Physician role, where we highlighted practical ways to decrease physicians' medico-legal risk.
Strengthening the CMPA also means investing in our people, our capabilities, and the systems that help us serve our members well.
Over the past year, we've continued building our capacity as a learning organization. This included a comprehensive AI needs assessment and finalizing an ethical AI framework to guide responsible adoption of AI tools across the CMPA.
For us, responsible AI means keeping human oversight at the centre, protecting trust, and preserving the human connection members expect from us, even as technology changes rapidly around us.
Dr. Singh: Turning now to safe medical care learning. In 2025, our learning reached more physicians, healthcare professionals, and stakeholders than ever before. The results shown on this slide indicate a strong interest in practical, accessible learning that supports safer care.
And we continue to see encouraging evidence that our work is making a powerful difference. One team that participated in our surgical safety course made sustained changes and reported a 50% reduction in surgical site infection rates.
Shifting to our governance modernization work, in 2025, members approved the new By-law 53. This was an important step toward a more modern and sustainable governance model. To prepare us for the new By-law, we’ve completed updates to the Governance Manual. In doing so, we took guidance from the member motion adopted at the 2025 Annual Meeting, which underscored the importance of diversity, fairness, and minimizing bias in governance.
Because CMPA was created by an Act of Parliament, implementing By-law 53 involves several steps, including approval by the federal government. I am pleased to share that we have submitted By-law 53 for federal approval and are now waiting for that process to be completed over the coming months.
In the meantime, the 2027 Council election cycle begins next week, with the call for nominations. Since By-law 53 will not yet be in effect, the 2027 elections will be conducted under By-law 52, even if federal approval of By-law 53 is received during the election. This will provide continuity for our election processes and avoid confusion for candidates and members once the election cycle has begun.
All information for the 2027 election cycle, including key timelines, will be available on our website as of August 26.
Dr. Calder: Turning now to CMPA’s role as a trusted, data-driven voice in safe medical care. In 2025, we continued to share insights from the world’s largest collection of physician-based medico-legal data, publishing 7 new specialty-specific Know Your Risk reports and 11 peer-reviewed research articles.
We also created an AI tool that summarizes and categories deidentified advice case files in real time. It also allowed us to code more than 200,000 files from the past 10 years, with 98% accuracy.
And as we expanded our support to international medical graduates through our IMG-specific resources, we reached nearly 18,000 users in 2025.
Dr. Singh: We will now move into the financial portion of today’s meeting. We’ll start with a message from Dr. Katy Shufelt, Chair of the Audit Committee, who I will invite to the mic. Katy.
Dr. Katy Shufelt: Thank you Birinder, and good afternoon, everyone.
The CMPA Audit Committee is comprised of five members of Council plus two external financial experts, all of whom are independent of management. As Chair of the Audit Committee, I am pleased to report on our 2025 financial statements, which were prepared by management and audited by KPMG.
The Audit Committee reviewed these statements with management and the auditors. KPMG has attested that the CMPA's statements properly present the results of 2025 operations and the CMPA’s financial position as of December 31st, 2025.
Now we’ll first watch a video in which our Chief Financial Officer, Cory Garbolinsky, shares the 2025 Financial Report.
We’ll then watch a video narrated by Lisa outlining the regional fees for 2027. Let’s start with the first video.
[First video]
CMPA has a responsibility to ensure we have the financial strength to support our more than 119,000 physician members and, on their behalf, compensate patients proven to have been harmed by negligent care, today and well into the future. Our financial model is designed to sustain this long-term commitment.
Before I review our 2025 financial performance, I’d like to walk through how the model works.
At its core, the model is made up of several interdependent elements: our net asset position; membership fees; medico-legal costs; liabilities for accumulated outstanding claims; and our investment portfolio. These elements work together to maintain balance over time.
We begin with our net asset position, the difference between what we own, largely our investments, and what we owe, primarily the estimated cost of future and unresolved claims. The net asset position is a key factor when setting membership fees each year.
Membership fees are collected annually to pay for the medico-legal costs of all incidents occurring in that year, even though those incidents may not be reported or resolved for a long time. This includes the costs of compensating patients where harm has been proven by negligent care, on behalf of members.
Those medico-legal costs are shaped by evolving trends, such as increasing case complexity, shifts in claim volumes, and rising costs per case.
These factors inform the level of assets we must hold to meet both existing obligations and accumulated outstanding claims.
The funds collected through membership fees are invested through our portfolio.
Investment income helps us keep membership fees as low as possible and plays an important role in helping ensure we can meet our commitments, not only today, but decades into the future.
There are four key principles that underpin how this model operates:
First: Occurrence-based protection.
Members remain eligible for CMPA assistance indefinitely, even after retirement, as long as they were members at the time the care was provided. This means we must be prepared to respond to claims that may arise many years and even decades later.
Second: Members share the costs of their own medico-legal protection.
Through annual membership fees, members pay the estimated cost of their shared medico-legal protection for that year, ensuring these costs are not passed along to future generations.
Third: Not-for-profit mandate.
As a not-for-profit, our goal is not to generate profit, but to maintain financial stability. We aim to hold sufficient assets to meet our obligations, ensuring we can compensate patients appropriately and support our members.
Fourth: A model that adjusts overtime.
Despite careful forecasting, actual results will differ from estimations. These differences create either surpluses or shortfalls in our net asset position. Since we cannot distribute profits as a not-for-profit, we adjust membership fees over time to maintain balance.
Now that we’ve walked through the fundamentals of our financial model, let’s turn to our financial performance in 2025.
As of December 31, 2025, our net asset position was $1.2 billion dollars, an increase of $17 million from 2024. This growth was driven primarily by strong investment returns, which I’ll speak to in more detail shortly.
Due to our strong net asset position, we have been in a fortunate position over the last several years to provide our members with varying levels of fee reductions.
Between 2021 and 2025, we reduced fees by a total of $858 million dollars. This means that our investment returns have paid $858 million of the cost of medico-legal protection for our members since 2021. In 2025 alone, fee reductions totaled $88.2 million dollars.
For the Ontario and British Columbia/Alberta fee regions, fees were relatively stable in 2025. As these fee regions account for 67% of our membership, the majority of our members experienced stable fees in 2025.
After several years of unprecedentedly low membership fees in Québec, fees increased in 2025 to be more in line with the anticipated medico-legal costs.
Similarly, in Saskatchewan, Manitoba, the Atlantic Provinces and the Territories, fees increased from unprecedentedly low levels, to better align with the anticipated medico-legal costs.
As always, fees were carefully calculated to ensure CMPA will continue to be there for members and their patients as needed. Membership fees fund medico-legal costs, including compensation to patients where harm has been proven by negligent care, as well as legal and expert expenses, safe medical care initiatives, and the operational costs of the Association.
Providing compensation to patients is essential to our role within the Canadian healthcare system, and it is the Association’s single largest expense. In 2025, on behalf of our members, we paid $341 million in compensation to patients.
While the total compensation amount varies from year to year, the CMPA has paid a total of $2.6 billion dollars in patient compensation over the last 10 years.
We plan ahead to ensure we have the financial capacity to meet future obligations, both for patient compensation and physician support.
The liabilities for accumulated outstanding claims represent the total estimated medico-legal costs arising from care provided by members up to and including 2025. For care delivered in 2025, we must ensure that sufficient funds are set aside to cover all associated costs, potentially over the next 4 decades.
As of December 31, 2025, the estimate for all accumulated outstanding claims was $4.5 billion, an increase of $156 million from 2024, based on updated cost-trends.
Compensation to patients accounts for over two-thirds of this $4.5 billion amount, while the remainder is largely legal expenses.
To provide independent and impartial oversight of our actuarial calculations, we engaged Ernst & Young to conduct a peer review. Their analysis closely aligned with our own. This work has subsequently been audited by KPMG as part of the external audit of our financial statements.
We have a diversified investment portfolio, with the objective to match or exceed a 6% investment return over the long term. However, over the past 10 years, we have achieved exceptional returns on our investments, earning a 7.13% compound annual return.
In 2025, the investment portfolio had a net value of $6.0 billion, an increase of $401 million from 2024.
The growth in the net investment portfolio over 2024 levels was due to an overall increase in financial markets, earning an investment return of 5.74%.
Our solid financial position will help us navigate market volatility and fluctuations in medico-legal case volumes and costs.
We remain committed to prudently investing and maintaining a financial foundation that ensures timely and appropriate compensation to patients on behalf of our members, protection and support to physicians, and safe medical care initiatives to support patient safety in Canada.
As I conclude my financial update, I’ll leave you with 3 key takeaways:
First, our occurrence-based protection means we operate with a long-term financial horizon, ensuring we can support members and compensate patients not only today, but well into the future.
Second, adjustments to membership fees remain our primary tool for maintaining a balanced net asset position.
Finally, our positive net asset position in 2025 reflects a strong financial foundation and provides confidence that we will be there for members and their patients when needed.
Thank you.
[End of first video]
[Second video]
Each year, we set fees with two goals in mind: ensuring CMPA remains financially strong and keeping member fees as low as possible.
The fees collected in any given year are used to pay the estimated medico-legal costs arising from that same year. These costs can unfold over the next four decades and include future compensation to patients and the cost of expert assistance to members when they need us. So, when we set fees, we’re making sure that we can support members today and decades into the future.
Before we look at the 2027 numbers, it’s helpful to understand how fees are equitably organized across the country.
CMPA has four financially independent fee regions, reflecting differences in medico-legal costs across Canada. Those costs vary based on factors such as the number and severity of cases and the number of physicians practicing in a region. Because each region is independent, there is no subsidization between them.
The four fee regions are: British Columbia and Alberta, Ontario, Québec, Saskatchewan, Manitoba, Atlantic provinces, and the Territories.
The average member fee is an illustrative number, not an actual fee paid by a member. It’s calculated by dividing the total regional fee by the number of members in that region.
Actual membership fees are then set by specialty or type of work. We know fee changes can concern members, so we take a careful, long-term approach to fee setting.
When the CMPA is in a strong financial position, fee credits can help reduce what members pay. Since 2020, we have provided more than $1 billion dollars in fee credits, largely because of strong investment performance.
In 2023 alone, we provided over $362 million in fee credits, effectively reducing member fees by 45 to 90%, depending on the region.
More broadly, our investment returns have helped offset a significant portion of our members’ cost of protection, therefore avoiding steep increases in fees across the country in the face of higher medico-legal costs.
While members pay their CMPA fees directly, provincial and territorial governments and medical associations or federations have negotiated reimbursement agreements to help offset some of those costs.
CMPA is not part of those negotiations. Overall, despite recent relative increases in some regions, average member fees in 2027 remain below pre-pandemic levels. That reflects strong investment outcomes and CMPA’s overall financial strength.
Now let’s look at what this means for each fee region in 2027, starting with British Columbia and Alberta. Medico-legal costs in this region continue to rise, but because this region remains financially strong, we can apply fee credits, keeping member fees largely stable, with only very minimal increases for some physicians. The average member fee is $5,325, still below the 2020 pre-pandemic average of $5,513.
Ontario remains the costliest region for medico-legal protection, which is reflected in higher fees. A strong current and projected financial position in Ontario means we can continue to offer fee credits. The average member fee will decrease by 7.5% to $6,068, following a 10% decrease in 2026. Compared with the 2020 pre-pandemic average of $8,187, the 2027 average member fee is 26% lower.
In Québec, the region remains in a strong financial position, while medico-legal costs are expected to continue increasing. In 2027, Québec’s average member fee will rise by 15% to $515. Even with this increase, Québec’s fees remain the lowest in the country and are 56% below the 2020 pre-pandemic average of $1,158. As medico-legal costs continue to rise, future increases may be needed to keep fees aligned with costs in this region.
Finally, in Saskatchewan, Manitoba, the Atlantic provinces and the Territories, fees will increase in 2027, so that they are better aligned with projected medico-legal costs. The average member fee will increase by 12.5% to $1,917, but remains 54% below the 2020 pre-pandemic average of $4,148.
Here is an overview of recent average fees per member by region.
As you can see, fees in all regions remain below their pre-pandemic levels, even where 2027 fees are increasing.
All 2027 membership fees are now available on our website. Members will also receive
an email in the fall when annual invoices are available in the member portal, as part of the Annual Membership Review.
Looking ahead, the CMPA’s strong financial position means we are well placed to continue supporting members and compensating patients proven to have been harmed by negligent care, now and well into the future.
Thank you.
[End of second video]
Dr. Calder: So I’d now like to share with you the 2026 Council election results.
Each year, approximately one-third of Council positions are scheduled for nomination and election by members. This year, CMPA elections took place in BC and Yukon, Alberta, Ontario, Québec, and Newfoundland and Labrador.
As usual, active members in areas where elections were taking place were eligible to vote for their preferred candidate. Every member had an equal opportunity to vote.
We are pleased to also welcome new and returning Councillors from across Canada, as shown on the screen. I’ll give you a few moments to read the names.
I’d also like to recognize our 2 departing Council members: Dr. Paula Cashin from Newfoundland and Labrador, and Dr. François Mercier from Québec. I sincerely thank you for your governance work at the Association during your tenure as CMPA Councillors.
Dr. Singh: I want to take this opportunity to acknowledge that there were concerns raised during and after the election that took place for the 2026 Ontario Area 5 Division B election. The concerns stem from social media posts and related activity that took place during the election in Ontario. In response to those concerns, an email was distributed to all Ontario members during the election to clarify any confusion from that social media activity. CMPA also retained the Honorable Harry S. LaForme, a retired judge of the Court of Appeal for Ontario, to provide an independent legal opinion on whether identified election period social media and related activity compromised the integrity and fairness of the Ontario election.
This independent legal review examined whether there was any legal or procedural basis to set aside or rerun the 2026 Ontario Area 5 Division B election. Consistent with the advice received and exercising its governance responsibilities, CMPA has determined that it will not set aside or rerun the 2026 Ontario Area 5 Division B election.
We also want to acknowledge that we have received a member motion in advance of today's Annual Meeting. The member motion pertained to the integrity of the Ontario election and called for an investigation into recent Ontario elections and whether any conduct was breached.
As is our usual process, we first needed to determine if the member motion was drafted in a manner that adhered to the requirements of our By-law and Governance Manual, in order to be submitted to the membership.
In order to respond to the member, the CMPA retained Brian Gover and Laura Cameron of Stockwoods LLP to provide an independent legal opinion on whether the motion could be added to the agenda.
Having reviewed the advice from the independent review, the CMPA determined it would not be reasonable for the proposed motion to be placed on the Annual Meeting agenda. As structured, the motion was vague and overbroad and infringed on the appropriate management of the Association's affairs. This is why the motion was not circulated to members in advance of the Annual Meeting and was not brought forward for consideration.
The CMPA fully supports members' abilities to bring forward motions to the Annual Meeting and aims to work with members to ensure these motions comply with our By-law and Governance Manual. This is so that the motion can be brought in front of the membership and be eligible for discussion and voting. In this case, while the motion was ruled out of order, the Association recognizes that there are opportunities to make our processes better going forward.
We take the concerns expressed in the motion seriously and, as a result, are committed to review the Election Campaign Guidelines and clarifying the relationship between the Election Campaign Guidelines and the Councillor Code of Conduct, and to review the CMPA's procedures for investigating election complaints and the timeliness of its response.
We will report back to you, our members, on our progress with these steps at the 2027 Annual Meeting. We appreciate the seriousness of the concerns and the importance of following our existing processes to ensure fairness and integrity of our elections. We remain committed to listening to our members and continuously improving our governance practices.
Dr. Calder: A point of order?
Dr. Singh: Yes. Mic 2?
Dr. Santanna Hernandez: Sorry, is this mic on?
Dr. Singh: Yes, it's on now.
Dr. Hernandez: Hi. So, Dr. Santanna Hernandez from Alberta. I was one of the signatories on this motion that was submitted. I’m having a hard time as I feel like what is being presented to the membership currently does not reflect the engagement that we had as the motion submitters and the signatories. And unfortunately Dr. Susan Abbey couldn’t be here today as well and asked me to be here to represent her motion on our team’s behalf, and there was 15 of us who submitted this motion.
We submitted this motion 64 days before when we were expected to submit this motion. We received acknowledgement of this motion, with no indication that there was any issues with this motion. And then 5 days before this motion was supposed to go out to membership, a different issue was brought forward to us about requesting a different bit of language change, and then asking us to get 10 new signatories for a newly-written motion, which we then responded that that was outside of the By-laws to have a motion submitted so late within the process.
And then less than 3 hours before documents were going to be released, we received from the CMPA the expectation to change it again. It was only then that all of a sudden, this new representation about it not being in accordance at no point in those 64 days leading up to that deadline was that - I think it is reasonable that the people on this space understand what was actually happening. And I’m unaware of whether or not Council even knew the process that was happening or if this was something that was coming down from management.
So I feel like if we’re going to be reflecting a process that happened, that process should be reflected accurately to the membership and that there should be accountability about what is happening.
Dr. Singh: Thank you, Dr. Hernandez. So we had… there were several interaction points from when the motion was submitted between management and the mover, Dr. Abbey. Various points were raised and in order to be fair, a legal opinion was… an independent legal opinion was asked for by the CMPA from a separate independent firm to make sure whether or not we were right in considering whether the motion was in order or not.
Following with the information we received from that opinion, it was felt that the motion was out of order, as it was vague, overly broad, and infringed on the appropriate running of the Association.
That being said, we’ve had several member motions in the past and, often, there are issues where it does not meet the requirements of the By-law. And we work with the members in order to make it so that it’s something that can come forward to the membership and can be voted on. There were time constraints absolutely here, but there were several attempts to work with the moving member, Dr. Abbey, and try to bring this forward.
I agree it’s unfortunate that the motion couldn’t have been altered and brought forward, but we also take quite seriously the idea that member motions need to be presented to the members in the appropriate timeframe so that members can decide whether or not to attend the meeting, and whether or not they want to participate in the motion that is going to be presented.
So because the timelines could not be met, it’s unfortunate but the motion could not be brought forward. But as I said, we understand the seriousness of the crux of the motion, and we have already undertaken processes to look into many of those questions and we will continue those processes to look into it, and, you know, either make changes or even improvements, and we will report back at the next meeting on what we brought forward.
Thank you.
Dr. Hernandez: I don’t think that actually addresses it, because these points of contact, as somebody who was in contact with the person who was receiving the point of contact, the very first one was the... one of the members who was named in the motion, Dr. Watkins, reaching out to her to have an informal discussion about the motion, which in my mind seemed more like an intimidation factor as opposed to a genuine reach out and trying to actually make the motion, because I would hope that somebody with governance experience leading an organization like this would recognize that the person being named in the motion probably is not the most appropriate person to be reaching out, and that third party or those reports should have been made available to allow the team to understand what was not in compliance, which has not been done yet to this date.
And I have been in correspondence and seen all the correspondence between Dr. Abbey and the CMPA, and none of that has ever been made clear. And I’m happy, like, to share those documents with the membership that’s here, the 160 members of our like 119,000 whatever members that are part of the CMPA, because I believe in transparency in the work that we’re doing, as somebody who’s new to this profession and who has spent a lifetime, in my entire life, in medical education and medicine advocating and being a part of governance and learning this language as an Indigenous woman, because I am living in a colonial system and need to understand that. And so I spent a lot of time training myself to understand this language and I’m really struggling to see how the organization is being transparent and how they are moving forward and proceeding.
Do you see the difference in how that works and how we are wanting to be? You claimed a few minutes ago that you were a trusted support for physicians, yet when motions are coming forward, there are these backhanded conversations, there are these secrets or reports that are not being made available to Council in order for that to come forward for the membership to make an informed decision on whether or not these practices were in good governance. And I can assure you, as somebody who has worked with Carl Nohr for a long time, who was on the CMA Governance Committee, I have spent a lot of time learning about governance. And I’m having a hard time understanding how the Council is fulfilling their fiduciary responsibility outside of Dr. Cashin who just recently resigned because she felt like you guys were not appropriately bringing this forward to membership and blocking membership and gatekeeping this from membership and having all of these different reports. And how can we now be sure that these reports are actually being shared to the right people so that informed decisions are being made?
Dr. Singh: Yeah. So, thank you for your concerns. All I can say is we did meet with Dr. Nohr, had a member motion before, we followed the same procedure. We talked with him behind the scenes and made a motion that could come forward. We've done that in subsequent years with other member motions and this is our process.
We are a learning organization, we will continue to learn from this experience. We will continue to try and be transparent and open with the membership. There’s many factors at play, but you know, again, I hear everything you’re saying and I think they’re all important points and we will take them back and consider them.
Thank you.
Dr. Calder: Thank you, Dr. Hernandez, for bringing forward those concerns. I echo what Birinder said. We hear you and we’re definitely interested in dialogue with our membership.
Before we open the floor to questions, I would like to take a moment to look ahead.
We continue to experience a healthcare crisis in Canada, which impacts how physicians can provide safe care across the country. Medico-legal issues are becoming more complex, and members continue to look to the CMPA for trusted guidance.
In the new year, we’ll be launching our new Strategic Plan, which is shaped by input from members, Council, employees, and stakeholders. This plan is firmly grounded in our mission to protect the professional integrity of physicians and promote safe medical care in Canada.
Two strategic priorities will guide our work:
The first is bringing prevention and protection closer together, to provide more proactive support and help members reduce their medico-legal risk.
The second is using AI responsibly to improve how we work and help physicians navigate a rapidly evolving healthcare landscape.
These priorities are going to be supported by 3 foundational enablers: relative membership fee stability, organizational capability, and EDI.
CMPA’s reconciliation journey runs in parallel throughout the plan. We'll continue to listen to you and adapt our services to meet your evolving needs.
As we reflect on 125 years of supporting physicians, one thing is clear: CMPA remains here for you.
Dr. Singh: And now we'll open the floor to your questions. Questions can be submitted online using the Messaging tab or in person at a microphone. I’ve asked Dr. Armand Aalamian and Dr. Pamela Eisener-Parsche to assist me in managing the questions.
It's OK? Go ahead?
Dr. Pamela Eisener-Parsche: So Dr. Paul Hacker asks: “How do you think this governance issue has impacted members' trust and impression of the CMPA as their legal representative? What does the CMPA plan to do to repair the damage and resolve the concerns transparently?" And he has a follow-up question as well, but we'll start with that.
Dr. Singh: OK. Thank you, Dr. Hacker. So as I’ve said, as an organization, we continue to look at our processes. We continue to examine what has happened and how we can improve for the future. We have a new By-law coming in that will change how we do several things, including deal with elections. And we’re not ignoring what’s happened. We’re learning from what’s happened. We have processes going on in the background where we’re looking into how we can do things differently and what happened and whether it was fair or not. All I can say is that we can state to you that fairness is the driving factor behind the decisions we make, how we approach all of these different concerns. And we’re glad members feel confident to raise their concerns and we will continue to look at them, find out where we can improve and change, and again we’ll try to come back to members next year with some of the lessons learned and any changes that we’ve made as a result of that.
Dr. Eisener-Parsche: Dr. Hacker's second question. Will you release the full legal opinion that underlies the decision by the CMPA to rule the motion out of order?
Dr. Singh: So the legal opinion is protected by solicitor-client privilege, and so we're not in a position to release the full opinion at this point. We have, again, clear guidance from the opinion that the decisions made and the approach that we've taken are sound and supportable. But at this point we won't be releasing the legal opinion.
I see someone at mic 2 in person. Go ahead. Yes, identify yourself and where you’re from.
Dr. Randall Sargent: My name is Randall Sargent. I’m a retired family physician working with an administrative permit in the province of Alberta. My question is in regard to coverage for administrative permits. That may not be something familiar to other areas, but in Alberta, it allows you to do administration without any permit to care for or prescribe for patients. The concern that I have is quite often, this is committee work. I was working with CPSA and AMA, and the income is minimal and the cost of the administration in my case was more than what I was earning in the last 2 to 3 years.
I'm wondering how we arrive at these fees in this sort of circumstance and if any special consideration is due to people in those sort of situations.
Thank you.
Dr. Singh: I'll let Lisa answer that.
Dr. Calder: Thank you very much Dr. Sargent for asking that question with respect to fees, and I would encourage you to give the CMPA a call, as well, as you have a specific question given your context. I'm going to hand it over to Dr. Pamela Eisener-Parsche to address your question.
Dr. Eisener-Parsche: Thank you, Dr. Sargent. We do have a type of work, as you know, for administration where you are acting as a physician, with a physician's knowledge and expertise, but without ability to see patients or prescribe medications or investigations. That is the type of work that you would be referring to. That type of work is one of the lowest fees actually that's available to the Association. The only ones that are lower are humanitarian work and resident fees. It is something that we can be taking a look at because I think the situation you've described is quite unique. The majority of physicians who would be seeking that type of work would have an income that would accommodate the type of work fee that goes with it. It is a very low fee, but I recognize that in the context of what you're describing, it's having a challenge.
So, I would encourage you to call in and have a conversation with our Membership Department and we will take a look at your specific situation.
Thank you.
Dr. Singh: Microphone 3?
Dr. André Bernard: Hi, my name is André Bernard. I'm a member from Nova Scotia. I'm an anesthesiologist in Halifax. I wear a second hat as the Board Chair of the Canadian Medical Association. I want to start off by just thanking you for hosting this meeting in this transparent way and for sharing the successes of the past year. I'll say that I was struck hearing that it's been 125 years of existence, and that sort of longitudinal presence for the protection of patients, for the upholding of the profession, says a lot, and as an older organization as the CMA similarly is, I just want to thank the CMPA for its endurance and its commitment to evolve and be that learning organization.
Because that is the challenge for all of our organizations and I think it's a challenge for us as members to support our organizations to thrive, and to represent, and to be what they need to be, and in your case fulfilling the mandate that I value as an anesthesiologist every day. And you know, the landscape is profoundly changing, and it's come up a number of times when I was reading the Annual Report, I was gleeful to see that AI has been embraced responsibly internally at the CMPA.
As an anesthesiologist, as a physician leader, as an administrator, I think about AI every day now. And I'm just wondering if you can help as a member, help me understand how the CMPA sees its role in evolving how it helps physicians in adopting and integrating AI into practice while navigating the very kind of substrate that is your work, the medico-legal risks that we have to sort of be aware of when we're moving through this. We can't keep up enough and I know the CMA putting that hat on is looking at moving into the policy space of how to articulate that, and I'd like to hear if there's an interest in collaborating as well.
So, thank you.
Dr. Calder: Thank you, Dr. Bernard. I appreciate all the remarks you made, and the question you have is quite timely. You're not the only one feeling like it's hard to keep up with what's happening with AI. It is quite staggering the speed and pace at which it is evolving. We've done quite a bit of work to understand the use cases for AI across the country. And I think my one message to physicians and members is that even if you don't think you're using AI in your practice, there is AI in your practice. It comes in, in somewhat insidious ways at times, and one of our concerns is actually very much around the speed. It is being adopted so quickly, and it is very clear in our engagement with governments and regulators that it's also hard for them to put in the safeguards rapidly enough to protect patient privacy, patient safety, physician decision-making, so many implications.
I would encourage you to check out our white paper on AI and healthcare, which provides actually a hierarchy of risk and our perception of use cases of AI and healthcare. We do not want to stand in the way of adoption of AI and healthcare when it is the right solution for helping improve the safety and quality of care, and I do believe there are some solutions out there that could do that exact thing and there's a huge amount of potential.
However, one of our huge concerns is where does the liability risk fall, and we are not alone in this in Canada. We've had discussions with our international counterparts, and a lot of these tools are being created by very large tech companies. And I can tell you that they do not see the liability falling to them. The liability will likely fall on the shoulders of the physician. And that is a concern for us. We believe our role is to make that very clear that we feel that that is unfair and inappropriate as much as we can. We have had discussions at multiple levels, urging governments and regulators to really think carefully about what safeguards need to be in place. We are aware, for example, of physicians adopting AI solutions without necessarily thinking through privacy implications, data security, the need for informed consent. So there's a huge conversation we could have on this. And to answer your question about collaboration, yes, we're very much interested in collaborating and hearing what other organizations views are on this very timely topic.
Dr. Singh: Microphone 2, Dr. Rinaldi.
Dr. fred Rinaldi: fred Rinaldi, Alberta. Potentially still, until I open my mouth, CMPA Councillor. And I declare that as perceived or potential conflict of interest.
The member spoke about the concerns about the motion that did not come forward, and I heard the CMPA commit to reporting back to this body at the next AGM. And what I'm asking is, because I trust that physicians trust and respect our organization, that is there not a more timely manner that stuff can be brought back to the membership than saving it for another year?
Dr. Singh: Thanks, Dr. Rinaldi. We can take that under advisement and see if there are opportunities to bring information to the membership sooner. Normally, the way it works from the AGM is that we bring it back for the following AGM, so all members have the ability to hear the information and ask questions. But I hear you that, you know, that's quite a long timeframe. So we'll definitely consider that.
Dr. Armand Aalamian: Dr. Singh? We have another question around why are Québec fees so much lower, from Dr. Pravin Batohi.
Dr. Singh: I'll let Lisa answer that?
Dr. Calder: Sorry, I didn't quite hear the question. Armand, can you restate it?
Dr. Aalamian: Why are Québec fees so much lower?
Dr. Calder: OK. So the fees in Québec. So, we build the fees based on the medico-legal risk of the region, and we look at, then, the financial position for that region. And in Québec, the medico-legal experience has been generally very low. The number of civil legal cases in Québec have been infrequent.
However, the amounts that we are seeing in terms of compensation to patients in Québec are starting to go up quite sharply. So, while the fees are low in that region right now, we do have a concern that could change, but it is really based on our examination of the historical medico-legal experience, which is low frequency. And we're keeping a close eye on those changes, but that's why the fees are low in that region.
Dr. Singh: OK. Thank you. We'll take one last question from microphone 2.
Dr. Nicholas Leyland: Hi everybody, my name is Nicholas Leyland and I'm the new President of the SOGC, the Society of Obstetricians and Gynaecologists of Canada.
And a number of our members have asked me just to bring forward the issue of Bill S-228, and for those of you who are not familiar with it, it has received royal assent on June the 15th. And basically, it's to make sure that obstetricians, gynaecologists and other people providing the kind of care for sterilization... It was brought about because, apparently, in parts of Canada, many Indigenous and marginalized people were submitted to forced sterilization without consent. And I understand that completely and was quite shocked to hear that. But the reality of it is, this legislation, actually... the question that the members have is around situations where we're unable to get fully informed consent with emergency surgeries, such as postpartum hemorrhage hysterectomy, that I get called in a lot for as a GYN surgeon, and ectopic pregnancies. How do we convince our membership that they're not at risk of actually receiving up to 14 years in jail for this particular transgression?
Dr. Calder: Thank you, Dr. Leyland. We certainly have been following Bill S-228 very closely, and I'm going to hand it over to Dr. Pamela Eisener-Parsche to answer your specific question.
Dr. Eisener-Parsche: Thank you for your excellent question. As you noted, we too condemn any sorts of hate or racism and anti-Indigenous discrimination in all of its forms and recognize those systemic impacts. This is a piece of legislation that we have followed closely. However, we don't set healthcare policy or laws. We are a mutual medical defense organization.
So our response to this is really looking at what does the legislation imply? What are the concerns about this legislation that we recognize as well and its potential impacts?
So, we're closely monitoring how this will be adopted, and I think our key role will be in supporting members facing any challenges around this, and trying to clarify the legislation as it unfolds over time. And so be prepared to receive the assistance of the Association in a robust fashion in the event that something like this should occur. This is something we're monitoring very closely.
Dr. Singh: So thank you all for your thoughtful questions. Hand it back over to Lisa.
Dr. Calder: So as we near the close of today's meeting, I wanted to take a moment to recognize Birinder. It's his last Annual Meeting as CMPA President. Birinder, over the last 2 years as President, and over the 12 years that you've actually provided service to the Association, you have brought wisdom, steadiness, and deep commitment to the CMPA and its members. Your leadership has helped guide the Association through an important period of modernization and renewal, and that includes the governance transformation you spoke to, the EDI progress that we are working on, and evolving our work in physician wellness, learning, and research.
As you often say, the CMPA of today is not the same as the CMPA of 10 years ago, and your guidance has made that progress possible. You are not afraid to give us feedback that we needed to hear, to help us push us to improve, and I appreciate that. On behalf of management, Council, and the members we serve, thank you. Your contribution has really helped strengthen the Association for the future.
[Applause]
Dr. Singh: Thank you everyone, and thank you Lisa. When I joined CMPA Council, I didn’t plan to serve in a senior governance role or as President. But over time, I saw an opportunity to contribute more fully to an organization that Canadian physicians value so highly. It has truly been one of the greatest honours of my career.
I want to thank Lisa for her incredible work as CEO and being someone with the utmost integrity. I thank the entire management team and all the dedicated employees of the CMPA for everything they do. I also want to thank my Council colleagues. While we may not always agree, we have worked constructively and kept our focus on where it belongs: the needs of our members.
And now it’s my pleasure to welcome our incoming President, Dr. Katy Shufelt, who officially takes on the role tomorrow. Katy is an interventional cardiologist at the Peterborough Regional Health Centre and has served on CMPA Council for the past 9 years. She brings to this role deep clinical expertise, a strong commitment to safe medical care, quality improvement, and physician wellness, and a thoughtful, member-focused approach to governance.
Please join me in welcoming Dr. Katy Shufelt.
[Applause]
Dr. Katy Shufelt: Thank you Birinder, and good afternoon, everyone. It’s an honour to take on the role of President of the CMPA and to serve alongside such a dedicated Council, management team, and community of members. I step into this role with a strong sense of responsibility, to be a thoughtful and prudent steward of the resources entrusted to us by members.
And as we look ahead, CMPA is entering an important period of change, with the implementation of our 2027-2029 Strategic Plan, continued governance transformation, and a rapidly evolving healthcare and medico-legal environment. The CMPA's mission has never been more important. Its unwavering commitment to protect the integrity of Canadian physicians ensures that we can focus on what matters most: caring for our patients. And that commitment will be the foundation and guiding principle of my leadership.
I look forward to working with all of you as we move forward together. Thank you.
[Applause]
Dr. Singh: Thank you, Katy, Lisa, and everyone who joined us today in person and online. This concludes the Annual Meeting. We look forward to seeing you at the 2027 Annual Meeting in Québec City. The meeting is now adjourned. Please just remember to leave your keypads on the table, and we'll see you all next year. Thank you very much.
[Applause]
2025 Summary of CMPA’s financial performance
CMPA has a responsibility to ensure we have the financial strength to support our more than 119,000 physician members and, on their behalf, compensate patients proven to have been harmed by negligent care, today and well into the future. Our financial model is designed to sustain this long-term commitment.
Before I review our 2025 financial performance, I’d like to walk through how the model works.
At its core, the model is made up of several interdependent elements: our net asset position; membership fees; medico-legal costs; liabilities for accumulated outstanding claims; and our investment portfolio. These elements work together to maintain balance over time.
We begin with our net asset position, the difference between what we own, largely our investments, and what we owe, primarily the estimated cost of future and unresolved claims. The net asset position is a key factor when setting membership fees each year.
Membership fees are collected annually to pay for the medico-legal costs of all incidents occurring in that year, even though those incidents may not be reported or resolved for a long time. This includes the costs of compensating patients where harm has been proven by negligent care, on behalf of members.
Those medico-legal costs are shaped by evolving trends, such as increasing case complexity, shifts in claim volumes, and rising costs per case.
These factors inform the level of assets we must hold to meet both existing obligations and accumulated outstanding claims.
The funds collected through membership fees are invested through our portfolio.
Investment income helps us keep membership fees as low as possible and plays an important role in helping ensure we can meet our commitments, not only today, but decades into the future.
There are four key principles that underpin how this model operates:
First: Occurrence-based protection.
Members remain eligible for CMPA assistance indefinitely, even after retirement, as long as they were members at the time the care was provided. This means we must be prepared to respond to claims that may arise many years and even decades later.
Second: Members share the costs of their own medico-legal protection.
Through annual membership fees, members pay the estimated cost of their shared medico-legal protection for that year, ensuring these costs are not passed along to future generations.
Third: Not-for-profit mandate.
As a not-for-profit, our goal is not to generate profit, but to maintain financial stability. We aim to hold sufficient assets to meet our obligations, ensuring we can compensate patients appropriately and support our members.
Fourth: A model that adjusts overtime.
Despite careful forecasting, actual results will differ from estimations. These differences create either surpluses or shortfalls in our net asset position. Since we cannot distribute profits as a not-for-profit, we adjust membership fees over time to maintain balance.
Now that we’ve walked through the fundamentals of our financial model, let’s turn to our financial performance in 2025.
As of December 31, 2025, our net asset position was $1.2 billion dollars, an increase of $17 million from 2024. This growth was driven primarily by strong investment returns, which I’ll speak to in more detail shortly.
Due to our strong net asset position, we have been in a fortunate position over the last several years to provide our members with varying levels of fee reductions.
Between 2021 and 2025, we reduced fees by a total of $858 million dollars. This means that our investment returns have paid $858 million of the cost of medico-legal protection for our members since 2021. In 2025 alone, fee reductions totaled $88.2 million dollars.
For the Ontario and British Columbia/Alberta fee regions, fees were relatively stable in 2025. As these fee regions account for 67% of our membership, the majority of our members experienced stable fees in 2025.
After several years of unprecedentedly low membership fees in Québec, fees increased in 2025 to be more in line with the anticipated medico-legal costs.
Similarly, in Saskatchewan, Manitoba, the Atlantic Provinces and the Territories, fees increased from unprecedentedly low levels, to better align with the anticipated medico-legal costs.
As always, fees were carefully calculated to ensure CMPA will continue to be there for members and their patients as needed. Membership fees fund medico-legal costs, including compensation to patients where harm has been proven by negligent care, as well as legal and expert expenses, safe medical care initiatives, and the operational costs of the Association.
Providing compensation to patients is essential to our role within the Canadian healthcare system, and it is the Association’s single largest expense. In 2025, on behalf of our members, we paid $341 million in compensation to patients.
While the total compensation amount varies from year to year, the CMPA has paid a total of $2.6 billion dollars in patient compensation over the last 10 years.
We plan ahead to ensure we have the financial capacity to meet future obligations, both for patient compensation and physician support.
The liabilities for accumulated outstanding claims represent the total estimated medico-legal costs arising from care provided by members up to and including 2025. For care delivered in 2025, we must ensure that sufficient funds are set aside to cover all associated costs, potentially over the next 4 decades.
As of December 31, 2025, the estimate for all accumulated outstanding claims was $4.5 billion, an increase of $156 million from 2024, based on updated cost-trends.
Compensation to patients accounts for over two-thirds of this $4.5 billion amount, while the remainder is largely legal expenses.
To provide independent and impartial oversight of our actuarial calculations, we engaged Ernst & Young to conduct a peer review. Their analysis closely aligned with our own. This work has subsequently been audited by KPMG as part of the external audit of our financial statements.
We have a diversified investment portfolio, with the objective to match or exceed a 6% investment return over the long term. However, over the past 10 years, we have achieved exceptional returns on our investments, earning a 7.13% compound annual return.
In 2025, the investment portfolio had a net value of $6.0 billion, an increase of $401 million from 2024.
The growth in the net investment portfolio over 2024 levels was due to an overall increase in financial markets, earning an investment return of 5.74%.
Our solid financial position will help us navigate market volatility and fluctuations in medico-legal case volumes and costs.
We remain committed to prudently investing and maintaining a financial foundation that ensures timely and appropriate compensation to patients on behalf of our members, protection and support to physicians, and safe medical care initiatives to support patient safety in Canada.
As I conclude my financial update, I’ll leave you with 3 key takeaways:
First, our occurrence-based protection means we operate with a long-term financial horizon, ensuring we can support members and compensate patients not only today, but well into the future.
Second, adjustments to membership fees remain our primary tool for maintaining a balanced net asset position.
Finally, our positive net asset position in 2025 reflects a strong financial foundation and provides confidence that we will be there for members and their patients when needed.
Thank you.
2027 CMPA Regional fees
Each year, we set fees with two goals in mind: ensuring CMPA remains financially strong and keeping member fees as low as possible.
The fees collected in any given year are used to pay the estimated medico-legal costs arising from that same year.
These costs can unfold over the next four decades and include future compensation to patients and the cost of expert assistance to members when they need us.
So, when we set fees, we’re making sure we can support members today and decades into the future.
Before we look at the 2027 numbers, it’s helpful to understand how fees are equitably organized across the country.
CMPA has four financially independent fee regions, reflecting differences in medico-legal costs across Canada. Those costs vary based on factors such as the number and severity of cases and the number of physicians practicing in a region. Because each region is independent, there is no subsidization between them.
The four fee regions are: British Columbia and Alberta, Ontario, Quebec, Saskatchewan, Manitoba, Atlantic provinces, and the Territories.
The average member fee is an illustrative number, not an actual fee paid by a member. It’s calculated by dividing the total regional fee by the number of members in that region.
Actual membership fees are then set by specialty or type of work.
We know fee changes can concern members, so we take a careful, long-term approach to fee setting. When the CMPA is in a strong financial position, fee credits can help reduce
what members pay.
Since 2020, we have provided more than $1 billion dollars in fee credits, largely because of strong investment performance. In 2023 alone, we provided over $362 million in fee credits, effectively reducing member fees by 45 to 90%, depending on the region.
More broadly, our investment returns have helped offset a significant portion of our members’ cost of protection, therefore avoiding steep fee increases across the country in the face of higher medico-legal costs.
While members pay their CMPA fees directly, provincial and territorial governments
and medical associations or federations have negotiated reimbursement agreements to help offset some of those costs. CMPA is not part of those negotiations.
Overall, despite recent relative increases in some regions, average member fees in 2027 remain below pre-pandemic levels. That reflects strong investment outcomes and CMPA’s overall financial strength.
Now let’s look at what this means for each fee region in 2027, starting with British Columbia and Alberta.
Medico-legal costs in this region continue to rise, but because this region remains financially strong, we can apply fee credits, keeping member fees largely stable, with only very minimal increases for some physicians.
The average member fee is $5,325, still below the 2020 pre-pandemic average of $5,513.
Ontario remains the costliest region for medico-legal protection, which is reflected in higher fees.
A strong current and projected financial position in Ontario means we can continue to offer fee credits. The average member fee will decrease by 7.5% to $6,068, following a 10% decrease in 2026.
Compared with the 2020 pre-pandemic average of $8,187, the 2027 average member fee
is 26% lower.
In Québec, the region remains in a strong financial position, while medico-legal costs are expected to continue increasing.
In 2027, Québec’s average member fee will rise by 15% to $515.
Even with this increase, Québec’s fees remain the lowest in the country and are 56% below the 2020 pre-pandemic average of $1,158.
As medico-legal costs continue to rise, future increases may be needed to keep fees aligned with costs in this region.
Finally, in Saskatchewan, Manitoba, the Atlantic provinces and the Territories, fees will increase in 2027, so that they are better aligned with projected medico-legal costs.
The average member fee will increase by 12.5% to $1,917 but remains 54% below the 2020 pre-pandemic average of $4,148.
Here is an overview of recent average fees per member by region.
As you can see, fees in all regions remain below their pre-pandemic levels, even where 2027 fees are increasing.
All 2027 membership fees are now available on our website. Members will also receive an email in the fall when annual invoices are available in the member portal, as part of the Annual Membership Review.
Looking ahead, the CMPA’s strong financial position means we are well placed to continue supporting members and compensating patients proven to have been harmed by negligent care, now and well into the future.
Thank you.
Recognizing Dr. Birinder Singh, outgoing President
Dr. Lisa Calder: So as we near the close of today's meeting, I wanted to take a moment to recognize Birinder. It's his last Annual Meeting as CMPA President. Birinder, over the last 2 years as President, and over the 12 years that you've actually provided service to the Association, you have brought wisdom, steadiness, and deep commitment to the CMPA and its members. Your leadership has helped guide the Association through an important period of modernization and renewal, and that includes the governance transformation you spoke to, the EDI progress that we are working on, and evolving our work in physician wellness, learning, and research.
As you often say, the CMPA of today is not the same as the CMPA of 10 years ago, and your guidance has made that progress possible. You are not afraid to give us feedback that we needed to hear, to help us push us to improve, and I appreciate that. On behalf of management, Council, and the members we serve, thank you. Your contribution has really helped strengthen the Association for the future.
[Applause]
Dr. Birinder Singh: Thank you everyone, and thank you Lisa. When I joined CMPA Council, I didn’t plan to serve in a senior governance role or as President. But over time, I saw an opportunity to contribute more fully to an organization that Canadian physicians value so highly. It has truly been one of the greatest honours of my career.
I want to thank Lisa for her incredible work as CEO and being someone with the utmost integrity. I thank the entire management team and all the dedicated employees of the CMPA for everything they do. I also want to thank my Council colleagues. While we may not always agree, we have worked constructively and kept our focus on where it belongs: the needs of our members.
Welcoming Dr. Katy Shufelt, incoming President
Dr. Birinder Singh: And now it’s my pleasure to welcome our incoming President, Dr. Katy Shufelt, who officially takes on the role tomorrow. Katy is an interventional cardiologist at the Peterborough Regional Health Centre and has served on CMPA Council for the past 9 years. She brings to this role deep clinical expertise, a strong commitment to safe medical care, quality improvement, and physician wellness, and a thoughtful, member-focused approach to governance.
Please join me in welcoming Dr. Katy Shufelt.
[Applause]
Dr. Katy Shufelt: Thank you Birinder, and good afternoon, everyone. It’s an honour to take on the role of President of the CMPA and to serve alongside such a dedicated Council, management team, and community of members. I step into this role with a strong sense of responsibility, to be a thoughtful and prudent steward of the resources entrusted to us by members.
And as we look ahead, CMPA is entering an important period of change, with the implementation of our 2027-2029 Strategic Plan, continued governance transformation, and a rapidly evolving healthcare and medico-legal environment. The CMPA's mission has never been more important. Its unwavering commitment to protect the integrity of Canadian physicians ensures that we can focus on what matters most: caring for our patients. And that commitment will be the foundation and guiding principle of my leadership.
I look forward to working with all of you as we move forward together. Thank you.
[Applause]
