Minutes of the 2020 CMPA Annual Meeting [Draft]

Virtual participation—August 24, 2020

The 2020 annual meeting of the Canadian Medical Protective Association (CMPA) was held, starting at 1:00 p.m. on Monday, August 24th, 2020, via videoconference. The meeting was conducted in English and in French and simultaneous interpretation was available for all attendees. The meeting was recorded as a webcast and will be available through the annual meeting page of the CMPA website. There were an estimated 252 physician-members present, as well as a further 123 non-member attendees.

Introduction

The President, Dr. Debra Boyce from Peterborough, Ontario, acknowledged that the land on which the CMPA’s offices are located in Ottawa, is the unceded, unsurrendered Territory of the Anishinabe Algonquin Nation whose presence reaches back to time immemorial. She further noted that the CMPA respects and affirms the inherent and Treaty Rights of all Indigenous Peoples across this land, and that the Council has and will continue to honour the commitments to self-determination and sovereignty, which have been made to Indigenous Nations and Peoples.

Dr. Boyce acknowledged the tragic death of Dr. Walter Reynolds in his Red Deer, Alberta clinic and extended, on behalf of the CMPA, sincere condolences to his family, colleagues, patients, and the citizens of Red Deer. She reminded members that the Association’s Physician Advisors are available to discuss safety concerns in medical practices.

The President welcomed attendees to the first CMPA annual meeting held in virtual format, a benefit of which is that it reached so many members across Canada. She noted that those joining from the CMPA offices were abiding by physical distancing guidelines, and explained how attendees could access supporting materials, technical support, and the language of their preference. Having indicated any additional business and questions should be raised for discussion during the other business section of the meeting, she reminded the participants that only members were permitted to ask questions, raise issues or vote.

Dr. Boyce introduced certain of her colleagues, several of whom would be presenting during the meeting:

  • Dr. Michael T. Cohen of Grand Falls-Windsor, Newfoundland, Incoming President and 1st Vice-President
  • Dr. Darcy E. Johnson, Council member and Chair of the Audit Committee
  • Dr. E. Douglas Bell, Acting Executive Director/Chief Executive Officer (CEO)
  • Dr. Lisa Calder, Incoming Executive Director/Chief Executive Officer (CEO)
  • Dr. W. Todd Watkins, Acting Associate Executive Director and Managing Director, Enterprise Services
  • Mr. Cory Garbolinsky, Acting Chief Financial Officer (CFO)
  • Dr. Pamela Eisener-Parsche, Acting Managing Director, Physician Services
  • Mr. Domenic Crolla of Gowling WLG, General Counsel

The President acknowledged the presence of four past presidents, Drs. Jean-Joseph Condé, Edward Crosby, Peter Fraser, and Michael Lawrence, as well as past Executive Director and CEO, Dr. John Gray. She then recognized the current and newly elected CMPA Councillors.

Dr. Boyce noted the business portion of the meeting would be followed by a virtual information session on Virtual Care in Canada: Lessons from the COVID-19 Pandemic. Stressing the value of feedback, she asked participants to evaluate both the business meeting and the information session, noting a survey link will be shared with all attendees at the end of the meeting.

Call to order

Dr. Bell, Acting Executive Director/CEO, read the notice of the 2020 annual meeting of the Canadian Medical Protective Association and declared the meeting to be duly constituted.

Appointment of scrutineers

The President indicated Drs. Edward Crosby of Ottawa, Ontario, Louis Godin of Westmount, Québec, and Barbara Kane of Prince George, British Columbia were prepared to act as scrutineers in the event a vote should be required. Dr. Edward Crosby was also prepared to act as lead scrutineer and provide a report should confirmation of the results of a vote be requested. Absent any opposition, the President identified the membership’s consensus to accept the proposed scrutineers.

Approval of the Minutes of the 2019 CMPA Annual Meeting

The minutes of the 2019 annual meeting held in Toronto, Ontario had been posted on the CMPA website.

A motion to approve the minutes of the 2019 annual meeting held in Toronto, Ontario was moved by Dr. Birinder Singh, seconded by Dr. Jennifer Gillis-Doyle, and carried.

President and CEO’s Report

Dr. Boyce referred to the past year as an unprecedented and unimaginable experience for all, a time that has been more turbulent and created more uncertainty then any period in recent history. As a physician and President of the CMPA, she expressed pride with respect to how the profession and healthcare system has responded to this crisis in Canada, and how the Association has rapidly adapted to support member efforts.

The environment

The President spoke of recent conversations with CMPA members, during which Physician Advisors have heard the angst and uncertainty related to personal protective equipment shortages, the possibility of allocating scarce ventilators or intensive care unit beds, the backlog of cancer treatments and delayed or deferred care that was deemed non-essential. Members are also grappling with changes to their scopes of practice, rapid adoption of virtual care, and financial pressures, to name a few. The heroic collective response to the COVID-19 pandemic has come at a price for the health and well-being of physician colleagues. Through it all, the Association has continued to navigate great uncertainty and adapted to do its part by answering members’ questions, providing medical-legal advice, and guiding physicians with compassionate peer support and just-in-time virtual education.

Evolving support to meet members’ changing needs

Dr. Boyce noted the CMPA has continued to deliver on its core mission and strategic plan throughout this period of unusual times. While medicine has looked different this past year, the Association’s core purpose has remained unchanged. Its plan to enhance the medical-legal and educational services provided to members continues to guide its work, and its focus on sustainability and adaptability continues to ensure it is there for members for another 100 years. The afternoon’s education session on virtual care is just one example of its forward looking approach and, while members are adapting to serve the needs of their patients and profession, the CMPA is adapting to serve physicians in today’s virtual climate.

2019 accomplishments

Dr. Boyce noted that in 2019, the CMPA had over 70,400 contacts with members on medical-legal issues, and another 22,900 on specific medical-legal matters in which advice and empathetic support was provided. The Association opened over 850 cases that involved civil litigation, 2,100 cases involving hospital privileges and complaints and 4,800 new College matters.

The CMPA launched the Member Support Program in 2017 to provide tailored advice and assistance to the small percentage of physicians who find themselves in a situation where their medical-legal experience threatens their ability to continue to practise. The peer-to-peer support offered by the program, and the renewed perspectives these members have gained, are leading to stress reduction, increased professional fulfillment, and enhanced understanding and application of safe care practices.

Enhancing safe medical care

The President cited the following examples of the CMPA’s contribution to enhancing safe medical care:

  • In 2019, the Association launched an innovative education program, “Theatre Arts,” to guide physicians and their perioperative teams to develop solutions aimed at improving the operating room environment and promoting safe surgical care. The resident symposium was delivered in 11 medical schools, equipping more than 1,700 residents with the knowledge to improve safety and reduce patient harm throughout their careers. 
  • In addition, the CMPA’s subsidiary, Saegis, delivered a one-of-a-kind, intensive interpersonal skills and training program. The Clinical Communication Program promotes effective communication and safer interactions with colleagues, teams, and patients. Saegis provides safety programs and practice management solutions to all healthcare professionals, teams, hospitals, and clinics.
  • The Association will continue to seek ways to adapt its education services, including a focus on delivering virtual education in response to the COVID-19 pandemic, to help members deliver the safest care possible across the healthcare system.

Focusing on physician wellness

Dr. Boyce reported, each day, the CMPA hears from physicians who are struggling with their wellbeing. A medical-legal event can be a stressful and potentially devastating time in a physician’s life and, when compounded by a global pandemic, many members struggle with their health and wellness. Self-reported member stress levels drop by an average of 33% after speaking to the CMPA; its Physician Advisors provide an empathetic ear and understand the challenges members are facing.

The Association recently strengthened its focus on physician wellness and invested in its capacity to identify and support physicians in need. Both its Physician Advisors and CMPA appointed legal counsel were trained to better identify members at risk and provide said members with crucial help. The physician wellness section of the Association’s website has been improved and updated to include the provision of COVID-19 specific resources. The CMPA continues to advocate for programs to support the wellness of its members and the call to action made during the 2017 annual meeting education session to other Canadian organizations to determine their part in fostering the “quadruple aims and physician wellness”.

Supporting members through COVID-19 and beyond

Dr. Bell, Acting Executive Director/Chief Executive Officer (CEO), reported the medical liability protection and support needs of physicians are changing. All areas of the healthcare system are experiencing significant stress that is increased by COVID-19. In recent months, the CMPA has been adapting its services to proactively respond to this new environment and empower better healthcare across all levels of the system. Dr. Bell cited the following examples of its focus on removing barriers to practice:

  • Membership processes have been simplified for members returning from retirement or seeking to change scope of practice during the pandemic, and for senior residents who are being granted temporary independent licenses.
  • The Association has been proactively communicating with Colleges and provincial and territorial medical associations to address concerns and reduce the potential for future medical-legal events created by members having to modify their scopes of work throughout the pandemic. The willingness of all parties to engage in these discussions is appreciated.
  • As an official observer organization of the Canadian Medical Forum (CMF), the CMPA has actively supported the joint CMF statement urging governments and public health agencies to mobilize Canadian production of personal protective equipment during COVID-19, and to develop standardized recommendations for use and advice on reprocessing.
  • To ensure physicians across the healthcare system have the information and advice required to navigate the pandemic so as to continue to deliver the safest and most effective care possible, the COVID-19 Hub was developed for the CMPA’s website. It contains frequently asked questions and key COVID-19 specific resources focusing on virtual care, ethical dilemmas and personal protective equipment.
  • As with the afternoon’s education session, the Association has proactively focused on delivering education to its members virtually and developed a number of associated products on the physician-related impacts of COVID-19, to include podcasts, digital articles and micro-learnings. Saegis is also continuing to provide healthcare leaders, practitioners and their teams with accredited, online learning. Said offerings include the COVID-19 Healthcare Cybersecurity eLearning course and the Just Culture in Healthcare program. The CMPA will continue including virtual learning as part of its broader strategy going forward.

The President added that, to further support members through COVID-19 and beyond, the Association explored every practical opportunity to offer financial relief to members this year. As a result of its prudent investment management, it closed 2019 in a strong financial position, which has allowed the CMPA to support members with aggregate fee reductions across all four regions in 2021. Aggregate fees will be reduced by 15% in British Columbia and Alberta, 10% in Ontario, 17.3% in Québec, and 15% in Saskatchewan, Manitoba, the Atlantic Provinces and the Territories. Moving forward, the Association will continue to ensure it maintains sufficient funds to compensate patients and is able to weather changes in medical-legal trends that may come. It will be ready to protect and assist physicians and support safe medical care across the healthcare system now and in the uncertain years ahead.

2019 Report of the Audit Committee

Dr. Darcy E. Johnson, Chair of the Audit Committee, reported that the firm of KPMG audited the CMPA 2019 financial statements and, in an unmodified opinion, attested the statements appropriately present the results of operations in 2019 and the financial position of the Association as at December 31st, 2019. The 2019 financial statements were available on the Association’s website.

2019 Financial Report

Mr. Cory Garbolinsky, Acting Chief Financial Officer (CFO), referred meeting attendees to the summary of the 2019 Consolidated Financial Statements in the CMPA 2019 Annual Report, as well as the audited statements, both of which were available on the Association’s website.

The Acting CFO noted the CMPA is a not-for-profit organization and does not seek to generate a profit or pay dividends to members. Its goal, over the longer term, is to maintain a fully funded position in which at least one dollar of assets is held towards an expected discounted liability. The Association provides occurrence-based protection that extends from the date care was provided, irrespective of when a claim is made. Given a claim may be initiated many years after the care was delivered, the CMPA must estimate the expected costs of a single year, recognizing these costs may not be fully known or paid for 35 years or more.

Membership revenues

Mr. Garbolinsky noted, in 2019, more than 100,000 physicians looked to the CMPA for their medical liability protection. Estimated payments for the ultimate cost of providing protection for occurrences arising in the 2019 membership year are expected to be made over the next 35 years or more. The total estimated cost of protection for each occurrence year should generally be paid by the members of the Association practising during that year.

In summarizing the membership fee calculations, the Acting CFO reported the estimated liabilities of two fee regions exceeded estimated net assets and, to address this situation, the Association applied a fee debit to the 2019 fees in the Ontario and the British Columbia and Alberta fee regions. Conversely, the Québec and the Saskatchewan, Manitoba, Atlantic provinces and territories regions were in a positive position, enabling the CMPA to reduce the fees otherwise collectible in those regions. The net result was a fee credit of $27 million, producing an estimate of the fees the CMPA expected to collect of $596 million. He demonstrated the relationship, over the preceding ten years, between the expected occurrence year costs and the membership revenue, with the difference being the adjustments to reflect the financial position.

Investment returns

Mr. Garbolinsky provided a graphical depiction of the cumulative hypothetical return on the CMPA’s investment portfolio using its 5.5% assumed investment return over the past 10 years, and of the cumulative actual return earned. He noted the CMPA has outperformed the assumed actuarial return by approximately $860 million over the last 10 years, fueling growth in its net asset position. The Association’s 2019 investment return was 11.3% with net investment income of $580 million.

Protection costs

Turning to the 2019 protection year costs, the Acting CFO reported, at $223 million, the compensation paid to patients on behalf of members is $37 million lower than 2018 and slightly lower than the linear trend line. The Acting CFO highlighted trends in the expenditures and identified the cost differential in payments between regions, which is reflected in CMPA membership fees.

Mr. Garbolinsky identified a 14% increase in legal civil expenses in 2019 due to an increase in trial activity and in the complexity of a select number of cases in the Ontario and the British Columbia and Alberta regions. He also indicated, while the costs of providing support to members involved with College, hospital and other matters saw significant increases between 2010 and 2013, these have levelled off in the past few years.

Provision for unpaid claims

The Acting CFO explained, at the end of 2018, the CMPA’s estimate of the liability from unpaid claims resulting from medical care provided by members, in the years leading up to and including 2018, was $3.769 billion. Having taken into account both payments made in 2019 and the estimated costs of providing protection for care delivered in 2019, and then re-assessing the valuation of those claims to apply the most current trends, the provision for unpaid claims, as at December 31st, 2019, was $3.860 billion. This provision for unpaid claims is subject to a peer review by Ernst and Young and is also audited as part of the external audit by KPMG, the CMPA’s external auditors.

Overall financial position

Mr. Garbolinsky reported, at the end of 2019, the CMPA’s total assets stood at 128% of the total estimated liabilities, resulting in a temporary excess of net assets of $1.18 billion, a marked improvement from the end 2014 position of a temporary deficit of net assets of $360 million.

The Acting CFO stated the Association takes a long term approach to the management of its financial position and recognizes that, in light of the year-over-year volatility and the estimated costs being paid out over a lengthy period of time, a long-term view that does not overreact to temporary excesses or deficits of net assets is required. He also believed the current strong financial position will allow the CMPA to weather any investment portfolio challenges associated with the COVID-19 pandemic disruption to the financial markets, and to provide fee credits to its members in all regions.

2021 aggregate fees by region

The Acting Executive Director/CEO commenced the presentation of the 2021 aggregate fee requirement by explaining a CMPA member can look to the Association for medical-legal assistance regarding an occurrence that took place while he/she was a member, regardless of when the medical-legal issue arose. As a consequence of this occurrence-based protection and of the CMPA’s commitment to maintain a fully funded position, membership fees levied in a given year are intended to cover the ultimate cost of all assistance provided to members arising from care in that year. As fees are set in advance of the occurrence year and many years before the ultimate costs of an occurrence year are known, the Association makes use of actuarial models to determine the best estimate of what these costs might be.

Dr. Bell indicated, recognizing there are different medical liability protection cost structures across the country and with a view to an equitable allocation of costs, the CMPA employs four fee regions. There is no subsidization or cross-assignment of costs between regions. Upon determining member fees, the Association calculates the aggregate fee for the region first and uses this as the foundation to determine regional fees based on members’ type of work. Recognizing the financial strain of COVID-19 on members, the CMPA aimed to reduce 2021 fees across all regions. Dr. Bell clarified that, while fees are being reduced across all regions, an expected membership growth from 2020 to 2021 makes it so the aggregate fee reduction on a per member basis is larger.

Summarizing the projected slides depicting current year costs and fees, the Acting Executive Director/CEO proceeded with a review of the 2020 aggregate fee requirement for each of the four regions.

2021 aggregate fee requirement for the British Columbia and Alberta region

The forecast cost of providing protection in British Columbia and Alberta in 2021 is less than in 2020. The 2021 aggregate fee will be, on a per member basis, approximately 16.7% lower than 2020.

2021 aggregate fee requirement for the Ontario region

The cost of providing medical liability protection in 2021, which is greater in Ontario than in any other region, is forecast to be lower than in 2020. For the second year in a row, the CMPA has seen a decrease in the estimated protection cost for this region. Given the region is also in an improved financial position, the CMPA will be applying a fee credit to the 2021 estimated costs of protection compared to a fee debit added to the costs of protection in 2020. The change results in an approximately 11.7% lower aggregate fee in 2021 compared to 2020. This represents a marked decrease over the past five years. 

2021 aggregate fee requirement for the Québec region

For a number of years, the costs of providing medical liability protection in Québec have not experienced the same level of year-over-year variance and have grown at a slower rate than in other parts of the country. This has enhanced fee predictability. Lower payments and better than forecast investment returns have contributed to a positive funding position in Québec, enabling the CMPA to reduce its fees through the use of fee credits. As a result, the 2021 aggregate fee will be, on a per member basis, approximately 19.3% lower than in 2020. The measured reduction of the net assets has been discussed with the Fédération des médecins omnipraticiens du Québec (FMOQ), the Fédération des médecins spécialistes du Québec (FMSQ) and the Ministère de la Santé et des Services sociaux (MSSS). The CMPA is grateful for their support for the adopted approach.

2021 aggregate fee requirement for the Saskatchewan, Manitoba, Atlantic Provinces and the Territories region

The region’s 2021 estimated cost of medical liability protection has remained generally stable, declining slightly on a per member basis. Given the region is in a positive funding position, for the 2021 fees, a fee credit has been assigned to produce an overall per member decrease of 15.6% over 2020.

2021 type of work (TOW) fees

Dr. Bell reported the CMPA allocates type of work fees, on a relative risk basis, within each region, with higher risk types of practice paying more than lower risk practices. The 2021 fee schedule was available on the Association’s website. Members’ individual fee invoices will be available online through the secure member portal on the CMPA website in the fall. Members will be provided with an email notification at that time.

2020 Council election results

The Acting Executive Director/CEO announced, each year, approximately one-third of CMPA Council positions are scheduled for nomination and election. Any CMPA member in an Area and Division with positions scheduled for nomination and election may seek nomination. This year, voting occurred for seven Council positions in five areas. Following a robust call for nominees, the CMPA Nominating Committee and the CMPA membership recommended 21 candidates with diverse backgrounds and experience to take part in the election. The results are as follows:

  • Area 1 (British Columbia and Yukon) (1 position in Division B1)
    • Dr. Victor Huckell, in cardiology, was re-elected.
  • Area 2 (Alberta) (1 position in Division A1 and 1 position in Division A or B)
    • Dr. Fredrykka Rinaldi, in family medicine, was acclaimed.
    • Dr. Wayne Rosen, in general and colorectal surgery, was elected.
  • Area 5 (Ontario) (2 positions in Division A and 1 position in Division B)
    • Dr. Debra Boyce, in family medicine, was re-elected.
    • Dr. Birinder Singh, in family medicine, was re-elected.
    • Dr. Katy Shufelt, in interventional cardiology, was re-elected.
  • Area 6 (Québec) (1 position in Division A and 1 position in Division B)
    • Dr. François Mercier, in family medicine, was acclaimed.
    • Dr. Claude Mercier, in pediatric neurosurgery, was re-elected.
  • Area 8 (Nova Scotia) (1 position in Division A or B)
    • Dr. Alfred Bent, in obstetrics and gynecology, was elected.
  • Area 9 (Prince Edward Island) (1 position in Division A or B)
    • Dr. Patrick Bergin, in general internal medicine, was acclaimed.

Dr. Bell extended thanks to all of the candidates in the 2020 election for their dedication and commitment to participating in the governance of the Association. Speaking to Council renewal, he acknowledged the retirements of Drs. Steven Edworthy and Sally Jorgensen after six years, and of Dr. Yolande Leduc after nine years. He thanked them for their commitment to the Association and to its members during their tenure as CMPA Councillors. He announced that the CMPA would continue to seek, value, and support diversity and lived experience across its Council and noted that, in the 2021 election cycle, members engaged in a residency program in Canada will be eligible to run for CMPA Council election.

Other business and questions

The President welcomed members to pose questions or share comments. Given the virtual format of the meeting, she delegated electronic receipt of the questions to the Acting Associate Executive Director and the Acting Managing Director, Physician Services. Like-minded comments or questions were grouped for efficiency of response following their having been put forward by the following members:

  • Aline Levi, a pediatrician from Dollard-des-Ormeaux, Québec
  • Tarek Khalil, a family physician from Coquitlam, British Columbia
  • Diane Francoeur, an obstetrician from Mont-Royal, Québec
  • Randall W. Sargent, a family physician from Canmore, Alberta
  • Katherine J. Aitchison, a psychiatrist from Edmonton, Alberta
  • George D. Carson, an obstetrician from Regina, Saskatchewan
  • Christian Farah, an anesthesiologist from Nepean, Ontario
  • Carole L. Williams, a family physician from Duncan, British Columbia
  • Clover A. Hemans, a family physician from Burlington, Ontario

The first question posed related to the tragic death earlier this month of Dr. Walter Reynolds and what members may expect upon calling the CMPA to discuss safety concerns. The Acting Managing Director of Physician Services reassured meeting participants of the confidentiality of conversations with Physician Advisors, the primary focus of which is to support and listen to the concerns of members to provide guidance and advice on how to work through the matter discussed. Said guidance may include how to implement an office safety plan, how to safely terminate a doctor-patient relationship, how to raise concerns within a medical institution, or how to manage a situation in which one feels abused, either by a colleague, patient or someone outside healthcare. If necessary, the Association may request legal counsel to assist a member in filing a report to police so as to ensure it balances the physician’s obligations to patient confidentiality and the physician’s safety.

To a request for clarification regarding the distinction between the role of Saegis and the CMPA's offerings, the President recalled the subsidiary having been created in 2017 to extend the Association’s reach, as well as its capacity to assist members with education. While CMPA education programs primarily target physician members, the creation of a wholly-owned subsidiary expanded the ability to include other members of the healthcare team in the delivery of educational and business practice services. The Chair of the Saegis Board of Directors indicated the subsidiary now has a number of programs available to members, such as Clinical Communication Programs, Strategies for Managing Unprofessional Behavior, and Just Culture in Healthcare, which has been very successful. Saegis is poised for greater success.

In explaining the CMPA’s decision not to provide a fee rebate this year to address the strain of COVID-19 on its members, the President indicated, while the financial issues associated with the pandemic in Canada came to light in March, the CMPA’s 2020 fees had been determined the previous year. The reimbursement arrangements vary widely across the provinces and, given they are negotiated and implemented by the provincial and territorial medical associations and governments, the CMPA does not take part in associated discussions. These and other challenges, such as concerns around its not-for-profit status, made it difficult to determine an option that would be fair and equitable to all members across the country. The Acting Executive Director/CEO added, because 2020 brought a state of flux and an inability to predict the medical liability consequences of the pandemic, the Association wanted to ensure it remained in a position to address members’ unanticipated future needs. As the market corrected somewhat after the initial drop and the effects of the pandemic became clearer, the CMPA focused its efforts on reducing the members’ 2021 fees.

Having received a request for comment on the effect of government changes in Alberta on the reimbursement of CMPA fees, Dr. Bell recalled that, in April 2020, the Alberta Ministry of Health unilaterally broke its agreement with physicians in the province, reduced a number of fees and decreased its contribution to the reimbursement program. Alberta Health assumed management of the reimbursement program and twice requested the CMPA extend its deadline for collection of membership fees for those physicians partaking in the early reimbursement program. Following a number of subsequent amendments to the Alberta reimbursement program, and an attempt to address a privacy issue associated with members forwarding financial information over unsecure internet to register for said program, the associated CMPA fees are now scheduled for collection September 1st, which should allow the Alberta members to transfer their private banking information to the government in time to receive the reimbursement.

The Association was asked why its fees in Québec remain stable while those in British Columbia have quadrupled, and why the fee reductions in Québec are larger than in other jurisdictions across the country. The President explained the variances in member experience impact the fees in specific regions to create said differences. The Acting CEO added the modelling projections for Québec turned out to be higher than their actual experience, which led to a temporary excess of net assets in the province that was compounded by the improved investment returns of 2019 and resulted in a large fee credit. Dr. Bell reiterated that the CMPA enjoys a relationship with the Fédération des médecins omnipraticiens du Québec (FMOQ), the Fédération des médecins spécialistes du Québec (FMSQ) and the Ministère de la Santé et des Services sociaux (MSSS), in terms of how it allocates the additional fee credits due to the temporary excess of net assets. The Association is grateful for this cooperation and for the efforts to maintain a reasonably stable fee structure in Québec.

The CMPA’s presentation of estimated 2019 protection costs over the next 40 years showed a peak in 2025. In response to a question as to whether peaks of occurrence year costs generally occur five years later, the Acting CFO explained that it traditionally takes between four and seven years for any of the larger settlements to be disbursed for a case, which is why the graphical depiction shows the highest payments for the 2019 occurrence year are felt within the 2023 to 2027 range.

To an inquiry as to when the slide deck for this meeting would be available to the public, Dr. Boyce announced it would be posted on the Association’s website within 24 hours.

Questions were posed regarding the relationship between the CMPA’s case experience and the continuing medical education developed by planners, special societies and medical schools. The Acting CEO responded that the Association’s Medical Care Analytics department studies its medical legal and College cases to identify themes based on different types of work. Associated data is collected and analyzed to inform the development of the CMPA’s educational products, and is occasionally shared with members who request specific information (e.g. grand rounds, surgical fires, etc.). The Association has also worked with members who have requested data to have associated findings published.

In explaining the difference between the roles of the CMPA’s President and its Executive Director/CEO, Dr. Bell noted the importance of having a good working relationship between the Executive Director/CEO, who acts as the executive officer of the corporation, and the President, who acts as Chair of the Association’s Council or governing body, otherwise known as a Board of Directors. Each year, Council approves an Operational Plan and Budget that is proposed by management, then holds management accountable to deliver what was proposed by ensuring the issues of importance and risks identified are being addressed.

Inquiries were received about the CMPA’s approach to diversity as an organization. The Acting Executive Director/CEO noted work is underway to promote diversity among CMPA Councillors via the nomination process and a People Strategy will seek to enhance diversity, equity and inclusion for the Association’s 450 employees. While the CMPA’s incoming CEO, 13 of its Directors and half of its Executive Leadership Team are women, the Association aims to also work on elements of diversity in addition to gender balance. Recognizing allegations of discrimination and systemic racism and the situations in which physicians may find themselves cover all manner of medical legal issues, the Managing Director of Physician Services indicated an in-depth examination is occurring with respect to how assistance is provided. Upon a member being faced with a medical-legal threat associated with systemic racism or discrimination, the Association is considering other ways it can provide assistance. Physician Advisors are being trained on appropriate cultural sensitivity, and to consider the unconscious bias that may exist in their internal decision making regarding member assistance. This multi-pronged approach will require ongoing engagement and discussion.

The Acting Associate Executive Director reported congratulations were received for Dr. Boyce, the first woman President of the CMPA, on a tremendous year in the role during a very difficult time. He spoke of also having received questions regarding medical-legal matters that relate specifically to an individual member’s experience. He encouraged said members to call the CMPA directly for an appropriate response.

Remarks from incoming CEO

The President introduced Dr. Lisa Calder, who was chosen as the CMPA’s next CEO following an extensive international search with preeminent candidates from all areas of healthcare. Since graduating from emergency medicine at the University of Ottawa, Dr. Calder has steadily honed her knowledge and leadership skills. She obtained a Master of Science in Epidemiology, completed fellowships in patient safety and leadership, served as an award winning Associate Professor, practised emergency medicine, and joined the CMPA as the Director of Medical Care Analytics. Fully bilingual, she recognizes the diverse and dynamic needs of members and stakeholders across the country, and is committed to improving healthcare for Canadian physicians and patients. She is highly connected to the physician community and has a deep understanding of the opportunities and risks facing the CMPA, its members, and the healthcare system as a whole. With her steady hand, eye to the future, close connections to the physician community, and authentic and collaborative leadership style, Dr. Calder will further strengthen the CMPA’s mission of protecting the professional integrity of physicians and promoting safe medical care in Canada now and for years to come.

The incoming Executive Director/Chief Executive Officer (CEO) shared three main ideas with members: we are here for you; we are going to modernize the CMPA; and, we're going to do it in a collaborative way.

Dr. Calder thanked the Association’s members for their leadership, service, and compassionate care towards patients during these exceptional times. She acknowledged the challenges physicians have been facing and those who have called for advice, used the Association’s medical-legal services, or engaged with its educational products. She committed to continued service excellence in providing medical-legal assistance, to strengthening the CMPA’s contributions to enhancing the system and to providing members with the tools required to improve the quality of care for patients and reduce medical-legal risk.

The incoming CEO reported, since the beginning of the pandemic, the CMPA has been agile and responsive, and will continue to evolve and modernize its services so that members feel well supported. To do so and to navigate the challenges ahead, collaboration will be required with the membership and healthcare organizations across the country. She expressed confidence in the deep talent and broad skill set held at the CMPA to protect the professional integrity of physicians and promote the safety of medical care in Canada. Dr. Calder noted she looked forward to leading this organization into the future.

Remarks from incoming President

The President also introduced Dr. Michael Cohen, a talented physician and skilled leader who will assume the role of CMPA President immediately following the annual meeting. Dr. Cohen practises family medicine in Grand Falls-Windsor, Newfoundland and Labrador. He graduated from Memorial University of Newfoundland with a Bachelor of Medical Sciences and a Doctor of Medicine. Since 1980, he has been on active staff at the Central Newfoundland Regional Health Centre, where he served as President and Chief of Staff for ten years. Throughout his medical career, Dr. Cohen has served as Past President of the Newfoundland and Labrador Medical Association, as Past Chair of the Canadian Medical Association’s committee on healthcare and promotion, and was a founding member of the Atlantic Provinces Medical Peer Review program. Since being elected to CMPA Council in 2000, Dr. Cohen has been a strong advocate for protecting physician integrity and for enhancing safe medical care.

Dr. Cohen indicated he was honoured to follow in the footsteps of the CMPA’s first woman President and to be able to work closely with the CMPA’s first woman CEO. He thanked Dr. Boyce for her hard work and dedication to the CMPA. Over her two-year mandate, she guided the Association through the evolution of its programs and services. Under her leadership, the CMPA has enhanced its support of physician wellness, increased its digital delivery of products and services, and expanded its education services across the country while protecting the professional integrity of its members and maintaining a strong financial position. Her steady leadership has helped the CMPA weather the current pandemic, and her enduring commitment to protect and support members has in fact strengthened its role as an essential component of the healthcare system. Having noted her exceptional contributions have made a tangible difference, he thanked Dr. Boyce for setting such a good example of healthcare leadership.

Closing remarks

Before closing the annual meeting, the President acknowledged the more than 400 people that work at the CMPA, the members of Council and the lawyers that serve the members. She also thanked her Peterborough clinic team, her family, the Executive Leadership Team, and the CMPA’s physician members. She cited many examples of the support offered by these individuals and groups during the most extraordinary time to be CMPA President and a leader in Canadian healthcare.

Announcements

Dr. Boyce announced the conclusion of the meeting and reminded meeting participants to return, following a short break, to the information session on Virtual Care in Canada: Lessons from the COVID-19 Pandemic.

Adjournment

There being no further business, at 2:37 p.m., the President declared the meeting adjourned.


[1] Council approved descriptors for Divisions A and B are outlined below:

  • Division A (member) — Certification from CFPC or CMQ (Specialists in Family Medicine), or physicians without CFPC, CMQ or RCPSC certification. One (1) Council position within Division A is filled by a member engaged in a residency program in Canada.
  • Division B (member) —Specialist certification from RCPSC or CMQ, not including specialists in Family Medicine