Minutes of the 2021 CMPA Annual [Draft]

Virtual participation—August 16, 2021

The 2021 annual meeting of the Canadian Medical Protective Association (CMPA) was held via videoconference starting at 1:00 p.m. on Monday, August 16th, 2021. 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 328 physician-members present, as well as a further 83 non-member attendees.

Introduction

The President, Dr. Michael Cohen from Grand Falls-Windsor, Newfoundland and Labrador, 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. He also acknowledged the island of Newfoundland as the unceded, ancestral territory of the Beothuk, whose culture has been lost forever and can never be recovered. He acknowledged that Ktaqmkuk (Newfoundland) is the unceded, traditional territory of the Mi'kmaq, and that Labrador is the traditional and ancestral homelands of the Innu of Nitassinan, the Inuit of Nunatsiavut, and the Inuit of NunatuKavut. On behalf of the CMPA, he recognized all First Peoples who were here before us, those who live with us now, and the seven generations to come. He expressed sorrow at the horrific discoveries of unmarked graves in residential schools across Canada and requested a moment of silence to recognize the lives that have been lost.

Dr. Cohen acknowledged that there is inherent systemic racism in our healthcare structures and within Canadian society, and it has caused unimaginable intergenerational trauma, grief, and harm to Indigenous peoples and physicians. As an organization, the CMPA has a role to play to combat racism across healthcare and support Indigenous communities in their efforts to heal. He 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 Canada’s commitments to self-determination and sovereignty, which have been made to Indigenous Nations and Peoples.

The President welcomed attendees to the second CMPA annual meeting held completely virtually. He noted representatives from a number of healthcare organizations were also present, and indicated he looked forward to exploring opportunities for collaboration with said fellow healthcare partners.

Dr. Cohen introduced several of his colleagues, many of whom would be presenting during the meeting:

  • Dr. Lisa Calder, Chief Executive Officer (CEO)
  • Dr. Darcy E. Johnson, Council member and Chair of the Audit Committee
  • Mr. Cory Garbolinsky, Chief Financial Officer (CFO)
  • Dr. W. Todd Watkins, Associate CEO
  • Dr. Pamela Eisener-Parsche, Executive Director, Member Experience
  • Mr. Domenic Crolla of Gowling WLG, General Counsel

The President acknowledged the presence of four past presidents, Drs. Debra Boyce, Jean-Joseph Condé, Edward Crosby, and Michael Lawrence. He then recognized the current and newly elected CMPA Councillors.

The CEO, Dr. Lisa Calder from Ottawa, Ontario, welcomed attendees to the second CMPA annual meeting held in virtual format. She noted that those joining from the CMPA offices were abiding by physical distancing guidelines, and those who have been introduced were fully vaccinated. She explained how attendees could access supporting materials, technical support, and the language of their preference. Having provided instructions as to how to pose questions or raise points in either English or French, or vote during the meeting, she reminded the participants that only members were permitted to ask questions on matters of CMPA business or vote on motions.

Dr. Cohen noted the business portion of the meeting would be followed by a virtual information session on Diagnostic decisions: Interventions for safer diagnoses. He 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. Calder, CEO, read the notice of the 2021 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 and Jean-Joseph Condé of Val d’Or, Québec were prepared to act as scrutineers in the event a vote should be required. Absent any opposition, the President identified the membership’s consensus to accept the proposed scrutineers.

Approval of the Minutes of the 2020 CMPA Annual Meeting

The minutes of the 2020 annual meeting held virtually had been posted on the CMPA website.

A motion to approve the minutes of the 2020 annual meeting held virtually was moved by Dr. Sam Daniel, seconded by Dr. John Turner, and carried.

President and CEO’s Report

Dr. Cohen referred to the past year as an incredibly difficult time during which the Association’s physician advisors heard, each day, from members navigating the challenges of the pandemic and the impacts of delivering care. Knowing many are grappling with changes to scopes of practice, including the incorporation of virtual care, he indicated the CMPA hears members’ concerns about backlogs and care. The Association understands the anguish of the physician having to allocate scarce resources, and it recognizes members are under financial pressure, and facing challenges that affect their own personal health and well-being. He thanked the membership for its perseverance, dedication, and for having the skills to make a difference in the lives of patients across Canada.

As a physician and CEO of the CMPA, Dr. Calder expressed pride with respect to how individuals have responded to what has been an incredibly difficult time for Canadian physicians, and how the Association has continued to assist members and empower better healthcare. She recalled having shared three goals during the 2020 CMPA annual meeting: to be there for members; to modernize the CMPA; and to do so in a collaborative way. She spoke of the CMPA’s focus on making these goals a reality and bringing value to both members and the healthcare system.

Providing members with relevant and valued support

The CEO indicated, during the pandemic, the CMPA continues to provide quality and timely information on key novel coronavirus (COVID-19) pandemic topics, like critical care triage protocols and vaccine issues. It offers sound advice and empathetic support to help members manage patient safety challenges and medico-legal concerns. She noted that in 2020, the Association’s trusted physician advisors responded to over 23,000+ advice calls from members who, upon being polled, reported a 97% satisfaction rate and a 72% reduction in severe stress levels. Physicians trust the CMPA to provide relevant and valuable information and advice.

Supporting physician wellness

Dr. Calder reported, each day, the CMPA hears from hundreds of members, including members significantly stressed by a medico-legal event. With each member conversation, the Association offers empathetic advice and compassionate, peer-to-peer support. Both its Council and management recognize the importance of member well-being, and have recently implemented a number of steps to better support physician wellness, including the creation of a Physician Support and Wellness department. The CMPA is actively enhancing its ability to assist members in distress, and is collaborating with partners to address physician wellness across the country.

Compensating patients

The President noted, on behalf of members, the Association compensates patients harmed by negligent medical care, or fault, as it is known in Québec. While the annual amount varies, a cumulative total of $1.1 billion was paid in patient compensation in the past five (5) years and a total of $206 million in 2020. The CMPA’s goal is to prevent patient harm through education and support, but when it’s proven that harm has occurred due to negligence, patient compensation is provided quickly and appropriately. The Association also invests wisely to ensure it maintains sufficient funds to compensate patients – now and into the future.

Advocating for liability protection

Dr. Cohen reported, as an essential component of the healthcare system, the CMPA advocates for enhancements that allow members to focus on providing safe, quality care to their patients. Having noted that all Association efforts help improve the safety of patient care and enhance the environment in which its members practice, he cited the following examples of how, throughout the pandemic, it has engaged in more advocacy than ever before:

  • Calls to action on personal protective equipment were supported.
  • Ministries of Health in Ontario, Québec, Manitoba, and Alberta were engaged by the CMPA to respond to pandemic hot spots and to support the development of policies on critical care triage protocols.
  • Provincial governments were urged to provide medico-legal protection for physicians delivering COVID-19 care.
  • Insights and expertise were provided on topics such as medical assistance in dying, virtual care, return to practice, and social media advocacy.
  • A Strategic Engagement and Advocacy department was created to strengthen the Association’s advocacy.

Contributing to safe medical care

The President spoke of how the CMPA values and fosters continuous learning for both its members and across the healthcare system. Since the pandemic, the Association has adapted its learning products to a digital world so as to make safe medical care education more accessible. The CMPA’s Resident Symposium and Faculty development workshops have been transformed into engaging, virtual events and it has published the new Good Practices resources which included accredited, easy to read strategies to address real-life practice challenges. The Association provided accredited, evidence-based eLearning activities, and launched the Practically Speaking Podcast.

Dr. Cohen further indicated the CMPA’s subsidiary, Saegis, developed resources to help teams, healthcare professionals, and institutions. Its accredited Saegis Shield Cybersecurity and Privacy eLearning program help clinics, hospitals, and institutions protect patient health information. Saegis also continues to deliver the highly effective Clinical Communication and Just Culture in Healthcare programs to help institutions and healthcare professionals improve patient safety. Additional information regarding Saegis programs is available on its website.

Research, insight and collaboration

The CEO reported, equipped with the largest collection of physician medico-legal data in the world, the Association uses insights from data to inform its safe medical care education and drive positive improvements to clinical practice and the healthcare system. In the past year, it has published in respected peer-reviewed journals, to include a manuscript on the medico-legal risks of airway management in the Canadian Journal of Anesthesia. It has fulfilled over 90 data requests, providing valuable, aggregate data to members, researchers, and teachers. The CMPA has provided expertise and worked with partners to support the development of safe medical care resources and programs, all to help advance safe medical care across the system.

Creating the modern CMPA

Dr. Calder indicated the Association must continue to evolve to meet the changing needs of the members, to include a focus on enhancing equity, diversity, and inclusion (EDI). Following the guidance of the CMPA’s Council and its senior leaders, it has embarked on a journey to develop a thoughtful, multi-year strategy to foster EDI for its employees, Councillors, and member services. As part of this work, both an EDI Sub-committee of Council and an EDI Management Steering Committee have been created. The Association has partnered with the Canadian Centre for Diversity and Inclusion (CCDI), a charitable organization specializing in promoting diversity and inclusion. The CMPA continues to be engaged in listening and learning with its members to gain a deeper understanding of their experiences and challenges, has spoken to a number of physicians across the country, as well as leaders from the Indigenous Physicians Association of Canada and the Black Physicians of Canada. These powerful conversations are identifying opportunities for collaboration, and shine a light on areas where the Association can do things differently. Given the EDI work is a long-term journey, Dr. Calder committed to updating the membership as the Association develops a strategy to support an equitable, diverse, and inclusive work environment for its employees and to enhance its member services.

The President described the initiatives undertaken over the past year as providing a clear view of how the CMPA brings value to its members, patients, and the healthcare system.

2020 Report of the Audit Committee

Dr. Darcy E. Johnson, Chair of the Audit Committee, reported that the firm of KPMG audited the CMPA 2020 financial statements and, in an unmodified opinion, attested the statements appropriately present the results of operations in 2020 and the financial position of the Association as at December 31st, 2020. The 2020 financial statements were available on the Association’s website.

2020 Financial Report

Mr. Cory Garbolinsky, Chief Financial Officer (CFO), referred meeting attendees to the 2020 Consolidated Financial Statements, which were available on the Association’s website.

Financial model

In walking meeting participants through a summary of the CMPA’s 2020 finances and an explanation of its financial model, the CFO reported the latter as consisting of several parts which all work together: membership fees, medico-legal costs, the money needed to pay for future claims and the Association’s investment portfolio. The CMPA must have sufficient funds to assist its more than 104,000 members, and to compensate Canadian patients on behalf of members, if the care provided is found to be negligent. He outlined the key principles that drive the Association’s financial model, as follows:

  • Principle 1. The CMPA’s occurrence-based protection provides physicians with eligibility for assistance any time in the future, as long as they were members when the care was delivered. Because the financial horizon to pay out all potential cases from a given year is long, the Association must hold funds to pay out potential cases up to 35-40 years from the time the care was delivered.
  • Principle 2. The CMPA’s financial goal is to hold at least $1 of assets for every $1 of liability to appropriately compensate patients and their families. It does not seek to generate a profit.
  • Principle 3. Members pay the full cost of their protection through their fees. In 2020, the Association collected the fees required to protect its members for all occurrences taking place in that year, even though they may not become apparent for up to four (4) decades.
  • Principle 4. The CMPA’s financial model is self-correcting. Upon its actual results differing from its estimated results, a temporary excess or a temporary deficit can be created. As a not-for-profit organization, the Association is not permitted to pay dividends to its members, but it may lower membership fees should a temporary excess be present.

The CFO explained the inter-connectedness of the various parts of the CMPA’s financial model. Its funded position, or the difference between its assets and liabilities, is a key factor in determining the membership fees in any given year. Said membership fees are used to pay the medico-legal costs of protecting and assisting the Association’s 104,000 members. The changing trends in medico-legal costs shape the size of the provision needed for outstanding claims. The provision is the amount of money needed to appropriately compensate injured patients and manage future legal and administrative expenses. Equipped with a solid investment portfolio, the CMPA aims to fund approximately one third (1/3) of its members’ protection costs through investment returns.

Membership fees

Mr. Garbolinsky noted membership fees collected in 2020 will pay the medico-legal costs resulting from care provided in that same year, which could result in a medico-legal action over the next 35-40 years. These funds are invested with the goal of earning one third (1/3) of the ultimate cost of protection for each year. There is a relationship between the estimated yearly protection costs as calculated by the Association’s Actuarial team and the membership fees collected, the difference between which shows the fee adjustments to reflect its financial position across its four fee regions over the past five (5) years. Should the CMPA find itself in a positive funded position, it may lower membership fees where appropriate through the application of a fee credit. The Association’s actuaries calculated the estimated cost of protection for 2020 to be $608 million. Favourable financial positions in the fee region of Québec, and in the fee region of Saskatchewan, Manitoba, Atlantic Provinces and Territories, provided the CMPA with the ability to reduce fees in said regions by about $40 million. The total membership fees collected was approximately $568 million, in line with its estimate. The membership fees are self correcting, and increase or decrease in any given year based on the health of the other parts of our financial model. And so in 2021, the Association reduced membership fees in all regions by $99.5 million.

Medico-legal costs

The CFO explained that the CMPA collects membership fees to pay medico-legal costs such as compensation to injured patients, legal and expert fees, safe medical care education programs, and the costs to run the Association. Having described compensation to patients is the CMPA’s single largest expense, he provided a five (5) year graphical depiction of the annual compensation payments as compared to the annual legal costs. In 2020, the Association paid $206 million to patients, which is $17 million lower than 2019. While the total compensation amount varies from year to year, the CMPA has paid over $1.1 billion in compensation and $892 million in legal costs over the last five (5) years. The slight increase of 1% in legal expenditures since 2019 is primarily due to an increase in legal costs associated with College, hospital, and other matters. While actual case count are down, the increase is driven by higher legal hours related to pandemic advice. Having noted the trends and expenditure levels are not equal across our 4 fee regions, he reported that while Ontario represents 40% of the CMPA’s members, this region has the highest legal fees and compensation amounts awarded to patients, and represents more than 50% of the Association’s annual costs. These regional cost differences lead to members paying different fees in different regions.

Provision for outstanding claims

The CFO described the provision for outstanding claims as the sum of all of the expected future medico-legal costs resulting from the care delivered by members over the past three to four (3-4) decades. For care delivered in 2020, the CMPA must look ahead and ensure it has funds available to cover any expense related to that care, either for patient compensation or member assistance, for the next 35-40 years. The bulk of the provision, which is close to $3 billion, is for compensation to patients. The Association reviews the provision each year and, in 2020, lowered the provision by $146 million based on the improved cost trends. This provision for outstanding 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.

Investments

Mr. Garbolinsky reported the provision includes an estimated payment pattern, which is used to model the investment portfolio, which is targeted to reach a 5.5% investment return over the long term. The portfolio’s two objectives are to invest membership fees so as to reduce the amount of fees the Association will collect in the future by approximately one third (1/3), and to generate an investment return that meets or exceeds the 5.5% target. By way of a graphical depiction, he compared the hypothetical return on the CMPA’s investments using the 5.5% target over the past ten (10) years, and the actual return on investments, to demonstrate that the CMPA has exceeded its expectations and outperformed the target by approximately $1.1 billion over the decade as a result of the favorable performance of the financial markets. These excess returns have fueled the growth in its net asset position, which may allow the Association to lower the cost of membership fees in future years. The 2020 investment return was 4.8%, which is less than the 5.5% target and likely due to the volatility of the overall financial markets last year.

Funded position

The CFO described the funded position as the difference between the total assets of the Association (primarily the investment portfolio) and the total liabilities of the CMPA (primarily the provision for outstanding claims). Given the Association recognizes its position is based on the estimates of costs that will not be fully known for many years, it takes a long term and measured approach to the management of its finances and does not take drastic measures to react to either a temporary shortage or a temporary excess of net assets. This is evident in the CMPA’s funded position over the last ten (10) years. At the end of 2020, its total assets were 134% of the total estimated liabilities, or a positive position of $1.44 billion, representing a marked improvement from 2014 when there was a $360 million shortfall. The improvement can be attributed to better than forecast investment performance and lower than anticipated growth in medico-legal costs, and this strong financial position will allow the Association to weather any further challenges the COVID-19 pandemic may bring to financial markets, as well as any fluctuations in medico-legal case volumes.

Mr. Garbolinsky concluded his financial update by summarizing five (5) key takeaways:

  1. The various parts of the Association’s financial model are interconnected and self-correcting.
  2. Due to its occurrence-based protection, the CMPA operates with a long-term time horizon of up to four decades, allowing for the protection of members long after they retire.
  3. Its positive funded position in 2020 should provide confidence to members and their patients that the Association is there for them when needed.
  4. Fee increases or decreases are the primary tool used by the CMPA to manage its funded position.
  5. The Association’s current strong funded position is primarily a result of strong investment returns over the past ten (10) years, as well as lower-than anticipated medico-legal costs.

2022 membership fee requirements

The CEO commenced the presentation of the 2022 membership fee requirement by announcing that, while the pandemic has placed financial strain on Canada’s healthcare system, the CMPA is committed to using its resources effectively and efficiently, and to containing growth in medical liability protection costs. In 2022, fees will be reduced across all four fee regions and the Association’s aim is to continue to use fee reductions to draw down its net asset position in each fee region in the coming years, which will help to stabilize its financial position. She clarified that, recognizing there are different medical liability protection cost structures across the country and with a view to an equitable allocation of costs, the CMPA has 4 fee regions.  They are British Columbia and Alberta; Ontario; Québec; and Saskatchewan, Manitoba, Atlantic provinces, and the Territories. Given each region is independent and there is no subsidization between them, if one region is in a positive or negative funding position, this does not impact the others. Membership (or aggregate) fees constitute the total fee requirement for each region, divided by the number of members within said region. The aggregate fee is only an average and does not represent the fee that an individual member pays. When determining individual member fees, the Association first calculates the aggregate fee for the region, and uses this as the foundation to determine regional fees based on the type of work.

2022 aggregate fee requirement for the British Columbia and Alberta region

The forecast cost of providing protection in British Columbia and Alberta in 2022 is, on a per member basis, $5,283. Due to the CMPA’s strong financial position, it is able to reduce these fees by $1,418 per member. The overall aggregate fee for British Columbia and Alberta is down 16% from 2021, making for a reduction of $17 million to $109.1 million. All members in the region will see a reduction in their membership fees.

2022 aggregate fee requirement for the Ontario region

The cost of providing medical liability protection in Ontario is greater than in any other region and this is reflected in the membership fee. In 2022, it is forecast to be, on a per member basis, $7,537. Since Ontario is also in a positive funded position, the aggregate fee per member is being reduced by $1,756, making for a reduction of $55 million across the entire fee region. This is a 20% decrease from last year.

2022 aggregate fee requirement for the Québec region

As has been reported during previous annual meetings, the projected costs of liability protection in Québec have risen at a slower rate than in other parts of the country. In general, the Association has also not seen the same level of variance in compensation to patients year over year as in the other three regions. As a result, membership fees are generally stable in this region, and the lowest of all four (4) fee regions. Given Québec’s positive funded position, the CMPA continues to be able to reduce the membership fees in this region, resulting in a per member aggregate fee that is 45% lower than in 2021.

2022 aggregate fee requirement for the Saskatchewan, Manitoba, Atlantic Provinces and the Territories region

Given this region has the fewest number of members, one or two medico-legal cases can have a drastic impact on its overall funded position. Therefore, the Association takes a conservative approach to setting fees for this region. For 2022, as a result of the region’s positive net asset position, the aggregate fee per member is reduced by 4%.

2022 type of work (TOW) fees

Speaking to a summary slide, the CEO demonstrated that there are significant regional differences in protection costs, with Ontario being far and away the most expensive region. The CMPA is committed to charging only those fees required to provide effective medical liability protection through a sustainable model which gives members confidence that assistance will be available to them in the event of a medico-legal difficulty. The Association’s commitment to members has not and will not change.

Having shared the aggregate fees by region, the CEO presented a practical example of the actual membership fees that family physicians practising in type of work code 35 will pay in 2022 versus 2021 across the four fee regions. She noted the full listing of 2022 membership fees was available on the CMPA’s website. Members’ individual fee invoices will be available online through the secure member portal on the Association’s website in the fall. Members will be provided with an email notification at that time.

Moving forward, the CEO committed to the CMPA’s continued exploration of opportunities to leverage its knowledge to enhance patient safety and reduce fees, while ensuring it remains financially stable and able to compensate patients and support physicians, today, tomorrow, and well into the future.

2021 election results

The CEO announced, each year, approximately one-third (1/3) of the CMPA’s 31 Council positions are scheduled for nomination and election across its ten Areas. To ensure appropriate representation across all specialties in medicine, surgery and general practice, members seeking election must practice in Division A or B. Any CMPA member in an Area and Division with positions scheduled for nomination and election may seek nomination. This year, voting occurred for twelve (12) Council positions in four (4) areas. In addition, voting occurred for a new national position within Division A, for a member engaged in a residency program in Canada. Following a robust call for nominees, the CMPA Nominating Committee and the CMPA membership recommended twenty-two (22) candidates with diverse backgrounds and experience to take part in the election. Dr. Calder extended the Association’s thanks and appreciation for the interest and commitment of these highly qualified physicians to the governance of the Association, and for their running for election during these unprecedented times. She also thanked those who took the time to nominate their colleagues and to vote in the elections. Voting was open to members in an Area in which elections occurred, and for the national resident position, to all members across the country. The results were as follows:

Area 1 (British Columbia and Yukon) (1 position in Division A1 and 1 position in Division B1)

  • Dr. Michael Curry, in emergency medicine, was re-elected.
  • Dr. Fay Leung, in orthopedic surgery, was elected.

Area 4 (Manitoba) (1 position in Division A or B)

  • Dr. Darcy Johnson, in family medicine, was re-elected.

Area 5 (Ontario) (2 positions in Division A and 3 positions in Division B)

  • Dr. Paul Healey, in emergency medicine, was elected.
  • Dr. Clover Hemans, in family medicine, was elected.
  • Dr. Alexander Barron, in pediatrics, was re-elected.
  • Dr. Gerard Craigen, in psychiatry, was re-elected.
  • Dr. Michael Sullivan, in critical care anesthesiology, was elected.

Area 6 (Québec) (3 positions in Division B)

  • Dr. Jean-Hugues Brossard, in endocrinology, was re-elected.
  • Dr. Geneviève Lalonde, in anesthesiology, was elected.
  • Dr. Patrick Trudeau, in general surgery, was re-elected.

National resident position from Areas 1-10 (1 position in Division A)

  • Dr. Victoria Januszkiewicz, in obstetrics and gynecology residency, was elected.

Dr. Calder extended thanks to all of the candidates in the 2021 election, in a time when maintaining strong leadership at the CMPA is critical, and welcomed the diversity of the candidates who submit their names for nomination. She acknowledged the members who would be departing Council, such as Dr. Gordon Crawford after 24 years, Drs. Robert Cooper and David Naysmith after 18 years, Dr. Fredrykka Rinaldi after 13 years, Dr. Yvonne Molgat after 3 years, and Dr. Boyce after 13 years, 2 of which were served as President. She thanked them for their commitment to the Association and to its members during their tenure as CMPA Councillors. Having presented all 31 of the 2021-2022 Council members by voting region, she thanked all Councillors for their commitment to the CMPA, our members, and enhancing the safety of the Canadian healthcare system.

Other business and questions

The President welcomed members to pose questions or share comments. Given the virtual format of the meeting, he delegated facilitation of the questions to the Associate CEO and the Executive Director, Member Experience. Like-minded comments or questions were grouped for efficiency of response following their having been put forward by the following members:

  • Dr. Flordeliz Gigi Osler, an otolaryngologist from Winnipeg, Manitoba
  • Dr. Valérie Villeneuve, an anesthesiologist from Saint-Laurent, Québec
  • Dr. George D. Carson, an obstetrician from Regina, Saskatchewan
  • Dr. Victor F. Huckell, a cardiologist from Vancouver, British Columbia
  • Dr. Modupe Tunde-Byass, an obstetrician from Gormley, Ontario
  • Dr. Robert J. Robson, a general practitioner from Dundas, Ontario
  • Dr. Mateen Raazi, an anesthesiologist from Saskatoon, Saskatchewan
  • Dr. Abdullatif Haresha a general practitioner and pediatrician from Winnipeg, Manitoba
  • Dr. Shirley Katz, a general practitioner from Thornhill, Ontario
  • Dr. Donato Gugliotta, a general practitioner from Trenton, Ontario
  • Dr. Sankar N. Prakash, a general practitioner from Windsor, Ontario
  • Dr. Melanie Chan, a psychiatrist from Richmond Hill, Ontario
  • Dr. Ming-Ka Chan, a pediatrician from Winnipeg, Manitoba
  • Dr. Randall M. Giuffre, a cardiologist from Calgary, Alberta
  • Dr. Jacques Lévesque, a radiologist from Québec, Québec
  • Dr. Katalin J. Margittai, a psychiatrist from Toronto, Ontario
  • Dr. Beatrice Kwamboka Osoro, a general practitioner from Holland Landing, Ontario

The first question posed related to the impact, positive or negative, of virtual care on medico-legal costs. The CFO responded, while it is too soon to make any determination as to whether or not there will be any impact, the Association is monitoring the matter closely.

To a question as to whether type of work fees were produced in the same manner in all regions and whether they are individualized by regional experience, Mr. Garbolinsky clarified that the fee setting work is performed within the boundaries of each of the four regions. First, the Association considers expected costs to determine the region’s aggregate fee, then considers its financial position to determine whether or not an adjustment is required via a fee credit or debit. The CMPA next examines how the expected costs of a particular type of work might benchmark against others within the region, then applies a relative risk rating to each type of work to identify a fee that is representative of said risk. He shared the example that an obstetrician would carry the highest level of risk with respect to future expected costs, and therefore, would have the highest fee in that region.

The CEO spoke to the Association’s having pivoted its education to an online platform, and to the impact said change has had on research and education across the country. As one of the largest continuing medical education (CME) providers in Canada, the CMPA used to deliver up to 300 face-to-face presentations per year. The pandemic necessitated a rapid move to a virtual digital learning format. In collaboration with Resident Doctors of Canada (RDoC), the resident symposium, which used to be delivered in person to every Canadian medical school, is now offered virtually and has experienced tremendous response from residents, increased attendance, and great satisfaction. Following its recent electronic launch, many individuals have visited the successful online version of the Association’s Good Practices, a tool that contains a remarkable amount of resources for any level of learner, teacher, or member seeking to gain additional continuing professional development (CPD) credits for the Royal College of Physicians and Surgeons of Ontario (RCPSC)’s Maintenance of Certification (MOC) program (to include section three assessment credits). The CMPA now also offers virtual workshops and, moving forward, will be investigating a hybrid model to provide certain face-to-face presentations, once safe, while continuing to deliver high quality digital learning products.

Having recalled that in the past five years, the Association paid out $1.1 billion in patient compensation and $900 million in legal fees, and reduced the provision by $146 million based on the improved cost trends, a member questioned whether the CMPA anticipates a similar reduction in fees. The CFO responded the Association evaluates its provision on an annual basis to estimate future costs. In an effort to bring its quite strong current financial position back to an appropriate level in future years, fee credits are expected to be offered.

With two British Columbia demonstration projects scheduled to begin in the near future to evaluate the impact of restorative approaches following an adverse event with patient harm, the Association was asked whether it encourages its members to participate in such demonstration projects. The Executive Director, Member Experience spoke to the CMPA’s recognition and concern that there is inherent systemic racism in the Canadian healthcare system that has resulted in significant intergenerational trauma within Indigenous populations. The Association is developing an EDI strategy, and continues to listen and learn from members about incidents they’ve experienced that have shaped the care of Indigenous populations. The CMPA is also engaged in conversations with British Columbia Indigenous groups who are seeking to understand which mechanisms of complaint resolution will better support members through such a process as it unfolds. The Associate CEO added, in these very interesting times, the Association makes continued efforts to evolve the way it provides representation to its members.

A member expressed interest in knowing how future modelling of the CMPA’s costs takes into account the changing landscape of the medical practice. The CFO noted the CMPA’s actuarial modelling is essentially based on the costs that have been paid out, and the Association closely monitors the potential impact of the changing landscape on future costs. The Association must first see the impact of landscape changes in trends before these can result in fee amendments.

To a request for an explanation as to how the Québec region experiences lower costs for claims, General Counsel spoke of the province’s different judicial culture in terms of the level of damages awarded, as well as its strong regulatory environment. The CMPA has been closely monitoring this trend for years, which ultimately, is the result of the willingness of plaintiffs and of plaintiff's counsel to initiate claims, and the willingness of courts to respond to them.

A member recalled that the Canadian Broadcasting Corporation (CBC) had recently aired a program describing that no patient harmed in Canada can win a lawsuit given the Association is so powerful. Absent any mention of the education the CMPA provides to mitigate patient harm, or of the fact it will protect rather than settle if the physician did not commit malpractice or negligence, it was felt the program maligned physicians and brought risk to the Association from a public relations perspective. The CEO reported that when the CMPA takes opportunities to engage in media interviews, such as a spring 2021 W5 interview, the Association aims to correct misinformation or misunderstandings that arise and to explain its value proposition. Not all information provided in said interviews is featured in the media stories. She encouraged meeting participants to visit the Association’s website, where it has recently launched clear messaging aimed to counteract some of the misinformation portrayed in mainstream media by speaking about how it empowers better healthcare. The CMPA continues to seek opportunities to correct any misinformation in the public and to clarify its value proposition.

To a suggestion the Association should compensate physicians who are wrongly accused by patients moving forward, General Counsel indicated the CMPA is a mutual defence organization created for the purpose of defending physicians in claims brought by regulatory authorities or patients. It is not created or constituted for the purpose of providing compensation to physicians. He added, albeit rare, a claim that was wrongfully brought and unsuccessful against a physician does have the ability for costs to be awarded to a successful litigant.

In response to a question regarding case payout limitations, the CMPA’s executive leadership team reported that, upon assistance being granted to a member, there is no maximum to the extent of assistance the Association would provide, and there are jurisdictional differences with respect to ceilings for patient compensation. General Counsel added, because the CMPA is not an insurance company, it does not maintain a pre-set maximum amount payable in respect of a single claim. However, the courts themselves have developed standards and, in particular cases, legislation exists to limit the amount of recovery.

The Association was asked, with the increased use of virtual care, whether it will be able to provide protection for telemedicine issues if the physician is physically outside of the country. The Executive Director, Member Experience responded that the CMPA does not generally provide assistance to members with medico-legal matters that arise outside of Canada. In addition, members residing outside of Canada on a long-term basis and providing virtual care to Canadian patients will generally not be eligible for assistance, regardless of whether the matter was initiated within or outside of Canada. The Association is assisting Canadian physicians with medico-legal matters that arise in the country, and those practicing virtual care would generally be eligible for assistance for matters in which the patient, physician, or both are temporarily located outside of Canada, such as for a short vacation or conference. Matters involving any of the parties who partake in a longer term absence from the country would generally not be eligible for assistance. She encouraged members who have been located outside of Canada due to the extenuating circumstances of the pandemic to call the Association for specific guidance related to eligibility for assistance in such a situation.

Having expressed appreciation for the new resident representation on Council, a member wondered whether the CMPA should consider having at least two resident positions and following a model similar to that of a faculty. The President responded that Council had decided to begin by adding one resident position and evaluating the way forward before it considers a second. He reported the move proved to generate a great response with a high number of residents interested.

A further inquiry was received around how, in addition to its work on EDI, the Association is structurally ensuring broad diversity within the various levels of its leadership. The President noted the principles embedded within the Association’s nomination process are centered around the fact that it seeks and values diversity and a variety of lived experiences on Council. As part of this same process, candidates are asked to proactively identify how they will contribute to diversity on Council and within the CMPA. Once elected, all Councillors undergo a robust learning and feedback process, which focusses on supporting EDI. The Association has been more successful in recent years in expanding the diversity of candidates, and it continues to raise awareness of elections and encourage members to consider the importance of diverse perspectives when voting. The CMPA is also working on developing a strategy to foster EDI for its members, Councillors and employees. The CEO added, from the perspective of enhancing diversity amongst the Association’s senior and executive leadership teams, a key part of the employee experience aspect of its EDI strategy is to consider how it can encourage diversity through all levels of its human resources. The CMPA is also excited to learn about the CCDI’s experiences in working with other companies. Finally, the Association is currently considering a hybrid model of both virtual and in-person work, which should create recruitment opportunities in this regard.

Having received a request for comment regarding the upward trend of CMPA costs incurred by defending physicians at their respective medical regulatory authorities across the country, the CFO spoke to a significant increase in the amount of said cases in the ten (10) years leading up to 2020. He reported, while the 1% change in the Association’s 2020 ‘legal other’ costs was solely the result of there being fewer cases last year, those received were more complicated due to the pandemic. With 2021 experiencing an uptick in cases regarding regulatory matters, the CMPA continues to monitor the trend and to make efforts to work with the medical regulatory authorities. General Counsel added said cases are typically generated by patients wishing to make a complaint or raise a concern with the medical regulatory authorities, and when these are raised, members are eligible for assistance from the CMPA. Interestingly, the cost associated with defending those individual cases on average has not increased. Given the trend is primarily due to increased volume over the past decade, as said volume stabilizes, it would be expected that associated costs would stabilize as well.

The Executive Director, Member Experience expanded on the Association’s work on physician wellness, an area that is a great priority. Recognizing the impact the pandemic has had on physician wellness, she indicated the CMPA has received approximately 30,000 telephone calls over the past year, in which members are requesting advice, guidance or assistance with a medico-legal matter. The vast majority of said calls are underpinned with elements of distress, stress and physician wellness issues. Understanding physicians are experiencing the strain of practicing in this current environment, the Association’s physician advisors are providing peer-to-peer support on those calls, and often delve into issues around physician wellness. Feedback from members indicates such interactions have made a significant difference to their overall wellness as they move forward with their medico-legal matter. In addition, the CMPA has been working to ensure its website contains appropriate information and is more accessible to members, particularly given the physician wellness pages of the site have experienced significantly more hits than in previous years. She also reported the Association has created a department of Physician Support and Wellness to help further associated initiatives, such as collaboration with Canadian partners to establish further programming that will benefit physicians. A valuable partnership with the Ontario Medical Association Physician Health Program (OMA-PHP) and the College of Physicians and Surgeons of Ontario (CPSO) is seeking to address concerns around physician suicide and considering how to identify physicians at risk so as to provide appropriate mechanisms to support them differently. The CMPA is looking forward to working through these issues with its partners over the next year and beyond.

Having congratulated the CEO for beginning the conversations around EDI, a member posed a final question around how the Association aims to engage physicians nationally who have felt they were not well represented by the CMPA and have perceived some level of racism in said representation, especially at the hospital level. The CEO indicated, as a key part of its EDI strategy, the Association continues to actively reach out to members via its listening and learning activities. Its aim is to better understand the impacts of racism and those who have had challenges in terms of services provided by the CMPA; to understand how it can strengthen the manner in which it offers medico-legal support to provide more culturally sensitive member service; and to understand how to best respond when physicians are experiencing racism. The Executive Director, Member Experience added that it has been a privilege to speak with several members across Canada who have experienced racism, either systemically or directly through the course of their practice of medicine. She indicated it has been an honour to hear their stories and experiences, which enables the Association to adjust its services appropriately to meet the needs of physicians moving forward. She spoke to her openness to have additional such conversations with members who wish to discuss associated challenges.

The President thanked all who posed questions and listened during the meeting.

Closing remarks

Before closing the meeting, the CEO empathized with the fact that COVID-19 is continuing to be an ongoing challenge and reality for Canadian physicians, and that some of the pandemic issues, such as surgical backlogs and delays in other aspects of clinical care, will be felt for years to come. She stressed that through it all, the CMPA is here for its members. No matter how healthcare evolves, the Association will remain a partner in practice with physicians. She thanked all 104,000 CMPA physician members for continuing to deliver the care that patients need, and for trusting the Association.

Announcements

Dr. Calder announced the conclusion of the meeting and reminded meeting participants to return, following a short break, for the accredited education session on Diagnostic decisions: Interventions for safer diagnoses.

Adjournment

There being no further business, at 2:25 p.m., the President declared the meeting adjourned.


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

  • Division A: Certification from the College of Family Physicians of Canada (CFPC), or the Collège des médecins du Québec (CMQ) (Specialists in Family Medicine), or physicians without CFPC, CMQ, or Royal College of Physicians and Surgeons of Canada (RCPSC) certification. One (1) Council position within Division A is filled by a member engaged in a residency program in Canada.
  • Division B: Specialist certification from RCPSC or CMQ, not including Specialists in Family Medicine.