Home About the CMPA 2023 CMPA Annual Meeting and Conference Minutes of the 2022 CMPA Annual Meeting [Draft]

Minutes of the 2022 CMPA Annual Meeting [Draft]

Vancouver B.C., with virtual participation—August 15, 2022

Welcome and opening address

The 118^th annual meeting of the Canadian Medical Protective Association (CMPA) was held beginning at 12:20 p.m. PT on Monday, August 15, 2022, in the Grand Parq Ballroom of the JW Marriott Parq Vancouver, 39 Smithe Street, Vancouver, British Columbia. Videoconference participation was also available. The meeting was conducted in English and in French and simultaneous interpretation was available for all attendees. The meeting was recorded as a webcast and will be available through the annual meeting page of the CMPA website. There were an estimated 197 physician-members present, with 95 participating in person and 102 virtually.

Call to order

The Chief Executive Officer (CEO), Dr. Lisa Calder from Ottawa, Ontario, read the notice of the 2022 annual meeting of the Canadian Medical Protective Association and declared the meeting to be duly constituted.

Land acknowledgement

The CEO welcomed Syexwáliya / Ann Whonnock from Squamish nation to begin the meeting with an opening prayer in a manner that honours and recognizes the lands on which we meet today. A knowledge keeper and elder advisor with the First Nations Health Authority, Syexwáliya is widely respected and acknowledged for her work, energy and commitment to her community. The CEO offered her tobacco for sharing her knowledge and wisdom. Syexwáliya welcomed meeting participants to the ancestral traditional territories of the Squamish Nation, her and her family’s nation at Tsleil Waututh and Musqueam. She welcomed energy from Creator and her ancestors as she guided attendees through breathing exercises, song and prayer to place a shield of safety and protection around each of them. She prayed for an excellent work day with all coming together in unity, transferring knowledge and information, and sharing words and listening with respect to create positive solutions for the present and future.

The President, Dr. Michael Cohen from Grand Falls-Windsor, Newfoundland and Labrador, thanked Syexwáliya and reiterated that Vancouver is situated on the unceded traditional territories of the Musqueam, Squamish and Tsleil Waututh nations. As an organization, he indicated the Association recognizes all first peoples who were here before us, those who live with us now and the seven generations to come. He also acknowledged that the CMPA offices located in Ottawa are on the unceded, unsurrendered territory of the Anishinaabeg Algonquin nation whose presence reaches back to time immemorial. He noted the Association honours and pays its respects to these lands and to all First Nations, Inuit, and Métis peoples throughout Turtle Island.

Introduction

The CEO spoke to COVID-19 protocols in place for the in person component of the meeting. She assured attendees that all onstage participants were fully vaccinated. She encouraged all to maintain physical distancing as much as possible, to wear a mask when not eating or drinking, and to use the hand sanitizer that has been made available.

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

Dr. Jean-Hugues Brossard of Montréal, Québec, Incoming President and 1^st Vice-President
Dr. Lisa Calder, Chief Executive Officer (CEO)
Dr. W. Todd Watkins, Associate CEO
Mr. Cory Garbolinsky, Chief Financial Officer (CFO)
Dr. Pamela Eisener-Parsche, Executive Director, Member Experience
Dr. Armand Aalamian, Executive Director, Learning
Mr. Chantz Strong, Executive Director, Research and Analytics
Mrs. Christine Holstead, Executive Director, Strategy and Operations
Ms. Leah Keith, Executive Director, People and Culture
Dr. Darcy Johnson, Council member and Chair of the CMPA Audit Committee
Mr. Domenic Crolla of Gowling WLG, General Counsel

He also acknowledged the presence of three past presidents, Drs. Debra Boyce, Jean-Joseph Condé, and William Tucker; all CMPA Council; and former CEO, Dr. John Gray.

Appointment of scrutineers

Dr. Cohen indicated Drs. Heather Ross of Toronto, Ontario and Katharine Smart of Whitehorse, Yukon 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 2021 CMPA Annual Meeting

The minutes of the 2021 annual meeting held virtually had been posted on the CMPA website.

A motion to approve the minutes of the 2021 annual meeting held virtually was moved by Dr. Birinder Singh, seconded by Dr. Victor F. Huckell, and carried.

A year in review

Dr. Calder observed that this year has been incredibly difficult for CMPA members, patients and all healthcare providers. She reflected on what physicians have experienced in terms of scarce resources, delays in care, changing scopes of practice, wellness issues and threats to personal safety. Through it all, members have continued to strive to deliver safe and effective healthcare for Canadians. She thanked them for their perseverance, courage, and skill, and noted that what they do each day makes a difference in the lives of countless Canadian patients. She remarked that as physicians support patients, the CMPA’s role is to support them, protecting their professional integrity and helping them provide safe medical care. Throughout the challenges this year, the Association has continued to be their partner in practice, focused on being there for them, modernizing and doing so in a collaborative way.

Being there for its members

The CEO asserted that the CMPA is there for its members in Canada. In 2021 alone, its physician advisors responded to over 24,000 advice calls, helping members manage patient safety challenges and provide safe medical care. The Association also supported members with more than 8,000 medico-legal concerns ranging from College complaints to hospital matters and civil legal actions. Over the past year when it came to emerging COVID-19 issues, the CMPA advocated on topics like critical care triage protocols and the resumption of non urgent care. It provided high quality medico-legal advice on issues ranging from medical assistance in dying to effective patient communication. The Association shared resources and information through many of its channels and its online COVID-19 Hub was accessed by over 77% of its more than 105,000 members. The CMPA was and continues to be a trusted source of compassionate support and empathetic advice.

Physician wellness: Dr. Calder reported the Association heard during the morning’s education session about the impacts of medico-legal events on the health and wellness of physicians, which it knows directly affect the safety of medical care and the risk of medico-legal events. The CMPA is taking tangible steps to support the wellbeing of its members who experience medico-legal issues. In 2021, a new Physician Support and Wellness department was created to enhance ongoing wellness efforts. These include compassionate advice and peer-to-peer support; physician support and wellness; increased capacity to help distressed members; collaborations with Physician Health Programs (PHPs); and Practically Speaking podcasts.

Patient compensation: The CEO indicated one of the CMPA’s key roles is its mandate to compensate patients on behalf of members when it has been proven that a patient has been harmed by negligent medical care, or known as fault in Québec. Over the past five (5) years, the Association has paid a cumulative total of $1.2 billion in patient compensation and a total of $276 million in 2021, which is $70 million more than in 2020. While the CMPA’s focus is on preventing patient harm through member education and support, when it is proven that harm has occurred due to negligent care, patients will be compensated appropriately and as quickly as possible. The Association also invests prudently to ensure it has adequate funding to compensate patients and support physicians now and into the future.

2023 Fee reduction: Dr. Calder informed meeting participants that 2023 member fees will be reduced across all regions through fee credits. To support members, one of the CMPA’s goals is to maintain relative fee stability and refrain from significantly increasing member fees. Due in large part to recent investment performance, the Association closed 2021 in a strong financial position. This has provided the opportunity to reduce member fees via fee credits. Moving forward, the CMPA will continue to ensure it has sufficient funds to compensate patients on behalf of members over the long term and weather any changes in medico-legal trends that may come.

Modernizing the Association

The President spoke to key efforts around how the CMPA is modernizing the Association.

Equity, diversity and inclusion (EDI): Dr. Cohen noted the CMPA continues to look for new ways to modernize and improve the way it supports members and contributes to safe medical care. A key component of this is to prioritize EDI, which is vital to how the Association operates and delivers services, and to the environment in which its members practise. Understanding that members and patients experience racism and inequities across the system, the CMPA recognizes that this significantly affects physicians, threatens patient safety and creates medico-legal risk. In the past twelve (12) months, the Association has taken significant steps to address this risk by committing itself to help mitigate bias and inequity in the services it provides to members and to build a workplace culture which supports EDI. The CMPA engages with members and listens to and learns from stakeholder groups and EDI leaders to help better understand and respond to challenges facing its members. Association leaders and Councillors were provided with comprehensive EDI and anti-bias training. The CMPA worked with expert consultants, the Canadian Centre for Diversity and Inclusion, to assess its own diversity and explore ways to make its work culture more inclusive and equitable. The Association continued to enhance capacity among its staff to understand and support member EDI concerns, and began the development of its long term EDI strategy, which has been a collaborative effort between Council, management and employees.

Governance practices: The President recalled the Association is always looking for ways to modernize and improve the way it supports members. This work includes efforts to support EDI and steps to modernize its governance. In the past year and a half, independent external governance experts were engaged to provide learning and resources to Councillors and senior leaders around best governance practices. As part of these conversations, the CMPA has begun discussing Council size, composition, representation, scope and structure. The Association has also been exploring opportunities to ensure its governance model and procedures are aligned with contemporary practices, and that its governance framework supports the needs of both the CMPA and its members.

Safe medical care – Learning: Dr. Cohen described contributing to safe medical care as a cornerstone of the Association’s mission. The CMPA actively provides continuous learning to help its members reduce patient harm and lower their medico-legal risk. In 2021, it delivered its virtual resident symposium to 17 Faculties of Medicine, continued to enhance its Good Practices guidance, and provided accredited evidence-based eLearning activities. The Association’s subsidiary, Saegis, also expanded its online programming and enhanced its capacity for facilitator-led group and individual learning.

Advocacy: The President explained part of the CMPA’s role is to advocate for system enhancements. Since the Strategic Engagement and Advocacy department was created in 2021, the Association has made 59 submissions to regulatory authorities and has engaged with governments, Colleges and stakeholders, providing insights on multiple topics such as COVID-19, medical assistance in dying, EDI, virtual care, healthcare human resources, and liability protection for members providing abortions to non-Canadian patients. The CMPA also signed the Canadian Health Workforce’s Call to Action on the healthcare human resource crisis, and recently reached out to the federal, provincial and territorial governments asking them how to work together to protect members from United States (US) medico-legal issues when providing abortion services to non-Canadian residents. The recent decision to overturn the Roe versus Wade decision in the US has been incredibly distressing for many members, and physicians have questions regarding medico-legal risks and its assistance with abortion services to US patients. He announced the CMPA will be hosting a virtual one-hour September 6, 2022, session on changes in US abortion laws, CMPA assistance and medico-legal risk. He added all members would soon receive an invitation to this session, which will include a panel of experts in the field and will be simultaneously interpreted.

Research, data and insights: Dr. Cohen reported the Association has the largest collection of physician medico-legal data in the world, and uses these to identify gaps that affect patient safety and pinpoint opportunities for quality improvement. CMPA data insights inform its safe medical care learning resources. In 2021, the Association modernized its research focus to provide timely insights into sepsis, ‘never events’ and rural health; published manuscripts in peer reviewed journals on topics such as spine surgery and medico-legal risk for residents; and fulfilled research project and data requests. Ultimately its research supports patient safety and helps prevent patient harm.

Doing so collaboratively

The President described collaboration, both within the CMPA and across Canadian healthcare, as key to many of the updates shared during this meeting. In these challenging times, it is more important than ever that all work together to support the changing needs of Association members, their patients and the healthcare system. The CMPA worked with the Healthcare Insurance Reciprocal of Canada (HIROC) to create learning aimed at reducing risk in obstetrical care. It provided advice to the Ontario Medical Association (OMA), Alberta Health Services (AHS), Health Canada and the Public Health Agency of Canada (PHAC) on vaccine hesitancy. The Association participated in a town hall in British Columbia to discuss physician bullying and harassment and was part of the Canadian Medical Association (CMA)’s Virtual Care Task Force, helping to develop strategies for the use of virtual care. The CMPA brings value to its members, patients and the healthcare system.

2021 Report of the Audit Committee

Dr. Darcy E. Johnson, Chair of the Audit Committee, reported that the firm of KPMG audited the CMPA 2021 financial statements and, in an unmodified opinion, attested the statements appropriately present the results of operations in 2021 and the financial position of the Association as at December 31, 2021. The 2021 financial statements were available on the Association’s website.

2021 Financial Report

Financial model

In walking meeting participants through a summary of the CMPA’s 2021 finances and an explanation of its financial model, Mr. Cory Garbolinsky, Chief Financial Officer (CFO), reported the latter as consisting of several inter-connected components: 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 105,000 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 30-40 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 2021, 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 105,000 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 earn income to ensure it can appropriately compensate patients and fund future medical legal expenses. The change in the funded position is the sum of all of the financial items mentioned.

Membership fees

Mr. Garbolinsky noted membership fees collected in 2021 will pay the medico-legal costs resulting from care provided in that same 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 (4) fee regions over the past five (5) years. Should the CMPA find itself in a positive funded position, which is the current situation, 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 2021 to be $603 million. Favourable financial positions in all fee regions provided the CMPA with the ability to reduce fees by approximately $99.5 million in total.

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 as 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 2021, the Association paid $276 million to patients injured as a result of negligent medical care. While the total compensation amount varies from year to year, the CMPA has paid over $1.2 billion in compensation and $939 million in legal costs over the last five (5) years. Having noted the trends and expenditure levels are not equal across the Association’s four (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. Each region is independent and there is no subsidization between the 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 up to the end of 2021. For care delivered in 2021, the CMPA must look ahead and ensure it has funds available to cover any expense related to that care for the next 30-40 years. Approximately two thirds of the provision, which is close to $4 billion, is for compensation to patients. The Association reviews the provision each year and, in 2021, increased the provision by $133 million based on updated 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% investment return over the long term. By way of a graphical depiction, he compared the hypothetical return on the CMPA’s investments using the targets 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 $1.25 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 2021 investment return was 12.8%, which is more than the 5% target and positively contributed to the funded position.

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, 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 2021, its total assets were 135% of the total estimated liabilities, or a positive position of $1.66 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 this strong financial position will allow the Association to weather the unpredictable investment markets, fluctuations in medico-legal case volumes as a result of the pandemic, and the current high inflation environment. The CMPA recognizes this funded position is higher than desired and may allow membership fees to be reduced in future.

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

The various parts of the Association’s financial model are interconnected and self-correcting.
Due to its occurrence-based protection, the CMPA operates with a long-term time horizon of up to four (4) decades, allowing for the protection of members long after they retire.
Its current strong funded position is primarily a result of strong investment returns over the past ten (10) years.
Fee increases or decreases are the primary tool used by the CMPA to manage its funded position.
The Association’s positive funded position in 2021 should provide confidence to members and their patients that the Association is there for them when needed.

2023 Membership fee requirements

The CEO commenced the presentation of the 2023 membership fee requirement by announcing that the CMPA is committed to ensuring fees collected from members are used efficiently and appropriately, and to containing growth in medical liability protection costs as it aims to optimize the stability and predictability of fees over time. Given the Association’s current financial position is strong, in 2023, fees will be reduced across all four (4) fee regions. She clarified that, in response to the regional cost differences across the country, these four (4) fee regions allow for an equitable allocation of costs. They are British Columbia and Alberta; Ontario; Québec; and Saskatchewan, Manitoba, Atlantic provinces, and the Territories. Given each region is independent and there is no subsidization between them, if one region is in a positive or negative funding position, this does not impact the others.

Dr. Calder reported the aggregate fee per member constitutes the aggregate cost per region (total amount to be collected in each region), divided by the number of members within said region. The aggregate fee is only an average, an illustrative number that does not represent the fee that an individual member pays. When determining individual member fees, the 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.

2023 Aggregate fee requirement for the British Columbia and Alberta region

The forecast cost of providing protection in British Columbia and Alberta in 2023 is, on a per member basis, $4,839. Due to the CMPA’s strong financial position, it is able to reduce these fees by $3,138 per member, resulting in an aggregate fee of $1,701. The overall aggregate fee for British Columbia and Alberta is down 56% from 2022, making for a reduction of $60.3 million to $48.8 million. All members in the region will see a reduction in their membership fees.

2023 Aggregate fee requirement for the Ontario region

In Ontario, the cost of providing medical liability protection is greater than in any other region and this is reflected in the membership fee. The cost of providing medical liability protection in Ontario in 2023 is forecast to be, on a per member basis, $6,646. Since Ontario is also in a positive funded position, the aggregate fee per member is being reduced by $3,448 to $3,198, making for a reduction of $107.8 million across the entire fee region. This is a 45% decrease from last year.

2023 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 of $227, which is 56% lower than in 2022.

2023 Aggregate fee requirement for the Saskatchewan, Manitoba, Atlantic provinces and the Territories region

For 2023, given this region’s positive net asset position, the aggregate fee per member is $345, a reduction of 90% from last year. For the entire region, the reduction is $41.6 million.

2023 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 will continue to modernize and enhance its member services to maximize the value it delivers to physicians.

Having shared the aggregate fees by region, Dr. Calder presented a practical example of the actual membership fees that family physicians practising in type of work code 35 will pay in 2023 versus 2022 across the four (4) fee regions. She noted the full listing of 2023 membership fees was available on the CMPA’s website. Members’ will be provided an email notification in the fall when the individual fee invoices will be available online through the secure member portal on the Association’s website.

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 sustainable and able to compensate patients and support physicians, today, tomorrow, and well into the future.

2022 Election results

The CEO announced, each year, approximately one-third (1/3) of the CMPA’s Council positions are scheduled for nomination and election. This year, eleven (11) Council positions were up for nomination and election in seven (7) areas, and voting occurred in Alberta and Ontario. Candidates in the remaining Areas were elected by acclamation. She presented the 2022 Council election results, as follows:

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

Dr. Olutoyese (Toye) Oyelese, in family medicine, was acclaimed.

Area 2 (Alberta) (1 position in Division A and 1 position in Division B¹)

Dr. Sanjeeve Sockanathan, in family medicine, was elected.
Dr. Susan Chafe, in radiation oncology, was re-elected.

Area 3 (Saskatchewan, Northwest Territories, Nunavut) (1 position in Division A or B)

Dr. Mansfield Mela, in forensic psychiatry, was acclaimed.

Area 5 (Ontario) (1 position in Division A and 2 positions in Division B)

Dr. Elliot Halparin, in family medicine, was re-elected.
Dr. Tracey L. Ross, in otolaryngology, was elected.
Dr. Jennifer Clara Tang, in emergency medicine, was re-elected.

Area 6 (Québec) (2 positions in Division A)

Dr. Jacques Bouchard, in family medicine, was acclaimed.
Dr. Fahimy Saoud, in general practice/family medicine, was acclaimed.

Area 7 (New Brunswick) (1 position in Division A or B)

Dr. Jennifer Gillis-Doyle, in palliative medicine, was acclaimed.

Area 10 (Newfoundland and Labrador) (1 position in Division A or B)

Dr. Michael T. Cohen, in family medicine, was acclaimed.

Dr. Calder welcomed the diversity of and extended thanks to all of the candidates in the 2022 election, in a time when maintaining strong leadership at the CMPA is critical. She acknowledged the members who would be departing Council, Drs. Paul Farnan and Christopher Wallace, and thanked them for their commitment to the Association and to its members during their tenure as CMPA Councillors.

Member motion

Dr. Cohen reported that on July 15, 2022, all members received an email from the CMPA advising that it received a member motion focusing on a review of the CMPA governance model, as follows:

Be it resolved that:

The Canadian Medical Protective Association commits to undertaking a comprehensive review of its governance model with a view to potential By-law amendments, including but not limited to Council composition (including size), representation (including geography, specialty and diversity) and skills.

The Canadian Medical Protective Association will bring forward an update to the 2023 Annual General Meeting, and the final report on the governance review (including any proposed By-law changes) to the 2024 Annual General Meeting for consideration and approval.

The President reminded delegates that only members may vote on the motion or ask questions. In the interest of time, he requested all speakers restrict comments to two (2) minutes, and indicated the discussion around the motion would be limited to twenty-five (25) minutes. He outlined the process of the member motion.

Prior to opening the floor to discussion, Dr. Cohen reported the Association is governed by an elected Council of thirty-one (31) practising physicians from across Canada, who work with management to foster the long-term success of the CMPA. The By-law outlines Council’s responsibilities and composition. Incorporated over one hundred and twenty (120) years ago by an Act of Parliament, this Act and the By-law lay out the rules that guide the conduct of the CMPA’s affairs. The By-law outlines the requirements and composition of Council, including its size. The Terms of Reference for Council and Councillors set out the manner in which Council organizes and conducts itself to fulfill its responsibilities, and describes the responsibilities of Councillors. He clarified that changing the CMPA By-law is not only an internal process, rather, it is an extensive process which takes significant time and consultation. The Association’s governing documents also require membership and government approval for the amendment to pass, a process which can take up to two years. The CMPA has changed its By-law in the past and is currently in the process of reviewing its governance practices and model, which makes this discussion timely. He thanked all members who attended this meeting to discuss the important issue and help the Association contribute to good governance.

Dr. Robert Cooper, a family physician from Toronto, Ontario who works primarily in addiction, and mover of the member motion, described the CMPA as a fantastic organization run by physicians for physicians, and the staff as incredible, caring, motivated to help physicians, and committed to modernizing the Association. He suggested the last vestige of the 20th century is an expensive, oversized, inefficient Council, and put forth a motion for the CMPA to investigate and apply governance best practices so that it is sustainable and available to protect physicians and patients for the foreseeable future. Having served on the CMPA Council for eighteen (18) years, and having sat on most of its committees, he felt a full governance review was long overdue, particularly given the Canadian Medical Association (CMA), College of Family Physicians of Canada (CFPC), Ontario Medical Association (OMA) and Medical Council of Canada (MCC) have taken part in a similar exercise and decreased their boards substantially.

Dr. Cooper further noted his presence during this meeting aims to ensure the CMPA becomes even better. He thanked Drs. J. David Naysmith, a plastic surgeon from Victoria, British Columbia, and Carole L. Williams, a family physician from Duncan, British Columbia, two additional former CMPA Councillors who signed and support the motion, for also caring to be present during today’s meeting. He stated The Wall Street Journal indicates the ideal board size for many organizations is between five (5) and seven (7) members. Up to fifteen (15) members are acceptable on the high end in unusual circumstances. On behalf of the 105,000 CMPA members, he thanked the CMPA staff for their caring, their dedication to the Association’s members, and the exceptional job they do every day helping Canada’s physicians. Dr. Cooper called on meeting attendees to vote in favour of the motion to send a clear mandate to the CMPA that they expect a modern, efficient, and cost-effective Council.

Dr. J. David Naysmith, a plastic surgeon from Victoria, British Columbia, also spoke in support of the motion. Having been a CMPA member since 1983 and having served on Council for eighteen (18) years, he recalled being immediately impressed and having his admiration grow from there with the commitment of Councillors, management and staff to the membership and to the needs of the members. He described the proposed motion as critical to one of the current CEO’s main goals, to modernize the Association. He recalled Council having considered decreasing its size in the past and deciding not to make a change based on its being unique. The CMPA annual report lists one (1) of its six (6) core values as responsible stewardship, which refers to the stewardship of funding of the Association by way of fees. The motion also calls for efficiency and the adoption of a governance model that is appropriate for the times. While a decrease to Council’s size would require a By-law change, which carries risk, it is an appropriate time to do so given other CMPA matters would also benefit from the exercise. While not part of the motion, Dr. Naysmith expressed the opinion that a move to a Council of ten (10) or twelve (12) would not compromise the fiduciary responsibilities of Council to membership. He encouraged all to support the motion.

The President welcomed members to pose questions or share comments on the member motion. Having indicated he would monitor the discussion and address any issues accordingly, he delegated facilitation of the questions from the floor and from online participants 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. Ajit Ninan, a psychiatrist in addiction medicine from London, Ontario
Dr. R. Douglas Wilson, an obstetrician/gynaecologist from Vancouver, British Columbia
Dr. Carole L. Williams, a family physician from Duncan, British Columbia
Dr. Susan L. Hayton, a family physician from Saskatoon, Saskatchewan
Dr. Olutoyese (Toye) Oleyese, a family physician from West Kelowna, British Columbia
Dr. Robert J. Robson, a family physician from Dundas, Ontario
Dr. Diane Francoeur, an obstetrician/gynaecologist from Montréal, Quebec
Dr. Efe Michael Ovueni, a family physician from Calgary, Alberta

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

The motion presented is friendly given the CMPA has already begun associated work and fully intends to undertake a governance review over the next few years.
The best governance model for the Association needs to be assessed to be sure any change made will bring value and support it in becoming additionally nimble, sustainable, and able to tackle the future.
To a comment that EDI is difficult to attain with a smaller Council, it was suggested both goals are achievable with careful thought and consideration. Given the Association’s commitment to advancing diversity while considering Council size, the modernization of governance is incorporated within the CMPA’s EDI strategy, and a governance consultant will be hired to assist with navigating the work and ensuring both goals are advanced.
The seconder of the member motion spoke in support of the CMPA Council becoming more nimble and focused on skills rather than equity and diversity, and expressed distress over the fact that most of this year’s Council positions were filled by acclamation.
While some of the organizations cited earlier as having decreased the size of their boards are similar to the CMPA, they are not the CMPA. The Association is unique in that it provides support for a complicated and critical profession working in Canada. It will identify a unique solution to its governance review, one that contemplates representation from the membership, a variety of skills, diversity, and the work that must be accomplished. Multiple elements will be considered and balanced in an effort to identify the best governance model, which will be presented to the membership in two years.
A smaller Council size will render it impossible for a Councillor to contribute eighteen (18) years or to acquire the experience of the various committees. It becomes increasingly difficult to ensure varied representation, and especially representation of minority groups, as Council size is reduced.
Should the governance review require a By-law amendment, this would provide the ability to consider including the voices of non-members such as patients, likely in an advisory role, on Council.
Having recently revised its board, the former President of the Society of Obstetricians and Gynaecologists of Canada (SOGC) offered support for the motion and recommended having a strong curriculum in ensuring Council is equipped with the necessary skills to work on reputational risk, legal issues, and finances. Council must not be too small, nor too large, and its Terms of Reference would benefit from ensuring diversity accompanies many other skillsets, and that opportunities exist for all to learn them.
To require a small number of Council members may prevent the CMPA from fulfilling the reason for having Councillors and for getting additional individuals involved. The Association could benefit from recalling how its Council grew to have 31 members before it considers reducing this number, given it currently comprises family physicians, specialists, individuals from various jurisdictions and backgrounds, all of which provide unique and diverse perspectives.
The current CMPA Council model is based on specialty, geography and approximate number of members. The governance review will seek to balance or rebalance the need for representation on Council with the modernization of the Association. It will come up with several different models and, following a consultation process, will be able to propose a new approach that will make sense.

The following motion was considered by the membership:

The motion was moved by CMPA Member Dr. Robert Cooper of Toronto, Ontario, and seconded by CMPA Member, Dr. Carole Williams of Duncan, British Columbia, as follows:

Be it resolved that:

Motion carried.

The President announced a question had been received from a member after he called for the membership to vote, and the CMPA will respond privately.

Dr. Cohen expressed the CMPA’s appreciation for its members’ guidance on this issue and reported Council will continue with its period of study and consultation both on this matter and on other matters already identified for review. He committed to providing an update in this regard during the 2023 annual meeting.

Looking to the future

The CEO believed, while many Canadians are used to being able to access a family physician, an emergency department or a specialist, this is changing due to factors such as the health human resource crisis and impact of virtual care, and will be discussed during the afternoon’s information session. With physicians now responsible to contribute to advancing EDI in healthcare, she announced the CMPA’s long-term Equity, Diversity and Inclusion (EDI) Strategy, which is available on the Association’s website and has been emailed to all members. Actively seeking to change its workplace culture to bring about more learning and to embrace a growth mindset, the CMPA’s EDI vision is that it is an organization where members and employees can be their authentic selves and are valued for their diverse experiences and perspectives, and where it provides members with fair and equitable support, helping them provide safe medical care. Knowing it will make missteps, the Association is committed to acknowledging these, apologizing and striving to do better. The CEO reported the strategy addresses five (5) essential elements, of which the CMPA will first focus on the first three (3); members, governance, employees, learning and advocacy.

Committed to taking action to better understand members’ EDI experiences and challenges so as to enhance its service delivery model, Dr. Calder announced the member pillar of the strategy has three goals. In the next three years, the Association will work to provide members with safe and inclusive services, explore opportunities to assist members in resolving medico-legal concerns using alternative approaches, and enhance representation in its service delivery model. The CMPA will strive to continue to listen, learn and engage with its members and stakeholders to explore how it can better support underrepresented and marginalized groups. It will continue to forge partnerships with EDI organizations to understand how it can include anti-black racism and anti-racist approaches in its service delivery model, and continue to actively seek ways to foster truth, healing and reconciliation for Indigenous members and stakeholders.

The CEO reported the Council approved EDI strategy lays out three governance goals to help continue to build a governance environment that is equitable and inclusive. These are to evolve its Council nomination procedures to better support diversity and representation, strengthen governance structures to support EDI initiatives, and grow inclusive governance practices through organizational learning and training. With a focus on being action oriented in the CMPA’s EDI strategy, she committed to providing the membership with regular updates, and to continuing to engage and consult with members to better understand how to build a more inclusive CMPA.

Dr. Calder noted, while the future is uncertain and rapidly changing, especially as individuals continue to deal with the pandemic, she continues to have hope. This is an opportunity for the CMPA to consider how it can better support its members and find ways to meet their needs in different ways to advocate for system change while continuing to deliver its core services. Scheduled to be presented at the end of the year, the Association is currently developing its next Strategic Plan, which will be a focused, practical vision to ensure that it continues to be there for members, modernizes the organization and does so collaboratively.

Remarks from the CEO

Given it was his last annual meeting as President of the CMPA, the CEO thanked Dr. Cohen for his guidance and leadership. She described him as instrumental in helping the Association continue to be there for its members and employees, and to understand members’ evolving needs. He supported the new organizational structure, which leaves the CMPA better positioned to be able to support physician wellness, leverage its data and develop learning to foster patient safety. Under his guidance, the Association developed an EDI vision and began taking steps to enhance its workplace culture and strengthen the delivery of fair and equitable member services, and made significant strides towards modernizing its governance. Dr. Calder thanked him for continuing to strengthen the CMPA’s role as an essential component of the healthcare system, and for helping the Association become a more modern and responsive organization.

Dr. Cohen indicated it has been a privilege working with the CEO and her dedicated, knowledgeable and professional management team. He was also honoured to have chaired the CMPA Council and collaborate with his Council colleagues to guide the Association.

Remarks from incoming President

The President introduced Dr. Jean-Hugues Brossard, a talented physician and knowledgeable leader who will assume the role of CMPA President immediately following the annual meeting. Dr. Brossard is a bilingual endocrinologist from Québec with significant experience in education and association governance. A current managing partner of the Clinique d'Endocrinologie de Montréal, Dr. Brossard has taught and practiced endocrinology as an associate professor of clinical medicine at the Centre Hospitalier de l'Université de Montréal since 1994. He also served as their Chief of Endocrinology until 2015. Dr. Brossard is the past president of the Fédération des médecins résidents du Québec and the Association des médecins endocrinologues du Québec. Given he possesses a deep and broad knowledge of the CMPA, Dr. Cohen expressed every confidence that the incoming President’s strong leadership, governance and healthcare system experience will position the CMPA for success for years to come.

Dr. Brossard echoed the CEO’s gratitude for Dr. Cohen’s guidance and leadership during the past two years, a time during which, given the pandemic, leading the Association was not an easy task. He recalled Dr. Cohen having met every challenge with grace and having continued to provide both Council and management with thoughtful direction, encouragement and support. He thanked Dr. Cohen for his commitment throughout his time on Council.

The incoming President remarked that the speed of change in our society and healthcare system does not seem to be slowing down. As he begins his tenure as President, he reflected on how the shortage of human resources in healthcare, the shift towards virtual care, and various stressors resulting from the pandemic will lead to profound changes. It will be important to gain a solid understanding of the challenges CMPA members face, and to be nimble, evolve and adapt without losing sight of the Association’s core values and priorities. Dr. Brossard indicated he is convinced the CMPA is in an excellent position to overcome these challenges. For over 120 years, the CMPA has been there for its members by remaining true to its core values and the principles of mutuality, which were founded on ethics and excellence in service, to name a few. He reaffirmed his commitment and described his main objective as continuing to modernize the governance of the Association while holding fast to its values, supporting the evolving needs of its members and maintaining the sustainability of the organization. Having described it as an honour to lead such an exceptional team, Dr. Brossard looked forward to working with Council colleagues and the CMPA staff to continue to protect the professional integrity of over 105,000 members in an effort to help them provide safe medical care.

Closing remarks

Before closing the meeting, the President indicated he looked forward to working with Dr. Brossard on Council to further the Association’s mission. He noted it has been a real pleasure and privilege to serve the Canadian physician community in this capacity for the last two years. He thanked physician members for the care they provide every day through these extraordinary times, as well as for their time, attention and thoughtful questions during the meeting. He concluded by reminding all meeting participants that the CMPA is there for its members.

Announcements

Dr. Cohen announced the conclusion of the meeting and reminded meeting participants to return, following a short break, for the information session on Medico-legal realities emerging from the pandemic – Opportunities and challenges of virtual care.

Adjournment

There being no further business, at 2:42 p.m. PT, the President declared the meeting adjourned.

[1] Council approved 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.