Minutes of the 2025 CMPA Annual Meeting [Draft]

Toronto ON, with virtual participation—August 20, 2025

Welcome and opening address

The 121^st annual meeting of the Canadian Medical Protective Association (CMPA) was held beginning at 2:00 p.m. ET on Wednesday, August 20, 2025, in the Toronto Ballroom of the Hilton Toronto, 145 Richmond Street West, Toronto, Ontario. 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 189 physician-members present, with 74 participating in person and 115 virtually.

Call to order

The CMPA Chief Executive Officer (CEO), Dr. Lisa Calder read the notice of the 2025 Annual Meeting of the Canadian Medical Protective Association and declared the meeting to be duly constituted.

Land acknowledgement

The CEO welcomed Kawennanoron Cindy White, who is Onondaga Snipe Clan from the Mohawk community of Akwesasne and currently living in the Six Nations Grand River Territory. Actively engaged in her personal healing and spiritual training since 1996, Kawennanoron studied nursing and received a Bachelor of Science degree from the State University of New York. Now a Ceremonial Leader and Traditional Healer, she has travelled among First Nations and across the globe to bring the Sacred Fire. In her role as the Elder-in-Residence at the Women’s College Hospital in Toronto, she provides guidance for program development and the implementation of practices specific to Indigenous peoples. Ms. White shared a traditional thanksgiving address, expressing deep gratitude to the Creator and all aspects of Creation - earth, water, plants, animals, celestial bodies, ancestors, and spirit helpers. She emphasized humility, spiritual connection, and the importance of love, kindness and service, then called on meeting participants to remember their purpose and to work together to create meaningful change for future generations.

The CMPA President, Dr. Birinder Singh, thanked Traditional Healer White before reflecting on living in Toronto (Tkaronto), acknowledging it as part of the Treaty Lands of the Mississaugas of the Credit, and honouring the ancestral and ongoing stewardship of the Anishinabek, Huron-Wendat, Haudenosaunee, Ojibway/Chippewa, Métis, and Mississaugas of the Credit First Nation. He also recognized that the CMPA offices in Ottawa are located on the unceded territory of the Anishinaabe Algonquin Nation. Respect was extended to all First Nations, Inuit, and Métis Peoples across Turtle Island.

Introduction

Dr. Calder reminded meeting participants that, as per the CMPA By-law, only active members could vote or pose questions. She provided instructions as to how both in-person and virtual attendees could do so.

The President announced he was joined by a number of colleagues from senior leadership, Council and General Counsel, many of whom would either be presenting during the meeting or available to answer members’ questions. He also acknowledged the presence of five former presidents of the CMPA, Drs. Jean-Hugues Brossard, Micheal Cohen, Debra Boyce, Jean-Joseph Condé and Peter Fraser; and two former CEOs, Drs. Douglas Bell and John Gray.

Appointment of scrutineers

Dr. Singh indicated Drs. Alexander Barron and Sally Jorgensen, both of Toronto, Ontario 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 2024 CMPA Annual Meeting

The minutes of the 2024 CMPA Annual Meeting had been posted on the CMPA website.

A motion to approve the minutes of the 2024 CMPA annual meeting, held in person with virtual participation available, was moved by Dr. Darcy Johnson of Winnipeg, Manitoba, seconded by Dr. Jean-Hugues Brossard of Saint-Lambert, Québec, and was carried.

A year in review

The CEO reported, having heard concerns from CMPA members and healthcare leaders regarding the challenges facing the Canadian healthcare system, the Association met with governments and healthcare organizations about various topics, including artificial intelligence, equity, diversity, and inclusion, and the support for international medical graduates (IMGs) who are new to practice in Canada. The CMPA’s Strategic Plan is aimed at meeting member needs amid these challenges, with a focus on three key priorities:

• Supporting its members and employees
• Strengthening its foundation through collaboration, and
• Adapting to the changing healthcare environment through modernization

Peer support

The President indicated the support of members’ medico-legal needs underpins all Association work. In 2024, members were supported with compassionate, peer-to-peer guidance more than 54,000 times, over the telephone and online. The CMPA answered members’ medico-legal questions, provided informed guidance and helped members prevent patient harm and practise medicine safely.

Physician wellness and the Member Support Program

Dr. Singh noted the Association also helped members cope with the stress of medico-legal events and continued to look for new ways to do this. In the past year, the CMPA launched the Physician Well-Being Index, bringing it to Canadian physicians for the first time in French and in English. Validated by the Mayo Clinic, this online tool provides members with an effective way to assess their levels of distress against their peers and links them to local resources.

The CEO added the Association’s Member Support Program supported the wellness and medico-legal needs of members by providing tailored support to those experiencing either a high or increasing number of medico-legal issues. With this program’s impactful results, 96% of the participants who were surveyed took steps to improve their practice and long-term impacts have included impressive reductions in College and hospital complaints.

Modernizing the member experience

Dr. Calder reported the CMPA continued to modernize the member experience by consolidating and making online resources on medical assistance in dying, artificial intelligence and health biases more accessible. When the law on medical assistance in dying changed in Québec, the Association provided medico-legal advice to help members manage the risks. To make peer support more accessible, the CMPA reduced its call return time to one working day and members can choose a time that best suits their busy schedule for a return call.

General Membership Survey results

The President provided statistics on the General Membership Survey held this year, in which 97% of respondents agreed the CMPA’s services met the medico-legal needs of the profession. "Trusted" was a top word used to describe the Association.

Compensation to patients

Dr. Singh spoke to the CMPA’s mandate of providing timely and appropriate compensation on behalf of members to patients proven to have been harmed by negligent care. In 2024, $322 million dollars in compensation was paid to patients.

Equity, diversity, and inclusion

An essential value for efficient and safe healthcare, the CEO described equity, diversity and inclusion (EDI) as at the heart of the Association’s mission. With members having confirmed said issues are closely linked to medico-legal issues, she noted the CMPA’s commitment to EDI is stronger than ever. She outlined the concrete steps taken to make the Association’s services more inclusive and to provide equity scholarships. The CMPA also used alternate dispute resolution processes in several cases and engaged with stakeholders who have an interest in restorative approaches to healthcare harm. In medico-legal cases where members faced racism and/or discrimination, the Association implemented a new extent of assistance principle intended to better assist and support its members. It is also striving to build a stronger healthcare system by collaborating with stakeholders.

Advocacy and collaboration

Dr. Calder noted one key area of support is for IMGs new to practice in Canada. The CMPA recently published new research called ‘10 things to know about IMGs’, which myth-busts commonly held narratives using the Association’s data. Having referred in person meeting participants to the IMG poster in the back of the room, she reported having engaged with the federal government and with provincial and territorial medical associations and federations to address the barriers IMGs face when integrating into the healthcare system in Canada.

The President added the CMPA will continue to monitor the healthcare environment and the legal landscape for issues that may impact its members. He committed to supporting the members with the significant reforms being proposed to Ontario’s civil justice system.

Safe medical care

Dr. Singh indicated the Association continues to strive to develop and deliver inclusive, data-driven learning products that are responsive to the needs of its members and advance safety in medical care. This past year, the CMPA’s learning and advice helped support a group of physicians to keep a medical clinic, on the verge of closing, open in a First Nations community. The Association published a paper on its Test Results Follow-Up workshop, in which 97% of participants said the improvements they made to their test follow-up system significantly enhanced patient safety within their practice. And participants in the Patient Safety Primer course for residents reported a marked improvement in their communication skills, including cultural and language sensitivity, resulting in an enhanced trust between physicians and patients. The CMPA’s 300 learning events were attended by a combination of 13,160 members this year, and its digital products were accessed 181,275 times.

Modernizing governance

The President reported, under Council’s lead and building on the last three years of work including extensive member engagement, the Association continued to focus on modernizing its governance model with an aim of enhancing agility for continued success in an ever-changing environment. Following last year’s membership vote to approve a new governance model, the CMPA made amendments to the By-law and will seek membership approval of those changes during this meeting.

Data, research, and knowledge sharing

The CEO noted the Association continues to maintain the largest collection of physician-based medico-legal data in the world. It developed tailored risk information by specialty in 8 new ‘Know Your Risk’ reports, including tools to allow members to self-assess their medico-legal risks against their peers. The CMPA also helped shape the future of artificial intelligence in healthcare by offering guidance to members via webinars, position papers, and stakeholder engagements.

2024 Report of the Audit Committee

Dr. Katy Shufelt, First Vice-President and Chair of the Audit Committee, which is comprised of five members of Council plus two external financial experts, all of whom are independent of management, reported that the firm of KPMG audited the CMPA 2024 financial statements and attested the statements properly present the results of operations in 2024 and the financial position of the Association as at December 31^st, 2024.

2024 Financial Report

Financial model

Mr. Cory Garbolinsky, Chief Financial Officer (CFO), reported the CMPA has a responsibility to maintain sufficient funds to support its more than 115,000 members and, on their behalf, compensate patients proven to have been harmed by negligent care today, tomorrow, and well into the future. 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, even in retirement, as long as they were members when the care was provided. As a result, the Association must hold funds to support members and compensate patients for up to four decades from the time the care was delivered.
• Principle 2: Members pay the expected cost of their protection through their yearly membership fees. Each year, the Association collects the fees required for the estimated cost of protection for all potential medico-legal occurrences taking place in that same year, even though they may not become apparent for many decades.
• Principle 3: The CMPA does not seek to generate a profit; its financial goal is to hold at least $1 of assets for every $1 of liability to appropriately compensate patients and support physicians.
• Principle 4: The CMPA’s financial model is self-correcting. Upon its actual year-end results differing from its estimated results, as a not-for-profit organization, the Association is not permitted to pay dividends to its members but it may increase or decrease membership fees from year to year to balance its net asset position.

The CFO explained the inter-connectedness of the various components of the CMPA’s financial model. Its net asset position, or the difference between its total assets and total estimated liabilities, is a key factor in determining the membership fees in any given year. Membership fees are used to pay the medico-legal costs of supporting the Association’s more than 115,000 members and compensating patients on their behalf. The changing trends in medico-legal costs shape the size of the assets needed for future and outstanding claims. This is the amount of money needed to appropriately compensate, on behalf of members, patients proven to be harmed by negligent medical care and to manage future legal and administrative expenses. The CMPA’s investment portfolio aims to earn income to ensure it can appropriately compensate patients proven to have been harmed by negligent medical care and fund future medico-legal expenses.

2024 Financial performance

Net asset position

The CFO reported, as of December 31^st, 2024, the CMPA’s net asset position increased by $163 million from 2023 to $1.1 billion. This increase was mainly the result of strong investment returns. 

Membership fees

Mr. Garbolinsky recalled that between 2021 and 2024, the CMPA reduced fees by a total of $770 million. In 2024, fee reductions totaled $108 million dollars, which were more modest than the reductions in the previous two years. With 2022 having seen lower than expected market performance and a steady increase in medico-legal costs in almost all regions, the combination of higher medico-legal costs and lower investment returns meant the overall financial position decreased. As a result, most 2024 membership fees increased from their significantly reduced levels in 2023, except those of Québec. This shift in 2024 fees ensured we could continue to be there for members and their patients as needed. A total of $500 million in membership fees was collected in 2024.

Medico-legal costs

The CFO explained that the CMPA collects membership fees to pay medico-legal costs such as compensation to patients proven harmed as a result of negligent care, legal and expert fees, safe medical care learning programs, and the costs to run the Association. Having described compensation to patients as the CMPA’s single largest expense, he reported that in 2024, the Association paid nearly $322 million to patients, an all-time high. While the total compensation amount varies from year to year, the CMPA paid a total of $2.5 billion in patient compensation over the last ten years, or an average of $249 million per year. Total legal costs over this same ten year period were $1.9 billion.

Assets for future and outstanding claims

Mr. Garbolinsky described the assets for outstanding claims as the sum of all of the expected future medico-legal costs resulting from the care delivered by members up to and including 2024. And for care delivered in 2024, the CMPA collected sufficient funds for anticipated expenses related to care for the next four decades. As of December 31^st, 2024, the estimate for all outstanding and future claims was $4.4 billion, an increase of $217 million from 2023 based on updated cost-trends. Approximately two thirds of this $4.4 billion amount is for compensation to patients proven to have been harmed by negligent medical care. This amount of assets for outstanding claims was subject to a peer review by Ernst & Young, whose independent calculation strongly aligned with that of the Association and was also audited as part of KPMG’s external audit of the CMPA’s financial statements.

Investment portfolio

The CFO reported the CMPA’s investment portfolio is targeted to match or exceed a 6% investment return over the long term. The Association achieved exceptional returns on its investments over the past ten years, earning a 7.3% compound annual return. This same portfolio had a net value of $5.9 billion in 2024, an increase of $309 million from 2023, which can be attributed to an overall increase in financial markets in which the CMPA exceeded its target, earning an investment return of 13.6%. The Association’s positive financial position will help weather the financial markets and fluctuating medico-legal case volumes and costs. The CMPA continues to invest responsibly to maintain an appropriate financial position that ensures timely and appropriate compensation to patients on behalf of members, protection and support to physicians, safe medical care learning and research to support patient safety in Canada.

In conclusion, Mr. Garbolinsky summarized three key takeaways:

• The Association’s occurrence-based protection allows it to operate with a long-term financial horizon of up to four decades, and to protect members and compensate patients today, tomorrow, and for years to come.
• Fee increases or decreases are the primary tool used by the CMPA to manage its overall net asset position.
• The Association’s positive net asset position in 2024 should provide confidence to members and their patients that it is there for them when needed.

The full report of the Association’s 2024 financial performance is available on the CMPA website.

2026 Member fees

2026 Regional fee requirements

Dr. Calder indicated each year, the CMPA sets membership fees to support its financial sustainability while striving to keep fees as low as possible. Membership fees in each of the Association’s four fee regions reflect regional variations in medico-legal costs, the number of physicians, frequency of cases, and the risk levels of different specialties. The fees are collected to pay the estimated medico-legal costs of any given year, including compensation to patients and the cost to support members, for up to four decades. The CMPA is committed to managing its members’ fees with care and foresight, and to keeping them relatively stable over the long term, even as investment markets and medico-legal costs fluctuate. Depending on its financial position, the Association uses fee debits and credits and returned close to $770 million in fee credits to members in the last four years alone, largely due to the positive performance of its investment portfolio. Returns from the CMPA’s investment portfolio have paid a large portion of its members’ cost of protection.

The CEO added, while membership fees are paid entirely by members, all provincial and territorial governments and their medical associations or federations have negotiated reimbursement agreements that are intended to offset some of the cost of liability protection. The Association is not party to these negotiations.

Dr. Calder further reported, with the better than expected performance of the CMPA’s investments being a positive story for both its financial position and 2026 membership fees, the overall 2026 average membership fees are similar to those in 2025, with small changes in some fee regions due to increasing medico-legal costs. In response to the regional cost differences across the country, the Association’s four 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 there is no cross-subsidization between each region, if one region is in a positive or negative financial position, this does not impact the others. The total cost per region is the amount to be collected in each region, and the average fee per member constitutes the total cost per region divided by the number of members in that region. This fee is only an average, used for illustrative purposes, and not an actual membership fee. When determining individual member fees, the CMPA first calculates the total cost for the region and uses this as the foundation to determine regional fees based on the type of work.

2026 Average fee requirement for the British Columbia and Alberta region

With its total regional fee requirement increasing by $12 million to $167 million, the average fee requirement in British Columbia and Alberta will increase by 5% in 2026, or about $250 per member. Part of this fee increase can be attributed to increases in medico-legal costs over the past five years that were slightly higher than predicted.

2026 Average 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. Due to a strong financial position, the total regional fee requirement in 2026 will decrease by $28 million to $308 million, meaning the average fee requirement per member will decrease by 10% to $6,558.

2026 Average fee requirement for the Québec region

Given the Québec fee region is in a strong financial position, in 2026, members in the province will see no increase in their fees. The total regional fee requirement remains at $10 million, and the average fee requirement per member remains the same at $448.

2026 Average fee requirement for the Saskatchewan, Manitoba, Atlantic Provinces and the Territories region

The fees in the Saskatchewan, Manitoba, Atlantic and Territories region will increase in 2026 to ensure alignment with projected medico-legal costs, and the total regional fee requirement will increase by $5 million to $26 million. This means the average fee requirement per member will increase by 20% to $1,704, or an increase of $284 per member. When compared to the fee requirements in 2021 and 2022, they are still considerably lower.

2026 Type of work (TOW) fees

In presenting an overview of recent average fee requirements per member by region, the CEO demonstrated that even though 2026 fees have increased in the British Columbia and Alberta region, and the Saskatchewan, Manitoba, the Atlantic Provinces and the Territories fee regions, fees across all regions are still below 2020 average fees.

Having shared the average fees per member, Dr. Calder presented an example of the actual membership fees that family physicians practising in type of work code 35 will pay in 2026. She noted the full listing of 2026 membership fees is available on the CMPA’s website. Members will be notified by email in the fall when the individual annual fee invoices are available on the website via the secure CMPA member portal.

The CEO offered the Association’s strong financial position as an assurance that it will continue to be there for its members and to compensate patients proven to have been harmed by negligent care on their behalf, today, tomorrow, and well into the future.

2025 Election results

Having referred to the slide projected to share the 2025 election results, Dr. Calder announced she was pleased to welcome a number of new and returning Councillors from across Canada, as follows:

• In Alberta, Drs. fred Rinaldi and Jenn D’Mello;
• In Saskatchewan, Northwest Territories and Nunavut, Dr. Mansfield Mela;
• In Ontario, Drs. Elliot Halparin, Jennifer Clara Tang and Yatin Chadha;
• In Québec, Dr. Jacques Bouchard; and
• In New Brunswick, Dr. Jennifer Gillis-Doyle.

The CEO acknowledged Drs. Susan Chafe (Alberta), Olutoyese Oyelese (British Columbia), Tracey Ross (Ontario), and Sanjeeve Sockanathan (Alberta), who would be departing Council. She thanked them for their commitment to the Association and to its members during their tenure as CMPA Councillors.

Lead General Counsel retirement

Dr. Calder announced that after almost 40 remarkable years of service, Mr. Domenic Crolla, esteemed Lead General Counsel, is retiring from his position. She described him as a steadfast presence and a guiding force through decades of change in both the legal and the medical professions. Having acknowledged that his wisdom, integrity, and unwavering commitment have shaped the CMPA in profound ways, she thanked Mr. Crolla and wished him all the best in his next chapter.

Other business and questions

The President welcomed only active members to pose questions or share comments on additional business. He requested that discussion of the proposed By-law and the related member motion, which was advisory, be deferred until after it was presented for approval. Given the hybrid participation format of the meeting, he indicated questions received both online and from the floor would be addressed. Facilitation of the questions was delegated to the Associate CEO and the Executive Director, Member Experience. Like-minded comments or questions were grouped for efficiency of response subsequent to their having been put forward by the following members:

Dr. Michael Cohen (CMPA Past President), a family physician from Grand Falls-Windsor, Newfoundland and Labrador

Dr. Atul Kumar Kapur, an emergency medicine physician from Ottawa, Ontario

Dr. Dominique Tremblay, an obstetrician/gynaecologist from Sherbrooke, Québec and President of the Association des obstétriciens et gynécologues du Québec

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

• Québec fees. Absent a plan to increase membership fees in Québec despite the Superior Court having ordered an obstetrician-gynaecologist to pay nearly $29 million to a patient in 2024, concern was expressed regarding the significant consequences new jurisprudence may have on payments in the private sector, on potential losses of income, and on it being used as a precedent-setting decision across Canada. Given the case is under appeal, it was noted that is too early to draw conclusions around the implications of this case both within and outside of Québec, however the fee region is in a strong financial position that has recently benefited from many CMPA fee credits. The Association’s actuaries are carefully considering the impacts of the provision to ensure it has the resources required and its legal counsel is closely monitoring this unusual case.
• Ontario civil justice reform. The CMPA and its legal counsel have been paying close attention and participating in the consultation process related to the most substantial reform to civil justice in Ontario in 40 years. It is likely that one of the reforms will introduce a prelitigation protocol before a case goes to court, requiring the two parties to come together and develop approaches to managing the file, identifying substantive issues, etc. The impact on members will include a need to engage in their defence earlier in the case, and to be responsive as the claim is assembled. Potential benefits include an enhanced effectiveness and efficiency of the system and an allowance for earlier settlements in appropriate cases. In engaging with those who are developing the reform proposal, and in collaboration with the Healthcare Insurance Reciprocal of Canada, there is an opportunity for the Association to bring forward its perspective in how to improve the civil justice system and best support its members. Absent knowledge regarding how the rules will be implemented into practice, it is too early to predict whether the reforms will result in changes to the CMPA’s legal expenses. However, the idea behind many of the changes proposed is to lower costs throughout the system for civil legal cases. The final recommendations of the reform are expected to be announced in September 2025, with a period to follow where they will be operationalized into rules of procedure.
• International medical graduates. Many provinces are actively recruiting IMGs as a solution to the current health human resources crisis in Canada. Meeting participants were referred to the infographic on the CMPA’s website that highlights the alignment and cross-collaboration between the Association’s various departments as they seek to understand the challenges faced by IMGs who are new to practice in Canada. Several resources now exist in these departments to work towards addressing the IMGs’ biggest challenge of integrating into the healthcare system, which requires an understanding of how to navigate its complexities and of the barriers they must overcome. IMGs represents one of the Association’s fastest growing segments of its membership.
• Investment Committee. Kudos was offered to the Investment Committee for its excellent work and contribution to the CMPA’s current favourable financial position.

Dr. Singh welcomed meeting participants to return to the meeting following a short break to discuss and vote on the proposed CMPA By-law 53.

CMPA By-law 53

The President announced that while the Association’s current governing body is known as ‘Council’, the new terminology of ‘the Board’ proposed with By-law 53 will be used during discussion of this matter. He noted, because the CMPA was formed by an Act of Parliament, to amend its By-law is a complex and lengthy process requiring approval from the federal Cabinet, which last occurred 15 years ago. While the current By-law 52 has served the CMPA well, the proposed By-law 53 reflects members’ need for an agile Association whose governing Board is positioned to respond to changes in the healthcare and medico-legal systems’ complex and ever-evolving environments. With an aim of being relevant for at least the next ten years, it uses modern and flexible language which allows the Association to more easily adopt modern business practices, and is written in a manner that allows for adaptability over time.

Dr. Singh recalled that a motion to review the CMPA’s governance model was approved by the membership in 2022, following which the Association consulted with members, engaged with experts, and conducted research to build a series of recommendations to enhance its governance model for years to come. During the 2024 annual meeting, members voted to approve recommendations to enhance the CMPA’s governance model, as detailed in the Modernizing CMPA Governance Review Report, following which the Association committed to implementing the recommendations and bringing the proposed By-law to members for a vote during the 2025 annual meeting. The President assured meeting participants that no matter how its governance and By-laws evolve, the CMPA will continue to be there for members with compassionate support, medico-legal assistance, and data-driven learning and research to help them reduce risk in their practice.

Meeting participants were reminded that in 2024, so as to modernize CMPA governance and strengthen its ability to be agile and responsive, the members approved recommendations to progressively decrease the Board size to 15-25 directors; to streamline Board nominations to a single process and maintain geographical representation on the Board; to provide the Board with the ability to appoint up to four Directors when needed; to create 12-year term limits for Board directors; and to maintain an appropriate mix of family physicians, specialists, and other physicians. On June 5^th and 6^th, the proposed By-law 53 was shared with members for review and discussion.

Highlighting the areas that will not change from the current By-law, Dr. Singh reported it will maintain members’ ability to participate in elections, which will continue in geographical areas, and the Board will determine the number of positions. The Board will remain a national body which supports the Association’s work at a national level and the CMPA will remain committed to maintaining the balance of specialties on the Board. The Board will continue to set the skills and competencies needed for each Board position and evaluate a slate of candidates recommended by the Nominating Committee using a robust skills and diversity matrix.

The President then elaborated on the following six key By-law features, which incorporate members’ approved governance model recommendations from 2024, and will give members more opportunities to shape governance and help make the CMPA more agile and responsive:

1. To maintain elected, geographical representation on the Board. While the current By-law provides a minimum threshold of “no fewer than 1” elected positions from each geographical area and dictates the number of geographical areas for election, with the Board size being reduced to 15-25 directors, the By-law will state that each geographical area must have “1 or more” elected Board positions. The Board will determine the number of geographical areas to meet the needs of the Association and can and will specify when more than 1 position is needed for an area.
2. To elect national positions to the Board. With an aim to provide opportunities to strengthen diversity and skills across the Board, and to increase opportunities for members to vote for candidates in their region and for national candidates, the Board will include positions elected at a national level as well as by geographical area. With a smaller Board, these national positions will help to provide more flexibility to adjust the Board to reflect the makeup of the membership and to include elements that are missing in the Board composition, including specialties, skills, practice settings, career stages, diverse lived experiences and viewpoints, geography and more. Within the Governance Manual, the Board will determine the criteria needed for national positions as well as the number of positions needed each year. The one national position currently allocated to a resident will be sunsetted, and residents will be able to seek nomination for any open position, including national or appointed positions.
3. To appoint up to four physician members-at-large to the Board, when needed. With a smaller Board, the CMPA will need more flexibility to adjust composition to better reflect the makeup of the membership or address skill and diversity gaps not always captured during the electoral process. The amendment will increase members’ opportunities to sit on the Board, ensure it reflects various viewpoints and lived experiences, and provide an opportunity to address geographical diversity. The definition for the member-at-large positions, which will be established by the Board and articulated in the Governance Manual, may include attributes such as medical specialty, skills, practice setting, geographic area, career stage, and diverse lived experiences and viewpoints. Candidates for these positions will be reviewed and recommended by the Nominating Committee and approved by the Board. Any member who contributes to the skills and experience needed will have the opportunity to be considered for an appointment as a member-at-large.
4. To foster renewal with 12-year term limits. While CMPA members do not currently have term limits, the proposed By-law will make it so all directors will have 12-year term limits, promoting Board renewal. To maintain stability, support leadership, and sustain knowledge, the President’s and Vice-President’s time in office as senior governors will not count towards their term limits.
5. To maintain a balance of specialties on the Board. Having heard that the balance of family medicine, specialists, and other physicians on the Board is crucial to members, the Association is committed to doing so while maintaining the flexibility to reflect diversity of medical practice. While the current By-law divides the Board into two Divisions (Division A: family medicine and 1 resident position; and Division B: other specialties) their definitions use language that no longer captures the diversity of medical practice. Specific definitions and categories will be removed from the By-law and the Board will define roles and maintain an appropriate balance within the Governance Manual, giving the CMPA more leeway to respond to emerging issues and changing needs.
6. To streamline Board nominations to a single process. Members have expressed confusion over the current By-law’s two-stream nomination process. The proposed By-law will call for one nomination stream with all candidates for open national or geographical area positions being reviewed by the Nominating Committee and recommended to the Board, ensuring equal evaluation for all candidates using a skills and diversity matrix. The selection process for these will be developed and set out in the Governance Manual, pending By-law 53 approval. The Committee may recommend more than one candidate for each position, increasing the slate, and any interested members who contribute to the skills and experiences sought by the Board can seek nomination and election. Additionally, at least two of the Nominating Committee positions will be filled by CMPA members who do not sit on the Board, which will support an increase in diverse viewpoints on the Committee and help to mitigate bias when considering candidates who may have differing viewpoints from those of the current Board directors. The skills and experiences needed for open positions will be determined by the Board and be clearly communicated to all members seeking nomination, supporting transparency. The Nominating Committee will be composed of six to ten members, including the President. At least half of the Committee must be Board directors.

Dr. Singh reminded members that following discussion of the motion projected on the screen, they would be asked to vote to approve or reject the motion proposed. The motion proposed was as follows:

Whereas at the 2024 annual meeting, CMPA members passed a motion approving the Report to Members on the Governance Review as the basis for implementing the governance model described in the Report. The Report included the following recommendations:

• Progressively decrease Council size to 15-25 total to enhance agility in the rapidly evolving environment
• Create a single nomination process to advance access to nomination and continue with regional elections to increase transparency and encourage strong candidates from across Canada
• Enhance diversity and skills by allowing Council to appoint up to 4 member physicians to Council when needed and create 12-year term limits
• Ensure the Council includes an appropriate number of family physicians, specialists, and other physicians
• Consider ancillary by-law changes related to procedural and structural issues, as well as some housekeeping amendments

And Whereas Council has developed proposed revisions to the current CMPA By-law to implement these recommendations and that those changes are reflected in the proposed CMPA By-law 53.

BE IT RESOLVED THAT CMPA By-law 53 be approved and that the Association shall take the necessary steps to bring CMPA By-law 53 into force.

Dr. Paul Healey, an emergency physician from Oakville, Ontario and mover of the motion, shared his experience as a CMPA Board member for the last four years and how it has culminated in the proposed By-law 53, which represents extensive discussion, debate and compromise by those who worked on it. He assured meeting participants that in following the detailed process used to arrive at the proposed By-law 53, he witnessed the professionalism of the management team, Board and senior governors, as well as their commitment and will to ensure members are well cared for within the proposed governance model and By-law.

The President thanked Dr. Clover Hemans, a family physician from Burlington, Ontario and CMPA Board member, for seconding the motion. The President welcomed members to pose questions or share comments on the motion regarding the proposed By-law 53. Facilitation of the questions was again delegated to the Associate CEO and the Executive Director, Member Experience, and like-minded comments or questions were grouped thematically for efficiency of response subsequent to their having been put forward by the following members:

Dr. Anierhe Joan Abohweyere, a pediatrician from Courtice, Ontario

Dr. Laurence Batmazian, a family physician from Pickering, Ontario

Dr. Patrick Bergin, (CMPA Past Board member), an internal medicine physician from Stratford, Prince Edward Island

Dr. Carrie Bernard, a family physician from Mississauga, Ontario and President of the College of Family Physicians of Canada

Dr. Jean-Hugues Brossard (CMPA Past President), an endocrinologist from Saint-Lambert, Québec

Dr. Diane Francoeur, an obstetrician/gynaecologist from Montréal, Québec and CEO of the Society of Gynaecologists and Obstetricians of Canada

Dr. Atul Kumar Kapur, an emergency medicine physician from Ottawa, Ontario

Dr. Alika Lafontaine, an anesthesiologist from Grande Prairie, Alberta

Dr. Fay Leung (CMPA Board member), an orthopedic surgeon from Vancouver, British Columbia

Dr. fred Rinaldi (incoming CMPA Board member), a family physician from Medicine Hat, Alberta

Dr. Wayne Rosen, (CMPA Board member) a general surgeon from Calgary, Alberta

Dr. Tariq Saeed, a family physician from Mississauga, Ontario

Dr. Elizabeth Wiley, a family physician from Victoria, British Columbia

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

• Concern was expressed regarding the single stream nomination process to becoming a Board member, and to moving key governance elements from the By-law to the Governance Manual, which was felt to reduce democracy, transparency, and member involvement with the Board. To the suggestion the CMPA clarify the nomination process before having the membership vote on the By-law during the 2026 annual meeting, Dr. Singh acknowledged the discomfort with such significant changes but emphasized the need for flexibility as the Board becomes smaller and more skills-focused. The Nominating Committee may have less influence over geographic positions than over the national and appointed roles. The Governance Manual will outline rules and allow members to propose changes to these processes more easily than through the rigid By-law process, which requires federal government approval. While not all concerns may be resolved, the intent is to empower members and improve governance adaptability.
• To a question, Dr. Singh reported that under the new By-law, the Nominating Committee will be kept at arm’s length from and work separately from the Board, following which the Board will have final approval and bring the slate forward to the members.
• A CMPA Past President reminded attendees that the current By-law changes are the direct implementation of the governance review approved by members during the 2024 annual meeting, which mandated a smaller Board and a single nomination route. The proposed By-law does not reflect new decisions but the operational actualization of what was already endorsed. A CMPA Councillor added that while it may be imperfect to certain individuals, the proposed By-law reflects thoughtful compromise and is in the best interest of CMPA members and Canadian physicians. He emphasized the importance of having a responsive and adaptable Board to meet future healthcare challenges and uphold the integrity of the profession.
• To a request for examples of how the current governance model has limited the CMPA’s responsiveness and agility, Dr. Singh responded that the large size of the recently 29–31 members slows decision-making and requires quarterly meetings and reliance on the Executive Committee between sessions. With a goal of modernizing governance to better support management and serve members, he noted a smaller Board will allow members to be more directly involved in decisions and reduce the need for reliance on a separate Executive Committee.
• The President confirmed general members will continue to vote on nominated candidates for elected positions, both geographic and national, ensuring broad participation. The flexibility in the new model aims to build a more effective and representative Board.
• Having acknowledged the expressed risk that to rely solely on a Nominating Committee could reduce diversity and limit who gets nominated, Dr. Singh emphasized that the new structure includes mechanisms to maintain diversity and necessary skills, especially since the Board will remain physician-only. He reassured meeting participants that the Governance Manual will provide rules and allow members to propose changes.
• Concern was voiced about long-term risks, such as a future Board manipulating nominations to maintain control, or the Nominating Committee limiting choices and undermining democratic elections. The President stressed that safeguards will be built into the Governance Manual, which members can review and influence. He explained that past rigidity in the By-law hindered responsiveness and that the new approach aims to empower members through more flexible governance. A CMPA Board member further clarified the proposed By-law amendments aim to improve transparency and accessibility. While the current dual nomination system is confusing, the new model allows any member to self-nominate and be vetted by the Nominating Committee, with what will likely be minimal exclusion criteria. Members can also apply for both regional and national positions, increasing opportunities for involvement.
• To a question about geographic representation, Dr. Singh explained geographic allocations will continue, with details outlined in the Governance Manual. While the number of positions per region may decrease due to the Board’s smaller size, the overall structure will remain similar.
• The President of the College of Family Physicians of Canada expressed strong support for the changes, praising the transparency, thoughtfulness, and responsiveness of the process. She felt the reforms reflect modern governance best practices and appreciated that members’ voices were heard and incorporated. She emphasized the importance of trust and was reassured by the role of the Governance Manual in maintaining member input.
• A CMPA member raised concerns about the omnibus nature of the governance motion and suggested controversial elements be separated for clarity; questioned the lack of formal member power over the Governance Manual and the potential imbalance between skills and diversity in Board selection; and warned that the Nominating Committee, largely composed of Board members, could create a self-sustaining cycle lacking transparency and accountability. Dr. Singh acknowledged the concerns and responded by emphasizing the importance of trust and the role of the Governance Manual in providing flexibility and safeguards. He reiterated that members will be able to bring motions during annual meetings to propose change and influence governance. The goal is to balance skills and lived experience while remaining responsive to member needs.
• The CEO of the Society of Obstetricians and Gynaecologists of Canada supported the motion after having successfully implemented similar governance reforms. She highlighted the benefits of an active Nominating Committee, of the inclusion of external experts, and noted that shorter term lengths could help attract younger members. She encouraged trust in the CMPA Board and the process.

A concern was raised regarding how the CMPA’s proposed governance changes may bring unintentional harm to individuals with lived experience, particularly Indigenous physicians, by limiting their access to leadership opportunities. It was further noted that while such individuals are often appointed to Boards for their unique perspectives, they may be tokenized and not supported in advancing to senior roles. The President emphasized the CMPA’s commitment to EDI and described the organization as learning, evolving and valuing lived experience, not as tokenism but as essential to improving governance and member services. He expressed hope that a smaller Board will allow for more intentional inclusion of diverse skills and experiences to strengthen leadership.

The motion outlined above, having been moved and seconded, was voted on and carried.

The President expressed the CMPA’s appreciation for its members’ guidance and approval of the CMPA By-law 53. He indicated the CMPA will now take the necessary steps to officially amend its By-law by seeking Cabinet approval, following which it will work to phase in the changes gradually and responsibly.

Member advisory motion

Dr. Singh recalled that on July 18^th, 2025, all members received an email from the CMPA advising that the following member motion related to the proposed By-law 53 had been received, as follows:

BE IT RESOLVED THAT if the proposed By-law 53 is passed, the Association’s Nominating Committee consider ensuring (a) that implicit bias is minimized by nominating as many Board applicants who meet the required qualifications as reasonably possible; (b) that transparency and trust in the nominations is created by providing specific and targeted feedback to members who applied but were not nominated, and releasing (upon member request) the number of candidates who applied; and (c) that diversity of opinion is respected by also nominating applicants who may have differing opinions than the Association’s prevailing viewpoint at the time. Furthermore, the Association is encouraged to consider maximizing the number of eligible applicants to the Board by ensuring that the required qualifications are not so specific and burdensome so as to exclude a large percentage of the membership.

Dr. Laurence Batmazian, a family physician from Pickering, Ontario and mover of the member advisory motion, shared a personal experience to explain the motivation behind his proposed motion. After trying to get involved with a professional committee and being rejected without clear feedback, specifically being told he didn’t meet “diversity attributes”, he felt discouraged and concerned about the lack of transparency and inclusivity in nomination processes. He highlighted the key aspects of his motion and the importance of creating accessible pathways for physicians like himself to contribute meaningfully, even without traditional leadership backgrounds.

Dr. Singh thanked Dr. Paul Healey, an emergency physician from Oakville, Ontario and CMPA Board member, for seconding the motion, then noted many current Board members are in support of the points raised and looked forward to receiving robust feedback. He welcomed members to pose questions or share comments on the member advisory motion, which were as follows:

• Gerard Craigen (CMPA Board member), a psychiatrist from Toronto, Ontario, also supported the motion, highlighting the importance of diversity and the need for inclusive nomination processes. He advocated for setting minimum qualifications and allowing all eligible applicants to run, reinforcing the motion’s intent to guide the Nominating Committee toward broader inclusion.
• Victoria Januszkiewicz (CMPA resident Board member), a resident studying obstetrics and gynaecology from Kingston, Ontario, spoke in favor of the motion, sharing her positive experience on the CMPA Board. Initially unsure if her role would be tokenistic, she found meaningful mentorship, leadership opportunities, and support that helped her grow professionally at the Association. She emphasized that the proposed changes aim to increase access and transparency, allowing more members, especially early-career physicians, to participate meaningfully in governance.

The motion outlined above, having been moved and seconded, was voted on and carried.

The President affirmed the CMPA’s commitment to fair, transparent nomination processes that respect diversity of opinion.

Looking to the future

The CEO thanked meeting participants for their feedback and support of the CMPA By-law 53. She noted, if approved by Cabinet, the CMPA would then begin with its gradual implementation and measured decrease of the size of its Board, beginning in 2027.

Dr. Calder announced, building on the feedback received via the membership survey, the Association will continue to strive for an even better member experience, to make its services more accessible, meaningful and easy to use. It will enhance its learning resources and continue to strengthen its use of research to drive safe medical care, and to look to apply the principles of EDI in all services.

The CEO shared that the CMPA is beginning to develop its next Strategic Plan, to be launched in 2027. She offered appreciation for the insights provided by members and stakeholders through surveys and engagements, and for their perspectives, which are critical to this next plan. She offered her commitment that, as always, the Association will continue to be there for members.

Closing remarks and adjournment

Dr. Singh thanked Dr. Calder and all members who joined the meeting, both in person and online.

There being no further business, at 4:50 p.m. ET, the President declared the meeting adjourned, and indicated he looked forward to meeting again during the 2026 annual meeting in Calgary, Alberta on August 19^th.