2024 CMPA Annual Meeting (Complete)
Dr. Jean-Hugues Brossard: So yeah, two o’clock, beginning of this AGM. Hi everybody, they wrote my name there to make sure that I remember my name. I am Jean-Hugues Brossard, President of the Canadian Medical Protective Association and welcome to our 120th Annual Meeting.
So, our meeting this year is being delivered virtually and in person from Halifax, Nova Scotia and we are excited to have about 80 members with us in person and online from across Canada.
Much of today's meeting will be delivered in English and everyone has access to simultaneous interpretation.
Lisa and I will be speaking in French from time to time, so I suggest that you keep your headset handy or that you use the interpretation on your computer that is coming with the online service.
As you can see, we will be taking a break halfway through the session to give you time to stretch before we discuss our recommendations to modernize CMPA’s governance model.
I hope you will stay with us for this important discussion and to vote on the recommendations.
In-person attendees can use the headset provided and those online can select the appropriate language on their screen.
Thank you all for taking the time to join us.
Let’s get started. Lisa, over to you.
Dr. Lisa Calder: Merci, Jean-Hugues, and welcome.
It’s great to see everyone here in person and welcome to all of you who are joining us online.
I’m Lisa Calder, I am the CEO of the CMPA.
There being quorum present, I hereby declare this meeting to be duly constituted and call it to order.
To begin our meeting today I would like to take the opportunity to introduce award-winning film producer and director, writer, facilitator, community activist, teacher, drummer and the first Mi’kmaw woman filmmaker from the Atlantic region, Elder Catherine Martin.
Elder Martin is a member of the Millbrook Mi’kmaw community in Truro, Nova Scotia. She received the Order of Canada in 2017 for her dedication and contribution to Indigenous and Canadian cinema.
Elder Martin is past Chair of the Aboriginal Peoples Television Network and the first director of Indigenous Community Engagement at Dalhousie University.</p
Elder Martin, it is an honour to have you with us and I’ll turn the floor over to you to open our meeting.
Elder Catherine Anne Martin: [Indigenous language]
Welcome, hello and it’s a beautiful day and my name is Catherine Martin, I’m a member of the Millbrook Mi’kmaw community under the Mi’kmaw Nation.
And traditionally for over… well, almost 14,000 years according to some people, we’ve been welcoming newcomers to our lands. Not just 500 years ago, for 14,000 years people have come and gone to our lands.
And it’s been our tradition, our basic foundation for our way of governance is... the fundamental... foundation part is sharing.
And so, when people come here, we share. We don’t sell land, we don’t have that concept. We have shared; you can’t buy Mother Earth.
You think you can, but no.
I am honoured to be here and I thought a lot about coming, saying okay, you know, what should I wear, what should I do?
And then I thought well, all I need to say is that, you know, all of you here, what you’re here for is sacred and when people like you or anyone come together it’s ceremony, all the time, it’s not just at the opening and the closing that you are in ceremony and this is sacred work and times and words that we’re hearing from everybody.
So I’m very honoured to be with you and I’m honoured to acknowledge the work and the journey you have been on in your time on this earth in the work that you do.
We also have a treaty, it was supposed to be honoured, and in the early 1750s we began to have a treaty with one of the newest immigrants at the time, the British, and they couldn’t kill us.
They tried everything and we were a strategically... informed... We had strategic warfare approaches.
So, we strategically were able to outsmart, outwit the British, on land and on sea. About a hundred-year battle on the sea and the British could not fight, couldn’t beat us.
That’s not in your history books. Yeah, who’s going to brag about that? We are!
Because we are here today and I’m speaking what little language I’ve been able to learn from my mum and my dad, and I’m not like, unlike a lot of our people my age, is where the language was not promoted and basically stolen from us.
So, I work with people all over the region and across the country and most of the work I do is finding out how is it that the original people should be reclaiming the rights that they have to being the original people.
This is my great-grandparents on my dad’s side hunting territory, their district.
They lived across the water in the last surviving Mi’kmaw villages in HRM, they call it now, we’re on the Dartmouth side, but in 1917 the Halifax explosion wiped them out by fire and then through a tsunami.
Once the explosion... it opened up the harbour. You could see the floor of the harbour. And so, then, the wave went up... up to the basin and when it came back all those that had been injured in our villages, many of them also had to suffer the tsunami that came back and flattened their communities.
And my great-grandparents on my dad’s side lived here, they were hunters and basket makers and in the summer they lived along the village, the Dartmouth shore, and in the winter they moved inland as we always did forever.
So, I welcome you also to the territory of my district, my clan.
Sarah Denny of Eskasoni was a Mi’kmaw woman who devoted her life to bringing back our language, our songs, our dances when it was safe in this country to do so and that was about early ’60s that the Indian Act was... challenged a bit and we were able to organize in the ’60s in Canada.
Up until then it was against the law for us to sing, dance, do ceremonies, anything, speak our language and you could be fined and jailed.
And also the agreement we had with the British was that we were able to live our life as we always had and always will and that was the Peace and Friendship Treaty, the only treaty we ever signed.
We were never conquered, we never signed off a piece of anything.
We’re unique in this country because of the Peace and Friendship Treaty that the British quickly broke and we suffered for 250 years here in Mi’kma’ki and across the country because we were no longer allowed to hunt, fish, gather and live our life that we had for thousands of years.
So lately because of Junior Marshall who was able to fight and bring it to the Supreme Court.
The Supreme Court of Canada in the ’90s acknowledged that we had a treaty, we still have a treaty, we will always have a treaty and that equals this is our land and everybody here is bound by a treaty.
So, all I have to say to you in order to make sure you’re safe is just: Be peaceful and friendly.
That’s all you have to do when you come here and you need to speak from your heart.
And Sarah Denny from Eskasoni asked the Grand Council in the ’60s if she could start to sing this chant, two chants that she heard on a wax cylinder and she taught me to sing this whenever people come together, whenever nations gather, whenever we celebrate life and death and everything in between.
So, around the ’60s we were also given the right to vote in this country. I always throw in a little thing just for thought.
Anyway, when I sing, it’s the heartbeat of Mother Earth, the drumbeat, and it represents the heartbeat of your mother and no matter who your mother was, whether you were raised with her or not, she gave you this and it’s the first language that we all speak around the universe.
And when we dare to speak from our heart and not think first before you speak, when you speak from your heart you’re speaking the truth because it’s the first language that was given to you and it’s the language of your mother, and when we speak that way, everybody can understand because we all had that first language.
So when we sing, we also… it’s a form of prayer, dancing, speaking, drumming, and I do the drumming because it gives you double points up there wherever that is.
They say, when you sing it’s double, double points.
So, I’m asking all of our ancestors to surround us and watch over us over the next day, over the time that you’re together and then also for you to have a safe journey home when you do and you find all your loved ones safe.
[Indigenous song performance]
So, at the end whenever we sing, we say Tahoo, it just means Tahoo, that’s it.
So, when I finish. [Indigenous language]. Ready?
Tahoo! Oh it’s got to be like Ta-hoe. Ready?
[Indigenous language]. Tahoo! There you go.
Dr. Birinder Singh: Thank you very much, Elder Martin.
My name is Birinder Singh and I’m the incoming President of the CMPA.
And I’m especially honoured to be able to deliver this land acknowledgement today, as my family’s settler story in Canada began here in Halifax in the late 1960s.
My grandfather was a professor at St. Mary’s University where my grandmother was a librarian.
My mother completed high school in Halifax along with undergraduate medical school and a family medicine residency at Dalhousie.
My father was a staff psychiatrist at the Nova Scotia Hospital in Dartmouth.
And I was a young elementary student at a public school here in downtown Halifax.
So, as we gather here in Jipugtug, otherwise known as Halifax, I would like to acknowledge that we are in the unceded territory of the Mi’kmaw people.
The sovereign nation holds inherent rights as the original peoples of these lands and we each carry collective obligations under the Peace and Friendship Treaties, Section 35 of the Constitution Act 1982 recognizes and affirms Indigenous and treaty rights in Canada.
I also recognize that African Nova Scotians are a distinct people whose histories, legacies and contributions have enriched that part of Mi'kma'ki, known as Nova Scotia, for over 400 years.
This place has nurtured my family and I pay honour and respect to these lands and the Mi’kmaw people and to all First Nations, Inuit and Metis people throughout Turtle Island.
And I thank the Mi’kmaw people for sharing this land with us.
Now I’ll turn the mic back over to Lisa. Thank you.
Dr. Calder: Thank you, Birinder, and thank you for sharing that personal reflection and for acknowledging the land.
We’re going to look at and turn our attention to some housekeeping items now.
So as a reminder, only active members can vote per the CMPA by-law and those of you who are online will vote using your screens, but those who are in person will vote using the app.
So, please let us know if you have issues with the app before voting begins.
Additionally, only active members can ask questions and those members will be identified in our minutes.
So please take a moment to review this slide with details and there’s also a handout on the tables for those of you who are in person.
Dr. Brossard: So you’re all experts with the app and all that online? Excellent.
So, thank you, Lisa. Thank you, Birinder.
As you see on the screen today, I’m joined by a number of colleagues from senior leadership, from Council, General Counsel, who will be presenting today or are available to answer your questions.
So, I will not name everybody but they are all on the screen.
We also have with us four former Presidents, three in person and one online.
So, Drs. Michael Cohen, Peter Fraser and Debra Boyce, so they’re all on the same table, easy for us, and there's Jean-Joseph Condé online, I think.
And we have two former CEOs, Doug Bell and John Gray all at the same table. So, it was not planned.
Okay. So, thank you all for joining us today.
We… in advance of voting today we have identified two scrutineers: Dr. Jane Healey and Dr. André Bernard.
If you wish to raise an objection to the scrutineers please let us know now using the app with Ask A Question button on your screen or the app or using a mic in the room.
So, I will let people think about the scrutineers, and if you can live with the two scrutineers that have been identified.
Okay, so no objection.
Perfect. So, Dr. Healey and Bernard are appointed scrutineers for the voting today.
Okay. Next, I would like now to seek approval of the 2023 Annual Meeting, the minutes from the 2023 Annual Meeting.
They were posted on the CMPA website ahead of the meeting today.
So, only active members can vote and for that we do need to have a vote.
So, if you have an amendment to the minutes please submit them with, again, Ask A Question button or the app or the mic in the room.
So, any amendment to the minutes that have been posted?
Receiving none. So, I need a mover and a seconder.
So, you can do that with your button on the screen or the app.
So, when you will have moved or seconded, the button will stop to be active.
So, waiting for a mover.
I will see them there.
We have... Do we have...Is it working?
No, it’s not working. Okay. We’re waiting for the... for the motion and the app.
No, nothing?
Okay, Mike Sullivan, moving.
Okay, Mike Cohen, moving.
Ah! It came up, okay.
So, we do have a mover, Michael Sullivan, and we have a seconder, Michael Cohen.
I have more than one mover now. Jacques Bouchard moved on the app and Robert Bates seconded.
So, we do have a motion. So, the minutes are moved and seconded.
Any more comments on the minutes?
We didn’t receive any change.
So, I would now ask members to vote.
The motion will come up on the screen for virtual members and if you are in person, it will take a minute and then it will appear.
It may be already there.
Okay. So please now vote and I’ll wait for the result and normally we have some music and I’m supposed to dance a bit.
Okay, so minutes have been approved. Are we surprised?
Okay, excellent. Difficult process but it’s been approved, so we’re good.
So, this being done, I think now I will turn it over to Lisa to look at more important matters, our Year in Review. So, Lisa.
Dr. Calder: Merci, Jean-Hugues, and thank you for your patience.
It is an interesting logistics feat to get voting in person, paper ballot, online, so appreciate your patience as we work our way through that.
Last year the CMPA launched a new strategic plan.
And since then, we’ve been focussed on achieving three goals: supporting our members and employees, strengthening our foundation through collaboration and adapting to the rapidly changing healthcare environment through modernization.
Our first goal, supporting our members’ medical and legal needs, really drives everything that we do. And it’s the core of every enhancement that we make at the CMPA.
As you can see from the slide, we provided assistance and support to many members with medico-legal issues in 2023.
We also provided just-in-time advice on key issues like the healthcare human resource crisis, medical assistance in dying and more. This work aims to help members reduce harm and practice more safely.
Additionally, our support resonates with members.
We recently conducted a member survey and one of the questions was: What word would you use to describe the CMPA?
The top three words were: respected, responsive and creditable.
And you can see from the quote here, this is one of many that we received, how members feel when they are supported by the CMPA.
Physician burnout and wellness issues continue to be a crisis impacting healthcare, they also have impact on patient safety and increased medico-legal risk.
We’re here to help members deal with the wellness challenges associated with medico-legal issues, and we offer an empathetic ear and compassionate support.
We continue to look for new ways to do this and as you can see, simply speaking with a physician advisor can significantly reduce stress levels.
Over to you, Jean-Hugues.
Dr. Brossard: Okay, we also provide on behalf of our members timely and appropriate compensation to patients when it’s proven they have been harmed through negligent care.
In 2023 we paid close to $308 million in compensation to patients.
Over the past 10 years, we have paid approximately $2.4 billion in patient compensation on behalf of members.
Of course, seeing those numbers, you understand that one of our main priorities is to help prevent healthcare-related patient harm from occurring in the first place through expert advice, learning and research.
We have also heard clearly from our members that equity, diversity and inclusion, EDI issues, can intersect with medico-legal complaints both on the part of physicians and patients.
Those issues are tied directly to our mission and it is why we have a responsibility to address EDI.
As you can see on the slide, we continue to move forward on this work in various ways.
This includes creating inclusive and safe spaces for our members to call and deepening our understanding of members' needs through a new EDI data collection.
Dr. Calder: Merci, Jean-Hugues. I’m going to be speaking French for the next couple of minutes. You may wish to put on your simultaneous interpretation headsets if you are in the room, so I’ll just give you a moment to do that.
According to the membership survey, we know that they wish that we continue to advocate with the governments for changes in order to contribute to a better healthcare system.
We will share the results of the full survey in the fall.
We continue to advocate with our partners on issues corresponding to our mandate, notably policies that have an impact on physicians, patients, as well as the medical accountability system.
For instance, we met with all the medical associations and Colleges in the Atlantic in order to discuss the implementation of the Atlantic registry.
We continue to provide our expertise to explore possibilities and challenges related to artificial intelligence in healthcare.
For instance, we co-presented a symposium on artificial intelligence with the College of Physicians and Surgeons of Alberta. This event helped to advance the conversation with regard to the main possibilities, the risks, as well as the obstacles related to the cautious adoption of these technologies in healthcare. Jean-Hugues.
Dr. Brossard: I’ll continue in French.
In addition to investing and focussing on promoting health and our advocacy with governments and Colleges, we also have to continue to address the new needs of our members by offering new data-based learning activities which are generated as a result of CMPA research and these activities are aimed at improving patient safety and reducing harm.
You can see several examples on the screen of these activities.
And these activities are either renewed or simply designed from scratch in order to address new members' needs.
In a nutshell, we collect and analyze data from the medico-legal experiences of Canadian physicians and then derive a number of learning points to help members to take enlightened decisions and also to provide safe patient and medical care.
All of these efforts, everything Lisa and I have shared over the past few minutes represent how CMPA brings value to the healthcare system and support physicians.
We are here for you and we are here to help you practise safely and confidently.
Now, let’s look at our financial information.
And we’ll start with a message from Dr. Michael Curry, Chair of the Audit Committee, who I will invite to join us on the stage.
Welcome Michael. You’re the voice of the Audit Committee.
Dr. Michael Curry: Thank you, Jean-Hugues. Bonjour à tous. Good afternoon everyone.
The CMPA’s Audit Committee is comprised of members of Council plus external financial experts, all of whom are independent of CMPA management.
The committee meets quarterly to ensure its duties are discharged and in an appropriate manner, consistent with good governance and sound operational procedures.
As Chair of the Audit Committee, I am pleased to report on our activities with respect to the 2023 financial statements, running from our financial year of January 1st to December 31st, which have been prepared by management and audited by the firm KPMG LLP.
The Audit Committee has reviewed these statements with management and with the auditors.
KPMG has attested that the CMPA’s statements properly present the results of operations in 2023 and the financial position of the Association as of December 31st, 2023.
Our Chief Financial Officer, Cory Garbolinsky, who is more technical than I, has prepared a video which shares our 2023 financial report.
Those of you listening in English will hear Cory directly, while those of you listening in French will hear the voice of one our translation professionals.
Let’s watch the video now.
2023 Financial report
Mr. Cory Garbolinsky: CMPA has a responsibility to maintain sufficient funds to support our 111,000+ members and on their behalf, compensate patients proven to have been harmed by negligent care today, tomorrow, and well into the future.
Let’s look at CMPA’s unique financial model that supports our long-term financial horizon and summarize our 2023 financial performance.
There are 4 key principles to keep in mind when considering CMPA's finances and our financial performance.
First, CMPA provides occurrence-based protection.
Physicians are eligible for CMPA assistance any time in the future, even when they are no longer active CMPA members, as long as they were members when the care was provided.
This means we must hold funds to support members and compensate patients up to 4 decades from the time the care was delivered.
Second, members pay the expected cost of their protection through yearly membership fees.
In 2023, we collected the membership fees needed for the estimated cost of protection for all occurrences taking place in 2023, for the next 4 decades.
Third, CMPA is a not-for-profit, member-based organization.
As a not-for-profit, we do not seek to generate a profit.
Our financial goal is to hold at least 1 dollar of assets for every dollar of liability to appropriately compensate patients and support physicians.
Finally, CMPA’s financial model is self-correcting.
Sometimes our actual year-end results differ from our estimates, creating an excess or a deficit in our net assets.
As a not-for-profit, we are not allowed to pay dividends to our members, but we can increase or decrease membership fees from year to year to address the difference.
Our financial model has several interconnected components: Our net asset position, membership fees, medico-legal costs, the assets needed to pay for outstanding and future claims, and our investment portfolio.
Let’s look at how they are all connected.
Our net asset position is the difference between the total assets of the Association (which is primarily the investment portfolio) and the total estimated liabilities (which is primarily the amount needed for future and outstanding claims).
It is a key factor in determining membership fees in any given year.
Membership fees are used to pay the medico-legal costs of supporting our 111,000+ members and compensating patients on their behalf.
The changing trends in medico-legal costs, such as the cost per case, complexity of cases, and the volume of new cases, shape the size of the assets needed for future and outstanding claims.
This is the amount of money needed to appropriately compensate patients proven to have been injured as a result of negligent care and manage future legal and administrative expenses.
Our investment portfolio earns income to ensure we can appropriately compensate patients and fund future medico-legal expenses to support our members.
Now, let’s look at our financial performance in 2023.
As of December 31, 2023, our net asset position decreased by $121 million from 2022 to $983 million.
This decline was by design, as we significantly reduced membership fees in 2023 to lower our net asset position, which was higher than ideal in 2022.
The decrease in membership fees collected was offset by a strong return in our investment portfolio, which we’ll look more closely at a little later.
2023 Financial performance: Membership fees
Fees were reduced by $99.5 million in 2021 and $200 million in 2022.
In 2023, reductions were $362.5 million, for a total of $662 million in membership fee reductions since 2021.
The total membership fees collected in 2023 were $199.2 million.
One of our goals is to maintain relative fee stability, but our fees are impacted in part by the performance of our carefully managed investments and market fluctuations.
As appropriate, we may lower membership fees when we are in a strong financial position and prudently raise fees when needed.
2023 Financial performance: Medico-legal costs
Membership fees help pay medico-legal costs, which include compensation to patients proven to have been injured as a result of negligent care, legal and expert fees, safe medical care learning programs, and the costs to run the CMPA.
Compensation to patients is the Association’s single largest expense.
In 2023, on behalf of our members, we paid nearly $308 million in compensation to patients.
While the total compensation amount varies from year to year, the CMPA has paid a total of $2.4 billion in patient compensation over the last 10 years, or an average of $241 million per year.
It’s important to note that compensation to patients is not equal across our 4 fee regions.
Ontario represents 40% of our members, but this fee region has the highest legal fees and compensation amounts, so it represents more than 50% of our annual costs.
Due to these regional cost differences, members pay different fees depending on their fee region.
Each fee region is independent and there is no subsidization between regions.
Therefore, members in Ontario pay higher fees than their colleagues in other fee regions.
Similarly, members in Québec pay the lowest fees in the country due to lower medico-legal costs in that region.
2023 Financial performance: Assets for outstanding and future claims
The assets needed for outstanding and future claims are the sum of all the estimated future medico-legal costs resulting from the care provided by members up to and including 2023.
For care delivered in 2023, we ensure we have funds available to cover any expense related to care for the next 4 decades.
As of December 31, 2023, the estimate for all outstanding and future claims was $4.2 billion, an increase of $127 million from 2022 based on updated cost-trends.
Compensation to patients accounts for approximately two-thirds of this $4.2 billion amount.
To provide impartial oversight of our actuarial calculation, we engaged an external peer reviewer, Ernst & Young, to perform an independent calculation, which strongly aligned with our own.
This was then audited by KPMG as part of their external audit of the CMPA’s financial statements.
2023 Financial performance: Investment portfolio
We target our investment portfolio to match or exceed a 6% investment return over the long term.
However, over the past 10 years, we have achieved exceptional returns on our investments, earning a 7.1% compound annual return.
In 2023, the investment portfolio had a net value of $5.6 billion, an increase of $169 million from 2022.
The growth in the net investment portfolio over 2022 levels was due to overall market performance in which we exceeded our target, earning an investment return of 8.5%.
Our positive financial position will help us to weather the volatile financial markets, fluctuating medico-legal case volumes and costs, and the recent high inflation environment.
We continue to invest responsibly to maintain an appropriate financial position that ensures timely and appropriate compensation to patients on behalf of our members, protection and support to physicians, and safe medical care learning and research to support patient safety.
If the financial market volatility continues, our financial position may be further impacted, which could lead to future increases in membership fees.
As I conclude my financial update, I’d like to summarize 3 key takeaways:
First, due to our occurrence-based protection, the CMPA operates with a long-term financial horizon of up to four decades into the future, allowing us to protect members and compensate patients today, tomorrow, and for years to come.
Second, fee increases or decreases are the primary tool used by the CMPA to manage our overall net asset position.
Finally, our positive net asset position in 2023 should provide confidence to members and their patients that we are there for them when needed.
2025 Regional fee requirements
Dr. Calder: Each year we set membership fees to support the financial sustainability of CMPA while striving to keep fees as low as possible.
Membership fees in each of our 4 fee regions reflect: regional variations in medico-legal costs, the number of physicians in the region, and the risk levels of their different specialties.
Medico-legal costs are calculated each year and include the estimated costs to compensate patients and support our members for up to 4 decades.
We are committed to stewarding our members’ fees responsibly.
Our goal is to achieve long-term membership fee stability in an environment influenced by volatility in both the investment markets and medico-legal costs.
To manage our financial position and help dampen large variations in fee volatility, we apply fee debits and credits.
Since 2019, we have provided members with increasingly greater fee credits, reaching their peak in 2023.
Over the past 3 years alone, we have given $670M in fee credits.
Due to poor market performance in 2022, we had to increase our fees in 2024 to better prepare for future medico-legal costs.
In 2023, the markets performed better than expected and our financial position stabilized, which is a positive story for 2025 fees.
Overall, the 2025 average membership fees which I am about to show you are similar to those in 2021.
As mentioned, the CMPA has 4 unique fee regions in response to the regional cost variation across the country, allowing for an equitable allocation of costs.
The 4 regions are: British Columbia and Alberta, Ontario, Québec, and Saskatchewan, Manitoba, Atlantic provinces, and the Territories.
Each region is independent and there is no subsidization between regions.
For example, if one region is in a positive or negative financial position, this does not impact the other regions.
The total cost per region is the amount to be collected in each region.
The average fee per member is an illustrative number that is the total cost per region divided by the number of members in that region.
It is an average and not an actual membership fee.
When determining membership fees, we first calculate the total cost for the region and use this as the foundation to determine regional fees based on specialty, which we call the type of work.
I’ll now share the 2025 average fee requirements starting with British Columbia and Alberta.
The average fee requirement in British Columbia and Alberta remains unchanged from 2024.
It’s worth noting that the 2025 average fee is less than pre-pandemic levels.
The total regional fee requirement increased by $6 million to $154 million.
However, this is a level we consider viable and there was no need to increase the average fee requirement per member.
In Ontario, the cost of providing medical liability protection is greater than in any other region and this is reflected in the membership fee.
As with British Columbia and Alberta, the average fee requirement per member in Ontario is not changing in 2025.
While the total regional fee requirement in Ontario increased by $11 million to $336 million, we also consider this a viable change with no need to increase the average fee requirement per member.
After several years of unprecedentedly low membership fees in Québec, the average fee per member will increase to be more in line with the anticipated medico-legal costs.
For 2025, the total regional fee requirement in Québec will double from $5 million to $10 million in 2025.
Although this is a 100% increase from 2024, you can see that the average fee requirement per member is still much lower than it had been in previous years.
Like Québec, membership fees in Saskatchewan, Manitoba, the Atlantic Provinces, and the Territories were unprecedently low in recent years.
And like Québec, the average fee requirement per member will increase to be more in line with the anticipated medico-legal costs.
In 2025, the total regional fee requirement will more than double from $10 million to $21 million.
As you can see, the average fee requirement per member will similarly increase, however it is still much lower than it has been in previous years.
Here is an overview of recent average membership fees by region.
As you can see, even though 2025 fees have increased in Québec and the Saskatchewan, Manitoba, the Atlantic Provinces, and the Territories fee regions, fees across all regions are still below pre-pandemic levels.
Having shared the average fees per member, here’s an example of the actual membership fees for family physicians practicing in type of work code 35, which is our largest type of work code.
The full listing of 2025 membership fees is now available on our website.
You will be notified by email in the fall when the Annual Invoices are available on our website via the secure CMPA member portal.
Our strong financial position should assure members that we will continue to be there for you and compensate patients proven to have been harmed by negligent care on your behalf, today, tomorrow, and well into the future.
Thank you.
Dr. Calder: So, I’m pleased to share with you now our 2024 Council election results and as you can see on the screen, we are welcoming a number of new and returning councillors from across Canada.
I would also like to thank our two departing Council members, Dr. Fahimy Saoud and Dr. Patrick Trudeau.
We really appreciate your commitment to the Association and its members during your tenure as CMPA councillors. Merci.
Dr. Brossard: So, thank you to all new and returning councillors and a special thanks to Fahimy and Patrick, my fellow councillors from Quebec that are departing. Thank you very much.
Now it’s time to open the floor for questions.
So, it’s the time that everybody is waiting for, the question time, and if you have questions about the governance review we’ll address them after the break when we come back on the Governance Review Report study.
So, for now, it’s questions about the general business of the CMPA.
So, if you have questions, you can ask them through the Ask A Question button or you can go to a mic or use your app to ask a question. So, I’m waiting for your questions.
Dr. Martin: I have a question.
Dr. Brossard: Could you please start by introducing yourself?
Dr. Martin: I work at one of the hospitals called the Jewish General and I’m a gynecologist by training or by fellowship.
My question is the feeling that we have at our hospital that we really appreciate how hard the CMPA works when we have a malpractice case, when we feel we’re defended up to the limit, but we’re less pleased, I might use the word, when we have a disciplinary action from the provincial or territorial Colleges that tell us that there’s an issue.
We feel that that… those issues are treated like the stepchild, they’re not as aggressively pursued... and it might be a philosophy, it might be your... PR or whatever you want to call it but... there is a feeling that we’re not as supported as we want to be by the CMPA, which does a marvellous job like I said with malpractice cases, but perhaps not as stringently and not as well with those disciplinary cases.
Dr. Brossard: Yeah. Well, Lisa, you want to comment on that?
Dr. Calder: Sure. Merci, Dr. Martin. And I appreciate that feedback, and I will say it does surprise me a little bit because we have worked really hard in terms of... we’ve had some very challenging cases with the College, and I am going to hand it over to Dr. Pamela Eisener-Parsche to speak to our experience there, but this is something that... we recognize how challenging College complaints are for our members and we also recognize how difficult the process can be.
And we have a dedicated team that’s really looking to support our members in Quebec and our Francophone members.
But Pam, do you want to speak to that experience?
Dr. Pamela Eisener-Parsche: Thanks, Lisa, and thanks for the question.
We’ve worked quite hard over the last couple of years to build a strong relationship with the Collège des médecins du Québec to try to help shape what those disciplinary procedures might look like to ensure that procedural fairness is being respected and to provide our perspectives and our input on alternative ways of addressing concerns that members may face through College processes and that relationship is beginning to bear fruit in terms of how the College is responding to a number of the cases that are coming to our attention and we will continue to focus on developing alternative approaches to some of the concerns that you’ve expressed to us, so thank you very much and I’m happy to have an offline conversation with you about that as well.
Dr. Brossard: I can assure you that difficult cases are discussed and we have a committee that is looking at those and we put a lot of time and effort in finding the best way to defend and to assure the best defence to our members and sometimes in College cases, the way to help our member the best is not always to... there are various ways to help our members and we use all of them and they are discussed at our CRC committee regularly, and a lot of effort is put on finding the best defence.
Dr. Eisener-Parsche: I have a French question, so if you could just... A question in French.
Can you explain the specific situation of Quebec when it comes to fees?
Dr. Brossard: Certainly. So, why are the contributions so low in Quebec?
Two reasons account for this, the first being that Quebec represents a lower medico-legal risk region compared to other regions in Canada, and even if physicians in Quebec were paying the total cost of protection that CMPA charges, the cost will still be lower compared to other regions, that’s the first explanation.
The second one is that we have excess reserves in Quebec that we’re trying to reduce and we have therefore subsidized contributions over the past years in order to reduce these reserves for the Quebec region, hence the reason why membership contributions are that low.
And this does not represent the entire cost of protection, but rather a fraction of it because we subsidize contributions, members' contributions in order to reduce the reserves that we have in store for the region.
Diane?
Dr. Diane Francoeur: Diane Francoeur, OB/GYN. I’ll speak French.
Can you tell us what are the trends, because even if everything is going well doctors are almost always responsible for the system’s incompetence, you know, even though there aren’t legal actions, there are still a lot of complaints that come from the lack of organization or the difficulty to access the healthcare system?
So, could you tell us what the tendencies are because we are seeing a trend upward, and we’d like to work with the provinces with the highest fees? Maybe not 40 years ahead of time, but at least one year at a time, so that we can limit our costs?
Dr. Brossard: Well, if we want to analyze tendencies, we have to analyze them by category of problem.
So, on the one hand, the number of medico-legal causes and civil causes is not increasing by a thousand members, so we don’t see an increase currently or in the past few years of cases per thousand members.
But what we do see is an increase of the gravity of the cases, and so of the cost of each case.
That’s something that’s being observed not only in Canada but elsewhere in the world.
So, the gravity, the costs are increasing but not the number. Obviously, if the number increased as well as the cost, well then, we’d have a multiplier, which would be horrible, but currently it’s the gravity that’s increasing and we could give you detailed numbers.
So, when it comes to the Colleges, it’s regional.
So, the most active College was Ontario. There was a change of Registrar and the number of cases decreased considerably.
Now, the College in Quebec is the most active, as well as in a few provinces in the Maritimes and in the West, it’s not Ontario anymore.
So, it’s hard to anticipate because it depends on who’s in post and what the philosophy is within each College.
So, the College complaints are increasing, but this is something that we need to work on within our relationships with the Colleges to make them understand how important it is to keep doctors practicing and to maintain the current active medical force and that’s what we’re currently working on.
Anything… anyone else? Lisa.
Dr. Calder: So, when it comes to the hospital and hospital complaints, there are increases across Canada.
You also mentioned that there are problems with the healthcare system and we are noticing that these are responsible for some of the complaints.
The Colleges understand that we can’t place blame on the doctors for what’s happening in the system and it’s not consistent throughout the country, but some Colleges will not follow up on a complaint if it’s related to the system instead of the doctor.
So, this is something we’re looking at closely but we do see that going up. Pam, anything to add, or Dom? No? All right.
Governance review
Dr. Brossard: Thank you all for being back in the meeting.
If you’re just tuning in, we will now discuss CMPA's work to modernize governance.
So, it’s the governance part of the meeting that we’re beginning.
As you can see on the slide, I’m joined by a number of my colleagues who are here to answer any questions you may have.
So are we all here? Yeah, we’re okay.
So, I will make a presentation for, I don’t know, I’ll speak for maybe 15-20 minutes about what is our proposal to modernize governance. I will explain all parts of that. And after that we will have a period of questions, and after that we will vote on the motion. So, let’s begin.
Who is CMPA?
So, CMPA is a unique organization.
We feel that we are an essential component of the healthcare system and because physicians rely on us to support their medico-legal needs and to give them strategies, data and learning to help them deliver medical care safely.
We advocate for change to the practice environment of physicians.
We advocate at government level, at federal, provincial, at College level.
We provide patient compensation on behalf of members when it’s proven that negligent care has occurred.
And to achieve that, we need to effectively steward our resources.
And all this work, all that is CMPA, is guided by our Council which is the CMPA's governing body.
We are quite proud of the work we do at Council, we are proud of the structure and the procedure that we have put in place.
But, as you know, governance is a living thing, it changes, it needs to be adjusted. It needs to be adjusted to the organization and to the time we’re living in.
Council oversees the management of CMPA affairs, including developing strategy, overseeing finances and identifying risk.
An example, in 2021, Council decided that CMPA needed to develop an EDI strategy and begin exploring how to provide safer and more inclusive service for members. It was an initiative coming from Council.
I remind you that all councillors on Council now are physicians. They are all in active practice and they bring a unique insight from their practice environment which helps inform CMPA's decisions.
Councillors are elected within their region. But even though they are elected within a given region, they are supported [inaudible] and owe a fiduciary duty to the CMPA.
We do think that our Council has been and continues to be highly effective, but we do think that it could be more effective.
The healthcare world is changing rapidly.
We have heard from our members that they need a responsive and agile CMPA, a CMPA able to respond to these changes. That’s why, over two years ago, we embarked on a thorough review of our governance model.
We were and we still are in a strong position to look proactively at improving our model. We’re not in a crisis, we want to make continuous improvement. Our aim is to set us up for future success and ensure that we continue to meet the evolving needs of our members.
But it needs to be very clear for all of you, no matter the changes we’ll make, no matter the enhancements that we’ll make to our governance model, we will continue to be the same
organization with the same mission, the same vision, we will continue to be there for you, for our members.
So, we’ll begin with a quick history of our governance review process, what we did over the past two years.
So, at our 2022 Annual Meeting a motion to review our governance model was approved by the membership and this motion was timely because we had already begun to work at Council to explore modernizing governance.
After that, we engaged expert consultants to help us research and review the governance practices and models in place at other healthcare and medico-legal organizations in Canada and outside Canada.
In 2023, we reviewed your feedback and answered your questions at our Annual Meeting and then we launched our first member survey to gain your insights. We reviewed your feedback and began developing our recommendation.
And, in 2024, we continued to counsel our members seeking your feedback through four virtual listening and learning sessions and conducting a second survey.
All this work including your feedback has helped Council develop a recommended approach to modernize our governance model.
Our final recommendation was shared with you in our governance report on July 12.
The changes proposed in this report aimed to make our governance more flexible, more agile. They will also help us ensure member voices continue to be strongly represented at CMPA and that will support effective decision-making and foster diversity and inclusion.
So, I want to thank everybody who has shared and provided input in that process, and over the next few minutes I will walk you through our proposed recommendations.
Active members will then have an opportunity to ask questions, we’ll have a discussion and at the end of that, a vote.
I want to clarify a few things before we go through all that. And I said it earlier and I will repeat it now, no matter how our governance model evolves, no matter what decision we take, we will continue to be exactly the same organization that provides compassionate support, medico-legal protection, and data-driven learning and research to enhance patient safety.
And you will see that, on the slide, that there were a few non-negotiable elements that Council determined must be included in our structure, whatever we do.
So, those non-negotiable points are:
That Council must be comprised of physician members.
That Council must have a regional voice which reflects the geographical diversity of practice in different provinces and territories.
That Council must reflect diversity and be appropriately representative of the membership and that members must be able to participate in fair and transparent elections.
Those elements were non-negotiable.
So, what we’re asking you today is to look at the report, the elements of the report and discuss and comment on those elements. And then you will have the option to approve the report. And then if you do approve the report, we’ll work to make those changes happen. For that, it’s a long process. First, it will require that we amend our by-law which is a complex and lengthy process.
So next year, if you approve the report, we will prepare those amendments to the by-law and we’ll come back, next year at the AGM, to present those amendments to the membership.
And then the membership will have the chance to vote on the by-law amendments.
And then, if the by-law amendments are approved, we’ll begin enacting the changes that have been approved.
It’s going to be a long process and take years, and there will be a transition phase before it’s in place.
So, today, we’re seeking approval on the report that will give us general direction to prepare the by-law amendments next year.
So, let’s look at that report.
So, first element of the report, it’s the Council size and composition.
As you can see from the slide, our current by-law mandates that Council must be comprised of 25 to 35 elected members in practice.
The composition of Council is determined by geography and specialty.
Councillors do not represent the provincial, territorial or regional interests of their members, they have a fiduciary duty to the CMPA and support CMPA work at a national level even though they are elected in a given region.
They are responsible for overseeing the conduct of CMPA business and collaborating with management to set strategy.
So, the goal is not to change Council’s core function. Without changing anything in Council’s core function, we do recommend progressively decreasing Council size to a range of 15 to 25 councillors, in total.
Decreasing size, maintaining the same goal and the same role. This will help enhance agility and support in decision-making.
The composition of Council will continue to be determined by geography and specialty.
This total number of councillors will include the Vice President and President, and any appointed physician councillor, a concept we’ll discuss later.
Any reduction in number will be gradual, and we will continue to maintain representation and diversity by applying a robust and transparent skill-based and diversity-based nomination process.
And nomination is our next topic, so let’s talk about that.
So currently, we have two nomination streams and our current two-stream process can be confusing, with a different time and requirements for each stream, and it means that all candidates are not evaluated in the same way when they proceed to get on Council.
So, after two years of comprehensive review and discussion, we recommend moving to a single-stream nomination process.
The goal of the single-stream nomination is to allow all members to submit their interests and be evaluated equally by the Nominating Committee, based on established criteria. It will also allow the Nominating Committee to put forward a larger pool of candidates for election whereas, now, they can only put forward one candidate for each position.
This recommendation focusses on the regional makeup... Okay, that’s nomination. So, this recommendation focusses on the regional makeup of Council. Currently, Council is divided into ten regions. We include all provinces and territories in those ten regions.
We wanted to explore our regional representation and election model to make sure it was still effective.
So, again, we discussed a lot: How can we do that? How do we maintain that regional representation?
And Council feels that we should continue to recognize the importance of geographical representation, and we recommend maintaining such regional representation. This will support a national focus and fiduciary duty of Council and promote geographical diversity.
However, and it’s an important point here... However, we do recognize that as the size of Council decreases, some adjustment to regional distribution will have to occur.
So, we commit to maintain regional representation, but it will have to be adjusted as the size of Council changes.
Next slide. Okay, so next topic.
Recommendation three allows for the possibility of appointing a small number of physician councillors and introducing term limits.
So, first recommendation, decreasing Council size. Second recommendation, maintaining regional representation. Third, here, is appointing councillors.
Currently, we do not appoint councillors. All councillors are elected, and we don’t have term limits, actually.
So, we do appoint non-physician experts on some of our committees. So, we have non-physician experts on Investment Committee, on Audit Committee, on Pension Committee, on Legal Services Oversight Committee. So, we do have experts that are
non-physicians on those committees, but we don’t appoint anybody on Council.
So, to make effective decisions and understand our members, we do need diverse skills and lived experience. And to support this, we recommend allowing Council to appoint up to four physician members, when needed.
And we support creating a 12-year term limit. So, term limits will encourage regular renewal and bring in new skills and viewpoints.
And appointing a small number of physicians at Council will help round skill and diversity needs in a way that may not be satisfied through the election process. Sometimes, we do need appointment that may help address representation. For example, appointing a physician from a rural community or appointing a high-risk specialty that could not be brought on Council through elections.
So, members and Council feedback suggests that... From the feedback we have from the general... The round we made from asking... We do need to maintain diversity of skills, diversity of representation and sometimes it’s not possible to achieve that through elections, and we do think that appointing a small number of physician members could help solve that problem.
The other issue that was discussed is appointing non-physicians on Council. And that was explored at Council level, it was explored with members in the survey and in the meetings we had with members.
And, for now, I would say that neither Council nor membership seem to support appointing non-physicians on Council. So, it’s still an option, but it’s an option that is not supported at this time and is not presented in the report.
Last recommendation, it looks at the representation of family medicine and other specialties on Council.
So, right now, our by-law knows that councillors must be considered to practice in one or two divisions. So, you have Division A, which is family medicine, and Division B is for other specialties, for example, Royal College specialties.
So, while a balanced distribution is not required in our by-law right now, we have tried over the years to maintain a balance between Division A and Division B, but it was done by us, not because by-law was requiring it. It was done because we thought it was important.
We know that the medico-legal experience of our membership varies greatly, depending on their area of practice and we still think and we do recommend that Council continues to include an appropriate number of family physicians, specialists and other physicians, and that number will be adaptable over time.
So again, as Council size changes, as the proportion of family doctors, specialists and other physicians changes, we will need to adjust those proportions.
So, here is a summary of all the recommendations.
First, Council will gradually decrease to 15 to 25 members.
Second, this range will include our President and VP and up to four appointed members, if needed, to complete the diversity needed or the skills needed. The composition of Council will continue to be determined by geography and specialty, and the large majority of Council members will continue to be elected by the membership, with the exception of up to four appointed members and the President and VPs during their term in office. We will implement a 12-year term limit and shift to a single-stream nomination process.
And finally, we will maintain regional representation and maintain appropriate representation from family medicine and other specialties on Council.
We’ll open that report for discussion. Then, all active members present today will be asked to vote. You will be asked to vote on the whole report, so to approve or reject that Governance Review Report as a whole, which includes all the recommendations I just outlined and explained.
So, those recommendations will be the basis on which we will prepare our change in the by-law next year. If you vote to approve that report, then you give us direction to prepare the writing of the by-law for next AGM.
And so, in 2025, we’ll bring back those amendments for vote. And you need to understand that when… if today the report needs to be approved at 50% plus one, the amendment of the by-law next year will need to be approved at two thirds support from the members of the assembly.
So, we’ll project the motion that will be considered.
We already have a mover and I will invite Dr. Debra Boyce to present the motion that is on the screen.
Dr. Debra Boyce: Thank you, Jean-Hugues.
I’m Debra Boyce, I’m a family physician from Ontario, and I have also served on CMPA Council. I’m a past President of CMPA Council. I’ve served on Nominating Committee, actually all of the committees, and so I’m quite familiar with much of what you’ve presented today, although I haven’t been part of these discussions, since I left Council in 2021.
Today, as I listened and participated here in the AGM, I reflected on the words that really opened our meeting today, from Elder Catherine Martin, and I appreciate her sharing her important value of sharing in the governance of your people.
And I appreciate that you recognize that we come together today in a ceremony and some work that is sacred.
And it’s very important, not only to the people here in this room and online, but the people that we… our members, 111,000 members from across Canada that serve all Canadians.
And so the work that we’re doing today has an impact on all of those people.
And Jean-Hugues, I appreciate your words that recognize governance as a living thing. I think that’s also very important.
So, the things that were important to me in the discussion today were particularly around the recognition of diversity, the strength that diversity brings to our Council, and actually to any governance body.
There’s lots of evidence to support that and I appreciate that your work, over the last couple of years... You’ve brought that into every part of the discussion.
In addition, I think that the report that was distributed July 12th to all of our members has addressed the member motion of 2022, and that is essential in the work that Council has been doing. And so, I’m happy to make this motion. I think that we've recognized the careful, thoughtful approach of CMPA. It’s what I’ve always known this organization for, and I appreciate that this is an ongoing step, but it’s foundational to the work that you’ve set out and outlined for us, and that work will happen over the next year, importantly, leading up to the presentation in 2025 of changes to the by-law.
But it goes forward from there too. And what I’m hearing is that proven, careful, responsible approach that the CMPA is known for.
So, I’m happy to make the motion, be it resolved that the modernizing CMPA governance, as presented in the Governance Review Report dated July 12th, 2024, is received and approved as the basis for implementing the governance model described in the report, recognizing that any changes to the current by-law will require approval by members as set out in the current by-law.
Thank you.
Dr. Brossard: Thank you, Debra.
Maybe we don’t realize it in the room, but there’s a one-minute lag between the online and the room. So, we need to wait for one minute for the people online to receive all that, to see the motion and then we’ll be able to open the app to get a seconder. So, we need to wait one minute.
So, when we say that it’s a ceremony, it’s ceremonial, we have a one-minute wait before we can open the app to get the seconder and then you will be able to second, somebody, I suppose the fastest of you will be able to second and then we’ll open the motion for discussion.
You want me to dance again? But there’s no music. But I cannot... You don’t want me to sing. Mic two?
Dr. Boyce: I was going to try and work it in that I think this is probably the first AGM with a dancing President. I did not dance. Mike Cohen did not dance. Peter Fraser did not dance. Jean-Hugues, congratulations.
Dr. Boyce: Dr. Brossard: You’re the first dancing President.
But I can tell you that…
Dr. Brossard: But Birinder sings, so... Okay. Well, I can ask for a seconder, it seems that the app is ready. On the app, online, on the app... Because we need to... everybody needs to have a chance to second. So... So, the winner is... Clover Hemans is the seconder. Okay, so thank you for seconding. So, the motion is moved and seconded.
So, now, I will invite questions, discussion around that governance review. You can come to the mic. You can use the app or online to ask your question. Yes, please.
Speaker on mic: I’m speaking in favour of the motion, but I do have some concerns.
But first, I’d like to thank the CMPA for all of the work, the consultation and the thought that’s gone into producing this document.
As I sort of posed it again, yesterday evening, it made me realize what a process this has been. And, overall, I think it really reflects what needs to be done.
My one concern is with the key considerations for changing the Council size. The range sounds very appropriate, however, when you consider the lower number of possibly 15 members, and you subtract up to four members who might be nominated, and you subtract the President and the Vice-President, who are going to be sitting on it, that leaves only nine people that are being fairly independently elected from 10 different regions, which strikes me as being too low a figure.
Dr. Brossard: Okay.
Speaker on mic: So, I’m just asking that when we start to look at our by-law, that we take that into consideration, and we look more towards the higher end of that range than the lower end.
Dr. Brossard: Thank you. This being said, the Vice President and President will have been elected to be on Council first, at some point.
And so just a comment on the VP and President not being in the election during their term as VP and President, it’s mainly because, as it is now, you can be a President and not be re-elected in the middle of your term as President. And it brings some risk to the governance structure and it’s a way to address the way that we don’t think that the President should be challenged while he is President and not be challenged during his presidency. That’s the issue that is looked at here. It’s not the fact that we don’t want them to be elected, it’s the fact that we want them not to be challenged while they are presiding the organization.
Speaker on mic: My point was that they would be on the Council via a different process which would limit the number of councillors that were directly elected from the various regions, not that they shouldn’t be there. They certainly should. Thank you.
Dr. Brossard: I do understand. I just want to explain to you what we’re trying to address, the problem we’re trying to address here. Patrick?
Dr. Patrick Trudeau: Patrick Trudeau from Chicoutimi. I’m a surgeon. I have a technical question. From the list of members who can be on Council, they are described in English as family physicians, specialists and other physicians.
These "other physicians", are they residents? Physiotherapists?
Dr. Brossard: Well, they are not physiotherapists. Right now, only practicing physicians can be members of the Association, no one else.
The discussion here is whether family doctors and specialists who are members of the College include everyone?
No, some specialists are certified by their province and not by the College.
So, some residents are in between, who are neither family doctors nor specialists.
And to try and include everyone, we have that third category of other physicians, which is non-specific but allows us to include all physicians who are practicing or are eligible to be members of the Association.
Dr. Lynn Murphy-Kaulbeck: Hi, Lynn Murphy-Kaulbeck. I’m speaking against the motion. I think if there’s going to be a governance review, I think it really needs to be impactful.
One of the things is, just having gone through this in another organization, I think, you know, if you’re sitting at a table, you’re sitting there, as governance, you’re not representing a region per se. So, anyone sitting at that table, I think, if they bring the skills,
would be needed rather than looking at regional representation.
And, I think, if we’re going to transform. I mean, having 25 Council members, up to 25, that’s a huge number. I mean, we need a quick, a nimble Board that can react quickly and I think we have to be fiscally responsible. And to have that many Board members or Council members, I’m not sure if it meets that mandate.
The other thing is I think, in modern governance, to have only physicians sitting around the table, I think we’re missing, you know, expertise or opinions coming from the public. And I think we would only benefit from having the public at the table with us. So, I think we really need to consider that and ask ourselves: Why don't we want a public member at the table? And I’ll leave it at that.
And I think the other thing, and again I’m just going to go back to it. I think for any Board or Council, whatever we want to call it, when you come to the table, you come not representing your region, you don’t come representing yourself. You’re representing all of the members. So, in that way, I don’t think we need to look at having 25 people. I think if I come to the table, I’m representing everyone, I’m not just representing my region. So, whether I’m from Halifax or BC, it doesn’t matter, I’m there for the governance, the strategic plan, to put that forward for the organization.
I will be transparent, I’m the President of the Society of Obstetricians and Gynaecologists of Canada. We just did a major governance review and it was tough, it was really hard. And people, you know, there was a lot of, I think, abuse that was flowing around as we went through it, but we got on the other side and I think we’re a much more nimble and... we serve our members better. Thank you.
Dr. Brossard: Thanks.
Dr. Michael Cohen: Hi, Mike Cohen, non-dancing past President. I’m in favour of the motion and I… but I think we really need to look at the regionality aspect of it.
We did a review in the early 2000s and John Gray may exactly know the year, but it’s he and I in the room. I’m not sure anybody else was there for it, when we moved from a regional approach to a provincial approach to make sure every province had a member in representation because every province has a different set of guidelines to follow when it comes to billing, which is becoming an issue. We just had talked to a member from Quebec and sometimes people have a unique perspective on what goes on in their province.
And history has a tendency to repeat itself over years. If you’re going to change the by-law and go to a regional approach, I think, when you do it, you should leave enough wiggle room in your changes to make other changes without having to go through this long, drawn-out process. But I do support the motion, wholly. Thank you.
Dr. Brossard: Thank you.
Dr. Francoeur: Diane Francoeur, OB/GYN. I’ll speak in English this time. So, I am against the motion and I have to declare that I’m the CEO of Lynn and we went through this process. Change is hard. Physicians are reluctant to change. CMPA and Royal College are probably the last two organizations to go ahead and move towards agile, active, fast governance and it really needs to be done.
And even though I’m totally in favour of modernizing the governance, I don’t think we go far enough and it has to happen. And what we did is, we have a matrix, we take into consideration all these impacts: women, men, EDI... Regional and regional representation
was the biggest issue we had to fight against, but we made it happen.
And now, as a CEO, we’re so much more active. We changed the whole organization. We stopped the night meeting because where are the young people here? There’s close to none. If we want to have young folks engage in their organization, engage in CMPA, we’re working for the next 40 years. We need to go faster and change is hard, but it’s necessary.
Dr. Brossard: Thank you, Diane. Online?
Dr. Todd Watkins: Jean-Hugues, we do. We have a number of questions online, Jean-Hugues. I’ll attempt to batch them together for efficiency.
And on this similar theme, Dr. Carson asks about recognizing the members are not representatives, but an important task is engagement. That means enough members sufficiently distributed and accessible to members in a large country. Will the smaller number of councillors be able to... to do that as well as the larger Council?
So similar theme, and then a second question related, from Dr. Nashed, who asks: Please explain how you maintain regional representation while shrinking the number on the Council?
Dr. Brossard: Okay. So, the first question is about engagement. So, you need to understand that the Board, the Council is the Board, so it’s a governance body. So, the role of the Board is to govern. And CMPA is a large organization with 500 employees... so... and those people are engaged in various provinces with Colleges, with members, with organization. We have physician advisors that are answering our members when... Those… this is not the Board’s work. The Board is a governance body.
So, the work here is to make sure that we are able to make decisions. The role of the Board is to... The role of governance and the role of a Board is to make decisions. So, what is the best team, the best group? How should that group be organized to be an effective decision maker? So that’s the goal. We do think that smaller is a good idea. And how small? Well, we heard not too small, we heard smaller. So yeah, so exactly. And I’m quite sure that we could go all around the place and obtain different answers from all of you. So, there’s a range here, a range that is smaller. Maybe not as small as some would want, maybe a bit smaller than you would want, but I think that is going in the right direction in terms of governance and our governance structure, because we do need to have enough diversity and enough skills around the table from multiple specialties, because we’re managing a variety of risks. Risk that is... Our business is member protection and our risk is regional. We have seen each region is different. Our risk is by specialty. Gynecology? Well, high-risk specialty. Endocrinology? Not so much. So, we do need to understand that, and for that we need people that have lived experience and do understand the risks of practicing medicine around the country. So, we need some regionality, but regionality is not all because our fiduciary duty is for the whole. So, we need some, but maybe not as much as we had until now.
So again, where is the line? Where should be the needle? Well, we think the needle should be there.
Dr. Watkins: We have another question, Jean-Hugues. Dr. Carson again. This is on the issue of the Nominating Committee process. And he asks: Will this mean that members cannot put forward their names to the Nominating Committee?
Dr. Brossard: No, any member will be able to put their name forward to the Nominating Committee. In fact, if somebody wants to come on Council and go through the election process, they will… every member will put their name forward to the Nominating Committee and the Nominating Committee will prepare a slate of candidates for the next election.
So, there will be one stream, everybody puts their name at the same place, and it goes from the same stream and the same process, and it ends up in an election for that position.
Dr. Watkins: Yeah. There are a number of questions, Jean-Hugues, that I will bundle related to the voting process here, and asking why we’re voting as a whole, the motion as a whole, versus individual components of the governance proposal.
Dr. Brossard: Well, I think that we should consider the governance with a holistic view because all those elements are linked. If you decrease the size of Council because you want it to be more nimble, then you do need to give more attention on the composition, the diversity, the skills of members that are there.
So, then you need to improve the nomination process, and if you do improve the nomination process you need to include nomination in the change, it’s linked. And then if you do that and you say, okay, but a smaller Board, we need to maintain the turnover, you need to add term limits, which are part of the piece that is essential then.
And then suddenly we have all sorts of questions that are linked to the speciality of the members and the regionality. It’s two elements of the discussion that have been quite sensitive, and we have heard today with the questions. So, you need to put them in there because you need to express the decision what you want to do with that and it’s part of the whole.
So, all those elements are linked together and you need to look at that as a whole, I think, and not in pieces.
Dr. Watkins: There are a couple of questions.
Dr. Brossard: Hold on, Domenic has something to add.
Mr. Domenic Crolla: Just to add to what you just said, I completely agree, but it makes it also very difficult from a drafting point of view, if we don’t have a holistic report to work from. Next year, we will come back hopefully with a complete set of by-laws drafted for you to vote at a very high voting threshold and there’s a lot of work necessary to be done there.
If, for example, we subtracted one portion of this report from the work, we’d have to go back and develop a holistic view. So, it’s much more... practical, frankly, to work from a holistic view, draft it out, and then the members will get the final chance to vote on those by-laws in about a year’s time.
Dr. Watkins: There are a couple of questions, Jean-Hugues, about the appointment process. Could you talk about next steps on that?
Dr. Brossard: Okay, so the concept here is to have the ability to appoint, if needed, some physician members that will complete the skill set or the diversity needed on Council. So, there are important words here: if needed and a limited number. So, that’s quite important.
Then what is the process to nominate? It’s going to be through the Nominating Committee that will be in charge of that. And, so, that process will go through the skill matrix that the Nominating Committee will use to assess the skills and diversity that is on Council, and to assess if there are some missing parts that need to be addressed and to be completed through a nomination process and an appointment process.
Dr. Watkins: Thanks, Jean-Hugues. We have another question related to the current election process. And so, Dr. Paul Missiuna asks: What is the current problem with the election process that limits our ability to reach diversity?
Dr. Brossard: I’m not sure I understand.
Dr. Watkins: What are the limits of our current election process that doesn’t allow us to reach diversity on the Board?
Dr. Brossard: So, one of the… well one of the main problems is that the Nomination Committee can only put one name forward as it is in the by-law, so we can only suggest one member for a given position.
And then the process is submitted to the election and it’s quite possible that the members will, for all good or less good reasons, will select somebody that will not complement and not be what is needed on Council. So, at the end of the election you can have four ENTs, I don’t know why I chose that, there’s a reason why, and three endocrinologists on the Board. Is it what is needed? Not necessarily. So, you may need to complement and to address those issues by another route and it’s what we suggest here.
So, is there any other question or comment? If not coming from online or coming from the room?
Dr. Watkins: There are a few other questions, some of them have been dealt with already.
Dr. Brossard: Okay.
Dr. Watkins: One question maybe just about the term limits. Why 12 years versus six, versus nine?
Dr. Brossard: So, CMPA is quite a complex organization. And so the financial model, legal aspect of things, the complexity of intervening in different jurisdictions and understanding the business.
So, for a new councillor coming on the Board, you need a few years to be, I would say at top speed and able to provide the best you can as a governor. And, so, you need to consider that aspect of things. So, we thought that 12 years is quite reasonable.
The other thing is that if you want your people to get some experience and go through the senior governance and become Vice President, President you need some years.
So, the idea of 12 years is to give enough time for people to get on speed and to accumulate enough experience and enough knowledge to be able to reach the senior governance stream and be able to provide for that senior governance on the organization.
Dr. Watkins: Dr. Fred Rinaldi, who we know well, having previously been on Council, makes a comment. She would have liked to have spoken on the stream but she’s written her comment here that with respect to the Nominating Committee process, she is hoping that all interested members should be able to put their name on the ballot and the Nominating Committee would review that, as long as they meet the criteria for Council.
Dr. Brossard: Yeah, that’s the goal. So, we have the motion, the motion has been moved and seconded. Debra, you have a comment?
Dr. Boyce: Yes, so I know if I speak, I’ll close the debate.
Dr. Brossard: Not necessarily no, not really.
Dr. Boyce: Okay. So, I do have a question and I’m not sure, Jean-Hugues, if it’s to you and possibly to Mr. Crolla as well. We’ve spoken today about a number of factors and just the attributes of the CMPA that make it a unique organization in Canadian medicine. And some of those are important to the path that you’ve taken in this report but they’re also important to how things are going to play out over the next couple of years.
And I wonder if it would help us to understand a few more of the details of CMPA as a special Act entity, because that adds to the complexity that is unique and that some other organizations or governance changes don’t have to consider in their work. And it may help members as well to understand why this is taking the steps and the time that it’s important to, that the CMPA just has to take.
Dr. Brossard: Yeah, so the fact that we are one of those organizations that exist through a special Act of Parliament... So, we do have to vote on our by-law and then we need to submit those amendments to the Cabinet to obtain authorization to proceed to make the change.
So, it adds some steps in the process. We cannot just say, okay, we vote that today and we implement tomorrow. So, we have another step, we have to go to the Cabinet and obtain an order there, yeah.
Mr. Crolla: And one additional thing, they don’t actually become effective until published in the Canada Gazette. So that adds quite a bit of time too. So even if we vote next year on a by-law and it’s passed, it then needs to get approval. That takes time and then it needs to be… that approval needs to be published in the Canada Gazette. In the past, that time has ranged from one to two years.
Dr. Brossard: So, there’s this long implementation that will follow those decisions, but it’s part of… if we don’t act, it will take more time.
So, we have a motion that is moved and seconded, so I think it will be time to vote. So, you will have the motion appear on your voting app at some point, it takes about one minute. So, again don’t rush, it will appear eventually and you will be able to vote. And so, I will maybe have again the occasion to dance a bit.
Dr. Watkins: So, Jean-Hugues, I have that comment if you wanted me to say it.
Dr. Brossard:
While we’re waiting, Todd received a comment that he wanted to share with us.
Dr. Watkins: Just at the end of our first part of our AGM we received a comment that I couldn’t fit in prior to us breaking, but it’s from a 52-year member of the CMPA, Dr. Mehta. Hi, Dr. Mehta, I know him well. He says congratulations on an amazing report and all you do for us. Thank you for doing so much for me over the last 52 years. I respect and appreciate that I have such a well-organized team behind me. I thought it was a very important message to share.
Dr. Brossard: Thank you. So, we do have the result of the vote. So, the motion carries and the Governance Review Report has been approved, and then received by CMPA and we’ll work on that next year to make sure that we’re able to come back at the next AGM with by-law change to implement that vote.
So, thank you very much for your support and so we’ll come back next year. It’s not me. In fact, we’ll come back next year with the amendment to the by-law and we’ll then be able to present all that to the Cabinet, as it has been explained earlier.
So, now I will hand the mic to Lisa to share some thoughts on how CMPA is looking ahead and prepare for the future.
Dr. Calder: And now this is Jean-Hugues’s last Annual Meeting as President of CMPA and truly it’s a bittersweet moment for all of us in management and on Council.
Jean-Hugues, over the last two years, we have benefitted from your wisdom, your expert leadership, your guidance.
You helped us develop a targeted and practical Strategic Plan.
You supported the execution of the EDI Strategy and helped drive our efforts. So, we now better understand our members’ experiences when it comes to inequities, racism and discrimination.
And under your guidance, we have also found new ways and are continuing to explore new ways to support physician wellness, we’ve enhanced our learning and research offerings.
And, as you’ve seen today, we’ve made huge strides in modernizing our governance.
Thank you for your many years of service to the CMPA. In particular, thank you for the last two years of your presidency. It has been truly a pleasure to work with you, and your leadership has helped us empower better healthcare across Canada. Merci.
Dr. Brossard: Merci.
So, for my last few words as President, I’m about to speak in French, so use your headset.
Thank you, Lisa. It’s been a real privilege to work with you and your dedicated, competent and professional management team. It’s been a moment of grace.
It was also an honour for me to chair the CMPA Board and to work with my fellow Board members to guide the Association.
Oh my god, I’m sure you can feel the emotion from my throat, it feels like my heart just jumped to my throat.
But honestly, I’m glad to pass on the baton of command to my colleague, Dr. Birinder Singh, who is not only a talented physician but also a lawyer with a wealth of leadership experience. Birinder is a medical director of Toronto’s Eglinton Station Medical Centre where he practices family medicine. He’s been a CMPA Board member for the last 10 years. Birinder is a veteran who understands the intricacies of the Association and the importance of representing the interests of members on the Board. He has served as a medical inspector of the College of Physicians and Surgeons of Ontario, a judicial assistant at the Supreme Court of Canada and a professor at the University of Toronto.
And it is this diverse experience that has deepened his understanding of the medico-legal issues facing physicians. I’m confident that his strong leadership, knowledge of governance and experience within the healthcare system will ensure the CMPA’s continued success in the years to come.
Please join me to welcome Birinder.
Dr. Singh: So, thank you very much, Jean-Hugues.
I echo Lisa’s thanks and gratitude for your dedication and service to the Association over the past two years and 20 years on Council. So, you know I have very big shoes to fill and I’m aware of it and I’m looking forward to it.
I thank you for your mentorship and the last two years have been an eye-opening experience and you really are a tremendous leader. So, thank you. Yes, absolutely, another round of applause.
As I step into the role of President, I will strive to emulate your passion, dedication and ability to guide and inspire us.
As President, my main objective will be to focus on our members. I have always had a member focus and I want to truly ensure that the CMPA remains a strong organization that is here for members for years to come. We will continue to modernize the governance of the Association which includes supporting the execution of our Strategic Plan and moving forward with our EDI Strategy, which both Council and I fully support.
I will do this while holding fast to our values, supporting the evolving needs of our members and maintaining the sustainability of the CMPA.
It is truly an honour to lead such an exceptional organization, and I look forward to working with my dynamic Council colleagues, and the immensely talented CMPA staff to continue to protect the professional integrity of our over 111,000 members and help them to provide safe medical care.
I thank you all and I look forward to working with you over the next couple years.
Dr. Calder: Merci, Jean-Hugues.
I do echo your thanks and really appreciate the member feedback, engagement and support for what is a really important step forward in terms of the governance model that was proposed today.
And as we shared with you, the CMPA is looking to continuously improve and become more agile. Modernizing our governance is a key step in this, but that is not where we’re stopping, we have more work to do.
Next year, we are going to focus on executing our Strategic Plan and look for better ways to support our members and employees, strengthen our foundation through collaboration and adapt to the changing healthcare environment through modernization.
I encourage you to read our Annual Report and our Strategic Plan, both on our website, and you can see what our plans are for 2024 and beyond.
No matter the changes that happen in healthcare, we will be here to protect physicians, our members’ professional integrity and advance the safety of medical care in Canada.
We are here for you and we are your CMPA.
Dr. Brossard: Thanks, Birinder, thanks Lisa, thank you everyone who joined us today. Thank all of you in front.
We look forward to seeing you next year at our 2025 Annual Meeting in Toronto on August 20th and if there’s no other business, this concludes the Annual Meeting and I’m on vacation.
I declare this meeting adjourned.
