2020 Annual Report

President and CEO message

Photo: Michael Cohen
Michael T. Cohen, MD
CMPA President

Photo: Lisa Calder
Lisa Calder, MD, MSc, FRCPC
CMPA Chief Executive Officer

For physicians across Canada, 2020 has been an incredibly challenging year. Throughout, the Canadian Medical Protective Association (CMPA) has focused on our commitments to assist you, to contribute to safe medical care, and to support the medical liability system.

This Annual Report explores the ways in which we’ve delivered on these commitments by supporting you, modernizing the CMPA, and working collaboratively to help you provide safe medical care during these challenging times. Here are a few highlights:

Providing a compassionate ear and empathetic support

At the CMPA, we understand the emotional toll a medico-legal event can cause – especially now. In 2020, we continued to focus on physician wellness by building our capacity to assist members in distress. We provided compassionate, physician-to-physician support on over 23,000 advice calls. We also enhanced our collaborative efforts and worked with physician health programs across Canada to find new ways of fostering member well-being.

Sharing timely and relevant medico-legal information

With healthcare environments changing so quickly, our role is to provide you with information on emerging issues to help you practice safely and with confidence. We delivered relevant, just-in-time advice and guidance on key COVID-19 related issues such as critical care triage protocols to ensure you have the information you need to care for your patients safely and effectively.

Read more

CMPA Council, Leadership team and Strategic Plan

Council

The CMPA is governed by an elected Council of 30 practising physicians who, working together and with CMPA management, foster the long-term success of the Association.

 
Meet Council >>

Leadership team

The CMPA's leadership team bring unique and diverse skills to advance our assistance to and support of members and our contributions to safe medical care across the healthcare system.

 
Meet the team >>

2019-2022
Strategic Plan

The CMPA’s commitment to its physician members and to the healthcare system at large is about empowering better healthcare.

 
Read now >>

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Supporting physicians & patients

How the CMPA empowered better healthcare during a pandemic

“I think the CMPA is a wonderful organization, professional and supportive. Especially during a time of the global pandemic.”

– CMPA member,
2020 Member Survey

Advice and assistance

Throughout 2020, the CMPA has been there for our members with expert, empathetic, physician-to-physician support and guidance, helping them to navigate the challenges of the pandemic and enhance the safety of their care.

How the CMPA’s advice and assistance made an impact in 2020:

We remain a highly trusted source of risk management and safe medical care advice and medico-legal assistance for members, delivering timely and relevant COVID-19 information, while working to remove barriers to help members respond to the pandemic.

In 2020, we:

  • Responded to 23,000+ advice calls, providing empathetic support and expert guidance to help members manage patient safety challenges, including navigating emerging issues such as personal protective equipment challenges, adapting to virtual care, and critical care triage protocols. Members who spoke to one of our 45+ experienced physician advisors reported a: 97% satisfaction rate; 72% reduction in severe stress levels.
  • Provided regular and timely COVID-19 information and advice through our COVID-19 Hub, quarterly Perspective magazine, ad hoc eBlasts, and monthly eBulletins. Members who accessed our COVID-19 information reported an: 87% satisfaction rate.
  • Simplified membership processes for members returning from retirement or seeking to change scope of practice during the pandemic, enabling physicians to return to practice to support COVID-19 care efforts across Canada.

“In case you ever wondered, the CMPA saves careers and I’m sure lives. My depression has turned to guarded optimism as I prepare to go back to practice.”

– CMPA member

Physician wellness

The intense pressures of caring for patients during unprecedented times are significantly impacting physician wellness. The CMPA offers physician-to-physician support and actively collaborates with partners across healthcare to enhance physician wellbeing.

How the CMPA has supported physician wellness in 2020:

The CMPA is here, listening to members concerns with a compassionate ear and offering meaningful, one-on-one support.

We recognize that the safety and sustainability of our healthcare system is linked to provider wellness, and that members remain committed to serving patients during these times of uncertainty, resource limitations and personal risk.

We remain steadfast in our efforts to collaborate with stakeholders to promote changes that support member wellbeing at the individual, institutional, regulatory, and policy levels.

In 2020, we:

  • Continued internal education, enhancing our ability to understand and effectively support our members during periods of distress.
  • Published numerous articles, videos, and podcasts addressing wellness issues and supported members with accessing resources and coping strategies.
  • Collaborated with the College of Physicians and Surgeons of Ontario (CPSO) and the Ontario Medical Association (OMA) Physician Health Program (PHP) on the distress and suicide recognition and response project, creating opportunities to improve awareness of physician distress and suicide.
  • Contributed to key discussions with the OMA’s PHP Advisory Panel, other provincial PHPs, and the Canadian Medical Association, sharing CMPA’s insights and expertise to support physician wellness.

While the annual amount varies, the CMPA paid, on behalf of its members, a cumulative total of $1.1 billion in patient compensation over the last five years.

Compensating patients

The CMPA is an essential component of the healthcare system. An important part of our role is to provide appropriate and timely compensation to patients harmed by negligent care (fault in Québec) on behalf of members.

How the CMPA ensured appropriate compensation to patients in 2020:

The CMPA is a not-for-profit organization. Physicians pay membership fees which are used to:

  • compensate patients harmed by negligent medical care (fault in Québec)
  • provide safe medical care education
  • support members facing medico-legal difficulties

While we educate and support physicians to prevent patient harm, we also compensate patients on behalf of members quickly, when appropriate.

We invest prudently to maintain adequate funding for compensation paid now and into the future.

In 2020, we:

  • On behalf of members, provided $206 million in compensation to patients harmed by negligent medical care (fault in Québec), helping to support their short and long-term care needs.
  • Generated a 4.8% return on investments, positioning us to continue to provide appropriate compensation to patients on behalf of members – no matter when the care occurred.
  • Closed 2020 in a strong financial position, providing the stability to weather uncertain financial markets and continue to hold the funds required to compensate patients on behalf of our members in the decades ahead.

Our advocacy efforts result in changes that help our members practice effectively during challenging times.

Advocacy and action

The CMPA advocates for system enhancements that allow physicians to focus on what they do best - providing safe, quality care to their patients. We continue to advocate on matters that impact the lives of both patients and physicians.

How the CMPA advocated and took action to support members in 2020:

Our data, insights, and unique perspectives enable us to provide input on key legislation, regulation, and policies regarding a range of healthcare and medico-legal issues.

Throughout the pandemic, we have supported calls to action on key issues, collaborated with healthcare leaders, and called on governments to influence emerging COVID-19 regulations and policies.

In 2020, we:

  • Personal protective equipment (PPE): Supported the Canadian Medical Forum’s call to action on PPE, urging governments to develop recommendations that protect the safety of physicians and patients.
  • Critical care triage protocols: Engaged with governments, Medical Regulatory Authorities and other healthcare stakeholders to support the development of critical policies, such as critical care triage protocols, providing physicians the guidance and support they need to care for their patients.
  • Legislation for protection during COVID-19: Urged provincial governments across the country to enact legislation that provides medico-legal protection to physicians delivering care during COVID-19.
  • Virtual Care: Worked with Colleges and provincial medical associations and federations to facilitate virtual care across provincial borders, enhancing access to needed COVID-19 care for patients.

“This was a fantastic, well-run session that should be a model for how future virtual seminars should be done.”

– University of Calgary resident, Prepped for practice: Medico-legal essentials for residents (2020)

Safe medical care education

In 2020, we were challenged to rethink and adapt our traditional face-to-face approach to delivering safe medical care education and pivot to a digital world. Guided by our deep understanding of members’ needs, we developed timely and impactful resources, available to members at their fingertips.

How the CMPA’s education and support made an impact in 2020:

Through our safe medical care education, the CMPA substantively contributes to the reduction in the likelihood and impact of patient harm from care provided by physicians and other health professionals.

In 2020, we:

  • Transformed the signature CMPA Resident Symposium (and associated Faculty Development Workshop) into Prepped for practice: Medical-legal essentials for residents, an online, interactive educational event for residents and their faculty.
  • Published Good Practices, a centralized, virtual repository of educational resources to help members navigate the challenges they face at all stages of their careers.
  • Provided accredited, evidence-based eLearning activities, helping members refine their skills and obtain CPD credits.
  • Launched the Practically Speaking Podcast, featuring episodes with topics that support safe and effective patient care.

As a member of the CMPA family, Saegis provides specialized programs and practice management solutions for physicians, healthcare professionals, and institutions. Visit Saegis.

Practice management solutions

Throughout the pandemic, the increase in virtual care has intensified security concerns across healthcare. Saegis took action to support members, their teams and their institutions.

How Saegis provided practice management solutions for teams and institutions in 2020:

Saegis developed specialized programs on topics like cybersecurity and privacy to help healthcare professionals, interdisciplinary teams, and institutions manage the risks of an increasingly digital world.

In 2020, Saegis:

  • Developed a free, online learning course (COVID-19 Cybersecurity Threat) to help healthcare professionals understand the increased risk of cyber-attacks and breaches.
  • Launched the accredited Saegis Shield Cybersecurity and Privacy eLearning program at a number of clinics across Canada, equipping healthcare teams with skills and resources to combat cybersecurity concerns and protect the privacy of patient health information.
  • Delivered specialized programs on topics such as disclosing harm and managing unprofessional behaviours to 225+ healthcare professionals and their teams, helping them perform at their best and provide safe and effective care.

CMPA peer-reviewed research is crucial to advancing the safety of medical care in Canada.

Research and insights

The CMPA has the largest collection of physician medico-legal data in the country. Our dedicated research team analyzes the data, identifying challenges and opportunities to improve the safety of medical care.

How the CMPA leveraged insights and research to enhance safety in 2020:

Our data and insights inform our safe medical care education, creating learning opportunities which are broadly applicable and tailored to the needs of members in specific specialties.

We also share insights from our data and research with members and stakeholders across Canada and actively collaborate to drive changes that advance safety improvements throughout the healthcare system.

Some examples in 2020 include:

  • Published research in respected peer-reviewed journals such as the Canadian Journal of Anesthesia, and Medical Education, providing risk management strategies to reduce harm in healthcare delivery.
  • Provided expertise to the Association of Faculties of Medicine of Canada’s Phase 2 Opioid Action Plan Steering Committee, supporting education in pain management and addiction medicine.
  • Collaborated with the Society of Obstetricians and Gynaecologists of Canada on a certificate program for safe obstetrical care (English only).
  • Worked with a number of Canadian patient safety organizations to advise on the development of the "Oxytocin to Start or Advance Labour: 5 Questions to Ask" handout, providing patients with valuable information to help manage their care.

"The CMPA is a wonderful organization. I'm proud to be a part of (it). It's rare that one finds the respect and care the CMPA has for its members and its employees"

– CMPA employee

Organizational resilience

By investing in our people, systems and technologies, we ensure the CMPA has the talent, capacity, and resources to continue to support members and empower better healthcare.

To serve our members well and positively impact the healthcare system, we provide employees with the support and resources they need to be resilient in responding to a changing environment and to enhance our capacity to serve members in new and innovative ways.

How the CMPA enhanced organizational resilience in 2020:

We are committed to supporting employees’ well-being and safety, exploring opportunities such as flexible work arrangements, and taking steps to understand and promote workplace equity, diversity and inclusion (EDI).

We maintain a compelling employee experience, fostering ongoing learning and career growth, and equipping staff with modern tools and technologies that help them deliver their best work.

In 2020, we:

  • Launched the 2020-2022 People Strategy, helping us nurture and build a culture that is supportive, diverse, inclusive and high-performing, and encourages continuous learning.
  • Partnered with the Canadian Centre for Diversity and Inclusion (CCDI) and created leadership and governance structures to foster the development of an organization-wide multi-year Equity, Diversity and Inclusion (EDI) strategy. Work will begin in 2021 to help us understand employees’ lived-experience around equity, inclusion, and diversity at the Association.
  • Enhanced internal processes, systems and technologies that support financial services, membership services, medico-legal assistance and education delivery.


Back to Supporting physicians & patients

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A year in numbers

Our members

In 2020, the CMPA had 103,075 Canadian physician members

Type of work

37% Family medicine
50% Specialists
13% Residents

Region

BC/AB 27,113
SMAT* 13,596
ON 41,343
QC 21,023

Age

38% Under 40
41% 41-59
22% Over 60



Our services

Education

118

Continuing professional development educational events and workshops

BC/AB 29
SMAT* 14
ON 41
QC 34

10,445

Continuing professional development attendees

BC/AB 2,544
SMAT* 618
ON 4,093
QC 3,190




Advice

23,702

New advice provided to members

BC/AB 5,426
SMAT* 2,234
ON 11,615
QC 4,427

2,780

COVID-19 advice calls

BC/AB 499
SMAT* 1,498
ON 551
QC 232




Medico-legal services


2020
BC/AB
SMAT*
ON
QC
New medico-legal cases
7,948




Legal actions
732
176
98
365
93
College (medical regulatory authority) matters
4,183
1,113
645
1,703
722
Hospital matters
1,773
405
200
499
669
Paying agency matters
293
30
16
9
238
Other
967
226
65
447
229

 




Resolved legal actions
645




Judgment for plaintiff
8
4
0
3
1
Judgment for physician
29
9
1
9
10
Settled with plaintiff
259
58
27
126
48
Dismissed/discontinued/abandoned
349
68
36
191
54

* Saskatchewan, Manitoba, Atlantic provinces and Territories

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Financial performance

How the CMPA maintains adequate funding to support physicians and compensate patients on behalf of members

The CMPA has a responsibility to maintain adequate funding so we can support physicians and compensate patients on behalf of members
now and into the future.

As a not-for-profit organization, the CMPA collects membership fees from physicians each year. Through prudent investments, the Association is able to reduce the fees charged to members by roughly one third. Funds held are used—on behalf of members—to compensate patients harmed by negligent medical care (fault in Québec), support members facing medico-legal difficulties and advance safe medical care.

We strive to ensure member resources are used efficiently and appropriately, and we are committed to containing growth in medical liability protection costs.

The strong returns on our investment portfolio over the past few years combined with a slowdown in the growth of medico-legal costs has significantly improved the CMPA’s financial position. As a result, steps have been taken to implement year-over-year reductions to member fees. In 2020 and 2021 respectively, members were provided with $40.4 million and $99.5 million in fee credits, lowering the cost of membership fees. In 2022, this number will double to almost $200 million in fee reductions (credits).

We will continue to provide timely and appropriate compensation to patients on behalf of our members, protect and support physicians and help them provide safe medical care. We will work to provide members with credits to reduce fees and lower the Association’s asset levels as appropriate.

Compensation to patients

On behalf of our members, the CMPA provides timely and appropriate compensation for patients proven to have been injured as a result of negligent medical care (fault in Québec).

While amounts vary from year to year, on behalf on its members, the CMPA paid a cumulative total of $1.1 billion in patient compensation over the last five years.

In 2020, on behalf on its members, the CMPA paid $206 million to patients harmed as a consequence of negligent medical care (fault in Québec).

Spending on learning

Through our research efforts, the CMPA develops evidence-based education that enhances the safety, reliability and quality of healthcare in Canada.

As one of Canada’s largest providers of continuing professional development, the CMPA addresses the educational needs of physicians to help them improve their practices and to provide safe medical care through the continuum of their careers.

In 2020, the CMPA spent $20.8 million on conducting safe medical care research and on developing and delivering safe medical care education to Canadian physicians.

Investment returns

The CMPA invests to secure sufficient funds—on behalf of members—to compensate harmed patients proven to have been injured as a result of negligent medical care (fault in Québec) and to decrease membership fees.

Due to the long payout period inherent with medical liability protection, the CMPA is able to invest a portion of the funds, and therefore, reduce the fees by roughly one third.

In 2020, the portfolio produced positive returns of 4.8%.

Net asset position

Net assets are the difference between assets and estimated liabilities. They provide a point-in-time measure that indicates whether the Association has the required resources to meet estimated liabilities over the next 30 to 40 years.

The overall net asset position can fluctuate from one year to the next, depending on external driving factors such as investment returns and/or compensation to patients paid on behalf of members.

The Association’s net asset position as of December 31, 2020 was $1,444 million, an increase of $264 million from 2019.

Aggregate fees

Fee debits and credits optimize the stability and predictability of the CMPA’s membership fee structure over time.

The CMPA aims for members to pay the costs of protection for the year in which the care was delivered.

If the actual values are different from the predicted values, future fees may be adjusted (increased or reduced) to address the difference.

On an annual basis, the CMPA uses fee credits to reduce membership fees when the Association is in a strong financial position.

A positive investment experience in 2020 enabled the CMPA to apply a reduction in fees (credit) of $40.4 million.

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View the 2019 Annual report