The CMPA is governed by an elected Council of 31 practising physicians who, together with CMPA management, foster the long-term success of the Association.
Members of the CMPA leadership team bring unique and diverse skills that help us assist and support members, and contribute to safe medical care across the healthcare system.
The CMPA’s commitment to support our members and employees, strengthen our foundation, and adapt to a changing healthcare environment.
To protect the professional integrity of physicians and promote safe medical care in Canada.
The CMPA is valued as an essential component of the Canadian healthcare system.
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As an essential component of the Canadian healthcare system, we empower better healthcare by assisting physicians, contributing to safe medical care, and supporting the medical liability system.
2022 saw severe challenges to the healthcare system. Through difficult times, we provided compassionate support to Canadian physicians facing high levels of stress and complex medico-legal issues.
93% of members surveyed agreed that the knowledge gained from speaking with a physician advisor would make a positive impact on their practice.
Peer support provided by CMPA physician advisors significantly assisted members in managing the stress and anxiety that can accompany a medico-legal concern, helping them provide safe medical care.
71% of members experiencing extreme stress who called for assistance noted a significant reduction in stress after speaking with us.
Equity, diversity, and inclusion (EDI) are crucial to safe medical care and physician wellbeing. Advancing EDI is directly tied to our mission. We have a responsibility to help mitigate bias and inequity in the services we provide to members.
We strive to be an organization where members and employees are valued for their diverse experiences and perspectives.
To keep supporting our members with high quality services, we invested in our people and infrastructure – creating a robust employee well-being plan and flexible work model, and initiating proactive recruitment activities.
The health and wellness of our employees is one of our top priorities.
As one of Canada’s largest providers of continuing professional development in healthcare, we delivered evidence-informed education to enhance the safety, reliability, and quality of healthcare in Canada.
82% of members agree that the CMPA is a key partner in promoting safe medical care.
In 2022, we leveraged our medico-legal data in new ways and enhanced how we share research and insights with members and stakeholders.
Our research and insights support patient safety and help prevent harm from happening in the first place.
We are a not-for-profit mutual defense organization. An important part of our role in the Canadian healthcare system is to provide, on behalf of our members, timely and appropriate compensation to patients, if the care provided is found to be negligent (fault in Quebec).
On behalf of our members, we have paid a total of $1.25 billion in patient compensation over the past 5 years.
We partnered with stakeholders to shape policy on key issues impacting patients, physicians, and the medical liability system. Virtual care was the main focus of our 2022 engagement and advocacy efforts.
Collaborating with healthcare organizations across the country helps build a stronger healthcare system.
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Type of work
Note:*Other: This category consists of two types of members: those who are currently working in another country and those who have renewed their membership to support COVID care activities.
In 2022, the CMPA engaged with members 49,599 times on the phone and online.
Advice calls provided to members
BC/AB 4,861SMAT** 2,104ON 10,109QC 4,075
COVID-19 advice calls
BC/AB 146SMAT** 70ON 388QC 109Unknown 6
Continuing professional development educational events and workshops
BC/AB 32SMAT** 18ON 212QC 43Outside Canada 1
Continuing professional development attendees
BC/AB 1,990SMAT** 778ON 6,350QC 6,348Other 350
** Saskatchewan, Manitoba, Atlantic provinces and Territories
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The CMPA has a responsibility to maintain adequate funding to support member physicians and compensate patients on behalf of members when negligence (fault in Québec) has been proven – now and beyond the member’s retirement.
Accordingly, our financial planning horizon is long.
As a not-for-profit mutual medical defense organization, we collect membership fees from physicians each year. On behalf of members, we use our funds to compensate patients proven to be harmed by negligent medical care (fault in Québec), to support members facing medico-legal difficulties, and to advance safe medical care.
Members pay the full cost of their protection through their fees. In 2022, we collected fees necessary to protect our members and compensate patients today, tomorrow, and well into the future for all occurrences taking place in 2022.
We strive to ensure the fees we collect are used efficiently and appropriately, and we are committed to limiting growth in medical liability protection costs. One of our goals is to maintain relative fee stability, but this is in part determined by the performance of our carefully managed investments. As appropriate, we may lower membership fees when we are in a strong financial position and prudently raise fees when needed.
Over the past 10 years, we have achieved exceptional returns on our investment portfolio -- earning a 7.96% compound annual return. This strong investment performance has contributed to our positive financial position and has allowed us to reduce fees over the past 4 years.
We continue to invest responsibly to maintain a stable 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.
For more information, read our consolidated financial statements and Independent Auditors’ Report.
On behalf of our members, we provide timely and appropriate compensation for patients proven to have been injured as a result of negligent medical care (fault in Québec). Compensation to patients and the cost of legal services are our largest expenses each year.
We paid a total of $2.29 billion in patient compensation on behalf of our members over the last ten years, or an average of $229 million per year.
The following graph highlights patient compensation by region.
2013 - British Columbia/Alberta: 65,095,579.74; Ontario: 97,052,890.01; Québec: 18,033,153.26; Saskatchewan/Manitoba/Atlantic and Territories: 13,316,638.03; Total: 193,498,261.04; | 2014 - British Columbia/Alberta: 45,122,483.61; Ontario: 161,320,246.61; Québec: 26,163,466.73; Saskatchewan/Manitoba/Atlantic and Territories: 4,288,617.68; Total: 236,894,814.63; | 2015 - British Columbia/Alberta: 34,446,374.23; Ontario: 122,660,468.06; Québec: 18,222,304.73; Saskatchewan/Manitoba/Atlantic and Territories: 19,480,332.72; Total: 194,809,479.74; | 2016 - British Columbia/Alberta: 50,375,512.83; Ontario: 83,832,405.49; Québec: 19,512,531.11; Saskatchewan/Manitoba/Atlantic and Territories: 17,964,540.84; Total: 171,684,990.27; | 2017 - British Columbia/Alberta: 34,875,714.64; Ontario: 162,391,086.79; Québec: 33,241,679.20; Saskatchewan/Manitoba/Atlantic and Territories: 19,972,610.92; Total: 250,481,091.55; | 2018 - British Columbia/Alberta: 64,962,377.44; Ontario: 144,823,869.34; Québec: 19,793,981.14; Saskatchewan/Manitoba/Atlantic and Territories: 30,537,734.07; Total: 260,117,961.99; | 2019 - British Columbia/Alberta: 36,057,340.09; Ontario: 156,356,720.28; Québec: 16,806,950.42; Saskatchewan/Manitoba/Atlantic and Territories: 14,176,574.04; Total: 223,397,584.83; | 2020 - British Columbia/Alberta: 53,020,743.88; Ontario: 112,084,663.76; Québec: 22,886,340.74; Saskatchewan/Manitoba/Atlantic and Territories: 18,006,544.67; Total: 205,998,293.05; | 2021 - British Columbia/Alberta: 78,058,205.40; Ontario: 157,282,315.72; Québec: 20,821,379.86; Saskatchewan/Manitoba/Atlantic and Territories: 20,079,610.47; Total: 276,241,511.45; | 2022 - British Columbia/Alberta: 80,360,288.16; Ontario: 166,395,822.83; Québec: 17,448,368.62; Saskatchewan/Manitoba/Atlantic and Territories: 15,143,882.35; Total: 279,348,361.96;
In 2022, on behalf of our members, we paid $279 million in compensation to patients harmed as a result of negligent medical care (fault in Québec). This is $50 million more than our ten-year average (2013-2022).
Patient compensation costs on behalf of members vary greatly from year to year. Contributing factors include case duration, the number of cases settled, and the medico-legal outcomes of cases.
In 2022, the $279 million in payments to patients was $3.1 million more than in 2021. When compared to years prior, this increase was driven largely by an increase in the number of cases greater than $5 million which contributed to higher average value per case. As compared to the ten-year average, the 2022 average payment per case was higher by 41%.
Since there is volatility in outstanding claims and compensation to patients, we have insurance to help protect us from unexpected costs for medico-legal occurrences prior to December 31, 2022. These policies will help us continue to compensate patients and support members even if there is an unexpected increase in medico-legal expenses.
When appropriate, we provide ethical defense to eligible members experiencing medico-legal issues. The legal costs we incur fall into two categories:
In 2022, we paid $215.6 million in legal expenses, which was a $7.6 million increase over 2021.
This increase was driven by the civil legal category. While the number of civil cases decreased, the costs associated with them increased. At the same time, the number of non-civil cases increased while the cost per case decreased.
Some of the increased costs in the civil legal category can be attributed to COVID-19 related court delays and postponements that created additional work for CMPA lawyers. There were also cases of increased complexity that required more hours per case than typical. The COVID-19 pandemic also created a situation in which more members reported higher levels of anxiety about legal matters. This anxiety required our legal counsel to spend more time supporting the well-being of members, helping them understand the legal process, and preparing for discoveries or hearings.
We have a diversified investment portfolio that earns income to ensure we can appropriately compensate patients on behalf of members and fund future medico-legal expenses to support our members.
In 2022, the investment portfolio had a net value of $5.4 billion.
This is a decline of $485 million from 2021. This decline can be attributed to a $315 million investment loss caused by an overall decline in financial markets, as well as significant fee reductions in 2022. The decline in the investment portfolio is the main factor behind the decrease in the Association’s financial position (more on this below).
The performance objectives of our investment portfolio are to:
Our investment portfolio consists of both public and private assets. We value our private assets conservatively at the lower of original cost or market value. At the end of 2022, we estimated that the fair value of our private assets exceeded their original cost by $825 million. At fair value, our investment portfolio value was $6.3 billion in 2022.
Membership fees collected in 2022 fund patient compensation and the medico-legal costs of our members well into the future for care provided in 2022.
This long-term horizon demonstrates our commitment to protecting members and their patients long after members retire. This is known as occurrence-based protection. Members are eligible for assistance (and patients are eligible for compensation if harmed by negligent medical care) any time in the future if the physician was a CMPA member at the time the care occurred. For example, a retired member could be eligible for assistance related to the care they provided early in their career.
We must hold adequate funds to compensate patients and support physicians with medico-legal cases for up to 4 decades from the time care was provided.
Our net asset position is the difference between our assets (things that bring money to the CMPA) and estimated liabilities (things that cost the CMPA money). It provides a point-in-time measurement that indicates whether we have the required resources to meet our financial obligations, including compensating patients over the next 4 decades.
This amount fluctuates from one year to the next, depending on factors such as investment returns and compensation to patients. We strive to maintain a reasonable net asset position and take a measured approach to temporary shortages or excesses. To manage our financial position over time, we increase or decrease membership fees as needed.
The Association’s net asset position as of December 31, 2022, was $1.1 billion, a decrease of $560 million from 2021. This decline was the result of fee reductions and a loss in our investment portfolio in 2022.
While the net asset position has decreased since 2021, it remains higher than ideal. The CMPA will leverage this surplus to lower membership fees in 2023, as appropriate. All the while, we will continue to appropriately compensate patients that have been harmed as a result of negligent medical care (fault in Québec).
We look ahead to ensure we have adequate finances to appropriately compensate patients harmed by negligent care (fault in Quebec) and manage legal and administrative expenses well into the future.
As of December 31, 2022, the estimate for all accumulated outstanding claims was $4.0 billion, an increase of $36 million from December 31, 2021.
Through prudent adjustments to membership fees, we aim to stabilize our membership fee structure over time. We strive to maintain relative fee stability, but our ability to do this is determined in part by the performance of our investments, which are managed carefully but subject to market fluctuations.
CMPA members pay the expected cost of protection for the year in which the care was provided. If the actual costs of protection are different from the predicted values, future fees may be adjusted (increased or decreased) to address the difference.
When we are in a strong financial position (e.g., our investment returns outperform our long-term expectations) we typically reduce membership fees.
Our recent strong returns on investments have allowed us to reduce membership fees. Fee reductions were $99.5 million in 2021, $200 million in 2022, and will be $362.5 million in 2023. This is a $662 million reduction in membership fees since 2021.
If our financial position normalizes (i.e., decreases from the highs we have seen in recent years), a future increase in membership fees is likely.
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