How the CMPA is supporting Canadian physicians in a complex healthcare system
The Canadian Medical Protective Association (CMPA) is an integral part of the multifaceted Canadian healthcare system. Within this system, our role is to advise and assist Canadian doctors with medico-legal matters related to their practice, on behalf of our members to compensate patients injured as a result of negligent medical care (fault in Québec), and to advance patient safety.
As Canada’s largest national medical association for doctors, with over 100,000 members, we are uniquely positioned to proactively enhance the safety of patient care and reduce the risk of harmful events by:
- conducting patient safety-related research, which informs our educational resources and which we share with healthcare stakeholders
- delivering educational resources and accredited safe medical care learning opportunities to doctors and their teams
- providing real-time advice to doctors on the phone and online
- advocating for system improvements that advance healthcare delivery
This page provides quick facts that explain the nature of the CMPA’s work, how we are funded, and how we compensate patients.
Compensating patients injured by negligent medical care (fault in Québec)
An important part of the CMPA’s role in the Canadian healthcare system is to provide, on behalf of its members, timely and appropriate compensation to patients proven to have been injured as a result of negligent medical care (fault in Québec) as determined during the medico-legal process.
While the total annual amount varies, on behalf of its members, the CMPA paid a cumulative total of $1.1 billion in patient compensation over the last 5 years.
For example, a baby who is injured by negligent care (fault in Québec) may incur costs throughout their lifetime. The CMPA is structured so we can compensate them and their family appropriately and in an amount that reflects their long-term care needs. Unlike an insurance company, the CMPA is not restricted by pre-set compensation amounts or capped damages.
Determining patient compensation is a collaborative effort between lawyers for all parties, based on input from independent experts. When agreement cannot be reached, a mediator may help the two parties come to an agreement, or the judge or jury involved in the case makes the decision.
Historical experience shows that approximately one-third of cases that proceed through the medico-legal process are resolved with compensation to patients and their families.
Understanding the CMPA mutual membership model
The CMPA is a mutual, not an insurance company.
The CMPA is a mutual medical defence organization for Canadian doctors that also advances patient safety.
We are not an insurance company, and we do not underwrite an individual doctor’s risk through a contract of insurance. We do not regulate the practice of medicine, grant or remove licenses to doctors, or set standards of care.
Being a mutual means that when doctors join, they agree to collectively share the costs, risks, and benefits of their CMPA membership. Members are eligible for assistance for matters related to the practice of medicine, and, in return, they commit to mutuality, including the expectation to practice in a manner consistent with the values of the medical profession. This commitment aims to prevent or reduce patient harm, and supports the best interests of the membership as a whole.
Members who experience a medico-legal difficulty, such as a medical regulatory authority (College) complaint, contact the CMPA to seek assistance. We first examine the facts and circumstances of the case, and determine whether the member is eligible for the CMPA’s assistance.
The CMPA generally assists with medico-legal matters that arise from the practice of medicine; the decision to assist in a particular case is discretionary, guided by a set of principles.
Improving safety of medical care through data-driven education
How a phone call can turn into proactive harm prevention
As a mutual, the CMPA is committed to preventing healthcare-related patient harm through education and support to doctors. Our first goal is to prevent harm from happening to patients in the first place.
Doctors contact us to get advice on how to provide the safest medical care possible for their patients, prevent harm related to healthcare, and navigate situations where medico-legal difficulties arise.
Each year, the CMPA responds to over 23,000 advice calls from doctors.
The CMPA has a team of more than 45 experienced doctors who answer calls and online inquiries, and provide empathetic support and expert guidance to help members handle specific medico-legal and patient safety challenges in their practice. The types of inquiries are many and varied, and may include:
- A family doctor wants advice on how to ensure patients have appropriate access to care, while also following pandemic-related restrictions on their practice.
- A surgeon is concerned that elective procedures are being cancelled, her wait list has grown as a result, and is worried about the potential impacts on the health of her patients.
- A doctor receives a request for medical assistance in dying from one of his patients and wants to ensure he follows the established protocols.
Using data and insights to reduce harm
CMPA data informs our innovative quantitative and qualitative analyses which, in turn, help to identify gaps that affect patient safety. Using these insights, the CMPA publishes risk management articles and develops accredited practice improvement learning opportunities for our members. The information is publicly available, and supports ongoing efforts of quality improvement, patient safety, and medical education organizations in Canada.
Supporting doctors facing medico-legal issues
CMPA members are eligible for assistance with medico-legal events related to the practice of medicine.
The CMPA provides its members with an appropriate and ethical defence, and we strive to do so in a timely manner.
Like all individuals, doctors have the right to a fair process.
When a patient or family initiates a civil action against a CMPA member, the role of the CMPA is to assist the member in dealing with the action, provide legal representation, and defend the member if medical expert opinion is that the standard of care was met.
What is standard of care?
The medical standard of care is not one of perfection but rather the standard of care that might reasonably be applied by another physician in similar circumstances.
If defence experts conclude the standard of care was not met and the breach of the standard caused the patient’s harm, the CMPA seeks to explore settlement as soon as possible.
Historically, approximately one-third of cases that proceed through the medico-legal process are resolved with compensation to patients and their families.
If a patient has been injured due to proven negligent care (fault in Québec), we aim to settle those cases as expeditiously as possible. While only a very small number of cases go to trial, those that do can last, on average, 4 to 5 years. Unfortunately, this duration is often outside of the CMPA’s control, as the complexity of a case, the involvement of other defendants (e.g. nursing staff, the hospital, etc.), and the intricacies of the Canadian legal system can make it difficult to reach a resolution quickly.
Championing a fair medical liability system
There are a number of countries with medical liability systems and medical protective organizations similar to ours—notably the United States, England, Ireland, Australia, South Africa, and France.
Canada’s model is grounded in a tort-based compensation system, which is a relatively inexpensive system compared to other models. If a patient is injured as a result of negligent medical care (fault in Québec), on behalf of its members the CMPA provides timely and appropriate compensation to the patient or their family.
The CMPA supports civil justice reform (including alternative dispute resolution), and improved case management and proportionality in the adjudication of disputes—all aimed at bringing cases to an early and fair resolution and reducing costs for all parties.
In the area of health law and health policy, the CMPA engages with regulators, healthcare stakeholders, and governments. As an example, the CMPA has contributed to the discussion about a national medical assistance in dying law.
In another example of advocacy, we requested governments to enact an emergency order to permit the use of critical care triage protocols should they be required to manage a surge of critically ill patients in a public health emergency. Emergency orders can clarify the processes around the use of critical care triage protocols and provide liability protection indemnity to health providers who comply with the requirements in good faith.
Effectively managing funds to ensure compensation for patients
How the CMPA is funded
The CMPA collects membership fees from doctors each year.
Funds held are used to compensate patients injured as a result of negligent medical care (fault in Québec), support members facing medico-legal difficulties, and advance safe medical care.
The CMPA is a not-for-profit organization. We do not receive any funding from governments or taxpayers.
Governments reimburse doctors for a portion of their CMPA fees; the amount of reimbursement varies by province or territory depending on the specific provincial/territorial agreement in place. These agreements are negotiated by provincial or territorial medical associations or federations; the CMPA is not party to these negotiations or agreements.
The CMPA’s actuarial team determines CMPA membership fees for each year, based on a number of factors: the clinical specialty of the member, the geographic region of work of the member, and the CMPA's financial position.
Obstetricians, for example, pay higher fees than family doctors. This difference reflects the level of risk associated with different specialties as well as the amount of compensation provided to patients in the event they are injured as a result of proven negligent medical care (fault in Québec).
Geographic region of work
The CMPA has four fee regions
- British Columbia and Alberta
- Saskatchewan, Manitoba, Atlantic provinces, and Territories
Differing fees are set for each region, taking into account the medico-legal costs within a region.
CMPA’s funds used to compensate patients and support members
As a not-for-profit organization, the CMPA uses the money it holds to compensate patients proven to have been injured as a result of negligent medical care (fault in Québec), and to support members facing medico-legal difficulties.
We have a responsibility to maintain adequate funding, both for current needs and projected compensation payments 35 years into the future. We ensure that we can meet this responsibility when we are in a positive funding position.
How the CMPA benefits both doctors and patients
Some question the need for the CMPA to hold the funds that it does, as well as whether and how these resources benefit patients and the healthcare system.
The CMPA’s medical liability protection provides doctors with the confidence to deliver care knowing they will have support, representation, and indemnity should it be required.
The CMPA also benefits patients proven to have been injured as a result of negligent medical care (fault in Québec) because, as determined through the medico-legal process, they will be appropriately compensated for costs associated with their current and future care needs.
Burnout among doctors is all too common, adding strain on the sustainability of the Canadian healthcare system when doctors leave practice either temporarily or permanently. Heavy workload, increased administrative demands, and anxiety stemming from a medico-legal difficulty, for example, can all contribute to deterioration of a doctor’s well-being—and may erode the ability to provide safe, quality care.
Members who spoke to one of our 45+ experienced physician advisors reported a 97% satisfaction rate. Members indicated a 72% reduction in severe stress levels after a call with the CMPA.
Supporting wellness for doctors is a shared responsibility among physician leaders, medical schools, provincial and territorial medical associations and federations, regulatory authorities (Colleges), and governments. As Canada’s largest physician organization, the CMPA understands the importance of wellness among doctors, and we actively work with others to assist doctors in maintaining health and attending to wellness issues. This, together with the CMPA’s many other activities, is how the CMPA empowers better healthcare for all Canadians.