Empowering better healthcare

How CMPA supports Canadian doctors and patients

The Canadian Medical Protective Association (CMPA) is an integral part of the Canadian healthcare system. Our roles are: to 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 109,000 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
• advocating for system improvements that advance healthcare delivery 

CMPA is here to protect the professional integrity of our members and proactively work with them to deliver safe medical care.

6 Things you should know about the CMPA

This video highlights the top 6 ways CMPA assists doctors and patients.

Compensating patients injured by negligent medical care (fault in Québec)  

An important part of 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.

For example, a baby who is injured by negligent care (fault in Québec) may incur costs throughout their lifetime. 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, 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 CMPA’s mutual membership model

CMPA is not an insurance company.

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 CMPA they agree to a reciprocal arrangement. 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 are expected to practice in a manner consistent with the values of the medical profession.

As part of mutuality, members are also expected to take an active role to improve the quality of care and help prevent future medico-legal events. 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 CMPA to seek assistance. We first examine the facts and circumstances of the case and determine whether the member is eligible for CMPA’s assistance.

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 patient safety and safe medical care through advice, support, research, and data-driven education

How a phone call can turn into proactive harm prevention

As a mutual medical defence organization, CMPA is committed to preventing healthcare-related patient harm through education, research, and support to doctors. Our goal is to prevent harm from happening to patients in the first place.

Doctors contact us to get advice on how to provide safe medical care, prevent patient harm related to healthcare, and navigate situations where medico-legal difficulties arise.

Members who spoke to one of our 50+ experienced physician advisors reported a 93% satisfaction rate. Members indicated a 71% reduction in severe stress levels after a call with CMPA.

CMPA has a team of more than 50 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.
• 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 improve patient safety

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 resources, peer-reviewed research, 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.

CMPA provides its members with an appropriate and ethical defence. Like all individuals, doctors have the right to a fair process, and we strive to do so in a timely manner.

When a patient or family initiates a civil action against a CMPA member, the role of 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.

If defence experts conclude the standard of care was not met and the breach of the standard caused the patient’s harm, 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 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 CMPA provides timely and appropriate compensation to the patient or their family.

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, CMPA engages with regulators, healthcare stakeholders, and governments. As an example, 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

CMPA’s financial model explained

How CMPA is funded

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.

Membership fees are set to support the financial stability of the organization while keeping fees as low as possible.

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; CMPA is not party to these negotiations or agreements.

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 CMPA's financial position.

1. Clinical specialty

   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).   

2. Geographic region of work
   

   CMPA has four fee regions
   

   • British Columbia and Alberta
   • Ontario
   • Québec
   • Saskatchewan, Manitoba, Atlantic provinces, and Territories

   Differing fees are set for each region, taking into account the medico-legal costs within a region.
   

3. CMPA’s funds used to compensate patients and support members

   As a not-for-profit organization, 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 take a long-term view of our finances. We have a responsibility to maintain adequate funding, both for current needs and projected needs, and ensure we have the funds to support members and compensate patients today, tomorrow, and up to 40 years into the future.

Supporting physician wellness

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 can all contribute to deterioration of a doctor’s well-being—and may erode the ability to provide safe, quality care.

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, 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 CMPA’s many other activities, is how the CMPA empowers better healthcare for all Canadians.