Principles of assistance
Providing care outside Canada
Originally published June 2004 / Revised August 2013
The CMPA is structured to assist members who encounter medical-legal difficulties arising in Canada from their medical professional work done in Canada. The CMPA does not generally assist with difficulties that arise outside of Canada or that result from care provided outside of Canada, owing to the potential for prohibitively expensive legal actions in other jurisdictions, particularly the United States.
In some circumstances, members may be eligible for assistance when working outside of Canada including travelling with Canadian groups participating at international non-professional cultural events or amateur sporting events, Canadian Forces physicians posted overseas, embassy physicians, members working for established humanitarian organizations, and members providing medical care as part of certain teaching or research programs. In all of these instances, members should carefully consider the matter before participating in the care of patients and consult the CMPA in advance about the extent of assistance that might be available.
Practising in a foreign country could mean practising without a licence
Significant medical-legal concerns exist when providing care outside of Canada, including licensure and the potential of facing a legal action outside of Canada. Without a licence to practise in a foreign country, travelling Canadian physicians could find themselves accused of practising medicine illegally. With or without a foreign medical licence, physicians could find themselves facing litigation in a foreign country without adequate professional liability protection.
When possible, members are encouraged to ask about licensure with the regulatory authority (College, state medical board, etc.) in the foreign jurisdiction. Many countries where humanitarian work is being done do not have established medical regulatory authorities. Under these circumstances, physicians should at least ensure the host hospital or any local sponsoring agency has resolved any privileges issues. Finally, to be eligible for CMPA assistance, members travelling abroad must continue to hold a Canadian medical licence.
Travelling with Canadian non-professional cultural or sport groups
The CMPA will generally extend assistance to members who provide care to the members of a Canadian non-professional cultural or amateur sport group, when the members of the group or team are residents of Canada who will return to Canada, and when the care provided by the member is limited to advanced first aid. The CMPA may also consider extending assistance when the member provides care to a team member who is not a resident of Canada, but who is competing for a Canadian national team. Members of the group or team who require medical care beyond advanced first aid should be transferred to the care of local physicians who have a licence to practise in the host country.
The CMPA will generally decline assistance with matters arising from care provided outside of Canada to individuals who were not official members of the group or team, such as family members, friends, media, and Canadian diplomats. However, the CMPA may consider extending assistance if the care was provided in a true emergency. Again, members are expected to transfer the care of these individuals on to a local physician as soon as possible.
CMPA members who travel with Canadian groups internationally should clarify with the group the limitations of their medical care before leaving. They should also contact the CMPA in advance to discuss their eligibility for assistance from the CMPA when outside Canada. In some circumstances, CMPA members may be advised they may not be eligible for the Association's assistance and therefore may need to arrange their own professional liability protection.
In anticipation of requests to treat individuals accompanying the Canadian group or team, travelling CMPA members should consider contacting the Canadian embassy or consulate in the foreign jurisdiction ahead of time to establish contacts in the foreign medical community, to whom they can refer Canadian visitors with medical problems.
Canadian Forces physicians
Military physicians (including both government or military employees and contract civilian specialists) who are CMPA members will generally be eligible for assistance with medical-legal matters brought in Canada arising from treatment provided during foreign deployments to Canadian military personnel, residents of Canada who are working for the Department of National Defence, and residents of Canada who are visitors at the military base. Military physician members should generally look to the Crown for assistance and indemnity with medical-legal matters arising from the treatment of foreign military and civilian personnel in foreign jurisdictions.
Military physician members who treat non-residents of Canada in Canada are generally eligible for assistance with legal matters brought in Canada, in accordance with the CMPA's guiding principles outlined in "Treating non-residents of Canada."
Military physician members may also be eligible for CMPA assistance when doing educational and humanitarian work in local communities abroad, except in the United States and all other countries where the U.S. legal system is applied.* Members are encouraged to contact the CMPA in writing prior to leaving Canada to determine their eligibility for assistance.
Military physician members who wish to maintain membership during foreign deployment will pay the membership fee corresponding to their type of work and the fee region where their home military base is situated in Canada.
Humanitarian work abroad
CMPA members who are involved in humanitarian work abroad may be eligible for assistance while they carry out such work outside Canada, except for work performed in the United States and all other countries where the U.S. legal system is applied.*
The CMPA has a separate fee category (type of work code 8) for members who participate in humanitarian work outside of Canada for a period of 3 to 12 months. For periods of less than 3 months, members are generally eligible for CMPA assistance under their current type of work and fee region. Eligibility for assistance for work abroad will not be extended for periods in excess of 12 months. Code 8 is not intended for members who are doing humanitarian work for extended periods of time or receiving a salary or a fee, nor is it for residents or fellows doing an out-of-country elective. The latter can be given special consideration if the elective is part of a training program, and the residents or fellows are accompanied and supervised by their teacher or a licensed Canadian physician.
To determine their eligibility for CMPA assistance, physicians must provide the CMPA with the following information in writing before they leave Canada:
- the name of the humanitarian organization
- the city and country where they plan to work
- the dates they will be working abroad
- a description of the work abroad (i.e. nature of care)
- information on the patients they will be treating (e.g. are they underprivileged or underserviced?)
Providing medical care as part of an acceptable teaching or research program (such as visiting professorship) and humanitarian work
CMPA members involved in teaching or research will generally be considered eligible for CMPA assistance with medical-legal matters arising from their professional work outside Canada, except in the United States and all other countries where the U.S. legal system is applied.*
Teaching or research work abroad (type of work code 9) applies to periods of work abroad for a maximum of 12 months. For periods of less than 3 months, members must maintain their current type of work code and fee region. Type of work code 9 is added to their membership for the required duration. Eligibility for assistance for work abroad will not be extended for periods exceeding 12 months.
To determine eligibility for CMPA assistance, physicians must provide the CMPA with the following information in writing prior to leaving Canada:
- the name of the teaching or research facility or humanitarian organization
- the city and country where they plan to teach or do research
- the dates of teaching or research abroad
- an invitation from the host medical facility or university
- if possible, a copy of the program confirming the member's participation
- whether or not the member intends to have clinical contact, and if so, whether the patients are underprivileged or underserviced
While it may be reasonable to accept payment or honorarium of minimal value or reimbursement of expenses, the CMPA will not generally assist with matters arising outside Canada where the member receives a salary or is paid a fee (such as for services provided to the patient).
Members acting as a teacher or participant in a course that involves patient contact as part of a humanitarian program will generally be eligible for assistance, except for work done in the United States and countries or territories under U.S. jurisdiction. Members should ensure that the centre or organization sponsoring the course provides adequate liability protection.
Members are reminded they should comply with any licensure requirements in all applicable jurisdictions and satisfy themselves that the host hospital has resolved any privileges issues.
The bottom line
- Members should contact the CMPA about 4 to 6 weeks before leaving Canada to discuss their eligibility for assistance, the appropriate type of work, and the fee region for which membership fees would apply.
- To be eligible for assistance when travelling abroad with Canadian non-professional cultural groups or Canadian amateur sporting teams, members should limit medical care to advanced first aid for official members of the group only.
- Except in the provision of advanced first aid to Canadian non-professional cultural groups or Canadian amateur sporting teams, members will not generally be eligible for assistance with matters arising from patient care in the United States or any country where the U.S. legal system is applied.*
For further clarification and assistance, please contact the CMPA.
*The U.S. legal system is applied in the following countries: Guam, Commonweath of the Northern Mariana Islands, Puerto Rico, U.S. Virgin Islands, American Samoa, and Swains Island.