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ANNUAL REPORT

2016

THE CANADIAN MEDICAL PROTECTIVE ASSOCIATION 2016 ANNUAL REPORT

OUR MISSIONTo protect the professional integrity of physicians and promote safe medical care in Canada.

OUR VISIONThe CMPA is valued as an essential component of the Canadian healthcare system.

OUR SERVICESOur service offering is built around the values that define the CMPA. We are committed to service excellence in all that we do — for our members and for Canadian healthcare. This includes:

▪ advice and assistance when medical-legal issues arise from a member’s medical professional work in Canada

▪ compensation to patients harmed by negligent care

▪ professional development programs and resources that help physicians provide safe care, manage risk, and be knowledgeable about their obligations

▪ public policy, submissions, and responses relating to medical-legal matters that impact physicians’ practice and the Canadian medical liability system

Legal assistance to resolve medical

liability matters

Advice to guide members in responding to medical legal issues

Education to prevent harm in

patient care

ABOUT USCMPA

CMPA’S CONTINUUM OF MEDICAL

LIABILITY SERVICES

■ ■ ■


95,691 members

456,512 contacts with members

29,642 newly opened cases

1,122,644 website visits

303 continuing

professional

development

(CPD) sessions

17,891 CPD attendees (member and other)

207 submissions and engagements

AT A GLANCECMPA

■ ■ ■


TABLE OF CONTENTSPresident and CEO’s introduction 5

Performance report

Strategic outcome #1—Assisting physicians 11

Strategic outcome #2—Contributing to safe medical care 16

Strategic outcome #3—Supporting the medical liability system 21

Financial and risk report 26

CMPA Leadership 39

This year’s 2016 annual report features photographs of just a few of our valued team members from across the organization.


5

President and CEO’s INTRODUCTION Canadian physicians practise in an increasingly turbulent environment in which funding challenges, evolving practice arrangements, legislative changes, the introduction of new technologies, and growing patient expectations tend to dominate both policy discussions and media reporting. What is often lost in the noise of competing views is that, every day, over 95,000 physicians deliver safe, high quality healthcare to Canadians. At the CMPA, we stand with those dedicated physicians, providing them the confidence to continue to deliver the medical care Canadians need.

As evidenced in our 2016 Annual Report, physicians’ need for assistance in medical-legal matters has never been greater, and this is reflected in the requests for advice and assistance we receive from members. We are gratified that, in responding to our 2016 membership survey, 94% of members expressed confidence the CMPA will protect their interests when a patient is harmed and that a similar percentage indicated they were satisfied with the scope and quality of our assistance.

We recognize that past results do not necessarily ensure future success and that, while continuing to deliver the core services that members rely upon, we must adapt our programs and services to meet physicians’ evolving medical liability protection needs. Team-based practices, electronic records, and medical assistance in dying (MAID) are but a few of the areas that pose emerging challenges for physicians.

The CMPA remains highly active in shaping the policy environment to ensure the legal and regulatory expectations of physicians are clear. Our protection of physicians starts with trying to reduce the risks associated with incompletely considered legislation and regulations and carries through to one-on-one assistance to our members, be it through one of our highly trained physician advisors or through legal counsel.

A percentage of our physicians find themselves in medical-legal difficulty resulting from their practice of medicine and we work to reach fair and equitable resolution to these matters, be they legal claims, College complaints, hospital matters, or other issues. Our philosophy of “defending the defensible” remains at the core of our value proposition to members.

■ ■ ■

At the CMPA, we stand with those dedicated physicians, providing them the confidence to continue to deliver the medical care Canadians need.

“

“


6

As a mutual defence organization, we are committed to meeting our obligations to members; we also expect that members will fulfill their responsibilities to the profession and to the Association. However, there is a very small percentage of members whose medical-legal experience is much greater than that of their clinical colleagues; many of these physicians risk entering a downward spiral that threatens their ability to continue to practise.

We are very pleased that, commencing in late 2017, we will be instituting a “member support program,” specifically aimed at identifying these at-risk members and developing tailored action plans to assist them in returning to a meaningful and safe medical practice.

We also know that the best approach to resolving medical liability issues is to avoid them in the first place. Risk reduction has long been the focus of our highly successful education program. The Association’s evidence-based presentations and courses assist physicians in improving the safety of care and reducing the likelihood of medical-legal difficulties. While we are justifiably proud of what we currently offer, we recognize that more is required and that our programs must continue to evolve to meet emerging member needs. To that end, in 2017, we will be offering more in-depth programs on specific topics, all aimed at assisting physicians in their delivery of care. These include improved communication with colleagues, strengthening the dialogue with patients, addressing unprofessional behaviour, and improving opioid prescribing practices. More of these in-depth programs will follow as we respond to members’ feedback.

Accordingly and within the rubric of our comprehensive set of educational offerings, we have developed a risk reduction program tailored for the specific needs of medical residents. Our first day-long symposia for residents will take place in Toronto in November 2017 and, with the outstanding support of the post-graduate deans of Canada’s medical schools, will be expanded across the country in the next few years.

Effective medical liability protection is essential for a well-functioning healthcare system and the CMPA recognizes our responsibility to exercise effective stewardship over the resources members have entrusted to us. We are proud of our efforts to optimize the delivery of legal assistance to members and to reduce, on a per member basis, our own operating costs. The 2016 Annual Report outlines our expenditures in support of our members, the largest of which is the payment of compensation, on behalf of our members, to patients injured as a result of negligent medical care.

■ ■ ■

■ ■ ■ PRESIDENT AND CEO’S INTRODUCTION

We are very pleased that, commencing in late 2017, we will be instituting a “member support program,” specifically aimed at identifying these at-risk members and developing tailored action plans to assist them in returning to a meaningful and safe medical practice.

“

“


7■ ■ ■ PRESIDENT AND CEO’S INTRODUCTION

Jean-Joseph Condé, MD

PresidentHartley S. Stern, MD, FRCSC, FACS

Executive Director and Chief Executive Officer

While the 2016 payment experience improved from prior years, the longer-term trends continue to indicate increases in compensation payments that are greater than those of inflation. We are concerned that an increasing portion of this compensation does not directly benefit the harmed patient but is diverted into transactional and other costs.

Throughout 2016, the Association expended considerable effort and resources to support a review of the civil justice system in Ontario as it relates to medical liability, as commissioned by the government of Ontario. We offered evidence-based recommendations to improve the fairness of processes and to reduce the unnecessary costs that are borne by both the patient and the CMPA – the latter of which result in higher fees for our members. We look forward to the government of Ontario’s release of the report, and to provincial governments across Canada taking meaningful steps to contain unnecessary system costs.

The next few years will be a crucial time for Canadian healthcare and for the profession of medicine. While there will be challenges and obstacles to progress, with strong physician leadership, the opportunities far outweigh the threats. As we have for over 115 years, the CMPA will be there to protect the professional interests of physicians and enable them to deliver safe and effective care. The confidence physicians can draw on from CMPA membership has never been more important and the Association’s elected council, management team, and experienced staff are focused on meeting our members’ current and future medical liability protection needs. We remain humbled by our members’ trust in us and are fully committed to retaining it through these challenging times.

■

The confidence physicians can draw on from CMPA membership has never been more important and the Association’s elected council, management team, and experienced staff are focused on meeting our members’ current and future medical liability protection needs.

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8

368active employees at the end of the calendar year

95,691Total number of members

Specialists

50% 13 %Trainees

General practitioners

37% 58%

42%

60 yearsand over

22% 41–59 years

42%40 yearsand under

36%

OUR MEMBERS

Overall membership has grown by 11% in the last 5 years, an increase of almost 10,000 members. In 2016, membership grew by 2.4%.

OUR PEOPLE 73

physicians and other healthcare professionals

OUR REGIONAL PRESENCE

ON QC BC/AB SMAT*

Members 38,412 19,583 24,867 12,829

Change in members since 2012 10.4% 9.4% 15.1% 7.3%

CPD events 102 60 79 60

CPD attendees 6,568 3,916 5,164 2,112

Physician to physician contact is an important part of our service model. Over 56,000 times a year, our physicians interact directly with members through a variety of channels to provide advice, counsel and support.

■ ■ ■

■ ■ ■ CMPA AT A GLANCE

According to our employee engagement survey, 82% of employees consider themselves to be engaged with the Association, exceeding industry benchmarks.

*SK, MB, Atlantic, and Territories

32%68%


9

-

3,000 6,000 9,000 12,000 15,000

70 140 210 280 350 420

-

3,000 6,000 9,000 12,000 15,000

70 140 210 280 350 420

BRITISH COLUMBIAAND ALBERTA

ONTARIO

QUÉBEC

SK, MB, ATLANTIC AND TERRITORIES

ADVICE MATTERS COLLEGE MATTERS HOSPITAL MATTERS LEGAL MATTERS OTHER

NEW CASES BY REGION, 20160 3000 6000 9000 12000 15000

NATIONAL MEDICAL-

LEGAL ACTIVITY

■

MEDICAL-LEGAL

ACTIVITIES BY REGION

■ ■ ■ CMPA AT A GLANCE

NEW CASES 2016 2015 2014 2013 2012Legal action 891 862 863 844 875

Advice to members 20,632 19,267 17,770 17,013 16,335

College (medical regulatory authority) matters 5,088 4,723 4,252 4,093 4,274

Hospital matters 1,743 1,611 1,486 1,382 1,337

Paying agency matters 218 198 256 259 241

Other 1,070 952 987 1,121 1,012

RESOLVED CASES 2016 2015 2014 2013 2012Legal actions 839 892 1,066 754 1,028

Judgment for plaintiff 9 4 26 19 10

Judgment for physician 45 55 85 51 62

Legal actions settled 290 350 377 281 442

Legal actions dismissed/discontinued/abandoned 495 483 578 403 514

-

3,000 6,000 9,000 12,000 15,000

70 140 210 280 350 420

DISMISSALS JUDGMENT FOR PLAINTIFF SETTLEMENTS

-

3,000 6,000 9,000 12,000 15,000

70 140 210 280 350 420

RESOLVED CASES BY REGION, 2016

BRITISH COLUMBIAAND ALBERTA

ONTARIO

QUÉBEC

SK, MB, ATLANTIC AND TERRITORIES

50 100 150 200 250 300 350 400 450

JUDGMENT FOR PHYSICIAN


10

Performance report


11

PRESSURES IN THE ENVIRONMENT

STRATEGIC OUTCOME #1

Assisting physiciansCanadian physicians care for their patients, confident the CMPA will effectively protect their medical liability interests.1

At the CMPA, we support physicians through a continuum of medical liability protection services that extend from education aimed at preventing harm in patient care, through to advice to guide members in responding to medical liability issues and, when required, legal assistance to resolve such matters. In the event a patient has been harmed by negligent medical care, the Association pays appropriate compensation on behalf of its members. Our protection enables physicians to practise with confidence, knowing that their interests and those of their patients are protected in the event of harm resulting from medical care.

Listening to our membersIn 2016, physicians continued to turn to us in increasing numbers for one-on-one support and assistance for medical-legal issues arising from their medical professional work. We are acutely aware of the increasing pressures on physicians from medical regulatory authorities (Colleges), hospitals, governments, and patients. Our 2016 survey of members indicated that a large percentage of Canadian physicians see the environment in which they practise as more threatening from a medical liability perspective. In 2016, we had more than 456,000 member interactions, an increase of 10% over 2015, confirming both the pressures being experienced by physicians and the value they place in assistance and support provided by the CMPA.

College/Regulatory

Health Authority

Hospital

Disruptive behaviour of colleagues/peers

Media

Patients

Ministry/Government

Tort Law/Policy

Rating websites

■ ■ ■


12

Supporting members —medical-legal mattersIn 2016, we opened just under 30,000 new medical-legal files, the majority of which involved providing advice to our physician members to help them navigate the more challenging environment in which they practise. This number grew by over 7% from 2015, including advice, civil legal actions, medical regulatory authority (College) matters, hospital matters, and other issues. With some year-over-year variance, the number of new civil legal actions commenced against physicians has remained relatively constant over the past decade. However, the number of members seeking assistance in College and hospital matters has continued to grow and the volume of newly opened College and hospital cases has almost doubled over the past ten years. These increases have been experienced in every region.

“We understand the pressures you are facing; we’ve been there. Increased regulatory attention, shifting employment situations, and privacy and eHealth concerns all combine and contribute to the increasingly challenging nature of the medical profession. My role is to respond in a timely manner with proven advice, knowledge, and suggestions to help guide you through the medical-legal issues you may be experiencing, and when required, place you in the hands of legal counsel to resolve such matters. Interacting one-on-one with fellow physicians is the most important part of my job.”

Peter O’Neill is a senior physician advisor, recently relocated from Kingston, Ontario, who continues to practise obstetrics on an occasional basis.

■ ■ ■

■ ■ ■ STRATEGIC OUTCOME #1 ASSISTING PHYSICIANS

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

10 year trend, National new casesNEW CASES, NATIONAL 2007-2016

21,000

18,000

15,000

12,000

9,000

6,000

3,000

0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

10 year trend, National new cases

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016


COLLEGE MATTERS HOSPITAL MATTERS LEGAL

0

3,000

6,000

9,000

12,000

15,000

18,000

21,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016


ADVICE MATTERS


13

Our physician advisors are skilled in assisting members in College, hospital, and advice matters and many such cases are handled without the use of legal services. In these cases, the physician advisors work with members to seek the best overall outcome – one that enables the physician to continue to practise in a meaningful and professionally satisfying manner. To meet this growing demand, we further increased our staff complement of physician advisors to ensure that our support to members is both timely and effective.

5,088 College matters opened in 2016

+86% since 2007

1,743 Hospital matters opened in 2016

+87% since 2007

891 Legal actions opened in 2016

-4% since 2007

■ ■ ■


20,632 Advice cases opened in 2016

+58% since 2007


14

WHAT MEMBERS

TOLD US “ “

of respondents were confident that the CMPA will protect their interests in the event that a patient was harmed.

Satisfaction levels across medical-legal services used* ranged from

…it gives me great comfort that I can practise good medicine with [the CMPA] team at my back…

94% TO87% 97%

2016 MEMBERSHIP

SURVEY RESULTS

View more survey results on the CMPA website

*Includes advice and support for College, civil-legal, hospital and others

Embedding mutuality at the core of our service modelOur service model is based on the concept of mutuality—we have a responsibility to our members and, in turn, members are responsible to their colleagues and the CMPA to practise in a manner consistent with the values of the medical profession. It is through this mutual commitment that we are an effective medical liability protection organization, one that provides real value to physicians and is an essential component of the healthcare system. While the concept of mutuality has always been at the core of our business model, we recognize that our members’ liability protection needs and expectations are changing and that we must continue to adapt to meet those needs. In 2016, we laid the foundations for programs and services that will provide members experiencing greater-than-average medical-legal difficulties with additional, customized support aimed at improving safety and reducing risk in their practice. These supportive programs and services will be rolled out in 2017.

■ ■ ■


Partners inMUTUALITYCMPA andYOU

Shared protection

Reciprocal responsibility

Collective benefits and risks

https://www.cmpa-acpm.ca/en/about/what-we-do/member-survey-results


15

SPOTLIGHT ON...

Support for physicians—Medical assistance in dying (MAID)The CMPA has a long track record of assisting physicians as they care for patients experiencing end-of-life issues. We know how difficult and emotional these situations can be. For many physicians, few issues are likely as difficult as medical assistance in dying (MAID). As lawmakers considered legislation, we were fully engaged to ensure physicians’ medical-legal interests were protected. This included providing written contributions and giving verbal presentations to the House of Commons Standing Committee on Justice and Human Rights and to the Senate Standing Committee on Legal and Constitutional Affairs; providing input to the federal health minister; and actively engaging the media to ensure physicians’ perspectives were known and understood. To support our members, we rapidly developed and delivered education programs, including a two-day comprehensive program co-ordinated with the Canadian Medical Association.

Since the passing of MAID legislation, members have turned to us for trustworthy advice and support to help them navigate the complexities of this issue. Our physician advisors are fully versed in this matter and ready to provide advice when the need arises. In 2016, our physician advisors and legal counsel provided over 300 members with general and case-specific medical-legal advice on MAID-related matters. In addition, our website articles on conscientious objection and guidance on the medical-legal impacts of the legislation were viewed more than 5,200 times.

We continue to advise members about MAID-related legislation and College guidelines and standards across all jurisdictions. We are also committed to continuing to work with stakeholders to ensure that physicians’ medical-legal interests are protected.

Since the passing of legislation rendering MAID legal everywhere in Canada, members have turned to us for trustworthy advice and support to help them navigate the complexities of this issue.

■



16STRATEGIC OUTCOME #2

Contributing to safe medical careIn support of a high-quality healthcare system, the CMPA contributes to safe medical care in Canada2

The CMPA is committed to contributing to safe medical care and we continue to look for opportunities to advance changes that support safe physician practices, improve quality of care, and reduce avoidable harm experienced by patients. Preventing harm saves lives and reduces medical liability protection costs. Contributing to safe medical care is one of our core values.

Sharing what we knowRecognizing that evidence-based knowledge represents an opportunity for the CMPA to support members throughout the continuum of their practice and across different practice settings, in 2016 we aligned our knowledge translation efforts into the following four streams:

■ ■ ■

CMPA GOOD

PRACTICES GUIDE (GPG)

We supported:

medical trainees by positively influencing the academic environment for medical training, planning a new resident symposia for roll-out in 2017, and updating our highly-regarded CMPA Good Practices Guide.

15Faculty

sessions

204 Medical

educators

OVER71,000visits to GPG

REACHING

2,300physicians in training

16 medical schools


17

physicians in practice by publishing a wide range of medical-legal risk articles in CMPA Perspective, and delivering highly sought after symposia events and regional conference tours. We constructively engaged with medical regulatory authorities, hospitals and others to advance educational approaches aimed at enhancing physician skills.

physicians in high-risk specialties by offering numerous online and

■ ■ ■

■ ■ ■ STRATEGIC OUTCOME #2 CONTRIBUTING TO SAFE MEDICAL CARE

in-person presentations, publishing articles in CMPA Perspective and other journals, authoring reports with others, and completing an institution-specific safety program at a community hospital.

physician leaders by working with over 130 physician leaders to enhance their abilities to deal with disruptive behaviour and to support a culture of civility in the workplace.

More than 1 millionsurgical proceduresare performedannually in Canada,

each with associated benefitsand risks. While healthcareproviders and organizationsstrive to provide safe care, surgi-cal patient safety incidents stilloccur.

A recent report from twonational organizations, theCanadian Medical ProtectiveAssociation (CMPA), which pro-vides medical liability protection

for most Canadian physicians,and the Healthcare InsuranceReciprocal of Canada (HIROC),the country’s leading provider ofliability insurance for healthcareorganizations and their employ-ees, offers insight into the factorscontributing to surgical safetyincidents and suggestions toimprove care.

Collaborating on surgicalsafety at the request of theNational Patient SafetyConsortium, representing agroup of key healthcare stake-

holders, the CMPA and HIROCconducted an in-depth retro-spective analysis of surgical safe-ty incident data. The collabora-tive report supports the CPSI’sSurgical Care Safety Action Planand provides an opportunity forshared learning from themedico-legal data.

On the release of this

research report, the organiza-tions affirmed that, “Patient safe-ty is a collective responsibility,achievable only through the col-laboration of governments,healthcare organizations, educa-tional institutions, individualproviders, and patients,” and that“the CMPA and HIROC are com-mitted to improving patient safe-

ty through continued sharing ofdata to identify and address pri-ority areas for system and prac-tice improvements.”

Learning frommedico-legal casesThe analysis of medico-legal filesidentified 1,583 CMPA cases and1,391 HIROC cases involving in-hospital surgical safety incidentsthat were resolved within thepast 10 years. A surgical safetyincident was defined as a patientsafety incident that occurredprior to, during, or after a surgi-cal procedure. Contributing fac-tors were categorized as resultingfrom system failures andprovider performance issues.Obstetrical cases were excludedfrom the analysis. Because theCMPA and HIROC use distinctcoding methods for capturingcontributing factors, the inter-pretation of cases may have dif-fered between the organizations.

Key findings fromthe analysisPeer expert reviews of the identi-fied cases found system andprovider issues in 53% of CMPA

I N T E R N A T I O N A L P E R S P E C T I V E

BY KIRSTEN DEVENNY AND JOANNA NOBLE

SURGICAL SAFETY INCANADA: A 10-YEARCOLLABORATIVE REVIEW

Kirsten Devenny, BSc, BScN, RN, is a Medical Analyst Researcher,Canadian Medical Protective Association (CMPA). Joanna Noble, BScN,RN, CRM, CPPS, is Knowledge Transfer Supervisor, Healthcare InsuranceReciprocal of Canada (HIROC).

I N S I D E M E D I C A L L I A B I L I T Y 49 T H I R D Q U A R T E R 2 0 1 6

The 2014 program

Canada’s National Patient Safety Consortium was created when the Canadian Patient SafetyInstitute (CPSI) brought together key healthcare stakeholders to discuss a national patient safetystrategy. The consortium identified surgical safety as one of four priorities to accelerate patientsafety improvement in Canada, and agreed on the need for improved learning from patient safetyincidents. They requested that the CMPA and HIROC collaborate in a retrospective analysis ofCanadian surgical safety data to fill in this important gap in knowledge. The resulting report,Surgical Safety in Canada: A 10-year review of CMPA and HIROC medico-legal data, was releasedin April 2016.

Canada’s National Patient Safety Consortium

IML 3Q BACK 2016 _Layout 1 8/12/16 9:44 AM Page 2

1. Medical marijuana: Considerations for Canadian doctors

2. A matter of records: Retention and transfer of clinical records

3. Improving patient handovers

4. Using electronic communications, protecting privacy

5. Can a child provide consent?

6. Emerging trends and medical-legal risks in medical tourism

7. Immigrant health issues: What physicians should know and do

8. The medical record: A legal document — Can it be corrected?

9. Preventing the misuse of opioids

10. Using email communication with your patients: legal risks

#CMPATopReads TOP 10

2016


18

Driving improvements in patient safety with analyticsEffective knowledge translation relies on credible data and sound analytics. In 2016, we further strengthened our analytical capabilities through the creation of a specialized team to enhance critical appraisal and evidence synthesis capabilities. In addition, we redesigned our contributing factors framework to more fully leverage our medical-legal data.

Team members responsible for this innovative new approach: Standing from left to right: Eileen Whyte, Renée Darling, Anna MacIntyre, Jun Ji, and Catherine Ogilby. Seated from left to right: Anne Steen, Cynthia Dunn, Robin VanderHoek and Kirsten Devenny.

■ ■ ■


Our Medical Care Analytics team uses innovative analytics approaches to transform medical-legal data into insights that support our education initiatives which assist physicians and contribute to safe medical care. In 2016, our medical coding approach was refreshed and a Contributing Factors Framework was created to enhance our ability to capture provider, team, and system factors that contribute to patient safety incidents. The new framework, which is aligned with patient safety theory and enables consistent interpretation and knowledge translation, was featured at the 2016 Institute for Healthcare Improvement National Forum on Quality Improvement in Health Care.


19

2016 MEMBERSHIP

SURVEY RESULTS

View more survey results on the CMPA website

of respondents read CMPA Perspective

of respondents felt it was extremely or very important for the CMPA to engage with members about the issue of disruptive behaviour.

of respondents read the monthly eBulletin

81%

of respondents like both products98%

69%

WHAT MEMBERS

TOLD US “ “… I have found their education events very informative, and to be some of the best CME [CPD] events I have ever attended.

■ ■ ■


62% of respondents participated in an in-person education session

have incorporated the teachings into their everyday practice

found the training to be helpful for their everyday practice

61%

81% 85%

https://www.cmpa-acpm.ca/en/about/what-we-do/member-survey-results


20

Responding to critical health system issues

Opioid-related published resources

▪ Opioids: We can do better

▪ Opioid prescribing for chronic non-cancer pain

▪ Safe use of opioid analgesics in the hospital setting

▪ Preventing the misuse of opioids

▪ The challenges of relieving chronic pain with opioids

The Canadian Medical Protective Association commits to:

▪ Analysis of medical-legal cases to improve patient care

▪ Opioid education sessions

▪ Risk management and advice articles

▪ Social media/awareness campaign

For more detailed information, please see the Joint Statement to Action to Address the Opioid Crisis

■


SPOTLIGHT ON...

The growing number of opioid-related overdoses and deaths is of national concern. We are committed to working with others to facilitate safe opioid prescribing and improve patient care, and to support our members as they provide care to patients addicted to opioids. In 2016, we published risk management articles, provided medical-legal advice and assistance to physicians, and used the forum provided by our 2016 Annual Meeting information session to heighten awareness of opioid prescribing issues. Our perspectives were also featured in over 40 national medical health news articles.

In November 2016, we participated with several other healthcare organizations in a national opioid summit organized by Health Canada and the Ontario Ministry of Health and Long-Term Care. Going forward, we will monitor and report on medical-legal issues in opioid prescribing, share our analyses with partners for use in educational efforts, and enhance our education and information outreach to members and stakeholders.

https://www.canada.ca/en/health-canada/services/substance-abuse/opioid-conference/joint-statement-action-address-opioid-crisis.html

https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-meeting/com_16_opioid_We_can_do_better-e.pdf

https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-meeting/com_16_opioids_chronic_non-cancer_pain-e.pdf

https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2016/safe-use-of-opioid-analgesics-in-the-hospital-setting

https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/preventing-the-misuse-of-opioids

https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2012/the-challenges-of-relieving-chronic-pain-with-narcotics


2121


STRATEGIC OUTCOME #3

Supporting the medical liability systemThe CMPA supports an effective and sustainable medical liability system that meets the needs of physicians and their patients.3

An effective and sustainable medical liability system enables physicians to focus on the delivery of safe care to their patients. The CMPA works with governments, medical regulatory authorities, and healthcare stakeholders to advance system-level improvements that ensure a sustainable healthcare system for all Canadians. We are also committed to delivering our services to members in a cost effective manner that reflects the trust members continue to show in us.

Advancing enhancements to the medical liability systemIn 2016, we advanced the CMPA’s perspectives on several important healthcare system issues, seeking fair processes for physicians in College, hospital and other matters. In this regard, we supported a comprehensive external review of the complaints process of the College of Physicians and Surgeons of Ontario, and have urged that many of its recommendations be adopted not just in Ontario but across the country. We argued for clarity in the legislation related to medical assistance in dying, and have been active in matters related to opioid addiction.

We recognize that the increasing cost of medical liability protection places additional strain on our members and, through reimbursement programs, on provincial and territorial governments. The CMPA has consistently spoken in favour of reasonable system reforms that would reduce the unnecessary costs in the medical liability system, reduce the time required for the resolution of medical-legal matters, and respect the rights of physicians and their patients. Our efforts are aimed at protecting our members’ ability to practise in a professionally rewarding environment in which their interests and those of their patients are protected.

SYSTEM ENGAGEMENTS

Governments 59

Provincial and territorial 53 medical associations/federations

Medical regulatory authority [College] 39

Safety organizations 20

Healthcare institutions 19

Others 17

TOP 5 ENGAGEMENT TOPICS

Medical aid in dying

Patient safety (opioids, and surgical safety)

Membership fees/ system costs

Medical regulatory authority [College] processes

Medical liability system

■ ■ ■


22

Supporting financial sustainabilityCompensation to patients (i.e. awards and settlements) paid on behalf of members represents the largest and most volatile component of our medical liability protection costs. While the 2016 median compensation to patients increased slightly from 2015 levels, the past 10 years show longer-term increases greater than the rate of inflation. This trend is similar across all four regions.

$172paid to patients in 2016

$23from 2015

$188 millionAverage annual compensation to patients over past 10 years

While the CMPA’s largest single expenditure item (i.e. compensation paid to patients on behalf of members) is generally outside our direct control, we are committed to ensuring those costs we can directly control (i.e. legal services, operations, etc.) are carefully managed. This is our commitment to members. Despite significant growth in the number of cases involving legal assistance, we have contained the increase in the costs of legal services to below that of membership growth, while maintaining the quality of member services. Through the effective use of technology and innovative process changes crafted by our employees, the per-member operating cost of the Association has remained relatively constant over the past five years.

■ ■ ■ STRATEGIC OUTCOME #3 SUPPORTING THE MEDICAL LIABILITY SYSTEM

■ ■ ■

MEDIAN COMPENSATION TO PATIENTS AND LEGAL EXPENSES PAID, CLOSED CASES (2016 $)

225,000

200,000

175,000

150,000

125,000

100,000

75,000

50,000

25,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

MEDIAN COMPENSATION TO PATIENTS AMOUNT

MEDIAN LEGAL COSTS

million

million

closed cases (2016 $)

0

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Median compensation to patients and legal expenses paid, closed cases (2016 $)

0

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Median compensation to patients and legal expenses paid, closed cases (2016 $)

0

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Median compensation to patients and legal expenses paid,

closed cases (2016 $)

0

25,000

50,000

75,000

100,000

125,000

150,000

175,000

200,000

225,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Median compensation to patients and legal expenses paid,


23

Members and reimbursing organizations alike value predictability in CMPA membership fees. Consequently, in 2016 the Association acquired insurance to transfer a portion of the volatility risk inherent in both the provision for unpaid claims and the estimated protection cost for a given occurrence year. This prudent approach to risk management should have long-term benefits and mitigate significant year-over-year variances. In 2016, these insurance policies led to a $42 million reduction in the provision for unpaid claims.

Prudent investment managementPhysicians and their patients can rest assured, confident in the knowledge that adequate funds are available to address their medical liability needs and, to that end, the CMPA maintains an investment portfolio of assets held against already incurred but unpaid claims. The expected returns on that portfolio also assist in reducing the required membership fee from what it would otherwise be, thereby supporting system sustainability. While the portfolio returned 3.37% in 2016, a strong investment return of 9.83% over the last four years contributed to the CMPA having returned to a fully funded position. The financial section of this report provides additional details.

The CMPA’s investment portfolio is a key component in supporting the CMPA’s long-term sustainability. The Association seeks to earn a reasonable rate of return on its assets while managing the variability of the investment return stream. The revenue generated is used to reduce the cost of membership fees. Our investments team is comprised of highly skilled, industry-recognized experts such as Serra Erdogmus, Senior Portfolio Manager, who manages the Association’s private assets. Serra was recognized by the global investment community who elected her to the Board of Directors of the Institutional Limited Partners Association (ILPA). In this role, she contributes to a global organization focused on advancing the interests of private equity investors, such as the CMPA, with member representation from 40 countries.

■ ■ ■



24

A fully funded positionThe concept of full funding at the CMPA entails that we hold one dollar of assets for every dollar of discounted liability. The majority of assets are held in our investment portfolio and the primary liability is our provision for outstanding claims. When the CMPA is fully funded, every dollar of that portfolio is required to meet those already incurred liabilities. With a view to ensuring member equity, we seek to maintain that fully funded position over the long term. After having been in a negative position for the preceding four years, in 2016 we returned to a fully funded position with a funding ratio (total assets to total liabilities) equaling 105%. The resulting positive position of $206 million is a $300 million improvement from 2015; the details of how this was achieved are provided in the financial section of this report.

$206 million

Net asset position

$300 million

Improvement in net assets

over 2015

■ ■ ■



25

We’re responsive, efficient, and effective

Our team of experienced physician advisors are our most valuable resource, and in 2016 we expanded their ability to assist members in College and hospital cases. This enhancement allows our physician advisors to handle more College and hospital cases internally, resulting in closer physician-to-physician contact and is just one example of improvements we are making to effectively and efficiently meet changing member needs.

When a service-provider equipment failure interrupted our telephone system in 2016, our response plan was put into effect. A multi-disciplinary team deployed to a fully-equipped offsite location where they seamlessly responded, in English and French, to both medical-legal and membership-related calls. Member services continued uninterrupted during the 3-hour disruption before normal services were restored, validating the Association’s well-rehearsed business continuity plan.

When we phased out cheques as a method for payment of membership fees, many members expressed interest in being able to pay directly through their banking institution, either as an online bill payment or by going to their bank branch. In 2016, we worked with banking institutions across Canada to facilitate these payment options, thereby providing members with more choice and greater convenience.

■


SPOTLIGHT ON...

Responding to evolving member needs, ensuring efficiency in our day-to-day processes, and providing effective service are just some of the ways we demonstrate our commitment to members.


26

Financial and risk report


27

Financial information

■ ■ ■

Report of the Audit CommitteeThe Canadian Medical Protective Association undertakes to manage the funds it holds in a prudent manner. The funds are held to meet incurred obligations arising from providing legal representation to members and appropriate compensation for patients proven to have been injured through negligent medical care.

The CMPA Audit Committee is responsible for reviewing the consolidated financial statements and the annual report, and for meeting with management and external auditors to discuss internal controls over the financial reporting process, auditing matters and financial reporting issues. Council, on the recommendation of the Audit Committee, approves the consolidated financial statements.

The Audit Committee is comprised of five members of council, plus two external financial experts, all of whom are independent of management. The committee meets quarterly to ensure its fiduciary duties are discharged in an appropriate manner consistent with good governance and sound operational procedures. The reports of the Audit Committee to council are a standing item on the quarterly agenda for council meetings.

In the coming years, the Audit Committee will continue to ensure potential financial risks to the Association have been identified and adequately assessed, and appropriate measures implemented to manage those risks.

On behalf of the committee, I am pleased to report the delivery of the 2016 consolidated financial statements as prepared by management and audited by the firm of KPMG LLP.

The external auditors have provided an unmodified opinion on the statements, attesting that they present fairly, in all material respects, the results of the 2016 operations, and the financial position of the CMPA as of December 31, 2016.

David Naysmith, BSc, DMD, MD, FRCSC, Chair


28

■ ■ ■

■ ■ ■ FINANCIAL AND RISK REPORT

AT A GLANCE

FINANCIAL PERFORMANCE

Funded ratio improved

from

98% TO

105%

Provision for outstanding claims

$6M

Insurance program initiated to mitigate volatility

Legal expenditures

1.7%

Compensation to patients

$23M

Net investment portfolio

$363M

$


29

1. CMPA membership includes occurrence-based protection, which means members’ protection extends from the date care was provided, irrespective of when the claim is made.

Our 2016 financial results overviewThe Association’s long-term financial objective is to hold at least one dollar of investment assets for each dollar of discounted liabilities. Given the nature of our occurrence-based protection,1 the Association carries a potential liability for medical-liability matters arising from its current and prior members’ medical professional work. This includes the work undertaken in the current membership year and the work from all preceding years. We hold $3,975 million in assets against the $3,579 million accumulated provision for outstanding claims, plus an additional $190 million in other liabilities.

The consolidated financial statements include the accounts of the Association and our wholly owned subsidiaries:

▪ Dow’s Lake Court Inc., which owns and manages the land and buildings occupied by the Association.

▪ CMPA Investment Corporation, which holds a number of investment assets.

■ ■ ■


https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-report/2016/2016_CMPA_Consolidated_Financial_Statements-e.pdf


30

Highlights of the CMPA’s financial statements with comparative figures for the previous four years are presented below.

See the consolidated financial statements for the year-ended December 31, 2016, along with the Independent Auditors’ Report and related notes.

Net investment portfolio Portfolio investments represent the value of assets managed by the Association to fund claims that have not yet been paid. Public assets are valued using the close price for each security at year end. Private assets are valued at their original cost, less any accumulated impairments or estimated reductions in value.

The performance objectives of the portfolio are to:

▪ provide sufficient returns to fund members’ protection by matching or exceeding the long-term actuarial return expectation used in fee setting of 5.5%; and,

▪ achieve positive value-added returns (over a passive benchmark return) after deducting management fees.

FINANCIAL HIGHLIGHTS

■ ■ ■


($ millions) 2016 2015 2014 2013 2012Statement of financial positionAssets

Investment portfolio $ 3,872 $ 3,507 $ 3,134 $ 2,872 $ 2,593Other assets 103 183 101 97 103

LiabilitiesProvision for outstanding claims 3,579 3,585 3,468 3,187 2,766

Other liabilities 190 199 127 128 161Net assets/(deficiency in net assets) 206 (94 ) (360 ) (346 ) (231 )

Statement of operations

RevenuesMembership revenue 566 656 404 346 197Net investment income 204 158 334 374 237

ExpensesCompensation to patients, legal and experts 347 365 405 375 418Insurance 68 - - - -(Decrease)/Increase in the provision for outstanding claims (6 ) 117 281 421 302Other expenses* 68 68 63 67 61

Excess of revenue over expenses (expenses over revenue) $ 293 $ 264 $ (11 ) $ (143 ) $ (347 )

* In 2014, the CMPA adopted the new accounting standards for reporting Employee Future Benefits. 2013 to 2016 reflect these accounting changes, whereas 2012 does not reflect these changes.

https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-report/2016/2016_CMPA_Consolidated_Financial_Statements-e.pdf


31

The Association has adopted investment policies, standards, and procedures to manage the amount of risk to which it is exposed. Our investment practices are designed to avoid undue risk of loss and impairment of assets and to provide a reasonable expectation of fair return given the nature of the investments. In our opinion, diversification provides the most significant measure to manage investment risk.

The portfolio produced positive returns during the year and the investment portfolio value of $3,872 million represents an overall increase of $365 million over the year-end 2015 position (see “Net Investment Income” on page 35 of this report for more information).

Private equities, debt, and real assets are carried at cost, less any impairments. Unrealized gains are not recorded in the financial statements. It is estimated that net unrealized gains in the value of the private investments totaled $190 million at December 31, 2016; this is not reflected in the net carrying value of the portfolio. Calculated on a fair value basis, the portfolio was estimated to be worth $4,062 million.

The various classes of assets are shown below.

NET INVESTMENT PORTFOLIO

■ ■ ■


CASH AND SHORT-TERM INVESTMENTS

FIXED INCOME

EQUITIES

HEDGE FUNDS

PRIVATE EQUITIES

PRIVATE DEBT

PRIVATE REAL ASSETS

PRIVATE ASSETS MEASURED AT FAIR VALUE

PUBLIC ASSETS MEASURED AT FAIR VALUE

CASH AND SHORT-TERM INVESTMENTS

17%

76%

7%

10%

4%3%

7% 18%

39%

19%


32

Provision for outstanding claims

The provision for outstanding claims is an actuarial estimate of the total resources required by the Association to provide protection to its members related to occurrences up to and including December 31, 2016. At December 31, 2016 the actuarial estimate for the provision for all accumulated outstanding claims was $3,579 million.

With the objective of reducing the volatility inherent in the compensation-to-patients component of the provision for outstanding claims, during 2016 the Association initiated an insurance program to address the compensation-to-patients component for occurrences prior to December 31, 2016, subject to policy limits.

The movement in the provision for outstanding claims represents the year-over-year change in the actuarial liability. The table below illustrates the change in the liability from the beginning of the year to the end of the year, broken down between the updated experience of prior occurrence years, the impact of adding the current occurrence year, and the volatility reduction due to the insurance contracts. The provision includes the estimated liability for future compensation to patients, legal and administrative expenses for both reported claims and expected claims that have not yet been reported. It is prepared annually by the Association’s chief actuary, subjected to peer review by external actuaries, and audited by the external auditor as part of the audit of the financial statements. The provision is valued on a discounted basis of 5.5% to reflect the long-term investment return expectations.

CHANGE IN PROVISION FOR OUTSTANDING CLAIMS

■ ■ ■


2016 2015 2014 2013 2012($ millions)

Provision for outstanding claims, beginning of year $ 3,585 $ 3,468 $ 3,187 $ 2,766 $ 2,463

Payments on claims relating to occurrences in prior years (331 ) (362 ) (403 ) (386 ) (437 )

Revaluation of the provision for outstanding claims relating to occurrences in prior years (174 ) 14 234 366 379

Change in provision for outstanding claims in respect of occurrences in current year 541 465 450 441 361

Volatility reduction due to insurance contracts (42 ) - - - -

Provision for outstanding claims, end of year 3,579 3,585 3,468 3,187 2,766

(Decrease)/Increase $ (6) $ 117 $ 281 $ 421 $ 303


33

Net assets Representing the difference between assets and estimated liabilities, net assets provide a point-in-time measure as to whether the Association is fully funded. The overall net asset position can be expected to change from one year to the next, in part as a result of the volatility in investment returns and/or claims experience. External factors such as financial market performance and trends in compensation to patients impact the net assets. As of December 31, 2016, the Association had a surplus in net assets of $206 million. The net asset position improved by $300 million over 2015, which is largely attributable to net fee debits charged in 2016, strong accounting investment returns, lower case-related disbursements, and a decrease in the provision for outstanding claims in 2016.

In 2006, the CMPA Council established an internal risk retention program to replace the former excess-of-loss insurance policies placed with third-party insurers for the years prior to 2007. With the adoption of a new insurance program in 2016, council wound up the risk retention fund. All amounts accrued under the fund were credited back to unrestricted net assets.

A ten-year view of the CMPA funded ratios (total assets/total liabilities) is shown below.

FUNDED POSITION

(500)

(300)

(100)

100

300

500

700

900

1100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

($ millions)

■ ■ ■


150%

140%

130%

120%

110%

100%

90%

80%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016


34

Membership revenuesRecognizing that the full value of the protection costs arising from a given year may not be known for 35 or more years, the CMPA seeks to collect, as fees, sufficient funds from members in that year to cover the anticipated incremental liabilities arising from care that has been delivered. Given the occurrence-based protection, fees collected in 2016 will fund the cost of medical liability protection arising from work performed in 2016 and will be paid over the coming decades. On an annual basis, emerging experience gains and losses1 are calculated in comparison to the actuarial predictions. The CMPA estimates the expected occurrence-year costs2 as a basis for membership fees. In the event the emerging experience is different from the predicted values, future fees may be adjusted (either increased or reduced) to address the difference. As a result of increases in both the estimated liabilities and forecast protection costs which eroded the CMPA’s financial position, the CMPA has previously had to increase its fees to both reflect these cost pressures and to address the negative asset position.

The following graph provides a five-year review of occurrence-year costs and membership revenues.

MEMBERSHIP REVENUE

0

100

200

300

400

500

600

700

2012 2013 2014 2015 2016

Expected occurrence year cost Membership revenue

($ millions)

■ ■ ■


1. Experience gains and losses refer to differences arising between estimates and actual experience.2. Expected occurrence-year costs are actuarially estimated costs for compensation to patients, and legal and

administrative expenses arising from adverse medical events in the year of occurrence.

2012 2013 2014 2015 2016

($ millions)

700

600

500

400

300

200

100

0

EXPECTED OCCURRENCE YEAR COSTS MEMBERSHIP REVENUE

0

100

200

300

400

500

600

700

2012 2013 2014 2015 2016


($ millions)

0

100

200

300

400

500

600

700

2012 2013 2014 2015 2016


($ millions)

The significant increase in membership revenue in 2015 was largely the result of the accounting treatment of a 2016 fee deferral agreement with the Ministry of Health and Long-Term Care in Ontario that required recognition of $92.9 million of 2016 membership revenues in 2015.


35

Net investment income

Net investment income is comprised of portfolio investment income, less investment expenses. The investment expenses represent monies spent, whether with external fund managers or internally within the CMPA, to generate investment income. In 2016, the portfolio generated revenue, before expenses, of $247 million, which was $41 million higher than that earned in 2015.

While the investment return on a fair value basis was lower in 2016 than 2015 (7.8% in 2015 and 3.4% in 2016), the investment income recognized in 2016 increased by $46 million. This is a direct result of gains realized on private assets whose fair market value would have occurred over the life of the asset and been reflected in previous years. However, accounting rules only allow recognition of this gain when the investments are sold.

Portfolio investment income is the combination of interest, dividends and securities lending income, unrealized and realized gains, and losses earned on securities and impairments or recoveries of impairments in the year.

PORTFOLIO INVESTMENT INCOME

17%

17%

62%

4%

Interest income

Dividend income

Net realized/unrealized gainsand impairment expense

Other

■ ■ ■


INTEREST INCOME

DIVIDEND INCOME

NET REALIZED/UNREALIZED GAINS AND IMPAIRMENT EXPENSE

OTHER


36

For internal measurement purposes, management reports private assets at estimated fair value. These fair values are a proxy of market value and are derived from the investment managers’ financial statements. Management assesses the valuations provided by the external managers to confirm reasonableness. At December 31, 2016, the fair value of the Association’s private assets was estimated to be $865 million, approximately $190 million above the carrying value.

The following table shows the annual returns calculated using the Modified Dietz Methodology,1 compared against the actuarial investment return assumption. It demonstrates the volatility associated with investment returns and the need to maintain a long-term perspective in considering both asset management and the Association’s financial position.

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

ANNUAL INVESTMENT RETURNS

■ ■ ■


20%

15%

10%

5%

0%

-5%

-10%

-15%

-20%

INVESTMENT RETURN

ACTUARIAL ASSUMPTION

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

1 The Modified Dietz Method is a calculation used to determine an approximation of the performance of an investment portfolio based on individual cash flows by the amount of time from when those cash flows occur until the end of the period.


37

TOTAL COMPENSATION TO PATIENTS BY REGION

Compensation to patients, legal, and experts

Compensation to patients on behalf of members, along with the cost of legal services, expert consultants and insurance, constitute the Association’s primary expenses, accounting for 87% of annual expenditures in 2016 (excluding the change in provision for outstanding claims).

The timing of individual compensation payments can be difficult to predict and this expenditure may fluctuate from year to year.

In 2016, at $172 million, payments to patients were $23 million less than in 2015. This decrease is attributable, in part, to a lower number of high-dollar-value cases being closed during the year.

When viewed on a regional basis, the most significant decrease occurred in Ontario, which accounts for 49% of total compensation to patients.

0

50

100

150

200

250

2012 2013 2014 2015 2016

$ Millions

■ ■ ■


($ millions)

250

200

150

100

50

02012 2013 2014 2015 2016


0

50

100

150

200

250

2012 2013 2014 2015 2016

$ Millions

BC/AB QUÉBECONTARIO SMAT* TOTAL



38

Legal fees and disbursements are broken down into two categories: legal costs related to civil actions and threats (i.e. those that might lead to compensation to patients), and all other matters, which include advice, College complaints, hospital matters, and other forms of medical legal assistance. Due in part to the Association’s efforts to improve how it provides assistance, and notwithstanding both higher case volumes and a growing membership, total legal fees have remained relatively constant from 2015 to 2016.

Excess of revenue over expensesIn 2016, the Association’s revenues exceeded expenses by $293 million. A number of factors contributed to this result, specifically a $46 million increase in investment revenues, and a $73 million decrease in expenses to support members.

Financial summaryThe CMPA’s net asset position stands at $206 million, an improvement of $300 million from 2015.

LEGAL EXPENSES

per member0

500

1,000

1,500

2,000

0

25

50

75

100

2012 2013 2014 2015 2016

$ Per Member$ millions

Legal-civil ac�ons

Legal-other ma�ers

Legal-civil ac�onsper member


■ ■ ■


($ millions)

100

75

50

25

0

LEGAL-CIVIL ACTIONS

2012 2013 2014 2015 2016

$ per member

2,000

1,500

1,000

500

0

per member0

500

1,000

1,500

2,000

0

25

50

75

100

2012 2013 2014 2015 2016

$ Per Member$ millions

Legal-civil ac�ons


Legal-civil ac�onsper member


LEGAL-OTHER MATTERS

LEGAL-CIVIL ACTIONS PER MEMBER

LEGAL-OTHER MATTERS PER MEMBER


39

Managing our risksAt the CMPA, we employ a risk management framework to identify, assess and respond to risks that could positively or negatively affect our ability to achieve our strategic objectives and to serve our members. This comprehensive analysis allows risk control efforts to focus on what is important, and ensures the Association’s decision-making capabilities are enhanced and the potential for surprises is reduced.

We develop appropriate mitigation strategies that address the full spectrum of risks, while the use of risk themes promotes an enterprise-wide approach to risk management. The main risk themes and risk control activities in 2016 are shown in the following table.

Risk theme Risk consideration Actions taken in 2016

Significance and relevance

The CMPA must remain relevant and important to its members and stakeholders by responding to their needs, while preserving the mission and values that underpin the CMPA’s commitment to its members.

Externally, the CMPA informed and guided transformational decisions on such issues as medical assistance in dying, opioid prescribing, and the modernization of the civil justice system. Internally, we modified roles and responsibilities, adopted new technologies, and streamlined processes to better serve our members.

Financial stability

Increase in demand for CMPA’s services, combined with rising compensation and legal costs, place pressure on the CMPA’s financial position.

To reduce the risk associated with future cost increases, the CMPA acquired an insurance program that transferred this risk and that will reduce the volatility associated with the provision for unpaid claims. We actively supported reasonable system changes aimed at reducing unnecessary costs.

Changing healthcare perspective

The healthcare environment is changing rapidly, and the CMPA must continue to evolve its services.

The CMPA engaged with governments, regulatory authorities (Colleges) and others to positively influence members’ practice environment. We developed a range of new programs and services for delivery in 2017 and, in partnership with other organizations, released influential safety-related reports.

■



40

CMPA leadership


41

Council 2016–2017 The CMPA is governed by an elected council of physicians from across Canada, practising in different specialties in the fields of medicine and surgery and of general practice. CMPA Council plays an important role in the overall success of the Association. It governs the Association and provides direction, guidance, and support to CMPA management in running the Association’s day-to-day business. The 2016-2017 governance structure consists of council and 11 committees.

AREA 1—BRITISH COLUMBIA, YUKONPaul A. Farnan, MB, BCh, CCFP, FCFP West Vancouver, BC

Barbara Kane, MD, FRCPC Prince George, BC

David Naysmith, BSc, DMD, MD, FRCSC Victoria, BC

W. Robbert Vroom, MD, CM, CCFP(EM) Vancouver, BC

AREA 2—ALBERTASusan M.J. Chafe, MD, LLB, FRCPC Edmonton, AB

Steven M. Edworthy, MD, FRCPC Calgary, AB

Fredrykka Rinaldi, MD, CCFP, AFCI, MBA, LLB, MPA Medicine Hat, AB

AREA 3—SASKATCHEWAN, NORTHWEST TERRITORIES, NUNAVUTSusan L. Hayton, MD, FRCSC, JD, LLM Saskatoon, SK

AREA 4—MANITOBADarcy E. Johnson, BSc, MD, CCFP, FCFP Winnipeg, MB

AREA 5—ONTARIOAlexander C. Barron, BSc, MD, MSc, MBA, FRCPC, DABP, FAAP Toronto, ON

Debra E. Boyce, BSc, MD, CCFP, FCFP (1st Vice-President) Peterborough, ON

Robert Cooper, LLB, JD, MD, CCFP, FCFP, FASAM, DABAM Toronto, ON

Gerard P. Craigen, LLB, JD, MD, FRCPC Toronto, ON

Gordon A. Crawford, MD, BSc, FRCSC Barrie, ON

Edward T. Crosby, MD, FRCPC Ottawa, ON

Elliot Halparin, MD, CCFP, FCFP Toronto, ON

Birinder Singh, MD, LLB, CCFP Toronto, ON

Michael E. Sullivan, MD, FRCPC Aurora, ON

M. Christopher Wallace, MD, MSc, FRCSC Kingston, ON

AREA 6—QUÉBECJean-Hugues Brossard, MD, CSPQ, FRCPC Montréal, QC

Jean-Joseph Condé, MD (President) Val-d’Or, QC

Dominique Dorion, MD, MSc, FRCSC, FACS Sherbrooke, QC

Michel Lafrenière, MD Québec, QC

Yolande Leduc, MD Longueuil, QC

Claude Mercier, MD, FRCSC Montréal, QC

Robert Sabbah, MD, FRCSC Montréal, QC

AREA 7—NEW BRUNSWICKJennifer A. Gillis-Doyle, MD, CCFP Fredericton, NB

AREA 8—NOVA SCOTIASally Jorgensen, MB, BS, CSPQ, FRCSC Bridgewater, NS

AREA 9—PRINCE EDWARD ISLANDPatrick C. Bergin, MD, FRCPC, FACP Charlottetown, PEI

AREA 10—NEWFOUNDLAND AND LABRADORMichael T. Cohen, MD (2nd Vice-President) Grand Falls-Windsor, NL

CMPA LEADERSHIP


42

Senior management 2016The senior management team is responsible for the strategic and organizational success of the Association. Our team of physician advisors offers professional and personalized frontline service to physicians, both online and in the community.

Hartley S. Stern, MD, FRCSC, FACS

Executive Director and Chief Executive Officer

E. Douglas Bell, MD, FRCSC

Associate executive director and Managing director, Office of the CEO

Stephen M. Bryan, OMM, CPA, CMA

Chief financial officer and Managing director, Enterprise Management

Patrick J. Ceresia, MD

Chief privacy officer and Managing director, eHealth

Gordon Wallace, MD, FRCPC

Managing director, Safe Medical Care

W. Todd Watkins, BSc(Hon), MD, CCFP, CCPE

Managing director, Physician Services

Lisa Calder, MD, MSc, FRCPC Director, Medical Care Analytics

Isabelle Des Chênes Director, Communications

Pamela Eisener-Parsche, MD, CCFP(COE), FCFP, CCPE Director, Physician Consulting Services

Cory Garbolinsky, CPA, CA Director, Finance

Tara Garcia, CPA, CA, CFA Project leader, Sustainability

Christine Holstead, BMath, MBA, CMC Director, Information Technology and Corporate Services

Lila Lee, BA Director, Human Resources

Guylaine Lefebvre, MD, FRCSC, FACOG Director, Practice Improvement

Lorraine LeGrand Westfall, MD, FRCSC, CSPQ Director, Regional Affairs

Lori Lennox, BSc (OT), MHA A/Director, Business Strategy and Analytics

André L’Espérance, FCIA, FCAS, FSA, MAAA Chief actuary

Josée Mondoux, CFA, FMA, FCSI, CAIA Director, Investments

Charmaine Roye, MDCM, FRCSC, CCPE Director, System Strategy and Engagement

James Watson Director, Membership and Contact Centre Services

■ ■ ■ CMPA LEADERSHIP


43

Physician advisors PHYSICIAN ADVISORS

Christine Bourbonnière, MD

Marie-Pierre Carpentier, MD

Shirley Lee, MHSc(Ed), MD, CCFP(EM), FCFP

Janet Nuth, MD, CCFP(EM)

Tino D. Piscione, MD, PhD, FRCPC

Ellen Tsai, MD, MHSc, FRCPC

PHYSICIAN CONSULTING SERVICESSENIOR PHYSICIAN ADVISORS

Dennis Desai, MD, FRCS, FACS

Louise Dion, MD, FRCSC

Dominique Racine, MD, CCFP, FCFP

Jeff H. Robertson, MD, FRCPC, FACC

R. Dale Taylor, MD, BSc, FRCSC

PHYSICIAN ADVISORS

Carolyn Atkinson, MD, CCFP

Liette M. Beauregard, MD, FRCPC, LLL

Heather Blois, MD

Micheline Boyer, MD, CCFP, FCFP

Meri Bukowskyj, MD, FRCPC

Christopher L.B. Canny, MD, FRCSC

Sharon Caughey, MD, FRCSC

Ann Cranney, MB BCh, MSc, FRCPC

Deborah Davis, MDCM, CSPQ, FRCPC

Caroline Ehrat, MD, CCFP, LMCC

Allan R. Forse, MSc, MD, FRCSC, FACS

Andrew D. Gilchrist, MD, CCFP, FRCPC

Merril Harmsen, MD

Geoffrey R. Hung, MD, FRCPC, FAAP

Julie Jenner, MD, CCFP

James Kissick, MD, CCFP, Dip. Sport Med

Sandra R. Lang, MD

Louise Lefort, MD, CCFP(EM), FCFP

Tom Lloyd, LLM, MB ChB, MD, MRCS, MFFLM

Suzanne MacMillan, MD, FRCPC

Yolanda Madarnas, MD, FRCPC

Dale P. McMahon, MD, FRCPC

Alain Millette, MD

Peter O’Neill, MD, FRCSC, FSOGC, MDIV

Cheryl Pollock, MD

Maria Rif, MD

Shena Riff, MD, CCFP(EM)

Robert N. Rivington, MD, FRCPC

Marc J. Roy, MD, CCFP, FCFP

Angela D. Sirnick, MD, FRCPC

René L. Soucy, MD, BSc, CCFP

Jocelyne Tessier, MD, FRCSC

Thomas Todd, MD, FRCSC

PHYSICIAN CASE FILE MANAGER

Brien G. Benoit, MD, MSc, FRCSC, FACS

PRACTICE IMPROVEMENT

SENIOR PROJECT ADVISOR Susan Swiggum, MD, FRCPC

SENIOR PHYSICIAN ADVISOR Steven J. Bellemare, MD, FRCPC

Professional advisorsGENERAL COUNSELGowling WLG

AUDITORS

KPMG, LLP

■ ■ ■ CMPA LEADERSHIP

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