In a year that saw emergency departments overwhelmed across the country, access to primary care at crisis levels and more physicians reaching their breaking point, the CMA used its voice and influence to call for urgent change.
At the forefront of our advocacy was the need to increase both health care capacity and support for physicians, as we pushed governments to sign funding agreements with the provinces and territories to unlock historic levels of federal health funding and help strengthen the system for everyone within it.
Recognizing that funding alone will not solve the national health care crisis, we continued to push for ambitious, long-term reform in the delivery of care. And momentum is building. Driven by our Impact 2040 strategy, our commitment to build a better future of health is resulting in positive change.
Here are some of the milestones we’ve reached in collaboration with medical learners, physicians and our partners:
Impact 2040 implementation
In October, federal health ministers committed to improving the mobility of the health workforce, something the CMA has long recommended as one way to improve access to care. Health leaders also made a commitment to expedite credentialling for internationally trained health professionals.
We began ironing out solutions to the health workforce crisis with more than 40 national and provincial health organizations. And alongside the College of Family Physicians of Canada, we stressed the need to reimagine primary care to help stabilize the health system, reduce administrative demands on family physicians and improve patient outcomes.
After a record wildfire season in 2023, the CMA issued a call for a national secretariat to facilitate and coordinate climate-resilient and low-carbon health systems in Canada. In December, we joined colleagues from around the world at the first day dedicated to climate and health at the COP28 UN Climate Change Conference.
of Canadians agree that a long-term plan for the health workforce is needed to ensure Canadians can receive the right care at the right time, no matter where they live. – Ipsos/CMA survey, September 2023
With the goal of reducing physician burnout and increasing time for patient care, we’re advocating for changes to sick notes and federal and national forms, and getting ready to announce the recipients of the Health Care Unburdened Grant, a $10 million joint program of the CMA, MD Financial Management and Scotiabank to reduce the administrative burden facing physicians.
We launched the Digital Health Interoperability Task Force — with the goal of driving national interoperability forward in a way that’s realistic and practical for physicians at the front lines of care — in partnership with the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada and Canada Health Infoway.
As part of our journey of reconciliation, the CMA is committed to a public apology, on our behalf and as the national voice of physicians, for medical harms that have been done and that continue to be done, to First Nations, Inuit and Métis Peoples. The path to an apology in 2024 includes national conversations with Indigenous representatives, an apology statement and an action plan to ensure our ongoing commitment to improving Indigenous health.
“It’s been incredible this year to see concrete progress driven by physicians and our colleagues across the health sector. There’s more investment in care — but also a recognition that money alone isn’t enough to fix what’s broken. We need to rethink how the health system actually works day to day and work together across the country. Positive change is coming.”
– Dr. Kathleen Ross, CMA president
Relationship building and engagement
Through events, surveys, working groups and programs, we connected with nearly 20,000 physicians and medical learners in 2023. And we met with provincial/territorial medical associations, affiliate societies and other groups more than 125 times to collaborate on common issues, build relationships and share knowledge and expertise.
7,200 people registered to attend four sponsored town halls with The Globe and Mail on public and private health care, exploring the implications for access, equity, system capacity and quality. And we held additional sessions with physicians, medical learners and people with lived experience to capture even more perspectives.
700 physicians, medical learners, advocates and patients came together in Ottawa and online for the 2023 Health Summit, offering valuable insights and varied perspectives into challenges facing Canada’s health care system, from scaling team-based care to unlearning anti-Indigenous racism.
400 physicians, medical learners and policy-makers from across Canada held candid discussions on wellness challenges and explored how we can build a more vibrant profession at the Canadian Conference on Physician Health.
of Canadians say they trust physicians the most to provide them with credible information about their health and the health system. – Abacus/CMA survey, September 2023
In an era when misinformation seems to spread faster than the truth, we partnered with Abacus Data for our first Health and Media Annual Tracking Survey, a snapshot of how Canadians consume health news. We plan to track this relationship over time to help ensure that health information remains grounded in facts and is delivered through trusted sources.
Get involved, stay involved
The CMA continues to broaden how we engage with members and the medical profession more broadly, building on your feedback and interest to collaborate with us on shared priorities. Ongoing opportunities for you to get involved include:
- CMA events: Engage with bold thinkers and leaders on what health care can be, including at the International Conference on Physician Health this October.
- CMA Community: Connect with physicians and other health stakeholders in virtual discussion groups on the ideas and issues that matter most to you.
- CMA Ambassador Program: Medical learners and physicians in their first five years of practice can join the CMA Ambassador Program to make connections and build leadership skills.
- CMA leadership: Leadership positions on our board of directors and committees are important opportunities to help shape the future of the health system and the profession.
By the numbers
250
interviews with national media in 2023
120
meetings with federal, provincial and territorial public office holders in 2023
Top 100
The CMA landed on The Hill Times’ list of the top 100 lobbyists for a second consecutive year
76
speaking engagements across Canada in 2023
40,000
social media followers of the CMA presidents and francophone spokesperson
2 million+
impressions via the CMA Media Network, a group of physician social media influencers who are amplifying our calls to action online
16
First Nations, Inuit and Métis leaders, experts and knowledge-keepers are guiding our journey to reconciliation as members of our second Guiding Circle
15
participants in the CMA’s Patient Voice are sharing their perspectives to inform our work
16,625
The number of times that CMAJ articles and content were mentioned or covered in national and international media in 2023 – a 27% increase over 2022
17.4
CMAJ’s impact factor (the most important indicator of how widely its articles are cited in scientific literature) increased from 16.9 to 17.4 in 2023
2.8 million
unique users viewed content on cmaj.ca in 2023, with 7.5 million full-text article views
54,127
Number of CMA members (as of Dec. 31, 2023)
Practising financial diligence
The CMA manages its resources with the goal of successfully delivering on its Impact 2040 strategy while ensuring its long-term financial sustainability. Continual financial diligence, along with an ongoing commitment to prudent expense management, ensures that the CMA stays on track with its overarching objective of ensuring a better future of health for all.
The Audit and Finance Committee oversees the financial management of the CMA and reports to the CMA board quarterly. The 2024 operating budget, approved by the CMA board, reflects the 2024 workplan and priorities outlined in this report, including a continued and deliberate intent to maintaining the momentum of strategic achievements from 2023.
2023 financial results — A year to refocus and invest in priority strategic initiatives
Fiscally, 2023 was a year of change, with both financial and human resources being directed toward the advancement of our strategic priorities under Impact 2040. More than $30 million was spent in 2023 on various elements of the strategic plan, representing an increase of more than 20% from the previous year. A realignment of resources, coupled with key decisions to divest certain products and services, enabled a larger investment in successfully executing on our strategy.
The health of the CMA’s subsidiary – CMA Impact Inc.
CMA Impact Inc., the CMA’s wholly owned subsidiary, continues to be a key contributor to Impact 2040. The activities of CMA Impact Inc. include providing leadership courses and publishing CMAJ and other journals and publications that support the CMA’s strategic objectives. In addition, CMA Impact Inc. provides organizational capacity for the CMA through various operational and administrative functions including finance, facilities, legal services, technology and human resources.
The CMA’s activities are predominantly funded through the repayment of a demand promissory note, payable by CMA Impact Inc. The CMA Impact Inc. Board of Directors oversees the operations of CMA Impact Inc. The investment portfolio of CMA Impact Inc. increased by 12% in 2023 (compared with a 12% decrease in 2022).
The execution of a prudent and sophisticated investment management strategy by CMA Impact Inc., in accordance with the CMA’s responsible investing priorities, continues to ensure the long-term sustainability of the CMA. This approach also provides opportunities for us to engage with public companies that are invested in within the portfolio on issues such as climate action, Indigenous reconciliation, and population health and health equity.
Examples include engagement with:
8
pharmaceutical companies on emission reduction strategies and health system implications — part of our work on climate change
13
listed Canadian employers on their policies around sick notes, expressing the CMA’s view on their redundancy — part of our work on reducing administrative burden
5
companies under the theme of “Investing in the Indigenous Economy,” via our fund manager and through partnership with SHARE, a responsible investment organization — part of our apology process for harms to Indigenous Peoples in health care
3
real estate investment trusts operating long-term care homes on quality of care for older adults and staff working conditions — part of our work on aging with dignity
2023 financial statement audit results
The 2023 non-consolidated financial statements of the CMA have been prepared in accordance with Accounting Standards for Not-for-Profit Organizations, which sets out generally accepted accounting principles for not-for-profit organizations in Canada. As in prior years, the external auditor has issued an unqualified audit opinion. View the 2023 CMA non-consolidated audited financial statements.
The investment portfolio of CMA Impact Inc. adheres to a formal Responsible Investing Policy, integrating sustainability and environmental, social and governance (ESG) factors in all portfolio management and oversight decisions. With a stated goal of net-zero greenhouse gas emissions in our investment portfolio by 2050, we’re on track to reach our 2030 and 2040 interim reduction targets.
Enterprise giving and partnerships
Through giving and partnerships – including through the CMA Foundation* and our affinity relationship with MD Financial Management and Scotiabank** – we’re helping partner organizations drive change on shared priorities, including fostering health equity and building a more supportive medical culture.
Amount of funding committed and/or disbursed in 2023 through our affinity agreement, the CMA Foundation and the CMA
# of organizations funded with the aim of catalyzing transformative initiatives in health, the health system and health workforce
Some of the initiatives being supported
Health Care Unburdened Grant program – Funding to implement ideas to help physicians reclaim lost time and improve patient care
Physician Wellness+ – Supporting provincial and territorial medical associations and other physician organizations to enhance wellness initiatives
Indigenous Physicians Association of Canada and Indigenous Peoples Resilience Fund – Fostering mentorship opportunities in medicine and bolstering initiatives that advance community wellness
Réseau d’action pour la santé durable du Québec and The Lancet Commission on Sustainable Healthcare, in partnership with the University of British Columbia – Advancing net-zero by promoting sustainable health practices and exploring health care resource consumption and environmental emissions to help define more sustainable practices
Centre for Aging and Brain Health Innovation at Baycrest Health Sciences – Four clinical innovation projects funded within home care organizations to advance solutions that enable older adults to age with dignity in their homes or chosen community settings
*The CMA Foundation is a registered charity, designated as a private foundation, whose sole member is the Canadian Medical Association. Funding and organizational information are included as part of the CMA Group of Companies initiatives.
**Scotiabank, MD Financial Management and the CMA are firmly committed to supporting the medical profession and advancing health in Canada. As proof of this commitment, and in collaboration with the CMA and MD, Scotiabank is investing $115 million to support physicians and the communities they serve across Canada.
Annual General Meeting 2024
At the 2024 Annual General Meeting (AGM), members will have the opportunity to ask questions of CMA leadership and vote on bylaw changes and other corporate matters, including appointing the external auditor.
Appointment of external auditor: Every year, members vote to approve the appointment of the external auditor who’s responsible for examining the non-consolidated financial statements of the CMA, performing procedures to obtain audit evidence about the amounts and disclosures in the statements and preparing a report in accordance with generally accepted auditing standards. Members at the AGM will be asked to vote on a motion recommending that Ernst & Young LLP be appointed as external auditor until the next AGM.
Motion AGM-1: Appointment of auditors
The Canadian Medical Association hereby appoints Ernst & Young LLP as external auditors of the association, to hold office as auditors to the association until the next annual meeting of the association or until their successors are appointed.
Proposed bylaw changes: The CMA’s Act of Incorporation and Bylaws (last amended in August 2022) set out the objects of the association and governance parameters. At the AGM, we will propose several minor amendments in the following areas:
Strengthen and modernize the eligibility criteria for CMA board directors
Under the CMA bylaws, the current eligibility requirements for board director candidates are: (i) CMA membership (except the non-physician position); (ii) adherence to the Conflict of Interest Guidelines; and (iii) residence in Canada.
The proposed bylaw amendments seek to add eligibility requirements that board directors must also: (i) be at least 18 years of age; (ii) not have been declared incapable by any court; (iii) not have the status of an undischarged bankrupt; and (iv) not have been found guilty of an indictable criminal offence for which they have not been pardoned.
These requirements are best practice in Canada and explicit under laws that govern most corporations. While the CMA is governed by its own Act of Incorporation, we currently require directors and some committee candidates to undergo background checks (e.g., criminal record, credit). It is proposed to make these requirements explicit in the bylaws.
Affirm members’ autonomy in applying for leadership positions
In 2022, members approved bylaw amendments that enabled members to directly apply for leadership opportunities, and the CMA to select its own leadership rather than accepting nominees put forward by the provincial/territorial medical associations and affiliate organizations. The CMA continues to work closely with partner organizations to promote leadership positions.
The proposed bylaw amendments would clarify the existing practice that requires applicants to submit their application forms directly to the CMA. References to nominations by third party organizations or their members would also be removed (note: Resident Doctors of Canada no longer has individual members). Finally, the use of the term “nominee/nomination” throughout the bylaws would be updated to accurately distinguish between the different stages in the process of self-nomination:
- “applicants” (those who submit a form and apply for a position);
- “candidates” (those deemed eligible for consideration); and
- “nominees” (those selected by the Nominations Committee to be presented to delegates at the AGM for approval).
Clarify AGM notices in the digital age
The proposed bylaw amendment is to clarify existing practice that electronic notice of the AGM (i.e., an email to members and publication on the CMA website) fulfills the existing bylaw requirement that the time and place of the AGM must be announced to members “in an Association publication with distribution to all members.”
View a detailed rationale for each proposed bylaw amendment as outlined in the below motions AGM-2 to AGM-5, as well as marked-up versions of the relevant bylaw provisions. Proposed amendments to the bylaws become effective when adopted by a two-thirds majority vote of members present and voting at the AGM.
Motion AGM-2: Strengthen and modernize the eligibility criteria for CMA board directors
The bylaw amendments to strengthen and modernize the eligibility criteria for CMA board directors (under sections 12.2 and 11.5) included in Appendix B of the Canadian Medical Association 2024 Report to Members are hereby adopted as the Bylaws of the Association.
Motion AGM-3: Affirm members’ autonomy in applying for leadership positions
The bylaw amendments to affirm members’ autonomy in applying for leadership positions (under section 11.5 and chapter 12) included in Appendix B of the Canadian Medical Association 2024 Report to Members are hereby adopted as the Bylaws of the Association.
Motion AGM-4: Clarify AGM notices in the digital age
The bylaw amendments to clarify Annual General Meeting (AGM) notices in the digital age (under section 9.1) included in Appendix B of the Canadian Medical Association 2024 Report to Members are hereby adopted as the Bylaws of the Association.
Motion AGM-5: Editorial changes to ensure readability and flow
The bylaw amendments included in the 2024 Report to Members as Appendix B are confirmed as the Bylaws of the Association; and in order to finalize such Bylaws, the Board of Directors is hereby authorized to make such changes to the Bylaws as may be required to ensure consistency and coherence throughout.
Looking ahead: continued consultation on who’s entitled to vote for president-elect
The CMA is continuing to explore other governance themes, including who’s entitled to vote for CMA president-elect. Members provided feedback on this theme through a governance survey in May 2023, at an information session in July 2023 and through informal polling at the AGM in August 2023.
Members will have the opportunity to provide further input on this theme at the 2024 AGM and in the months that follow, as we consider bringing possible changes forward at the 2025 AGM.
If you’re interested in learning more and providing feedback on CMA governance, join the ongoing discussion on CMA Community. (Please note: you must be logged in with your cma.ca credentials to participate.)
Operating rules and procedures: Changes were made to the operating rules and procedures in the past year primarily to:
- remove the legacy conflict of interest exemption afforded to those directors who were in office when the provision was first introduced in 2018; there are no remaining directors affected (found in rule 12.4);
- affirm the existing practice of providing the Nominations Committee chair with the authority to grant accommodation requests to applicants where these are based upon prohibited grounds of discrimination (found in rule 12.2.4);
- clarify that sole candidates for the president-elect position must be verified by a conscious affirmation (i.e., a vote) by members in their province or territory to be presented to delegates at the AGM for approval (found in rule 14.1); and clarify that the elected nominee (or affirmed nominee, if a sole candidate) is the president-elect nominee submitted to delegates at the AGM (found in rule 14.2).
Corporate business proposals: Every year, the CMA welcomes member ideas and input on business- and governance-related matters. The CMA did not receive any corporate business proposals for consideration at the 2024 AGM. The deadline to submit a corporate business proposal for consideration at the 2025 AGM is Mar. 2, 2025.
Report from the Committee on Ethics: As per our bylaws, the CMA provides an annual update to members on the Committee on Ethics’ activities. Under the leadership of chair Dr. Barry Pakes, the committee has identified two focus areas for its work: artificial intelligence in medicine, including overlap with the CMA’s work on administrative burden; and public and private care and corresponding CMA policy updates. The committee is also involved in the CMA’s apology process for harms to Indigenous Peoples and is providing an ethics lens on other strategic priorities as needed.
Annual membership fee: As per our bylaws, the CMA provides an annual update to members on its membership fees. The CMA board has approved maintaining the membership fee for practising members at $195 (plus GST/HST) and waiving it for medical students, residents and retired physicians.
Nominations Committee report: update for delegates
As set out in the CMA bylaws, delegates are appointed by virtue of their position, or they are appointed/elected by their provincial/territorial medical association or affiliate society, or they may be invited by the CMA if they are from Quebec (which does not have a provincial medical association). Their role is to approve certain leadership positions at the CMA.
Every year, the CMA runs a comprehensive process to fill vacant positions on the board of directors and certain committees, as well as the roles of AGM chair/vice-chair and president-elect. The Nominations Committee collaborates closely with partner organizations to encourage candidates to come forward to secure strong and balanced leadership for the CMA.
To encourage participation from historically under-represented groups, a call for expressions of interest is issued to provincial/territorial medical associations, affiliates, associated societies and observer organizations. Candidates are asked to voluntarily self-identify across a range of skills and diversity attributes. The Nominations Committee considers each candidate’s lived experience, professional standing and development, and/or academic credentials and preparation against the role requirements. It also seeks nominations that reflect the diversity and demography of the physician population, specifically with a sensitivity to age, gender, sexual identity, ethnicity/race, Indigeneity, disability and regional balance.
The Nominations Committee will bring a slate of nominees to delegates for approval at the 2024 AGM. The Nominations Committee report includes bios for each nominee and information about the nominations and elections processes.
