The body that provides malpractice insurance for doctors says it may not cover doctors who work with nurse practitioners.

The Canadian Medical Protective Association released a discussion paper that questions who is legally liable if a nurse practitioner makes a mistake and is successfully sued by a patient.

Doctors said the question of liability could endanger new collaborate health care models, the kind the Romanow Commission on health care is expected to encourage.

"It's a worrisome speed bump that needs to get leveled very quickly as we move forward to a better health care model," said Richard MacLachlan, head of the family medicine department at Dalhousie University in Halifax.

"It will certainly develop caution in people participating in these models. It will delay people in some cases signing on so I do hope CMPA provides clarity very soon," said MacLachlan.

The head of the CMPA said while the organization does not want to discourage collaborative health practices, they should be approached with caution.

John Gray said courts tends to hold the doctor responsible for medical malpractice, even if someone in their office is the one found guilty.

"Our concern is that the liability issues might get in the way of this being done successfully. If they're not addressed, I fear that despite a lot of good will and good intentions, these models will not be successful," said Gray.

Raising the fees for insurance is one option the CMPA is considering. But the organization could restrict or eliminate coverage for collaborative practices.

Or it could require doctors who work with nurse practitioners to get extra private insurance.

"What we want to do is ensure that our members' fees are used to cover only the liabilities of doctors and not of others," said Gray.

Gray said he hopes the Romanow Commission will require nurse practitioners to have adequate malpractice insurance before they join collaborative practices.