Dr. Alain Jodoin discusses the goals and objectives he hopes to fulfill during his mandate as President of the Association.

• Thank you very much Bob for your kind remarks. I hope that your expectations will be realized. Being introduced here in Calgary is very exciting especially this year. I hope to be as good (or better) than the Flames have been!
  
  
• Distinguished presidents of the International and provincial Orthopaedic Associations, members of the Board and the executive, dear members, ladies and gentlemen.
  
  
• It is indeed a privilege to be president of this association. We have a long history of extremely capable officers. I am excited and enthusiastic in representing the association in this very challenging year.
  
  
• Before I start, I have a few "Thank You's"
  
  • COA past presidents who have helped me to prepare for this during my many years at the executive and particularly Chick Duhaime, Cec Rorabeck and Bill Rennie
    
    
  • I'd like also to mention some of the mentors that helped me especially at the beginning of my career: Dr Carroll Laurin, John Hall, John Fowles
    
    
  • Mes associés actuels et passés de l'Hôpital Sacré-Coeur de Montréal qui m'ont patiemment supporté et avec qui j'ai fait équipe et développé un service dont nous sommes très fiers.
    
    
  • Les professeurs du POES de l'U de M toujours enthousiastes pour l'enseignement et la recherche et qui m'ont confié les rennes du programme depuis presque 7 ans. Nous avons maintenant plus que jamais l'opportunité d'offrir à nos jeunes recrues une formation clinique et en recherche de la plus haute qualité.
    
    
  • Members of the COA staff:
    
    • Doug Thomson, Yuri Kojima and Cynthia Vezina
      
      
  • Ma famille ,
    
    • Xavier, Benoit et Thomas
      Ginette, mon épouse depuis 30 ans qui m'a permis de me réaliser pleinement tant sur le plan personnel, familial (sauf pour une fille) que professionnel
      
      

ISOLATIONISM

• Today I will talk about two different issues.
  
  
• The 1^st one is entitled Isolationism which is defined as the characteristic of a nation or a group to actively isolate itself from outside influences.
  
  
• As an association we always had a problem with participation of Orthopaedic surgeons across the country. It is especially true when we look at Quebec where we only have 50% of participation whereas the participation rate averages 80% in other provinces.
  
  
• As the 5th COA president from Quebec in the past 20 years, I would like to address this issue in my term.
  
  
• I think that 2 main reasons for lower participation from Quebec can be identified.
  
  1. "Regionalism"
  • More Quebec surgeons particularly those outside the academic milieu of U of M and McGill prefer by and large to meet at QOA meetings 3 to 4 times a year where this is a high rate of participation
    
  • The QOA is also very active and influential on economic and political fronts and provides excellent CME opportunities
  2. The 2^nd reason is a lack of effort of the COA itself. Despite the fact that we are officially bilingual, COA does not make a lot of effort to improve the problem of language. Why? Well…
  • COA does not see it as a priority
    
  • It is felt as unnecessary, difficult and costly
    
    
  • There are 2 consequences to this situation
    

1. Quebec surgeons are not receiving equal value for their membership dues since the services offered by the COA to its francophone members are not as comprehensive as it is for its English-speaking members.
   
2. Other Canadian orthopods are deprived of an original innovative professional force. There is a significant body of research done in Montreal, Quebec City and Sherbrooke but the researchers are not equally inclined to expose their work at the COA meetings.
   
   
• Unfortunately, given the demographics in Canada, this is not going to change in the near future. However a small change will occur next year to improve this situation
  
  
• Dr Hans Uhthoff, one of our past presidents, has made a generous donation in order to set up a new session in French at our AGM. I want to salute this initiative and we are going to implement this session at our next meeting in Montreal.
  
  
• But we need to do more. Here are 2 other ideas that I would like to explore during my mandate:
  
  
  • Bilingual committee minutes as they were until 6 or 7 years ago
    
  • Exchange of fellows and residents between French and English Programs
    
    
• I believe it is one of my roles to work on this aspect during my mandate at the COA presidency
  
  
• Je crois que nous devons combattre l'isolationnisme. Nous avons déjà transformé la structure de notre conseil d'administration de façon à obtenir une représentation de toutes les régions du pays. Nous devons maintenant travailler à créer une association plus bilingue. Ceci devrait favoriser de meilleurs échanges entre nos membres et l'ACO pourrait alors devenir vraiment plus représentative de tous les orthopédistes du Canada.
  
  

ADVOCACY

• As the Bone and Joint Decade is now under way, the COA advocacy role will become more and more important.
  
  
• During this past year, under the leadership of Bob Hollinshead, the COA was involved in the Chaoulli / Zeliotis case at the SCC
  
  
  • These 2 people have succeeded in having the SC hear their case. They argue that the Right to Life, Liberty and Security as guaranteed under section 7 of the Charter of Rights and Freedom is violated under the current Health care system.
    
  • Through a joint effort, the CMA and COA have obtained Intervenor status
    
  • An important Factum have been prepared and submitted to the SC on June 8 in Ottawa
    
  • Through a well done paper, we testified of the serious delays our patients faced in order to have access to surgical care and to orthopaedic care in particular
    
  • Timely access to care was advocated by the CMA and COA (as explained yesterday by Senator Kirby)
    
  • Although it is much too soon to appreciate the impact of this initiative, there is no doubt that this will significantly increase COA public visibility and also the COA reputation as a committed organization.
    
    
    
• In the recent past, there have been several reports on the status of Orthopaedic services and I would like to highlight few items
  
  
• In September 2003, the JBJS published this paper from Shipton, Badley and Mahomed: Critical Shortage of Orthopaedic Services in Ontario. It shows some critical points such as
  
  
  • The mean age of the active orthopaedic surgeons was 49 years, an increase of 4 years since 1997
    
    
  • The clinical hours spent annually represent only 2 full time equivalent Orthopaedic surgeons per 100,000 population
    
    
  • These data of course, suggest that there is a shortage of orthopaedic services in Ontario which will be exacerbated by the aging of a profession already working near full capacity.
    
    
  • Although this was written from an Ontario perspective, we can certainly agree that this situation is the same if not worse throughout all the country.
    
    
    
• Secondly I'd like to remind you of some of the data from last edition of "Waiting your turn" from the Fraser institute
  
  
  • This is global picture: Median wait by province An average of 18 weeks from referral to treatment
    
    
  • Now if we look at the median wait by specialty, we see that the longest wait for patients to specialized care is for Orthopaedics. Over 32 weeks from referral to orthopaedist to the actual treatment. And this has been the case year after year…
    
    
  • Si vous croyez que la situation s'améliore, regardez ce graphique. Lorsque que les chiffres de 2003 sont comparés à ceux de 1993, il y a 10 ans, on voit que la situation s'est détériorée dans toutes les provinces canadiennes. L'attente moyenne de la référence au traitement était de 19,5 semaines en 1993 alors qu'elle est maintenant de 32 semaines..
    
    
  • One interesting number from the same study showed that 1.5% of the patients are receiving Orthopaedic care outside the country.
    
    
    
• Yesterday, at the COA Board meeting, our National Standard Committee, chaired by Hans Kreder and Ted Rumble, has submitted a major report on manpower and resources issues
  
  
  • A Press release has been made of these data and I'd like to highlight some of them.
    
    
    • Data from CIHI indicate that we were 1126 active orthopaedic surgeons in Canada in 2002
      
    • There are 54 new Orthopaedic surgeons each year graduating from our programs and from immigration.
      
    • However, there is an average loss of 28 surgeons per year to US and 35 more retire each year.
      
    • The net loss then averages 9 orthopaedic surgeons per year.
      
    • The committee considered that Canada should have at least 4.5 FTE orthopaedic surgeons per 100,000 population. This is up from the current 3.1 and still considerably less than the U.S. recommendation of 5.6 per 100,000 population.
      
    • To achieve this, we would need 400 new orthopaedic surgeons right away!
      
    • But there will be no benefit to increase the number of practicing Orthopaedic surgeons in Canada without providing the necessary resources to provide patient care. We need also an increase in the productivity of orthopaedic surgeons i.e. more OR time only to meet the current needs of the Canadian population.
      
      
    • Le comité des Normes nationales est aussi en train d'évaluer les besoins moyens en services orthopédiques pour la population. Cette information va mener ensuite à l'élaboration de recommandations précises pour le nombre de salles d'opération et de cliniques, ainsi que le nombre d'orthopédistes requis pour fournir tous ces services.
      
      
  • The recommendations of this report should be implemented quickly and this will be on the Executive and Board agenda this year.
    
    
• Three weeks ago, La Presse newspaper in Montreal published a substantial article from a group of highly competent experts (none of whom were doctors). This group has made a very severe diagnosis of our system in Quebec which I think applies to any province.
  
  
  • The principles of the system are still very profoundly desirable and characteristic of our identity as Canadians. However health care cost increase at least 5% per year (sometimes up to 7%) but the resources of the governments increase less than 4% per year. If nothing changes, in 2050, health care would represent 66% of the province budget!!
    
    
  • Clearly the current health care system is not viable in the long run.
    
    
  • Any reform or in-depth discussion is virtually impossible because of the political, corporate and union interests.
    
    
  • This group of experts offered many interesting possible solutions to increase the funding and the productivity.
    
    
  • However citizens, union leaders and politicians must be willing to discuss and consider a paradigm shift!
    
    
• I have chosen these examples because, in my opinion, they illustrate the mission of the COA
  
  • We can and should influence policies in Health care and its delivery in Canada.
    
  • We must strive to be really representative of Canadian Orthopaedics.
    
  • We can do this by strengthening our partnerships with the provincial / regional associations and with the subspecialty societies
    
    
• En terminant, j'aimerais une fois de plus remercier l'Association canadienne d'orthopédie de m'offrir cette opportunité extraordinaire. Je réalise pleinement à quel point je suis favorisé d'avoir ce privilège. Ginette et moi sommes déterminés à faire tout ce qui sera en notre pouvoir afin de représenter l'ACO, ici comme à l'étranger, de la manière la plus adéquate possible.
  
  
• Finally I'd like to invite you to Montreal in June 2005. Please visit our table in the lobby. We hope to see the largest number of members for our next annual Meeting.
  
  Thank you -- Merci