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Isolationism and Advocacy
Alain Jodoin, M.D., FRCSC
President, Canadian Orthopaedic Association
In my first Bulletin message as President of the Canadian Orthopaedic Association (COA), I would like to bring your attention to some of the material I referred to in my President Elect Address, delivered at the Calgary Annual Meeting. I focused primarily on two different issues.
Isolationism
Isolationism is defined as the characteristic of a nation or a group to actively isolate itself from outside influences. As an association, we have always had a problem with achieving participation from orthopaedic surgeons across the country. It is especially true when we look at the province of Quebec. Only 50% of Quebecs orthopaedic surgeons are members of the COA, whereas the participation rate averages at 80% in other provinces.
Advocacy
As the Bone & Joint Decade is now under way, the COA advocacy role will become more and more important.
During this past year, under the leadership of Dr. Robert M. Hollinshead, the COA was involved in the Chaoulli/Zeliotis case at the Supreme Court of Canada (SCC). These two individuals have submitted that their Right to Life, Liberty and Security as guaranteed under section seven of the Charter of Rights and Freedom, is violated under the current health care system.
Isolationism
Isolationism is defined as the characteristic of a nation or a group to actively isolate itself from outside influences. As an association, we have always had a problem with achieving participation from orthopaedic surgeons across the country. It is especially true when we look at the province of Quebec. Only 50% of Quebecs orthopaedic surgeons are members of the COA, whereas the participation rate averages at 80% in other provinces.
I think that two main reasons for Quebecs lower participation can be identified as such:
1. More Quebec surgeons prefer to meet at Quebec Orthopaedic Association (QOA) meetings three to four times a year where there is a high rate of attendance from local orthopaedists. The QOA is also very active and influential in economic and political fronts and provides excellent CME opportunities.
2. The 2nd reason is a lack of effort displayed by the COA itself. Despite the fact that we are an officially bilingual organization, the Association does not make a tremendous amount of effort to communicate in French. Why not? The COA does not see it as a priority. It is felt as unnecessary, difficult and costly.
There are two consequences to this situation:
1. Quebec surgeons are not receiving equal value for their membership dues. The opportunities offered by the COA to its francophone members are not as comprehensive as they are for its English-speaking members.
2. Other Canadian orthopods are deprived of an original, innovative professional force.
Given the demographics in Canada, this is not going to change in the near future. However, next year with the help of a donation from Dr. Hans Uhthoff, one of our Past Presidents, we will organize an Instructional Course Lecture (ICL) in French at our Annual Meeting.
That being said, we still need to do more. Here are two other ideas that I would like to explore during my mandate: 1) bilingual committee minutes as they used to be issued until six or seven years ago, and 2) exchange of fellows and residents between French and English training programmes.
Advocacy
As the Bone & Joint Decade is now under way, the COA advocacy role will become more and more important.
During this past year, under the leadership of Dr. Robert M. Hollinshead, the COA was involved in the Chaoulli/Zeliotis case at the Supreme Court of Canada (SCC). These two individuals have submitted that their Right to Life, Liberty and Security as guaranteed under section seven of the Charter of Rights and Freedom, is violated under the current health care system.
Through a joint effort, the Canadian Medical Association (CMA) and the COA have obtained Intervener status and have testified to the serious delays our patients face in order to have access to surgical care particularly, to orthopaedic care. The CMA and COA advocated timely access. The judgment is expected next fall. It is much too soon to appreciate the impact of this initiative, but there is no doubt that this will significantly increase public visibility while gaining the COA the reputation as a committed organization.
In the recent past, several reports on the status of orthopaedic services have been issued and I would like to highlight a few items.
In September 2003, the Journal of Bone and Joint Surgery (JBJS) published a paper from Shipton, Badley and Mahomed entitled, Critical Shortage of Orthopaedic Services in Ontario. It illustrates some significant points. For example, the mean age of an active orthopaedic surgeon was 49 years a four-year increase since 1997. The clinical hours spent annually represent only two full-time-equivalent (FTE) orthopaedic surgeons per 100,000 population. This data suggests 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.
The last edition of Waiting Your Turn from the Fraser Institute demonstrates that, in general, the median wait by province averages 18 weeks from referral to treatment. However, orthopaedics maintains the longest median wait by specialty, which is over 32 weeks from referral to the actual treatment. This situation is now much worse than it was 10 years ago when the median wait was only 19.5 weeks.
At our last Board meeting in Calgary, our National Standard Committee, ably chaired by Drs. Hans Kreder and Ted Rumble, has submitted a major report on manpower and resources issues. Data from the Canadian Institute of Health Information indicate that we were 1126 active orthopaedic surgeons practicing in Canada in 2002. Fifty-four new orthopaedic surgeons are added each year through immigration and graduates from our programmes. However, there is also an average loss of 28 surgeons to the United States and 35 retirees each year. The net loss thus averages nine 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 immediately.
There would be no benefit from increasing the number of practicing orthopaedic surgeons in Canada if the necessary patient care resources are not provided. We also need an increase in the productivity of orthopaedic surgeons. More OR time is necessary to meet the current needs of the Canadian population.
In my opinion, the examples I have chosen illustrate the mission of the COA.
o We can and should influence policies in health care and its delivery in Canada.
o We must strive to be, in reality, representative of Canadian orthopaedics.
o We can do this by strengthening our partnerships with the provincial and regional associations and with the subspecialty societies.
The Association should continue to work year after year on these central issues and I certainly look forward to doing so during my term as your President.
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