A COA Member's Journey through Orthopaedics and the Manitoba Provincial Election, May 23, 2007

Douglas E. Kayler, M.D., FRCSC
Winnipeg, MB

I will pick up the tale of my journey into a brief run at provincial politics to the Spring of 2001. My colleagues had selected me to lead our provincial association, the Manitoba Orthopaedic Society (MOS) for the next two years. This was a period of ferment in Manitoba medical politics and restructuring, as the Winnipeg Regional Health Authority (WRHA) was beginning its consolidation of services process. This would involve new ground for MOS, and in preparation for our Fall activities, I arranged a meeting with my WRHA surgical programme director to plan how MOS might best work with WRHA on the problems facing orthopaedics.

The WRHA took this agenda, expanded it to include other large surgical specialties and in July, 2001, announced the designation of regional leaders for surgical specialties to lead their groups in a combined business, operational and human resource plan and to include the broad areas of practice change, and capital equipment. The COA submission to the Romanow Commission in 2002 covered this well for orthopaedics.

Dr. Douglas E. Kayler

The rest of my first year presiding over MOS was an ongoing experience of rejection of a full-order orthopaedic plan, so it was timely that at the Provincial President's dinner at the COA 2002 Annual Meeting, Dr. Don Dick of Alberta asked me how things were going in Manitoba. Don explained to me that in Edmonton, it was the orthopaedic surgeons, in response to demographic demands, who established an orthopaedic power bloc. It became a driving force in fairly rapid consolidation in the Capital Regional Health Authority (CRHA). The bloc was achieved when the competing subgroups in orthopaedics agreed to submit to overall rules regarding basic needs of orthopaedic surgeons anywhere. These are covered in COA policy and include OR time, on-call control, income, professional fulfilment, and quality of life.

Resulting from the Edmonton initiative, Alberta Bone and Joint Health Institute (ABJH), a province-wide umbrella, came into existence in June 2004. With Dr. Dick and Dr. Cy Frank in Calgary as Clinical and Academic Co-Chairs of ABJH, Alberta had shown that inter-city and town-grown rivalries can be overcome in a win-win arrangement for all. This provincial effort in orthopaedics was not lost on the Alberta business community, as Mr Bud McCaig made a ten million dollar donation to ABJH in March, 2005.

Don Dick's encouragement kept me going in my second year as President of the MOS, as my next two orthopaedic proposals were rejected by the surgeons, the WRHA, and the deputy minister. After my term as chair of MOS, I watched for a few years as Manitoba proceeded with a non-physician WRHA orthopaedic manager instead of the CRHA system of academic and clinical orthopaedic chiefs. Throughout this time, the divisions between university and community, and between varying subspecialties and general orthopaedics were deepening. I incorporated Manitoba Bone and Joint Health in September 2005, with goals similar to ABJH. Ironically, this was rejected as divisive, and further efforts to promote it resulted in the WRHA reporting me to the College of Physicians and Surgeons in February 2006. Although the College found no substance to the WRHA complaint, it was now clear that promoting a provincial system through orthopaedics was both futile and dangerous.

In a public system with public accountability, the political arena remains the final pathway to press for reform. With the ruling NDP cruising with a popular premier, and the opposition Tories avoiding specific health care reform policies, I joined Dr. Jon Gerrard and the Liberals, who are a distant third provincially. Dr. Gerrard was a respected physician and now career politician, and is a proponent of ABJH and MBJH. We campaigned for a provincial orthopaedic umbrella as part of Dr. Gerrard's overall prescription for progress. The campaign experience was personally rewarding. Though I was soundly defeated at the polls, Dr. Gerrard retained his seat and we opened the principles of the COA submission to Romanow to public consideration.

Why do we continue against opposition in Manitoba? The following examples are selected from the deficiencies that result in a health care system where the powerful leave the weak behind. The WRHA and CRHA are both large city health regions associated with smaller outlying regions. Each is large enough for most orthopaedic subspecialties, has one medical school, and about the same number of surgeons. Despite the Alberta oil advantage, Manitoba's economy and transfer payments add up to considerable health care spending. What does Manitoba lose for having competing university and community interests, and competing subspecialties, hospitals, clinics and smaller regional health authorities which are outside a provincial plan?

On-call in the CRHA varies between 1/6 and 1/8, and in WRHA between 1/3 and 1/17. While some surgeons over 60 are excused from call in CRHA, all the surgeons in WRHA doing approx 1/3 call are over 60, covering two hospitals. All CRHA surgeons have university appointment, but in WRHA there is chronic antipathy between university and community interests, and half the Manitoba surgeons and orthopaedic sites have no orthopaedic university or residency involvement. Basic OR time allotment in CRHA varies between 12 and 15 hours per week. WRHA allocations vary between 7 ^1/2 and 19. While "small pay for small bone" hampers access to foot and ankle, and hand surgery nationally, CRHA has maintained half a dozen fellowship surgeons doing this as the major part of practice, while Manitoba has none. There is no Manitoba "bone phone", and nothing corresponding to the ABJH-orchestrated visiting orthopaedic programmes to smaller provincial regions.

My participation in the election was to support those who want integrated provincial musculoskeletal health care systems. This report is an appeal to my home province to join in, or debate openly. It is also my opportunity to thank the COA for taking the lead in setting policies to meet the needs of all our patients, and provide professional fulfillment for all surgeons.