Have a Joyous Holiday Season

Brendan D. Lewis, M.D, FRCSC
President, Canadian Orthopaedic Association

The past six months have been a memorable experience for Dolores and I in many ways.

The COA continues to move forward in promoting our vision of Achieving Excellence in Orthopaedic Care for Canadians.

Dr. Brendan & Dolores Lewis

In 2001 the COA developed a strategic plan following a review of concerns from our members. This was facilitated by Dr. Cyril B. Frank on January 19, 2001.This was a tipping point in the progress of our organization. Our members told us that the COA lacked relevance for orthopaedic surgeons and was inadequately representing them. It was also noted that the COA was not equipped to lobby the government on behalf of surgeons and their patients.

The goals we wanted to develop included providing Canada with outstanding and committed surgeons and ensure that adequate and accessible resources are available for Canadians when needed. The proposed four new objectives to assist the Association in fulfilling its vision and achieving its goals included - 1) Advance professional fulfillment; 2) Promote and provide education; 3) Communicate and Inform; and 4) Advocate for national standards.

The COA recognized the need for change. Restructuring our committees was the first step. Tremendous developments have since occurred. April 2001 saw the "Canada in Motion"- mobilizing access to orthopaedic care campaign initiated. This assisted with government lobbying and raising the profile of orthopaedics. It was designed to help improve patient access to care, address the manpower shortage and enhance the quality of orthopaedic care. This programme was helpful for us in becoming part of the Wait Time Alliance with the Canadian Medical Association. The First Ministers acknowledged the importance of "timely access to care" in their 10-Year Plan to Strengthen Health Care and a commitment to develop benchmarks for medically acceptable wait times in five priority areas: 1) cancer, 2) cardiac care, 3) diagnostic imaging, 4) joint replacement and 5) sight restoration - by December 31, 2005 as part of an effort to achieve "meaningful reductions" in wait times by March 31, 2007. This was further reinforced by the Supreme Court of Canada's decision in the Chaoulli/Zeliotis case on June 9; 2005.

The work of the National Standards Committee (NSC) has been published in two reports that have been extremely effective in outlining issues related to wait time policies. The National Workforce and Services Report (June 2004) evaluated the current and future orthopaedic human resources requirements in Canada. The Report on Benchmarks for Wait Times (March 2005) determined the maximum acceptable wait times.

The NSC is currently developing a model of physician extenders with establishing physician assistants to assist orthopaedic surgeons with patient care. The NSC has held two meetings with the CMA related to this topic. We have their support on this endeavour with view to considering a pilot study. The NSC provides information on "Best Practices".

I would encourage all members to read "The Final Report of the Federal Advisor on Wait Times". The author, Dr. Brian Postl, highlights that the wait times are a multi-faceted problem that will require all stakeholders working together to find a solution. He points out that if the subject of wait times is dealt with in isolation, there will be little progress. He highlights that the weakness in the 2004 First Minister's accord was that the government focussed only on the five priority areas (mentioned earlier in this article). The fear and danger is that the five conditions that figured prominently in the First Minister's meeting agreements will starve all the others for attention, resources and technology leaving other diseases, the so called "Cinderella diseases", behind. As has been diligently outlined by our NSC, wait time benchmarks have been developed for many orthopaedic conditions which are critical to the development of wait time guarantees.

Communication issues have been addressed with continued support from the Bulletin and our capable editors Drs. Emil Schemitsch and John Antoniou along with Production Assistant, Cynthia Vezina. Excellent contributions by our colleagues provide concise and current information about a variety of topics. The Bulletin is noted to be well read by many of our members. Our COA Dispatch (monthly e-mail and fax communiqué) continues to outline up to the moment information on a timely basis. Our web site is up and running and continues to receive an increasing number of visits per day. This is providing information that is used regularly by our members. It also includes the on-line live surgery feeds that are viewed almost daily.

Our Annual Meeting attendance has improved with 225 active surgeons attending in 2001 to 362 attending in 2006. We have changed the format of the meeting as requested by the membership. We also recognize the difficulty for our younger surgeons with young families to attend the meeting in early June. The dates for the next two meetings are already set, however the 2009 meeting in Whistler, BC is scheduled for early July. The meeting that was held in July 1999 in St. John's was well attended and received a lot of positive feedback on the timing of the event.

As we continue to build on the Strategic Plan of 2001, we feel the time has come to develop a plan for the next five years. This will be developed through the Board of Directors. We would ask our members to forward along any suggestions for consideration.

In the past few months I have attended a number of national and international meetings as your President. In the international arena, Canadian orthopaedics is highly regarded among our colleagues. While in South Africa, I was able to visit both the public and private hospitals with an anesthetist friend who worked in Corner Brook in the past. There was a significant difference observed from the physical plant to the type of equipment used between the two modes of health care delivery. There are 45 million people in South Africa with about 450 orthopaedic surgeons to provide their care.

Dr. Robert Salter and his Fellow presented a paper at the British Orthopaedic Association meeting: "44 Year Outcome of Open Reduction and Innominate Osteotomy for Late Developmental Hip Dislocation". This paper drew a lot of attention and discussion recognizing Dr. Salter's' tremendous contributions.

The combined Australian and New Zealand meeting had excellent Canadian representation on the speaker's podium.

Dr. Bill Cole spoke at one of the plenary sessions. His paper "Osteoporosis - A Disease of Childhood" was well received raising further awareness of this chronic disease.

Dr Emil Schemitsch presented a number of papers related to trauma and his ongoing research. Dr. Tim Daniels provided his experience on a number of foot and ankle topics, problems and their management.

The provincial association meetings in Manitoba and Ontario included programmes with many diverse topics that met the needs of many aspects of orthopaedics. The Winnipeg group was well equipped to provide two live surgeries. These were very well executed.

The COA is concerned about the working conditions in Quebec as a result of Bill 37 (see Bulletin #74 Aug/Sept 06 pg. 14). Stiff penalties are imposed on doctors who take any stand on the issue. This is a significant burden on our orthopaedic colleagues and unacceptable in a democratic society. It calls into question the integrity of this government and will likely affect the recruitment of new physicians in Quebec.

The COA continues to maintain our profile with the CMA. I attended the CMA meeting in Charlottetown in Prince Edward Island where Dr. Brian Day was elected as President-Elect of the Association. We congratulate him. He is a strong supporter of the COA. We continue to attend the Canadian National Medical Organizations Meeting, a committee of the CMA where we and 44 other medical organizations are members.

Partnering with Osteoporosis Canada, we recently met with the Honourable Stephen Fletcher, Parliamentary Assistant to the Minister of Health. We felt we were successful in raising awareness about osteoporosis and the significant health concern it continues to be. We are promoting Dr. Earl Bogoch's model that primarily requires full time coordinators as part of the health care team approach to patient care.

The Canadian Association of Physician Assistants recently hosted their fifth annual meeting. The COA was invited and presented on the role of the PA in orthopaedic practice.

The planning for the COA meeting in Halifax June 1-3 is well underway. Drs. Bill Stanish and Joe Hyndman are co-chairs of the Local Arrangements Committee while Drs. Ross Leighton and Mike Dunbar are co-chairing the Programme Committee. This will prove to be a truly outstanding and memorable meeting. Dolores and I warmly welcome you. You may be able to spend extra time exploring the province or other areas in Atlantic Canada.

At this time, with the Christmas season upon us, Dolores and I, our two children, Danielle and Brendan, and the COA Staff would like to extend wishes for a very joyous and healthy holiday season and a wonderful New Year.