William R. J. Rennie, M.D., FRCSC
President, The Canadian Orthopaedic Association

Since publication of the last COA Bulletin, Mr. Roy Romanow delivered his much heralded and awaited report on the Future of Health Care in Canada on November 28^th, 2002. While it is difficult to dispute the goal of making Canadians the healthiest people in the world, or of improved accountability and transparency in the system, or of stable predictable funding, the report falls short in some critically important areas.  

The first and most important failure is to completely ignore the crises in access to and delivery of care by specialists, including orthopaedic surgeons, in Canada. Waiting lists continue to grow and delays in treatment continue to have a severe impact on the lives of patients and their families and/or caregivers. There is also an enormous economic impact on both the health care system and the country.

While better access to primary care and diagnostic services is important, earlier diagnoses will not improve access to treatment unless additional steps are taken. Orthopaedic manpower is shrinking relative to need. Training programme numbers are stagnant and those surgeons currently in practice are both aging and already overwhelmed by the volume of work that needs to be provided.

Little note is taken in the Commissions' Report of the demographic realities in Canada. We are dealing with an expanding aging population, who live longer and want to remain physically active. Many of the "diseases of aging" are related to the musculoskeletal system, such as degenerative arthritis. Having paid for the system during their working lives, these aging, active Canadians will demand access to treatment in a timely fashion and we need to be able to provide it. Not only are we unable to do so at present, we will be less able to do so in the future unless changes are made today. For solutions to the escalating crises in orthopaedics care in Canada, the Romanow report is tragically silent.

What are we as a national organization doing? We are continuing with the Canada in Motion project to make every effort to get our case in front of provincial governments and the federal government.

The COA was represented at a Bone & Joint Decade stakeholders meeting held in Calgary on February 1, 2003. This was hosted by the Institute for Musculoskeletal Health and Arthritis (IMHA), and offered an additional opportunity to exchange ideas at the national level.

The National Standards Committee of the COA, ably chaired by Drs. Hans Kreder and Ted Rumble, has created an appropriate waiting time survey which has been circulated for completion by all COA Active members. A copy of this survey has been included as an insert in this Bulletin mailing. We need you as members to get involved and to complete this survey. We need and value your opinions and we need to speak as one voice.

The National Standards Committee is also working with ICES using access modeling methodology to evaluate existing service rates and distribution, and to propose appropriate levels of various services resulting in the ability to calculate manpower and other resource needs. This is a 3-year project and a CHSRF grant has been obtained.

I am happy to report that the financial health of the Association is markedly improved. Thanks to the efforts of CEO Doug Thomson, the Treasurer, Dr. Brendan Lewis and the Finance and Audit Committee chaired by Dr. Don Dick, we now appear to have a stable financial platform on which to proceed.

I want to give you a taste of the Annual General Meeting to be held in Toronto, May 30^th to June 2^nd, 2003. The Local Arrangements Committee, chaired by Dr. Barry Malcolm and the Programme Committee, chaired by Dr. Emil Schemitsch, have combined to provide a meeting which I think you will find both exciting and stimulating. More importantly, perhaps, significant changes in the meeting format have been made in direct response to post meeting surveys completed by you, the membership.

A shorter, more concentrated meeting with more Symposia and live surgical demonstrations are planned. An exciting Gala evening entitled "Them Canadian Bones" is not to be missed. I hope to see as many of you as possible in Toronto.