President’s Message

We Are Our Own Best Friends

Kevin Orrell, M.D., FRCSC,
President, Canadian Orthopaedic Association

Mr. Chairman, members and partners of the COA, special guests, ladies and gentlemen, Mesdames et Messieurs,

It goes without saying that it is a great privilege for me to serve as the 72nd President of the Canadian Orthopaedic Association. This honour is magnified even more, occurring on the occasion of the 150th birthday of Canada, in our nation’s capital.

In preparing this address, I have had the opportunity to review several of the presidential addresses of the past. These contain a great deal of wisdom and scholarly advice from impressive members of our organization. I am happy to say that I recall many of these past presidents and consider them my mentors and dear friends.

C’est un privilège pour moi de servir comme 72e président de l’Association Canadienne d’Orthopédie. En tant que chirurgien communautaire, travaillant de près avec l’Université, je me sens bien placé pour reconnaître plusieurs des soucis importants qu’éprouvent les chirurgiens orthopédistes partout au Canada. Je suis fier des liens que j’ai noués avec de nombreux collègues dans chaque province du pays. Ces amitiés et contacts m’ont servi d’appui tout au long de ma carrière. Aujourd’hui, ces amitiés servent de thème à ma présentation.

For my part, as we continue to grow as an organization, I would like to reference the importance of the friendship we have come to enjoy as Canadian orthopaedic surgeons. We have taken full advantage of this collegial relationship to create a very significant orthopaedic presence in the health-care system in this country. Relatively speaking, we are a small number and we are spread across an enormous geographical area. Yet, unlike many other specialties, the bonds of friendship we share has empowered us and strengthened our impact on Canadian health care.

Thomas Aquinas stated, “… there is nothing on earth more prized than true friendship”. As Canadian orthopaedic surgeons, I believe we truly understand what this means.

As a young surgeon, I was surprised by how much time and effort was necessary to deal with policy makers and administrators to speak on behalf of the rights of our patients for timely care. In Nova Scotia, when I began to practice, surgeons had to lobby for protected beds, adequate OR time, appropriate prosthetic budget, sufficient manpower, committed trauma time etc. Regrettably, we must remain actively involved and continue to lobby on behalf of our patients and fellow Canadians. We are still dealing with many of these same issues. Currently, I live in a province where 80,000 people do not have a family doctor. In some parts of Nova Scotia, patients wait three years for joint replacement surgery.

In those early years, there was an impression that the richer provinces in Canada did not have the same concerns. Now, of course, there are fewer richer provinces. Later in my career, as I established friendships with other Canadian orthopaedic surgeons, I was astonished to discover that our problems in Nova Scotia were mirrored by colleagues across the entire country. There were very diverse initiatives for resolution of these problems. In many parts of Canada there were very important champions among the ranks of orthopaedic surgeons who worked very diligently on behalf of all of us. I am certain you will agree with me that two notable examples are Jim Waddell and the late Cy Frank, whose work with Bone and Joint Canada has improved our ability to care for our patients. In every region of the country leaders among our ranks stepped forward to influence change. The Atlantic region had no shortage of such individuals. Orthopaedic surgeons understood what was necessary to practice our specialty and the bonds of friendship we enjoyed helped us to move forward as a united front.

There was, and regrettably still are, very different levels of interest and cooperation by provincial governments in addressing the problems that are well known to us. I came to appreciate that the shared experiences of friends and colleagues contributed significantly to the efforts that I could make as an individual. This united appeal helped to strengthen our voice in Canada. We understood each other and the task was to assist our departments of health and decision makers to understand us. Over time, the success achieved in one province established a standard of care that other provincial authorities could not ignore. The shared knowledge and cooperation among orthopaedic colleagues assists all of us in improving our local situations.

As an alumnus of the orthopaedic training program at Dalhousie University, I have fond memories of the leadership of my chief, Dr. Reg Yabsley. In his presidential address in 1991, Dr. Yabsley makes reference to the establishment of the residency training program in Halifax. He explained, “Medical students became orthopaedic residents for the first time at Dalhousie, and residents became orthopaedic surgeons, and they have all become close friends.”  This, of course, is not unique to Dalhousie. I believe it is reflective of all our training programs and lays the foundation for the close relationships we enjoy as Canadian orthopaedic surgeons.

Dr. Yabsley went on to state, “Medicine has been good to me and for me, and I want the President of the COA in 25 years to be able to stand before you and say the same…”

Twenty-six years later I am proud to be able to say the same thing. I believe this is true because we are able to make a significant difference to the lives of our patients with musculoskeletal disease in Canada. Importantly, the fraternal manner in which we work together to improve how we deliver this care, contributes significantly to our job satisfaction. So, in the same enthusiastic manner as Dr. Yabsley, it is my hope that the COA President 25 years from today will enjoy the same contentment.

As a community-based orthopaedic surgeon with university affiliation, I feel well placed to articulate some of the ways in which the COA promotes friendship among all Canadian orthopaedic surgeons. In this address, I wish to do the following:

Firstly, I would like to provide the younger members and those in doubt more about the role that the COA plays in their professional lives.

Sadly, we are all aware of the irony in this country, which is among the worst in the developed world for wait times for surgery; yet, there are still 160 unemployed well-trained orthopaedic surgeons looking for permanent jobs. The lack of vision of our policy makers has never been more apparent. As an organization, the COA must continue its efforts to correct this. Externally, we must lobby our governments for appropriate access to care for the citizens of Canada. This can only be done by increasing patient access to orthopaedic surgeons. As friends who understand this current employment crisis in Canada, we must work together to resolve this issue. Permanent employment for these young surgeons is critical.

Internally, we must become more aware of the transition from late career to retirement creating opportunities for newly-trained surgeons. The COA and others have provided some guidance in this regard but we can and will do more. A central registry should be created identifying job opportunities across the country. As these young surgeons work in alternate positions awaiting permanent jobs, we must establish guidelines concerning their work conditions. Ultimately, we need to assist and encourage these young surgeons to remain in Canada.

Secondly, I would like to articulate the recent efforts this organization has made and continues to make for both our membership and the Canadian public. Under the leadership of our Past President Dr. Robin Richards, a position paper on Access to Care has been formalized. We have a consensus statement for patients with total joint replacements requiring dental procedures put forward by our National Standards Committee in collaboration with the Canadian Dental Association and the Association of Medical Microbiology and Infectious Disease. Under Dr. MacDonald’s term of office, the COA has addressed late career transitioning, intimate partner violence, unemployed graduates and we have made statements on freedom to travel. The COA has also finalized a report on podiatry in Ontario in partnership with the Ontario Orthopaedic Association. Currently we are addressing issues of opioid usage through our National Standards Committee under the leadership of Dr. Jeff Gollish. The COA is also participating in the Choosing Wisely movement which seeks to identify tests and treatments commonly used that are not supported by evidence and may expose patients to harm..

Lastly, I would like to encourage all of our members, especially our young surgeons, to become involved in the work of the COA. This organization provides a venue for you to meet and work with colleagues from across this country and make the friendships to which I have referred. These friendships will empower us as a profession to continue to make a difference on behalf of the Canadian public. Citizens of this country are aware that the system does not adequately provide for their needs. No one understands better what has to be done to improve orthopaedic care than orthopaedic surgeons. Therefore, it is our responsibility now, as it has been in the past, to take every opportunity to identify and change the obstacles that hinder our profession. To do so as a united group of friends and colleagues has much more impact than anyone of us could make individually. Wayne Gretsky stated “you miss 100% of the shots you don’t take”. He spoke these words in reference to a team sport recognizing that everyone on the ice contributes. If we are the players on the orthopaedic team in our health-care system, then the COA can serve as the club franchise. We must take every opportunity available to us to improve our organization.

This pattern of involvement may commit you for a long time but you come to enjoy its rewards. Interestingly, in 1991 I was the President of the Canadian Orthopaedic Residents’ Association (CORA) to be succeeded by Dr. Peter MacDonald the following year. Now, in reverse order, we will serve as President of the COA. In between, we have become good friends.

Near and dear to me is the Canadian Orthopaedic Foundation (COF), an organization with which you can also become involved. Following my tenure as Chair, the COF’s leadership passed to the capable hands of Dr. Jim Waddell and now Dr. Geoffrey Johnson, both Past Presidents of this organization. It has a proven record of support for orthopaedic surgeons and our patients.

Une partie importante du travail que nous accomplissons comme chirurgiens orthopédistes, c’est d’agir comme porte-parole pour ceux et celles qui ne sont pas en état de se prononcer eux-mêmes. Nous devons tenir responsables aussi bien les administrateurs que les politiciens de nous permettre d’offrir un niveau normalisé de soins appropriés. C’est en œuvrant ensemble comme amis et collègues que nous pouvons le mieux accomplir cette tâche. En s’appuyant l’un l’autre, cela rend l’effort de chaque chirurgien moins exigeant. De plus, cela rend davantage possible un accès équivalent aux services dans chaque province du Canada. L’Association Canadienne d’Orthopédie joue un rôle clé dans la promotion de ces relations collégiales dans notre communauté orthopédique au Canada.

Before closing, I would like to gratefully recognize Doug Thomson, our CEO, and our staff, Cynthia, Trinity, Meghan and Helen. They are a small but mighty group who work very hard on our behalf.

I will always be indebted to Drs. Ed Abraham and John Ready, with whom I trained during my residency. We became and have remained the best of friends throughout our careers. I am also indebted to my orthopaedic colleagues and friends in Sydney, Don Brien, James Collicut, Horacio Yeppes, Faith Dodd and Michele O’Neill. We are a small group and I am grateful for their support during this year as President. It has been the relationships with such people that have served as inspiration for my address today.

Finally, I would like to acknowledge the tremendous love and support of my wife and best friend; Anne, and our family; four of whom are here today. For someone who has enjoyed as busy a career and as wonderful a family as I, I must acknowledge the tremendous effort Anne has made in keeping everything in focus. I am very grateful for your encouragement and tolerance of all of my adventures. Our five children have been our greatest joy and are now mature adults who encourage and celebrate our success. As they proceed along their career paths, three in medical professions, I am hopeful they will be surrounded by the supportive friendships we have enjoyed through the years.

William Penn said, “A true friend advises justly, assists easily, adventures boldly, takes all patiently and defends outrageously.”

I have been fortunate to have been surrounded by such people within the orthopaedic community in Canada, and I am very grateful.

Thank you. Merci.