President’s Message

Modest Beginnings and Striving to Improve
Des débuts modestes et une volonté de s’améliorer

We are pleased to share the President Elect Address delivered by Dr. Mark Glazebrook on Friday, June 21 during the COA Annual Meeting held in Montréal.

C’est avec grand plaisir que nous vous transmettons ci-après l’allocution prononcée par le Dr Mark Glazebrook à titre de président élu à la Réunion annuelle de Montréal, le vendredi 21 juin.

I want to begin by sharing my opinion and insight on your Canadian Orthopaedic Association. For me, what is most important for us all to understand is that we are the COA. Every one of you out there is a driving force of the COA, and if we want the COA to accomplish something, it falls on us to take action and do it. Your COA has over 1,300 members, along with an Executive committee, Board of Directors, and multiple volunteer committees working behind the scenes. Of course, the dedicated staff acts as the driving engine behind the COA, there to help you and support the things that need to get done. Remember: You make up the COA.

J’aimerais commencer par vous présenter ma perspective sur votre association canadienne d’orthopédie. Selon moi, ce que nous devons avant tout comprendre est que nous sommes l’ACO. Chacun et chacune d’entre vous êtes un des moteurs de l’ACO, et si nous voulons que l’ACO accomplisse quelque chose, c’est à nous qu’il incombe d’agir. Votre ACO compte plus de 1 300 membres, ainsi qu’un comité de direction, un conseil d’administration et de multiples comités composés de bénévoles qui œuvrent dans les coulisses. Bien entendu, le personnel dévoué de l’ACO est le grand catalyseur de tout cela; il est là pour vous aider et faire ce qui doit être fait. N’oubliez pas : vous êtes l’ACO.

I’d like to discuss some of the challenges our specialty faces, and how people like you make a difference. The COA Bulletin has been addressing diversity in orthopaedics by publishing spotlight interviews with female surgeons from different orthopaedic career stages, settings, and geographic regions. Yesterday, I attended an ICL on implicit bias and gender diversity, which was fantastic. At times during the session, I was uncomfortable, and some of my colleagues commented that this was a good thing because it helped me reflect inwards and gave me a new perspective on the topic. How did it all come together? People drove this initiative, and their efforts made it a successful ICL.

In 2018-19 the COA did a full audit on women’s involvement in COA membership, leadership, Annual Meeting attendance, and participation as speakers and faculty on the podium. The result show that women make up approximately 11% of the COA membership and are generally well-represented in the membership, at the Annual Meeting, in committee positions, and travelling fellowships. However, I believe that we can do better. A snapshot of full-time positions held by women across Canada reveals that some provinces need improvement. Diversity is not just about gender; the COA embraces diversity in age, geography, ethnicity, seniority, and career setting along with stature diversity. Executive member, Dr. Laurie Hiemstra, led the gender diversity ICL with great supporting speakers, and did an incredible job. She, just like each of you, is the COA, and you make things happen along with the COA head office staff.

Every orthopaedic resident in Canada is supported by the COA through various initiatives that run during each year of their training, including free membership to both the COA and their own Residents Association (CORA), the CORA Annual Meeting, and the COA’s support of various review courses. This year’s Annual Meeting inaugurated a ‘Mentor for a Day’ program where residents and fellows could choose to shadow attending surgeons for one day during the Meeting. I was lucky enough to be paired up with Dr. Susan Ge, a third-year resident at McGill University. During our mentorship time together, I learned a lot from Dr. Ge and this experience has been a true exchange of ideas. It is members like Drs. Markku Nousiainen and Veronica Wadey, who stand as examples of surgeons that drive resident education by encouraging resident involvement in the COA. These are members of your COA, just like you.

Opioid addiction is a serious issue that is being addressed by the COA’s Standards Committee through their development of a pain management survey, which produced consensus statements on the orthopaedic surgeon’s role in opioid management. The recommendations put forward in the position statement include writing prescriptions for not more than two weeks in length, constant reassessment of your patient, consulting acute pain more appropriately, advising patients about addiction risks, and safe storage and disposal of medication. Again, the COA needs surgeons, researchers, and orthopaedic staff members like you to initiate and work on these initiatives. The Standards Committee Chair, Dr. Jeffrey Gollish, has worked tirelessly on the opioid position statement amongst others. He is an example of a member who drives your COA.

Your COA is also involved in addressing intimate partner violence and bringing the EDUCATE program to fracture clinics across the country. Yesterday, I attended the second EDUCATE Champion Training Workshop and I was amazed at the level of experience and training provided by those involved in the program. Again, programs like this happen because individual members of the COA get together and commit time to develop them. Drs. Mohit Bhandari and Sheila Sprague have been leading the EDUCATE project with McMaster University, and this is an example of how your COA works for you.

Today, Canada has the fewest orthopaedic surgeons, yet longest wait times amongst all the developed countries across the globe. Meanwhile, we have over 150 unemployed, highly trained, orthopaedic surgeons and, paradoxically, long waitlists for surgery, few surgeons for the population, and unemployed surgeons. We have to find a way to employ these surgeons which will solve the wait time issue and lack of surgeons per capita. This improvement can only happen on local levels through member involvement. The COA cannot create new jobs, but individual surgeons can make differences.

Earlier in my career, I was surrounded by a media storm because I had a wait-time of 10 years and approximately 3500 patients on my waitlist. This situation was simply unmanageable, so I decided to present the reality of the problem to the media and in doing so, captured the interest of the national news. Essentially, I tried to responsibly embarrass my provincial government, in the interest of patient care. This led to a meeting with the Nova Scotia Minister of Health, Dalhousie Orthopaedics Division Chair, and myself. We presented the Minister with a graph that outlined wait times and suggested that if efforts were not made to rectify this, there would be a further negative progression of wait times for foot and ankle care in Nova Scotia. During this meeting we also brought solutions to the table such as reducing wait times with the addition of one surgeon, and elimination of excessive wait times with the addition of two surgeons. In the end, Dalhousie Orthopaedics did hire an additional foot and ankle surgeon, my partner Dr. Joel Morash. Together, we have cleaned up the foot and ankle wait time in Nova Scotia over the past few years. One additional surgeon solved this problem. This is an example of mitigating excessive wait times through increasing surgeon employment.

Going forward we can address the country’s employment issue through a multi-factorial approach that involves members of the COA. We all have to get in involved, and I believe that the first step is public awareness. The COA membership has to get the message and reality of surgeon unemployment out to the public through press releases, social media, and paid media messages. We can raise public awareness and promote patient advocacy, rather than cutting further residency training positions. As a part of the COA, we should be responsible to ensure that we meet the needs of future orthopaedic patients. Job sharing options and retirement transition models should also be at the forefront of our advocacy initiatives.  We have to do a better job in any way we can to reduce delays in the OR. Every little improvement makes a difference.

Over the next year, my initiative is to work with COA members on improving wait times and surgeon employment though a multifactorial approach including:

  1. Public & COA member awareness through publicity
  2. Continue residency training position assessments
  3. Retirement/job sharing transitions
  4. Government lobbying
  5. Patient Care/Resource allocation innovations
  6. Private care innovations

Let’s improve our specialty together. I’d ask you to bring your ideas and innovative projects to action by working with the COA. The COA has been addressing challenges but it needs you. Ask not what your COA can do for you, but what you can do for your COA.

Ensemble, améliorons notre profession. J’aimerais que vous collaboriez avec l’ACO afin de concrétiser vos idées et projets novateurs. L’ACO relève déjà des défis, mais elle a besoin de vous. Ne demandez pas ce que votre ACO peut faire pour vous. Demandez ce que vous pouvez faire pour votre ACO.

I would like to thank my foot and ankle colleagues who have fostered my career for the last 15 years, and my Nova Scotian colleagues who hold my hand when I can’t fix the hard fractures, and who will support me in my presidential journey over the next year. Most importantly I’d like to thank my family, who has always been there for me. Finally, thank you to our members; together we are the COA.