Editor's Column
Martin McKneally
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In this issue of the Spotlight,
we celebrate the arrival of a talented
group of residents, who
will carry on the tradition of
surgical scholarship exemplified
by Bill Bigelow.
Those following Bill’s legacy into
cardiac surgery have entered a six
year direct entry residency. This
innovative entry program in General Thoracic Surgery
was also established in Canada in 1994 (1). Only recently
a few training programs the United States have experimented
with direct entry into cardio-thoracic surgery. In
the November issue of the Annals of Thoracic Surgery,
an early report from Mount Sinai Hospital in New York
City indicates that their new 6 year direct entry program
is attracting academically excellent candidates - similar
to Jordan Van Orman p11 - with advanced degrees and
more life experience than recent medical school graduates
applying to the traditional programs (2).
A direct entry program was established at the same time
in Canada in General Thoracic Surgery. This proved
impractical, as graduates who entered practice settings
where they were the only thoracic surgeon in town
were required to share on-call duties in general surgery.
They were undertrained for this scope of responsibility
and lacked adequate cross-coverage of their own
specialty. Focused training may become more practical
for Thoracic Surgery as regionalization of develops, concentrating
the operations and practitioners in specialized
centers the way cardiac surgery is organized.
Like our Department of Surgery, Canada has a communitarian
ethic that enables cooperation toward agreed upon
goals like these. This requires some sacrifice of individualism
for the good of the community. Sid Levitsky drew
attention to this attribute in his Bigelow Lecture p7. He
reminded us that Canadians share a background derived
from an imperial culture, whereas the entrepreneurial
competitive character of US surgery and medicine derive
from a revolutionary culture. The collaborative approach
has fostered the development of a nearly universal system
of healthcare insurance in Canada and a co-operative
approach to healthcare delivery, illustrated in this issue by Mike Tymianski’s Neurosurgery colleagues at the Toronto Western Hospital.
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As the country enters a two year period of discussion
leading to the 2014 renewal of the Canadian Healthcare
Act, we will need similar professional models of care
delivery and management of the health enterprise to
renew and sustain our practice. Our surgeons have developed
exemplary programs of efficient care in the surgical
treatment of trauma, obesity, cancer, cataracts, cardiac
and joint disease. Stitching these and similar programs
together, integrating them effectively with homecare
and family practice, and coordinating the whole into a
system are challenges for the next several years.
The resources needed to accomplish these goals will take
more than the public currently invests in healthcare. It is
encouraging to see the investment by philanthropists like
the late Jim McCutcheon, Terry Donnelly, Peter Munk,
Seymour Schulich and other donors. The Li Ka Shing
auditorium where Jim Rutka gave his annual address and
the five new operating rooms planned for St. Michael’s
Hospital indicate the growing support and insight into
the needs of Canadian Healthcare.
Surgeons can provide much of the leadership required
for this transformation, because of their accustomed role
as responsible decision makers. Our contribution can be
strengthened by the kind of management and business
training Mike Tymianski receives from his company’s
board of directors.
As we enter the winter season of holiday gatherings with
family and friends, let’s be grateful for the satisfactions we
derive from our work, for the richness of our professional
lives, and the good fortune we enjoy – to be members of the
remarkable department described in this issue.
M.M.
1. Mulder, D., McKneally, M. The education of thoracic and
cardiac Surgeons: A canadian initiative; Ann Thorac Surg,
1995;60:236-238
2. Chikwe, J., Brewer, Z., Goldstone, A., Adams, D. Integrated
Thoracic Residency Program Applicants: The Best and the
Brightest?, Ann Thorac Surg , 2011;92:1586-1591
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