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Richard Reznick's Metabolic Surgery Network and Other Co-ordinated Departmental Programs

Martin McKneally
Martin McKneally

In my report on bariatric surgery in the last issue, I neglected an important foundational point. Richard Reznick brought the surgical community and the Ontario government together in 2009 to establish a coordinated Bariatric Surgery program. Patients enter the program through the registry (http://www.bariatricregistry.ca/
). They are interviewed at one of the Network's assessment centers. There they are carefully evaluated by a team of dietitians, psychiatrists and nurse practitioners, and prepared for surgical treatment. Surgery is performed in dedicated treatment centers in the network. As Teodor Grantcharov (see article in this issue) describes it, "the hospitals work not as isolated units, but as part of a well-coordinated program put in place by Richard Reznick. He is an amazing leader who brought everyone to the table, including the government, and solved the problems that arose when Ontario was sending patients to the United States for bariatric surgery. Those patients did not do well because they did not have a total program of diet, psychiatry and other supports. Surgery is an important part, but the multi-disciplinary program is essential. Richard is doing the same thing in Kingston. His leadership made Toronto a world centre for surgical education and is now doing the same with bariatric surgery. Bariatric surgery two decades ago was regarded as weird and questionable. Now it is regarded as a wonderful advance."

Networked programs offer synergistic use of clinical and research resources, enhance the academic impact of our department's members, and provide patients with a sense of order and purposefulness in an often bewildering healthcare environment. The trauma program and the spine program (http://www.surgicalspotlight.ca/Article.aspx?
) are examples of the collaborative model of healthcare delivery. Similarly, the Surgeon Scientist program attracts scholars to our department because it is coordinated and harmonized with clinical training, not simply a collection of unrelated laboratories, competing investigators, and unplanned interruptions to pursue research questions.

I recently had the opportunity to address my classmates at Cornell's 50th year medical school reunion. Their moral distress at the state of the competitive, entrepreneurial practice of medicine and surgery in the US was palpable – expressed as reluctance to encourage their grandchildren to pursue a medical career. They were competing for patients, and with insurers. "We only accept cash" one surgeon from the wealthiest county in the US told me. My classmates were surprised by the experience I was able to describe as a surgeon in our Department.

A colleague from New York University related the effects of the competitive, entrepreneurial non-system of care when hurricane Sandy flooded lower Manhattan. "The power was knocked out in our hospitals (Langone, Bellevue, and the Manhattan VA). Carrying the patients down 25 floors by flashlight with no loss of life was a lot easier than getting them accepted at the other hospitals. They bickered about taking uninsured and Medicaid patients despite the crisis."

Our Department, meanwhile, is moving onward and upward as we add new faculty and new residents, and embark on an ambitious next strategic plan. Visitors, accreditors and other external reviewers are impressed by the energy and accomplishments of our surgeons, residents, scientists, students and staff. We wish all of them and all our readers a cheerful and healthful holiday with friends and family, and look forward to a productive new year together.



The University of Toronto Department of Surgery will present a one day Surgical Ethics Course at the Rim Rock Hotel in Banff, Alberta on May 28, 2013, immediately preceding the Canadian Bioethics Society annual meeting. The course will focus on surgical Innovation, life sustaining treatment, and recent developments in organ donation.

For information on registration contact martin.mckneally@utoronto.ca

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