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10 Questions for Jim Rutka

Rutka in lab

James Rutka in the lab

Q1: What do you think Dean Whiteside meant when she told us you will take the Surgery Department to the next level?

The Department of Surgery is in great shape. We are probably ranked in the top 20 in the world based on my scan of other Departments, and my strong hope and belief is that we will be able to move up within the top 5 over the next 5 years. The criteria by which Departments are judged include grant capture, publications, faculty presentations, innovations, patents, and the training programs. For the latter reason, funding and support of the Surgeon Scientist Program (SSP) will remain as one of my top priorities. The SSP continues to attract the most talented residents to the Department. The pendulum swings periodically, more towards clinical training and education at one time, and towards research at other times. Another one of our goals will be to recruit the very best faculty investigators. While we have an outstanding Department using the traditional metrics, we also have a great opportunity to improve our performance and ranking by continuing to publish high impact papers and demonstrating a higher percentage of grant capture amongst faculty. The leading Departments in the world whom we should emulate and surpass are UCSF, Duke, Johns Hopkins, University of Michigan, and Harvard.

Q2: Is there a Rutka philosophy or approach that you will bring to the department?

My approach as Chair of the Division of Neurosurgery was to place a personal touch on the program, getting to know all the residents, fellows, and faculty. While the Department of Surgery is a larger enterprise, by a factor of 10 compared to neurosurgery, I will try to do the same. I also strongly believe in striving for excellence at all levels – patient care, education, surgical technique, and research. And I would never ask a faculty member, resident or fellow to do anything I would not do myself. So I lead by example, and hold myself to the same standards I set for members of the Department.

Q3: How did a microvascular fellowship at the University of Nagoya and a postdoctoral fellowship in immunology at Juntendo University in Tokyo go? Did you speak Japanese when you were there?

Yes. I did an intense 7 month Berlitz course in Toronto at first. I highly recommend this type of crash course as it mandates your speaking Japanese right from the outset, sometimes fumbling and making mistakes, but gaining confidence in your abilities to converse in a very short time frame. I also took Japanese lessons when we lived in Japan. To this day, I still practice my Japanese with my Japanese research fellows in the lab. I can still remember renting a car in Tokyo years ago, and performing the entire transaction in Japanese, before we drove to the ancestral Shinto and Buddhist shrines on the Romantic Road to Nikko. I also spoke Japanese with my colleagues on the neurosurgical services in Tokyo and Nagoya. My surgical mentor Dr. Sugita in Nagoya kindly emphasized that I would like to speak Japanese when I was there, even though many of the surgeons and residents were interested in practicing their English.

Q4: Do you have a priority list for the department to work on in terms undergrad, postgrad, international, academic surgery and clinical surgery?

My first priority will be to engage the faculty in a strategic planning session so that we can set the blue print for change and advancement of our goals over the next 5 years. This will be conducted in the early fall of 2011. We will also be preparing for the ACGME accreditation of the medical school in 2012. There is still some work to do regarding the manner in which we instruct medical students about surgery. Following that, we will work on preparing the postgraduate program for Royal College accreditation in 2013. This will give us a chance to strengthen all of our divisions. International surgery and global health will build on the strengths of the fellowships like the Bethune fellowship fostered by Andrew Howard and dedicated recently by Adrienne Clarkson. We will also work on increasing our fundraising capabilities within the Department with the help of Martin Barkin, Chair of the Surgical Alumni committee, and Darina Landa, our newly appointed Departmental Advancement Officer.

Q5: In the postgrad sector, do you see changes related to the imbalance David Latter recently described between graduating surgeons and opportunities to enter practice - the “well trained- no job” problem?

Ron Levine, our Director of the Postgraduate Program has heard this issue about “no jobs” for graduating residents across all specialties. Ron considers this to be one of our major challenges in the Department, and I agree with him. To help solve this issue, we will need to work at several levels but especially at the Provincial level in conjunction with the Ministry of Health to determine the true workforce constraints in the system. I have great empathy for the residents who are confronting this change in the practice of surgery. We will focus on new models for job opportunities in the Department in our strategic planning session this fall. The mentoring and practice transition approach for senior surgeons that David Latter wrote about should be helpful, as will programs to prepare surgeons for the version of their lives that follows retirement.

As a follow up question: Can you comment on the recent developments in postgrad education, such as the Competency Based Curriculum and the introduction of Nurse Practitioners and Physician Assistants?

The use of the Competency Based Curriculum (CBC) and the more widespread use of nurse practitioners (NPs) and the newly graduated physician assistants (PAs) will be helpful in reducing excessive service work performed by residents. I am intrigued with the possibilities of using the PA programs’ graduates and surgical hospitalists to fill the gaps with alternatives to surgical residents. The current PAIRO contract is up for review and renegotiation at this time. I am hoping that the current resident work week will be maintained in the next iteration of the contract, as I think our residents are receiving excellent instruction in surgery, and a balanced approach to lifestyle across all divisions. I sincerely hope we do not veer towards a European model of 48 hrs of practice per week, as I have seen firsthand how that model has reduced the experience of residents/registrars in that system.

Q6: Will the department retool surgeons who are currently in practice, but trying to catch up with evolving new techniques and technologies?

Retooling for minimal access surgery, image guided interventional radiology, robotic surgery and neuronavigation all need to be developed. Terry Axelrod will help lead this effort as our Director of Continuing Medical Education (CME). We plan to offer numerous CME courses throughout the year which surgeons can take advantage of to hone their skills in these recently emerging areas. This form of CME will also help to raise funds for the Department.

Q7: Is the proposal to add an option of private care a threat to our department?

It could be advantageous if it comes. Last year, as President of the American Association of Neurological Surgeons, I worked through the implications of the Patient Protection and Care Act (PPACA) of the Obama administration with my neurosurgical colleagues in the US. There is a lot of trepidation about how PPACA will be implemented, at least amongst the neurosurgeons and other surgical subspecialists. At that time, I became keenly aware of the value of the Canadian system, despite some of its limitations, as I listened to the concerns of my American colleagues.

Q8: What are you most proud of?

My family. Mari, my wife of 31 years is in her third term as a school board member in North York. Daniel is a film and web producer in Los Angeles, after graduating from McGill with a degree in jazz and history. Hana is a graduate of the National Ballet School in Toronto and dances in London, England at the Central Ballet Academy. And Marissa is a film student at the Tisch School of Film Studies at New York University.

Q9: Can you tell us a little about what you do outside of surgical life?

For me, the most important and cherished activity is family time. I also continue to enjoy playing the piano. I trained at Toronto’s Royal Conservatory of music years ago, and on occasion have performed in public in recent times. I am an outdoors enthusiast. This summer, Mari and I will go on a canoe trip deep into the interior of Killarney Provincial Park. We have been doing this for years, and our children have joined us for many of these expeditions. I am still active in athletics, playing hockey with full equipment, squash, cycling, and rollerblading.

Q10: Does the date of November 18, 1978 have any special significance for you?

That’s the day we beat the University of British Columbia at Varsity Stadium to win the Vanier Cup College Bowl Championship. In fact, I still have a piece of the goal posts as there used to be a tradition of tearing the goal posts down after the game in those days. We won 16 - 3. I was the quarterback for Queens. Both teams had strong defenses. We had one long drive - a quarterback draw, followed by two pass plays. When we finally punted to their five yard line, they fumbled, we recovered, and made the crucial game winning touchdown. There is a saying about old quarterbacks: that “Old quarterbacks never die, they just fade back and pass away”. I must say, there were many life lessons to be learned from playing football including drive, second effort, teamwork, and believing in yourself. All these lessons have been enormously helpful in my own surgical practice and career.


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