10 Questions for Jim Rutka
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.
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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.
M.M.
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