Recruitment and Retention of Orthopaedic Surgeons:

The Lifeblood Which Will Sustain the Specialty

Emil H. Schemitsch, M.D., FRCSC
Editor in Chief
The COA Bulletin

Over the past year, I have written a number of editorials around the theme of the fragility of our health care system. Much of this has centered on the crisis in access to delivery of care by orthopaedic surgeons in Canada. A related issue is the significant manpower shortage, which exists in the specialty of orthopaedic surgery. Long waiting lists and delays in treatment have had profound impacts on patients. In part, delays in treatment are related to a shortage of orthopaedic surgeons, the number of which, at many hospitals, has declined and the average age of which has increased substantially. This trend is not positive in light of an aging population requiring increased access to orthopaedic and fracture care.

The solution to this manpower problem will not come overnight. It involves recruitment and retention of orthopaedic surgeons as well as a concerted effort to bring young people into the field from the ranks of our medical schools. In the short term, every effort must be made to improve the working conditions of those who provide orthopaedic care, particularly in off hours, at night and on weekends. Less orthopaedic surgeons working harder is certainly not a solution. In particular, we must redefine how it is that we provide care. New models of how it is that we provide trauma care must be entertained. Changes to the system are required and more resources need to be made available. Orthopaedic units should have access to daily fracture room time. This will allow fracture cases to be done during the day and have a positive impact both on patients and physicians. The provision of such operating room resources to deal with fractures should not come at the expense of elective time; otherwise elective waiting lists and delays in treatment will only grow longer.

We must also encourage medical students to consider orthopaedic surgery as a career. This is the lifeblood, which will sustain the specialty. Fewer students are considering orthopaedic surgery as a career. This may be related to lifestyle and other issues. It is worrisome when I hear that there may be fewer applicants to orthopaedic training positions than there are positions. We must make an effort to connect with students and give them an idea of how fulfilling a career it can be. Similarly we must encourage more women to consider orthopaedic surgery as a career, thus reflecting the makeup of current medical school classes. Our organization, the Canadian Orthopaedic Association, must be a strong advocate in this regard.

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