Check the OR

Dr. Ed Buchel, one of the foremost plastic surgeons in North America, is driving home from the so-called “Disneyland for Doctors” in Arizona—the Mayo Clinic’s satellite medical centre in Scottsdale—after career stops in New York City and “Mother Mayo” in Minnesota, where he trained his hands to do microsurgery that would give you a headache just to think about. As he pulls into the driveway of his mountaintop home on an acre of land overlooking the city of Phoenix—with a lap pool in the yard, a quarter acre of land on one side filled with fruit trees, and a basketball court on the other—he knows he’s living the dream. Forgive him if the first thought on his mind is not moving north to Winnipeg.

Fast-forward three years or so to this August morning and Buchel—newly-appointed Medical Site Leader for the Surgery Program at Winnipeg’s Health Sciences Centre—is a blur in his office, coordinating a team that just might be changing the way medicine is done back here in his hometown.

As attending plastic surgeon, what Westwood-raised Buchel does at HSC roughly 10 times more than was done three years ago when he brought his family—including wife Tamara, who now heads up the University of Manitoba’s Family Medicine Residency—back home, is a breast reconstruction technique called DIEP (pronounced “deep,” as in, “lap pool”). Also known as a Free Tissue Transfer, DIEP works like this: In a traditional reconstruction, muscle, along with fat and blood vessels (about .25mm in diameter in this case) is taken from the abdomen, back or leg and moved up to the chest. The thing is, the muscle isn’t needed. It’s just holding those blood vessels (which are needed) hostage. The DIEP technique is a way to get those blood vessels from the muscle and take them along with the overlying fat and skin for the reconstruction. “I’m no longer taking a muscle out of their abdomen,” Buchel says, “and if I’m doing this on 55 or 60 year-olds in our society who are very active, I no longer have to take away 50 per cent of their abdominal strength.” Plus, they get a tummy tuck to go along with that reconstruction, and it all happens while they are still on the table for that mastectomy, meaning their stay in the hospital is three or four days instead of a week or 10 days.”

You might think, great, ‘bout time Manitoba’s constant game of catch up reached breast reconstruction, too…but you’d be wrong. “People in this province have a rare opportunity in having access to this procedure”, says Buchel. “Across North America (according to some sources) only about 20 per cent of patients who want immediate reconstruction can get it. In this province, it’s 90 per cent.” That revelation is just the thin end of the wedge, because Dr. Buchel and his team are of a mind to make HSC something akin to the Mayo of the North. More than that, this guy—who by his own admission is “a little wacky”—sees no reason why, before long, everyone from the no-seniority nurse to the top surgical talent in Canada shouldn’t be saying to themselves, “I want to work there because they do good things. It’s fun to go to work in an environment that allows me to flourish in my chosen profession.”

That’s right, Dr. Ed Buchel and his colleagues are taking on no less than the all-mighty Manitoba “brain drain,” and you’d be surprised at their progress in the three short years since Buchel left the Arizona sun behind.

In 1998, according to numbers provided by the College of Physicians and Surgeons of Manitoba (CPSM), the total number of registered doctors in the province was 2016. This year the number is 2272, or just over 13 per cent more.

Why the gain? Dr. Bill Pope, Registrar and CEO of the CPSM cites “a big increase in the resources being offered by the HSC and the University of Manitoba…(including) the new intensive care unit at HSC and the new neurosurgery gamma knife which will make that a leading unit (in the country). The fact that those kinds of things are being both approved and supported in Manitoba is really exciting.” On the teaching front, there is the new Clinical Skills Teaching and Assessment Unit being built at HSC, which will include the latest audiovisual and computer technology and advanced patient simulators (including trained actors portraying patients), and fully-equipped exam rooms. “It’s based on stuff that is being done at the Mayo Clinic, and also at the medical school in Tel Aviv where the simulation centre has an emergency room that can simulate a bomb blast and actually fills with smoke,” explains Pope. “That’s the kind of facility that we’ll have here (tailored, of course, to more local scenarios).”

The impetus for all of this is a brain trust that includes the “very supportive” president of the university, Emöke Szathmáry. However, the real key players here, says Pope, are Dr. James Sandham, the med school dean, Dr. Brian Postl of the Winnipeg Regional Health Authority, and Dr. Brock Wright, COO of HSC. “The dean, particularly, came into his position a few years ago with enormous energy, and he’s really pushed the simulation centre and the research centre,” says Pope. Add Dr. Buchel to that mix and you’ve got a perfect storm of energy and—equally key—a “buy-in,” as Buchel calls it, by administration to push for the changes needed to halt and reverse the brain drain and move things toward Buchel’s vision: Winnipeg as professional destination for doctors.

Agree with Buchel on that “wacky” thing? Well don’t look now, but the pendulum just moved. “There are now five key members to the group that we’ve recruited back: Dr. Tom Hayakawa, Dr. Lonnie Ross, Dr. Sarvesh Logsetty, Dr. Stephanie Olivier, and myself,” explains Buchel. “Doctors Hayakawa and Ross are Winnipeggers who have come back to practice here like I did. Dr. Logsetty is one of only five burn specialists of his particular discipline in Canada, and we recruited him out of Edmonton, and Dr. Olivier came here originally on a three-month placement to learn the breast reconstruction procedure and decided to stay. She left a job at a teaching centre in Montreal, and her family, to come and work in Winnipeg. She has said, I don’t care how much you pay me. I like working here every day, and I like these people. The other issue (for her) is that right now, the working environment is so antagonistic in Quebec between the health system and government that doctors are choosing to leave. My feeling on that is: Great. I’ll take the best of those people, bring them here, and we’ll develop a cool place to work. If we’re going to put in 12 hours a day, it damn well had better be fun, and fun for a surgeon who has spent 15 or 20 years getting an education is getting to do what he or she has trained to do. It’s a wonderful, satisfying feeling to know that you didn’t waste two decades.”

Believe it or not, that feeling isn’t uncommon, and historically is part of the problem that has led to Manitoba’s brain drain, although Buchel says it’s endemic to the Canadian system. “It’s very difficult to accomplish what you thought you were going to accomplish when you were a med student,” says Buchel. “You (think) you are going to help people, but after five years in practice, you’re saying ‘Damn, I’m good at filling out forms and dealing with cancelled cases, and figuring out where I’m going to operate, and answering the fifth complaint letter from a patient who hasn’t been operated on because I don’t have operating time. It is completely destructive to not allow people to do what they are trained to do. The single most important thing is under-funding the system to the point that you do not allow your professionals to feel that they are delivering the care that they were trained to do...Tons of people will do it for less money and do it in Winnipeg. It’s not a terrible place to live, if you just make work okay.”

Dr. Pope of CPSM agrees. “We (need to) provide physicians with other staff so that they don’t have to be on call every other night, for example, but so that they can have time to actually rest in between cases to think about things, to have others to do some of the busy work for them so that family physicians don’t have to spend three hours every night filling out forms.” To that end, the U of M is developing a Physician’s Assistant program, modeled on one used for many years in the U.S., to create a support staff for doctors. “Those are the kinds of things that will allow us to retain physicians”, says Pope.

That, and a growing reputation for excellence. “At the last Canadian meetings, we had 17 publications presented”, says Dr. Buchel. “Fifty per cent of all of the microsurgery reconstruction papers…were out of Winnipeg. For three years in a row, we’ve been the most dominant producer of microsurgical research in Canada. That gets noticed, so you have program directors from Vancouver and Toronto and other large centres coming to Winnipeg.”

You read that right.

So here is Dr. Ed Buchel, in Winnipeg, doing what he loves to do…exactly what he was doing in one of the most beautiful cities in the U.S. What, then, after being unsuccessfully chased for a couple of years by Winnipeg’s medical powers, really brought Buchel back? “Things started to change at home here to the point where I started considering it, and I finally called them back to talk. We made the decision for our kids and for ourselves and our parents,” he says. “Moving back was the right thing to do.”

There you have it. Good Winnipeg boy. When it came right down to it, he was able to see through that rippling mirage of prestige, money and that house on the mountain in the Arizona desert to what was real: his family needed him here at home with them in their advancing years. Good on ya, doc.

But wait. Couldn’t he bring his parents to the desert? As a matter of fact, Buchel says the Mayo Clinic offered to move his family down there; even offered to buy them a house in Phoenix. Yet, here he is, proving that what he came back to is bigger than everything The Mayo Clinic and a desert oasis had to offer. “I wasn’t going to come back if it was going to be torture,” he says. “What brought me back was the vision that Dr. Louis Oppenheimer”—head of surgery at the time, and a man Buchel calls “a wonderful visionary at the WRHA”—wanted to develop: to bring people back who had energy and passion, who could form a core group of people who wanted to build something that they are proud of.

“The nice thing is that the government has bought in and our reimbursement has gone up significantly,” says Buchel. “But on top of that, the work environment is what is driving people to come here and to stay here; what moved a burn surgeon to leave a practice in Edmonton and take a pay cut to work here; what moved somebody who doesn’t speak the language and who has never been out of Quebec to leave home to want to work here. I love this team that is being developed. Everybody buys into the concept: No, we’re not just going to be okay at this. We’re going to do this better than anyone else. It’s not a case of, (defeated tone) ‘We’re in Winnipeg.’ It’s now, ‘Hey, we’re in Winnipeg, and everyone knows we’re in Winnipeg, and here’s what we do.’”

The doctor is in.