E91 Rick Buckley on How to Age and Retire Gracefully in Surgery

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Rick Buckley  00:00

I think a lot of doctors think that they’re Superman and this, you know, superhero complex, they can’t live without being a doctor because in fact, that’s what their whole life has strived to become – is a doc – and they really don’t want to give it up when in fact, if they were to be tested critically, they’re not nearly as good as they think they are.

Chad Ball  00:31

Welcome to the Cold Steel surgical podcast with your hosts Ameer Farooq, and Chad Ball. We’ve had the absolute privilege of chatting with some amazing Canadian as well as international guests over the past year. While the topics have been broad in range, whether clinical, social or political, our aims for the podcast continue to remain the same. We hope to inspire discussion, creativity, scholarly research, and career development in all Canadian surgeons. We hope you enjoy our second season as we continue to highlight some incredible guests, deliver detailed masterclass sessions on a myriad of clinical topics and introduce some fresh new features such as debate and companion formats. We hope you relish the podcast as much as we do.

Ameer Farooq  01:14

In this episode we are joined by Dr. Richard Buckley. Dr. Buckley is an orthopedic surgeon at the Foothills Medical Centre in Calgary, and he has had an amazingly productive career with more than 30 years of clinical practice and hundreds of publications. Most importantly, however, Dr. Buckley has really pushed surgeons, particularly in Calgary, and across Canada, to think beyond received wisdoms, and critically examine how we treat patients, and how we organize our systems. We get a taste of his unique insights on topics from resident call to his orthopedic textbook. And finally, his thoughts on how to age and retire gracefully from a life in surgery. Dr. Buckley, thank you so much for joining us today on Cold Steel. Where did you grow up? And what was your training pathway?

Rick Buckley  02:19

Well, I’m actually sitting right now on the family farm where I grew up just about 10 miles west of Calgary and went to school out in my little country school and then decided it was time to get an education. And so, I was the first kid in my family to go to college. I went to a little college called Camrose Lutheran College for my first year and was lucky enough to play basketball up there. That was kind of something that was a real sideline and work hard to keep my marks up, then came back to university and then it’s all history. I just stayed at home until I went away for fellowship.

Chad Ball  03:04

Where did you do your fellowship, Dr. Buckley?

Rick Buckley  03:07

Well, I didn’t have a clue. When I was in my fourth year, everybody else was applying to different things. And so, I just thought, well, I like trauma. So, I got what’s called an AO fellowship, which is a lovely opportunity to travel to different and faraway places. I went to Switzerland for six months. And I worked at the base of a ski complex in a small town called “Visp” – V-I-S-P. And then a couple months in Geneva after that. And then I went to Vancouver for a year of Orthopedic trauma. So, I was pretty lucky I made some good choices with those and had some good mentors.

Chad Ball  03:49

I mean, it’s interesting, it’s probably a little bit of a chicken or the egg. But when I think of the quintessential orthopedic trauma surgeon in Canada, I think of you. And your personality seems to meet or merge with that so well, almost stereotypically, but I’m curious what pulled you into doing trauma orthopedics as opposed to the myriad of other choices?

Rick Buckley  04:11

Well trauma is something that it’s always exciting to get up for. I guess I’m a little bit of an adrenaline junkie, and I didn’t really hit it off with doing total joints over and over again. And I really couldn’t imagine, you know, doing knee scope after knee scope. And I mean, that’s not all of orthopedics. orthopedics is pretty big and broad. But when I thought about how fun trauma was, it was obvious to me and when I did my fellowship, I really had good mentors that kind of excited me and then Chad, you know, I was so lucky to start some research and find out that despite the fact that I thought I didn’t like it, I actually really, really, really liked it. And that’s what pushed me to, you know, be involved as really an academic traumatologist. And really what has been the focus of my career because I’ve upgraded lots, I really don’t need to do that, but the research never is tiring for me.

Ameer Farooq  05:10

One of the things that has always resonated with me and something that you brought up a lot, which I think is perhaps a bit counterculture or a bit iconoclastic of you, and sort of your views on call. And, you know, while many of our senior colleagues kind of talk about, you know, I did this much call and, therefore, you guys should do that this much call as well, you’ve always kind of been a proponent of actually, if I understand correctly, of actually trying to limit the amount of call that residents do. And I distinctly remember you saying things like, Well, you know, how much does call actually contribute to residents education? What are your thoughts on call for residents going forward? And how do you think we can sort of sort this out going forward?

Rick Buckley  05:57

Well, it’s a really good question and one that I think we’ll all grow through as we learn more and more. Patients need coverage at nighttime, there’s no question. So, call is important. However, residents in their time of learning, it’s a real short time period, you know, it’s only a certain number of years doing a certain amount of time in different areas. And to think of being tired a day after you’ve been up all night dealing with frivolous things. And I use the term frivolous. I mean, there’s some interesting things happen at night, especially in trauma. But so often, you’ll go through four or five, six nights without much you know, of interest, and maybe even lose the next day, or perchance get sick, when, you know, it’d be better off if you maybe worked in evening shift and went home at midnight, or one, and then got up at seven and had a good day the next day. And I really believe this, and you know, my time as a program director taught me this, because it’s a limited time, you have to train and you want every single hour to count and wasted time in the middle of the night where you’re up walking the halls and not really getting much out of it. I think it’s too bad we have a system that’s based on that.

Ameer Farooq  07:19

Now, I wonder if some of this is driven by sort of the different practice patterns of orthopedics versus general surgery? Do you think that, you know, the amounts that trainees get out of their call depends a lot on what specialty they’re in? Or do you see that sort of being a broad issue that applies to multiple surgical specialties?

Rick Buckley  07:39

Well, no, I think it is applicable to all parts of medicine. I mean, if you think about obstetrics, it seems, all the babies are delivered between midnight and six in the morning. At least that’s what I remember. And so, you have to do some time at night. In fact, I think orthopedics is probably the busiest between about 4 in the evening, and one or two in the morning. But then really, there’s not much happens in orthopedics after that. You know, general surgery, yeah, things can happen. trauma, in other words, bowel obstructions, and appendicitis. But my goodness, we should be able to take a certain period of time between about one or two in the morning and about six or seven in the morning and say, look, this is pretty sacred for sleep, to get recharged to stay healthy, because boy getting sick is just not fun, and you miss your time, and you don’t feel good. And I know if I’m not feeling good, then I’m short. And I’m snappy. And I don’t do a good job of practicing medicine.

Ameer Farooq  08:39

I can, as having spent many, many nights as a resident up at those times, sometimes doing things that I didn’t consider very important to my education, I totally agree with you. But had the counter argument that we always hear is, you know, when you’re a faculty surgeon, or a staff surgeon, you’re going to be out there, perhaps in the community, having to deal with these things up all night operating and then having to deal with your elective list or clinical lists the next day. And part of residency training is sort of preparing you mentally and sort of emotionally and physically for that challenge. How do you respond to those criticisms, or push back?

Rick Buckley  09:22

Well, I have to say, I disagree with you Ameer. What’s going on in orthopedic trauma is when we didn’t have any daytime trauma rooms, we had to work through the evening and often through the night. And we just thought not through good research, but we thought that we were providing better care when we were doing open fractures and some things through the middle of the night. But it’s virtually been proven with randomized controlled trials and much larger clinical studies that there’s very few things should be operated on after midnight. In fact, there’s just been a study on hip fractures, it was called hip attack. And it basically said that we always think, oh, we get these little old hip fractures to the OR, well, let’s do them all within six hours. And in fact, it made no difference whether it was six hours, or we’d like to get them done before 24 hours. And so, there’s virtually nothing now except the patient in Extremis, that needs an orthopedic consult in the middle of the night. That maybe, and compartment syndrome. You know, things like flesh eating disease, yes, we team up with plastics, but there’s so few things, open fractures, except in the mangled limb, again, don’t need care for the surgeon in the middle of the night. And so, we’re left with a very short list Ameer that has to be operated on. And we’ve actually determined that list through better and more efficacious studies. We’ve proven that we don’t need to be up. And so, the trauma room is what’s helped us. And I’m hoping other areas in medicine and surgery will lead that way too with good studies.

Ameer Farooq  11:01

I think you’ve raised a really important point that a lot of perhaps the trials and tribulations that we experience as surgeons is largely self-inflicted. And if you can reorganize things better such that, you know, these emergency things perhaps don’t need to be done in the middle of the night? You know, I mean, I’ll talk about the Foothills, the fact that we still don’t have an acute care room for general surgery means that we often are having to do these cases in the middle of the night. So, I think you’re right, that a lot of things that we have to deal with are self-inflicted and could be fixed with better research and better systems. I did also want to shift gears a little bit and talk about one of the textbooks that you’re involved with. And it’s one of my favorite textbooks in medicine and surgery in general. I’m talking about your textbook, the surgical exposures in orthopedic surgery. And what I really like about this textbook is how it kind of shows an approach to different operations as opposed to you know, this is step one till 10 of how to do X Y Z operation. How did you get involved with this textbook?

Rick Buckley  12:15

Pure luck, absolute pure luck. So the original pair of Stanley Hoppenfeld and Piet De Boer, were a team of a Britisher from York and a New York spine surgeon. And they teamed up with a medical artist by the name of Hugh Thomas. And I had met Piet De Boet at a conference, and he liked the way I talked. And we got to know each other over about five or six years. And one day walking along the street, going back to our hotel after a long day of conference, he said to me, you know, Stanley is getting kind of old, would you like to do the approaches textbook with me? And so, I said, wow, that’s a huge honor. Because it’s multinational. It’s in about eight languages. It’s a huge medical bestseller. And so, I started helping and in fact, during this last COVID break between March and June, we were able to put together the next edition. And it’s right now just being copy edited, so that it’ll come out hopefully next spring.

Ameer Farooq  13:31

What has that experience been like, being involved in a textbook like this?

Rick Buckley  13:34

Well, it’s hugely educational. You know, when I was taking orthopedics, as a resident, we didn’t have what are called surgical approaches. We had surgeons who knew how to get to a place and when I’m talking about a place, orthopedics is about half the body, when you think about the surface area and the true guts of the MS case system, which are the bones and to get there, you need to get there safely. Well, these surgeons would just know, this is what I was taught so this is how we go there. So there is such a thing as a safe surgical approach, who’s an inter muscular, inter nervous plane. And so the whole textbook is built on inter nervous inter muscular planes that we can approach safely. Always to protect nerves, always to protect vessels. And that’s what made it a medical bestseller because it allows people worldwide to get to certain spots on the body. And we basically covered every single anatomic location and the part that the bones are involved with, especially for fixation or tumors. And we can get there. So for me, it’s been educational, I’ve been able to keep up with my writing, I’ve been able to, you know, become much more learned with my anatomy, and it’s been a huge focus for me. Plus, we’ve now added a number of videos which we’ve had to demonstrate our prowess at surgical dissecting on the videos. So these are part of the new text.

Chad Ball  15:03

Dr. Buckley, if we switch gears a little bit again, you know, you were clearly one of the very earliest members and real potentiators of the Canadian orthopedic trauma society. I’m curious for the listeners and for us as well, how that got started, what it looked like initially, because, you know, certainly, and I bring this stuff often on the general surgery, emergency general surgery side of things nationally, you know, the Canadian orthopedic trauma society, as well as the critical care trials collaborative, are the two groups that have done some incredible work. The clavicle study, of course, would be just one of them. So how did that evolve? And I’m particularly curious how you were so productive as a national collective on the research side of things.

Rick Buckley  15:48

Well, Chad, that one could be talked about for about an hour, but I’ll give you a Coles notes version here. I was lucky during my fellowship to take six weeks and go down to McGill and take a course in epidemiology and statistics and ethics. And so when I finished my fellowship, I came back to Calgary, really quite interested in research because I’d spent time as a resident, I did one good prospective randomized trial as a resident. And it was obvious to me. When I came back, Nick Metodi, was back just a year ahead of me. And the two of us really thought that randomized control trials were the way to go and Si Frank was around and excited about these. And I had a number of Canadian colleagues, and I’ll name the people at the time, Bob McCormack from New Westminster, Bob Meek in Vancouver, Ross Leighton out in Halifax, and Bob Galpin, who was an orthopedic surgeon in London, Ontario. We got together and in about 1991 said, look, we need to do some prospective trials. And let’s start with this calcaneal study how about we do operative versus non operative care of calcaneal. It had never been done. It can’t be done elsewhere, because everybody thinks you need to operate on it. And so off we went. And it was so successful that it was almost like when we presented it to the Americans in a meeting in the mid-90s, you could almost hear the gasps when they were seeing us with a cohort that was ethically attained, willingly saying oh no, I’ll go without surgery and another group that was willingly operated upon, and then we end up with having had almost 450 calcaneal fractures equally spread between the two with a randomized trial. We ended up with no difference between the groups. And the Americans, just their jaws dropped. And it truly opened things up. And we as Canadians could say, look, we can do these studies to prove one way or another whether things make a difference. I got a little bit of funding from the workers compensation group actually. And that’s a group that is really keen on things because they deal with hundreds of injured workers, and they have quite a bit of research money. And that’s what got me started. And then after that, our group has put together about 20 good, randomized control trials. And one of our biggest and best things we’ve ever done was we helped spawn Mo Bhandari and his clinical trials unit out of McMaster who has now you know, surpassed the COTS group with what he’s done with his multi center and international randomized control trials obtaining 1000s of patients. And so Canada has really shown in orthopedics to be a world leader and COTS kind of started things off. And it’s one of my proudest moments for sure is to be a originator of COTS. That was fun.

Chad Ball  18:58

Yeah, I mean, you know, the Canadian Orthopedic Society in general in the community owes you a great thank you for all of that vision. You know, I say it often and Ameer will attest to this to the general surgery trainees, that we have the ability in this country in Canada to do studies that you simply can’t do in the United States. Part of that is collaboration, friendliness, and the social nature, I think across these small groups, you know, nationally. But you know, things like implied consent or delayed consent for emergency general surgery or trauma patients, you simply can’t do that in most of the US. Population base captures in many of our provincial registries, again, you simply can’t do that in the US. So we’re very, very lucky. And you guys certainly lead the way on the surgical side to show us all that. So thank you.

Rick Buckley  19:46

Well, it’s interesting, Chad. It’s exactly like you say, you know, we’ve named ourselves the Canadian Orthopedic Trauma Society, but really what we are is the collaborative orthopedic trauma society. We’ll often get together at our meetings, and we’ll hash out new projects. And if it isn’t for collaboration where someone will say, okay, I’ll let Joe do that study. But now you got to do mine. And we all agree that Oh, yeah, that study has to be done too. And we give and we take on various things. And pretty soon we come up with some really excellent studies that make a difference. A lot of studies are done, and they really don’t affect patient care much. But when you take on simple problems that have never been answered and obtain some grant money, people really respect you. And so yeah, it’s something we’re proud of. And now, whether you know it or not Chad and Ameer, there’s the orthopedic trauma society out of Britain, and there’s something called Metric down in the States, and most of their money comes in department of defense in the US. And they’ve started to come up with some big studies that can compete with ours. So, you know, we’ve got competition now, which is good.

Chad Ball  20:51

Once again, it’s all because of you guys. So thank you. We wanted to take a bit of a left turn here and chat with you about retiring. Retiring as a surgeon or transitioning out or whatever sort of language that folks are maybe least sensitive about, really is what we’re talking about. And you know, I was saying before we started recording that I’ve had the privilege of listening to you talk about this many times, you know, anecdotally and outside the operating room, and you always had such great advice. And I know it’s something that you’re very passionate about, you’ve been writing about, and you’ve been talking about. So can you frame retirement for a surgeon, maybe how we should think about it and how your personal process has gone?

Rick Buckley  21:36

Well, I always talked about working hard and playing hard and sleeping hard. My wife always gave me a hard time about sleeping hard, but because I was working hard, boy, I needed my sleep. And so I had said that well by 55, freedom 55, I was going to use that term, and I can’t remember which company had talked about that or which money institution talked about freedom 55 if you invest with them, but I said look, I can do this. And because I started pretty young as a resident and then staff guy, you know, I’ve been doing call, by the time I was 55, I’d done 30 years of one in three call because when I came back, I was doing trauma call one and three. I didn’t make freedom 55. But by 56 and a half, I basically had and I gave my practice away. My practice was based on trauma days, and I was operating with 10 days – 10 days a month. And I gave that up to two young aspiring surgeons who I’m so proud of who are still at the Foothills with me. And I decided to live on two days a month and continue and finish the research I had going. And I think it was just because I was seeing young people who didn’t have a job and we weren’t going to be able to make room for them unless they had time. I could give them time. I could get the advantage of their young healthy bodies and excited young souls, then I could start my my own plan of a little more fitness, a little more sleep and a little more time to myself and with my wife. And it’s worked out beautifully. When I think about my talk coming up, it’s basically in a couple parts; one showing that in fact, you peak as a surgeon between 45 and 50. And after 50 it’s walking downhill in many ways: physiologically, mentally, socially, you just don’t have the same ability. And when you add it all up, it can be added up. And certainly we’ve got some studies now that show we don’t do as well. Now, in certain operations, we can do well. But it’s basically because of experience and your choices that you make. It’s not because of your physical skill or because of your physical abilities. And so my decision was one that I’ve got the farm, I’m still living on the farm, and I’ve got lots of things to do. And you have to be prepared to fill your day with lots of things because as a surgeon, you’re used to being active, you know, sometimes 18 hours a day with work and play and family. And so suddenly when you take a bunch of surgery days away and patient clinic days away, you’ve got lots of time to spend. So you have to kind of retool, reboot, refocus on things that are exciting for you. And certainly with me, it’s fitness and it’s other community things. It’s new sets of friends that I’ve made. These are just important things that you need to do to be successful. And of course it keeps your brain working and that’s good for all of us.

Ameer Farooq  25:01

It’s remarkably thoughtful and insightful for you to, number one, have this plan in your head that, you know, freedom 55, I’m going to set a date, and I’m going to try to meet that date. And then also, that you would recognize that there’s a big problem for trainees getting a job. And you lead by example, and made way for people so that they could do that. And I think that, again, shows your vision and insight. I did want to pick up on one thing that you talked about a bit about sort of the decline of surgeons as they get older. And we just had a great discussion among some of the surgeons on our new companion format that’s going to accompany the podcast. And we talked about an article that was published in the CMAJ that talked about age of surgeon and post-operative outcomes where they actually showed that the age of the surgeon as it increased, was associated with better post-operative outcomes. And you sort of alluded to it a little bit by saying, you know, it’s your experience and your case selection.

Rick Buckley  26:07

Ameer, it’s the only paper out there that shows they do better. I can’t find another paper.

Ameer Farooq  26:12

So what do you think they’re maybe highlighting that other papers are missing?

Rick Buckley  26:18

The ability to make choices gets better, because we have more experience. But our ability to keep up with what’s called plasticity or innovative changes, so we can make good experiential choices. But our ability to be innovative when it comes to a clinical problem really diminishes after about 45. And so, if you’re provided with a very difficult problem that you’ve not seen before, often, as you get older, you don’t have that plasticity in your brain to come up with an innovative solution. And I think back on some of the tough problems I had when I was in my early 40s. And geez, I got through most problems satisfactorily, at least I thought I did. But I think that’s because you have that ability, as you get older, you just don’t have that. Now, that’s on top of the fact that your eyes aren’t as good, your hands aren’t as quick, often people develop strength issues. And that’s certainly a problem. You don’t have the staying power with long surgical procedures. There’s one paper out that talks about after 50, it doesn’t matter what profession you’re in, on average, you only have 10 good years left of work. And doesn’t matter what profession. And that’s simply because after 50, if it’s not your medical health, it could be your eyes or your gut or your physical strength, or the fact you’re on multiple medications. And so really, when you think here, I am now 62. And I’m still able to work a bit. I have, you know, pretty good day here at home often doing some papers and teaching. But I’ve had my 10 years after 50 already. And so I feel pretty lucky that I’m still going. And I think a lot of doctors think that they’re Superman, and this, you know, superhero complex, they can’t live without being a doctor because in fact, that’s what their whole life has strived to become – as a doc. And they really don’t want to give it up when in fact, if they were to be tested critically, they’re not nearly as good as they think they are.

Chad Ball  28:29

It’s so interesting that you brought up Freedom 55 Financial, I think which was the company. I remember my dad talking about that. And I’ll tell you without naming names that some of your contemporaries, a small handful of them across Calgary within general surgery used to reference that a lot. And then sitting back, you know, coming through as a trainee and then leaving for a fellowship and coming back. I watched them blow through 55 now well into their, you know, early to mid-60s still working away. And I wouldn’t imply you know, someone else’s frame of mind or someone else’s experience. But it does make me think a little bit about some of the examples certainly that we’ve all seen over our careers or times training of maybe surgeons were you know, as you’re implying, retiring too late, or at least transitioning poorly. I’m curious, how do you how do you help that surgeon through that process? Because I think you’re sort of the guy having thought about this and being such an articulate teacher, maybe to provide some solutions. But like, when do you start thinking about retiring? How do you set up for it? And what do you do with the person who absolutely doesn’t want to go at the administrative level?

Rick Buckley  29:51

Yeah, those are all tough problems. And so to answer one very simply, you start thinking of retirement with your first paycheck. And you know, we have to be good with our finances, that’s absolutely crucial. And there’s a saying out there that says a doctor and his money is soon parted. And it’s because you collect information from the doctor’s lounge about this financial opportunity, and then it goes belly up, and then you hear about the car dealership on the corner and how they need some money, I know you can partake in that opportunity. And that goes belly up. Doctors don’t do well with their money. We’re doctors and we should let our money work for itself with somebody who, you know, spends time building cash value, not with us trying to fiddle with it, that’s the first thing. Secondly, is when you have docs who aren’t looking logistically forward to see what their future is going to be, it’s really important. And no one fits the same pathway. But I think you’d have to make sure that as surgeons get older, they take their case set that they do and what they’re good at, they should continue on with. But the difficulty in the cases that they’re involved with probably should be lessened. Their night call should be lessened. They just don’t do as well with tough cases and long cases. Those that are involved have other ways to give. And that can be in teaching and research. And I’ve certainly found this and would probably, I feel personally that I’m probably a better teacher now than I was in the past. I have more skills with dragging out different tools to help students learn and different ways that I can be a better teacher. And so as you get older, I think that is underutilized. But there’s a personality of docs out there that some of them, that’s all they’ve lived for is to be a doc. And it’s one of the biggest hits that retirement places on some people. And you know, doctors have a high rate of suicide among doctors. Anesthetists are first and veterinarians actually are quite high as well. But surgeons are right in there behind the anesthetist with suicide rates. And a lot of it’s because as soon as you take away that clinical image of Dr. Buckley’s no longer a doc, you know, he’s no longer a surgeon, if I don’t have something else that I can grab on to or some other platform that can, you know, stand with me and underneath me that makes me feel useful, there’s a real problem. Because we stand on one of the biggest pillars as surgeons of any professional group. And some people, that’s what keeps them going. So, it’s really important that we have other things to fall back on. And I’ve been very lucky to have lots of different things to fall back on. So surgery has kind of become less important. And to me, that’s just fine. I’ve enjoyed so many other parts of my life.

Chad Ball  32:51

I’m so glad that you brought up the teaching aspect, you know, as we become more senior, and maybe move into retirement. And we’ve talked about that a fair bit with a number of guests and sort of my impression both in the literature recently, as well as anecdotally, you know, as I move through kind of mid-career here is that we dramatically and drastically underutilized senior surgeons towards the end of their, you know, towards retirement or after retirement in terms of education of our trainees. They seem to have the experience, the mindset, the ability to communicate the time to do it, rather than running around the hospital on call trying to do all these cases. And you know, it becomes a secondary thought after patient care. How do we maybe in Calgary or elsewhere, create a system where that’s invited and prescribed and really cherished? Because I don’t get the impression that we do that now outside of a small handful of folks like yourself?

Rick Buckley  33:55

Well, Chad again, tough problem. And I think you have to stand up for yourself a little bit. Because when you’re young, you need OR time. You need cases, you need to make a living. The young students, the residents, they want to be with you when you’re young, because you’re new, you’re hot, you’ve got all this stuff. Plus, you actually get along with your students because you’re almost in the same peer group. When you get to the middle of career like you are now, yeah, you’re popular because you’re top of your game and you have lots and lots of knowledge and you’re the one being asked to go, you know, to national, international conferences. But as you get older, you start to lose that cool factor with the residents and so some of it, it’s a two-way street. Sometimes the residents don’t necessarily want to spend as much time with you despite the fact you’ve got oodles and oodles of experience. You may not be the one who’s right on top of their research. Because some people they get a little bit out of date. But they have core knowledge and that’s this experiential knowledge I was talking about – experiential thinking. The innovative thinking that comes from being young is well, you’re still able to be quite plastic in your thoughts. Us old guys, we really teach on principles. And that’s what young people need. So as far as how to do it, I would think that we need more time spent, you know, being a mentor is a real cool thing. And I think I’ve been a pretty good mentor to some of my young orthopedic trauma colleagues. That’s one way to do it. Another way is that I spend a lot of time with the residents outside of medicine. So every year I take the orthopedic residents down to my cabin in Whitefish for a ski weekend, and one for a water ski weekend. So we have two different weekends. So this year, it’s been off with the COVID. But I have about a 20-year history now of taking them down and showing them that you know, even though you’re an old guy, you can have fun on the ski hill doing something completely different than medicine. Even though you’re an old guy, you can take them out on the water and kick their butt waterskiing, or wakeboarding or whatever they want to do, which I still can do. And it’s so fun to be with them in other ways. And so there’s the other side of medicine that shows them that you actually have a life outside of medicine, you need to develop other things. And you can be somebody who’s an educator or a researcher, a clinician, but you’re also a person who somebody can look up to because you’ve got another side to yourself, rather than just your hospital site.

Chad Ball  36:34

Yeah, that’s such sage advice, you know, for the listeners who of course, probably wouldn’t know your Whitefish, as well as your branding party, essentially, you know, on your family’s Ranch there is stuff of legends. And it’s something that, you know, I’ve seen orthopedic graduates that you’ve had talk about, honestly, decades later, a couple of decades later now. So you’re exactly right. And, you know, it’s been a learning process for me personally, because that’s in my life, something that I don’t really show very much at work, the other stuff that I do with my kids at the lake, and so on. And so I’m still trying to get better at that for sure. On the social side, I wanted to transition maybe lastly into your family. You know, I’ve had the pleasure of hanging out with one of your sons on the trauma service, when he came as a medical student in terms of rotation, and he is just, Andrew’s a tremendous young man. Really, in all aspects of that word. It was an absolute pleasure. And I know Ameer knows him as well. And just a great guy. You and your wife have clearly been star parents, and I know you’re gonna defer in your usual humble way. But as a guy who tries to balance three kids and my job and you know, Ameer, his training and his kids and his wife and his family. How did you do that? Question one. Question two is, how do you view your role as a parent? Where does that come in terms of how you think of your day? And really, how did you harmonize all of that? Because from the outside it, you know, it looked tremendous.

Rick Buckley  38:15

Well, that’s, I guess what you’d kind of call the heart, isn’t it? That’s where you live. Well, I think Whitefish was a big part of our life. Because when my oldest daughter was two, we bought the place down there. And we made a commitment to ourselves that we’d get 20 ski days. And that was in the winter. And then we get another 20 ski days in the summer. So we had 40 ski days. And that was something that, you know, we’d spend so much time in the car talking with kids and my wife, and then when you get down there, you’re completely away from medicine. So you’ve got the chance to really get recharged, to get rebooted, to have a fresh look. And orthopedic trauma kind of played into that because it’s one area of practice where we have to work as a team, we pass our patients off to the next person who’s on call, whether it be a weekend or a long weekend or a week of holidays, and we leave and you know, some people have never bought into that as surgeons or clinicians. They look after everything themselves and I’m convinced that will kill you as a person inside and out because your family never sees you getting a break. So that’s the first thing: is we put time aside always for holidays and for time away for us. You know, I was always involved in my daughter who was a skier, and I was always involved with my son who was a football player and he went all the way through the ranks with his high school, university and then his pro career with the stampeders. And that was just a dream come true for me because I played football as a university kid. I played my five years; one year basketball and four years of football at university and to see my kid go through and then get up to the level of playing pro, that was pretty special. And so we spent a lot of family time around football when traveling. We never missed a game. And that was important.

Chad Ball  40:25

Yeah, I mean, I can speak to that firsthand, having been a resident trainee on your service, on weekends. As well as being around you for many, many years. You always did make that a huge priority. You would bolt in between cases, you would schedule your day on a weekend to make that happen. That was clearly a priority. And it was something that I learned very early by watching you. And so I thank you for that.

Rick Buckley  40:51

Well, and Chad, you know, to add on to that, I’m still coaching high school football now. This year has been weird, because the poor kids, they haven’t been allowed within Alberta here to have games. We actually practice for six weeks out on the field. And so, they come out, all of us coaches, most of us community members, and the high school kids, and we’d play football for two hours and have fun. And, you know, I’m involved up with the senate at University of Calgary. And that’s allowed me to, you know, speak to the university athletes, to mentor a few, and to really help the university try to develop ways that they can better serve students. And a lot of it is through sport. Because it’s such a known fact that when you combine sport and academic checks, you do better than if you just take on one or the other. So, I think that’s a big part of your life is having other things that you contribute to, both as a community member and as somebody who has a larger community. Like the university community, I got back into the university rather than just being Foothills campus focused. That was really important.

Ameer Farooq  42:00

If you could go back in time and give yourself advice as a trainee. What would that advice be?

Rick Buckley  42:07

I kind of felt like trauma was fun. So, I went there. And then I kind of felt that this research bits fun. So, I went to McGill. And then I was lucky to be involved in Vancouver where I had really good mentors out there with the orthopedic trauma program in Vancouver. But I stumbled upon it. It wasn’t active decisions. And so, I guess I tell young people that they really should be active in trying to find something that really turns them on. But within medicine, you have to have a turn off switch, and then you have to have something that really turns you on outside medicine. Now, I’m convinced that everybody needs a family around them. And that’s a given. But you need something other than your family and other than your clinical medicine side because it’s just good for you. It’s healthy. And that combined with fitness, God don’t forget your fitness. That, when you combine all those things, you’ve got your family, your fitness, your work and your special things, you really got the full life. And so, I guess it’s to follow your heart in many ways, but to seek those things out. To get good at them so that you’ve got other things as you get older.

Ameer Farooq  43:24

You you’ve been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you’ve liked what you’ve been listening to, please leave us a review on iTunes. We’d love to hear your comments and feedback. So, feel free to email us at podcast.cjs@gmail.com, or connect with us on Twitter @CanJSurg. Thanks again.