E37 Premier Andrew Furey On Team Broken Earth, Advocacy, and Leadership

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Chad Ball  00:00

Welcome to Cold Steel, the Canadian Journal of Surgery Podcast, with your hosts Ameer Farooq and Chad Ball. The goal of the CJS podcast is threefold. The first is to highlight the best research currently being completed by Canadian surgeons. Second is to offer educational topics for both surgeons and trainees alike. And most importantly, the third goal is to inspire discussion, thoughts, creativity and career development in all Canadian surgeons. We hope you enjoy it.

Ameer Farooq  00:27

Surgeons often feel powerless to make change in the systems that we work in. But as Dr. Andrew Furey says in this episode of Cold Steel, the key to change is to just do it. Dr. Furey is an orthopedic surgeon at the Memorial University of Newfoundland. He’s also the new premier elect of the province of Newfoundland after winning the Liberal Party nomination on August 4, 2020. In this episode, we hear about how Dr. Furey started Team Broken Earth, a humanitarian organization, his work with Team Broken Earth in Haiti, and his thoughts on leadership and physician advocacy.

Chad Ball  01:26

Dr. Furey, thank you so much for coming on Cold Steel with us. We really appreciate you coming on, especially during these very uncertain times. I know many of our listeners will know you well. But for those who may not, can you tell us a bit about where you grew up? How you ended up in medicine and why orthopedic surgery? And what made you stay in Atlantic Canada as a faculty surgeon?

Andrew Furey  01:48

That’s pretty loaded question, multiple parts to that. But first, thanks for having me on. I grew up in St. John’s, Newfoundland. I actually did a fairly liberal undergrad degree, wasn’t sure what I wanted to do in life. Was drifting towards medicine, but come from a family of teachers and lawyers, and was also kind of keen on that. So I applied to both medical school and law school, got into both and then took the leap of faith into medicine. Decided to stay at home to study medicine. As I was doing my undergrad degree, I realized that I really enjoyed the surgical specialty pretty early on. Was attracted more to the anatomy then the physiology, so to speak. And from there, discovered that I was really keen on MSK. I’m not the typical orthopedic surgeon, I’m not the kind of jock who was on every sports team in high school like that. I never had really any exposure to orthopedics, but was really attracted to the biomechanics and the immediate difference you can make in someone’s life. You can see an X-ray, you could see the problem, you could articulate the problem, you knew what the problem was, and then you could articulate and execute on a solution and then see the fruits of your labor in short term. Seeing someone who was involved in a motor vehicle collision with a femur fracture, who was not able to walk in traction and then, 24 hours later, is walking on the ward, was pretty powerful for me. And that led me down the path of orthopedics. I was always attracted to the fracture side of orthopedics, even as a clerk and medical student and that continued orthopedics has a lot of incredible careers to offer. But I was really still attracted to the excitement of trauma. That led me to a fellowship in shock trauma in Maryland. Myself and my wife were living there and we had actually entertained taking a job there. I actually had taken the job and my wife came home one day and just said, this is too busy, it’s too crazy, we just had a baby. She said this is an incredibly dangerous city, there was a cop shot in our neighborhood and I was working all kinds of crazy hours. And she said, maybe it’s best if we move back to Newfoundland. And so we did. Set up shop here in Newfoundland in 2007. And even though she’s a come from away, I couldn’t get her away from here even if I tried.

Chad Ball  04:53

That’s awesome. Shock trauma is a really interesting place, eh? Both in the orthopedic side and the general surgery side. It’s incredibly unique.

Andrew Furey  05:02

I feel incredibly privileged to have experienced it, it is a truly special place for special people. Very humbled and honoured to have been able to be there for a year. It was truly, truly amazing.

Chad Ball  05:19

It’s amazing as Canadians, whether it’s orthopedics, general surgery, urology, whatever that is, heading down to the US to some of these incredibly high volume, unique and a little bit rough, as you point out, experiences. A lot of our country is, at least on the trauma side, injury side, is trained in the same way with similar experiences, it’s quite neat.

Andrew Furey  05:40

Yeah, and as you know, it’s a standard at the time, as soon as the band along the phones, the only standalone trauma facility in the whole country. So you had to meet a certain injury severity scale to get in through the doors. I still don’t think people believe me here, my local colleagues when I say I didn’t see an elderly hip fracture for a full year.

Chad Ball  06:06

Exactly.

Andrew Furey  06:07

I never saw any joint replacements. It was all young people who were involved in a trauma, had multiple injuries. I think I forgot that, towards the end of it, towards the end of the fellowship, I think I forgot that you could have a closed injury, you know? Everything was an open fracture. Everything. Everything’s an open fracture. I mean, an incredible place to live for a year, an incredible place to work, incredible people. Just the amount of experience you can get in a year is phenomenal.

Chad Ball  06:43

Yeah, it’s mind boggling. The list of those kind of jewels for all of us is short, but wow are they impressive. Andrew, one of the things that we all know you very well across the country for, is your tremendous, and the longevity and the intensity and the successes of of your interaction with global surgery. I guess the vehicle or the moniker that we mostly know is Broken Earth. I’m sure there’s others as well that you’ve been involved with, both in the past and present. But we’re curious, what prompted you to create Broken Earth over the years? Can you describe it to us? And in particular, I wondered what those initial days looked like when you were trying to set it up and trying to get it moving?

Andrew Furey  07:28

Sure, yeah. So the kind of serendipitous, or the different portion of this kind of adventure has been that, in medical school and residency, global health was never really on my tip. It wasn’t something that we grew up talking about at the dinner table. I had known some medical student friends who had gone to Uganda and other places. Look, I was their biggest cheerleader, but I never really thought that it was something that I would end up doing, or being a part of my life. And then, when we came back from this high powered fellowship with lots of traumas, still keen to try to find ways to keep that level of energy and adrenaline up, but never really found something. Then, fast forward a few years and the earthquake happens in Haiti and, sitting in my living room and watching the images coming in live of the collapsed buildings and the human despair and destruction, it kind of hit me that people were going to die, or had died, of general surgery injuries, neurosurgery injuries. But they weren’t necessarily going to die with orthopedic injuries and maybe I could find some way to help. So I volunteered initially then with a group other shock trauma to go down as a part of a crew of people operating in a partially collapsed hospital in downtown Port-au-Prince. And it was life changing. That’s the bottom line. Standing amongst all the rubble and this mass unity type of hospital. It was one of those moments where you either say, okay, check this off the list. I’ve been, there done that. Or been there, seen it. And there’s so much more to do, let’s try to do something bigger. So when I got home from that first experience, having never done anything like it before, I was fundamentally changed and I wanted to do more. Part of being a part of a team from the United States, mixed with all kinds of different people from all over, I felt that there was a way that we could improve on the efficiency of that model by just going with people that you know, and trust. Like anything, if you’re meeting with a group of people and you’re thrown into a chaotic situation. You still don’t know their names, you’re trying to remember where they’re from, you’re trying to figure out if you can trust them. Because as we all know, not everyone in medicine who says they can walk the walk, can. But I thought, I know my anesthesiologists here, I know my plastic surgeons here, I know my nurses here. Why can’t we just take a group of 30 of us or whatever, from Newfoundland and Labrador, and go to Port-au-Prince. Then I know I can trust them, I know what they can do. And that’s how the concept began. It really kind of started over a cup of coffee in the OR lounge with two guys asked me about the initial experience in Haiti and wondering if they could be involved if we ever decided to go back. And up until that point, I’d never really thought about really, truly, going back. Right after the trip, people started asking. And then I thought, well maybe we can put together this team. And this was only supposed to be a one off, it was supposed to be, okay, we’ll go down with one team. That’ll be Newfoundland and Labrador’s contribution to the relief effort in Haiti. And it was just a total fluke that we put a name on it called Team Broken Earth. Because I felt like people would want to feel like they were part of something and, just to say Team Newfoundland didn’t really make any sense. So we went down and with a team of 27, or 30 of us initially, I think. Operated out of a hospital in downtown Port-au-Prince in the red zone, one of the most violent areas in a violent city, and made a real difference to a lot of people. Started to build some relationships there. Really, on the plane ride home, I thought, oh, that’s pretty neat, we just did some cool stuff and we should all be proud of that. But I wonder if there’s anything else to this. And within minutes of landing, my Blackberry had just been totally lit up with nurses and doctors and physiotherapists. All saying that it was one of the best things they’ve ever done, they want to go back. And, when can we go back? And let’s go back. So there’s another epiphany moment of, well, maybe if Newfoundland and Labrador sends two teams once a year to Port-au-Prince, we could have a regular rotation. We can develop relationships, we can start to think about education, we can start to have a continuity of care and start to build a program. So that’s kind of how it started. Then believe it or not, the rest of it is a lot of word of mouth. Paul Duffy from Calgary, an orthopedic surgeon who I trained with, excellent guy. I consider him one of my best friends, even though there’s a geographic distance between us now. Here in Newfoundland, playing a hockey game. An annual general surgery versus orthopedic hockey game that we have here every year. Orthopedics, of course, has to win every year. We will fly people in, ringers like Paul, to make sure we win.

Chad Ball  13:37

I love it.

Andrew Furey  13:41

So we’re in a in a dressing room and chatting afterwards and Paul saw the Broken Earth emblem on the hockey bag and said, what’s that all about? And he said, well, I think we could do that in Calgary. Calgary was the first kind of jump off where, Newfoundland and Labrador, we’re only 500,000 people and everyone’s taking their vacation time. Two teams a year, that’s more than we could expect. But if everyone in Canada started to do a little bit, then all of a sudden you have a real program, real continuity of care, people offering different skill sets, building different relationships and building through capacity, in particular in Haiti.

Chad Ball  14:28

It’s interesting, I didn’t realize that the Calgary group was so early. Because when we went down, it felt like it was pretty well oiled. It felt like everything was smooth and there was no big hiccups, at least up-front. I didn’t realize that. I’m sure there must have been some pretty significant challenges for you. Setting it up, moving forward in particular maybe with the communication and the relationships on the ground and with the locals. Is that accurate?

Andrew Furey  14:59

Absolutely. The challenges, the hurdles, and the barriers that we’ve overcome, they seemed immense at the time. But it’s funny thinking about them now, they’re hard to remember. There was many, many, many crossroads,. Whether it’s the first trip, or the second or third. Where we kind of thought, you could have put your tools down and just said this is too hard. Oh, there’s no way we can overcome, I don’t know, travel insurance or the finances or whatever. We just kept pushing and initially, it became frustrating. But then you just accepted it, if you got over one hurdle, you knew there was going to be another one just around the corner and you try to deal with that as best you can and move forward. But initially, the relationship I think, I talk about Broken Earth a lot around the country and in the United States. And I think what makes us a bit different than some other organizations, with respect to Haiti in particular, is that we have committed to this one entity, and we built those relationships so that people can leverage what relationships we have built. I think if you were going to set up your own Broken Earth and call it something else, you would find the money, believe it or not. You would find people to do it with you. You would find a location that would take you. But the hurdle that is the most difficult to overcome, and it’s only because we’ve been at it for 10 years, is the relationship and the trust that’s just been built over time. That’s kind of the added value that we bring to the equation.

Chad Ball  16:51

Yeah, makes sense. You wrote a really great paper in the Canadian Journal of Surgery about the 2014 Haiti Orthopedic Trauma Symposium and the concept of legacy or of sustainability, of leaving maybe as much as you take from it, is something that you’ve talked about. It’s something that is ingrained in Broken Earth, I would say as a culture. Can you talk about that paper and what that goal, in terms of the conference, was, and your view of sustainability?

Andrew Furey  17:23

Sure. We’ve evolved from being entirely clinical, initially. And I think obviously that was what brought us there in the first place in terms of the earthquake. But then it became immediately evident that we needed to shift to an education component if we were going to make an impact long-term. Because you can treat one femur, but if you can teach someone how to treat multiple femurs, then that should be the ultimate goal. And the ultimate goal should be to work ourselves out of a job down there. So we quickly pivoted, as an example, as an orthopedic trauma symposium. And the symposium, we’ve done 5 times now in. We’ve been on hold for last year, initially, because of the political instability down there, and now because of COVID. But what it is, it’s a series of lectures put off by Canadian orthopedics and US orthopedic surgeons from across two countries. We bring as many orthopedic residents as we can in from around Haiti, including subsidizing their travel from up north and bringing them to Port-au-Prince. And we do a series of lectures, fracture care. Then there’s a series of labs that have saw bones, fake bones. Or we fly down hundreds of thousands of dollars worth of equipment. And then the residents are able to practice in the lab, about how putting plates and screws on bone, under the guidance of the Canadian and US surgeons. I mean, we always knew that it was building capacity and that it was the teaching people and that would be a true legacy. But I tell you that one of the most proudest moments for me in all of this was in the craziness of running one of these courses, the last course in particular that we ran. You see the guys and girls who were the junior residents on the first iteration of the course are now in PGY5 and they’re helping teach other residents at the table [inaudible]. And you know that you’ve really made a difference. That was a pretty cool, aha moment. Even though, hopefully you could have predicted it coming, you never know. But to see it firsthand was pretty special. And in terms of building capacity, we did do something good initially. A lot of what we’ve done is just by fluke. But as we started to grow, I felt that it was really important that we concentrate on what we wanted to accomplish and look inwards about what our core competencies want to be. Because you can imagine, as you start to grow, you can go off quick, all different directions pretty quickly. And it can get out of control pretty quickly. So we have always concentrated on clinical care, education, infrastructure and relationships. That’s what we want to build any team around. So in terms of building capacity, education is an incredible piece. Obviously, relationships are critical. Infrastructure is important as well. So we’ve built a new hospital down there, probably since you’ve been there. A new hospital wing within the confines of the space and the footprint of Bernard Mevs. It’s two stories, effectively doubles the capacity the hospital. I think that that’s a pretty cool legacy piece that, even if, for whatever reason, political instability, global pandemic, whatever, we’re never able to get back to Haiti ever again, the education that we’ve left, and the infrastructure that we’ve left them with is a pretty significant contribution to the Haitian healthcare system on behalf of all Canadians.

Ameer Farooq  21:43

Not only have you done a lot of work globally, particularly in Haiti, but clearly you have an eye locally and have been active in trying to understand the problems that affect Canadians. We wanted to highlight another of your papers in the Canadian Journal of Surgery, talking about the morbidity and mortality from pelvic rami fractures in elderly Atlantic Canadians. Traditionally, we don’t think of pelvic rami fractures as being a particularly morbid or serious injury. But your study highlighted how different that might be for an elderly population. Can you talk to us about your study? And how do you think we can prevent some of these injuries within our more vulnerable populations, particularly in the elderly?

Andrew Furey  22:35

Myself and Chris Hamilton, [inaudible] surgeon, he was a resident at the time. We’re chatting, I was his master supervisor and we were chatting about different projects. One thing that always struck me was, an elderly person falls from a standing height and one of two things happens, they either break their femoral neck or intertrochanteric hip, or they have a pelvic ring injury of some sort. Usually the pubic or Hema with some sacral injury in the back. But we totally ignore the pubic ring injury, but we fix every single hip fracture. Surely there is morbidity and mortality associated with the pubic ring and in the sacral fracture that we’re just ignoring or don’t understand, or hasn’t been a part of our treatment algorithms. So we looked at that. It definitely has an impact because if you don’t treat, the same as treating a hip fracture non operatively, to a certain extent, you’ve committed them to bed for a certain period of time, they already generally have multiple comorbidities with limited mobility. So it was really supposed to be a paper evaluating that. And looking forward to potentially, should we be thinking about treating some of these surgical so that they can mobilize faster, so that they can get back on their feet and prevent any post injury complications from happening? There’s no question. He said the elderly are some of the most vulnerable in society. And they are. And we’ve even looked at, we’ve done another paper with looking at the rates of, even surgeon understanding of elder abuse. Everyone appropriately talks about intimate partner violence, and we’re part of the big study on that as well. But there is an element of elder abuse that I think that as a society we are missing. I think that as surgeons, we need to shift our attention towards that as well. Because they are, and I think this COVID crisis is certainly linked a different lens to how vulnerable our seniors actually are, or even at home. We need to do a better job in protecting them and making sure that they’re able to live their last years as some of their most fruitful years.

Chad Ball  25:25

It’s so true. Just this month, my last week on our trauma service, we were talking about this exact thing. It’s funny it comes up, but we are clearly under diagnosing or under detecting elderly abuse. It’s clearly going on at a much greater level than I think we appreciate. Sure, we pick up the most exotic or bright cases, but we probably need to do a better job of screening our elderly.

Andrew Furey  25:54

Even if you assume that there’s, I don’t know, a 2% or 3% for the fractures that occur in an institution in particular, is rate of elder abuse. I can tell you I’ve never, I don’t know many that have, identified that in a fracture clinic or in a hospital setting because, you know, for all the reasons, right? But maybe we need to be better at developing a screening tool to direct our attention towards it.

Chad Ball  26:26

Yeah, for sure. Andrew, we promised we wouldn’t ask you any questions in particular about your foray into maybe your next job. But I did want to dance around that a little bit. And ask you what your view of the concept of leadership was. Ask you some of the roles that you’ve played beyond Broken Earth, in terms of leadership. And whether that’s in your hospital, or even before that. I was just curious on your viewpoint of that concept. Because it’s a pretty obviously broad 30,000 ft term leadership, but people interpret it in very different ways.

Andrew Furey  27:07

Yeah, I’ve never looked at leadership as a command and authority type of leadership style. I’ve always looked at it as a, you need to figure out the right tools to engage people, empower them, and help navigate them through complex, often difficult, situations. But you can only do that if they believe in the vision and the direction in which you’re going. But you need to support them, empower them to make their own decisions and to follow you into an unknown situation. I don’t think you can do that with the command style leadership, that really authoritative “follow me because”, only works for short periods of time and in very trying situations. But if you really want to move and engage a team of people to follow you, then you need to make sure they’re empowered, engaged, have an understanding what you’re trying to do and motivate them to perform. So that would be my 30,000 ft view. I mean, there are all kinds of different, leaderships become almost a science, or tried to become a science, in terms of different papers looking at the different elements of leadership and the combination of cognitive and emotional intelligence. But at the end of the day, it’s about the people that you’re trying to engage and lead. And if they believe in the vision, and they believe that they can make a difference, that they’re not just part of a train that’s going along anyway, then I think that’s the style to employ when trying to motivate a large group of people.

Chad Ball  29:10

It’s so true. We had a great conversation on Cold Steel with a gent by the name of Phil Dawe, who you may or may not know, comes from a very proud military family. He’s a general surgery trauma surgeon out in Vancouver. And really the hour, or close to it, surrounded the concept of leadership. I think, certainly listening to Phil and in contemplating it, the contemporary definition of leadership really surrounds exactly what you say. It’s maybe less of a hierarchy, it’s less top down, and it’s much more  engaging at the so-called grassroots level. So I guess my question for you is, how do you do that? How do you whip up personal investment in folks as you try and move the whole bus forward on whatever that given topic is?

Andrew Furey  30:02

It’s easy enough to write these things down. But the how is always the..

Chad Ball  30:07

Right, when the rubber meets the road? Totally.

Andrew Furey  30:10

Yeah. I think it involves a lot of trust in people. But trust is obviously incredibly important, but you also have to trust them to fail. And it’s okay to fail. I think if people have some ideal notion of perfection at all times, it won’t work. So if you empower people on your team to make decisions, to take pride in those decisions, but that it’s okay if at some point, inevitably, there’s a bad decision or the outcome isn’t favorable, then I think it allows them to be more creative, it allows them to be more engaged, it allows them to take ownership, it allows them to feel like they’re actually helping steer the bus, as opposed to being a passenger on the bus.

Chad Ball  31:10

Yeah, for sure. It’s an interesting time in Alberta right now and we certainly won’t get into the nuances of what’s going on here, politically and with the healthcare system. But I was just curious on what your view is as to how best physicians can advocate both for physician wellness, but certainly more importantly, for patient wellness in a balanced, responsible way. Recognizing that certain areas are tougher than others, and so on. But how do you view that relationship in general?

Andrew Furey  31:43

Yeah, so first of all, I wouldn’t say more importantly for patients. I think patient wellness, obviously, we’re bred to be patient advocates and we would never get rid of that element of who we are. But I think we’ve done a terrible job at being our own advocates, to date. Part of that is just total culture. I really worry about physician burnout and a lack of balance between the old school of being in the hospital 24 hours a day, seven days a week and trying to find a balance with life as we know it. I think the generation just below me, in particular, is excellent at pushing that work-life balance. And I think, as physicians and physician leaders, can never lose sight of how important that is. Because a burnt out physician is no good to anybody and bleeds into terrible patient care ultimately. So you’d rather have a physician who’s engaged, who is not burnt out, who’s ready to go, who loves the job, loves every moment of the job, is truly passionate about it. I think preventing burnout and maintaining that passion and empathy and compassion is incredibly important both in terms of the profession and looking after patients. I also think that physician leaders are often afraid to step, we’re all great at pontificating in the OR lounge about how things should be, right? But a lot of us, many of us, are afraid to be a part of the political system. My father would always say that if you’re afraid to put your hand up at all, or engage in the process at all, and then your voice doesn’t matter. So I think there’s a growing number of us around the country, in particular in the last 5 to 10 years, who have recognized that being part of the political process, and that doesn’t mean putting your name on a ballot, by the way, there are all kinds of other ways to be involved in the political process, is incredibly important. Because we can sit and dump on politicians all we want, but they’re the ones who make the decisions. And they’re not making the decisions in some sort of echo chamber, by the way. They’re trying their best, presumably, to listen to all points of view and to make the decision. So if you don’t have a voice at that table, they’re not going to hear it and then they’re not going to make a decision that, of course you’re going to be upset with their decision because you haven’t adequately influenced how they’re going to make the decision. So I think it’s important to recognize that, as doctors, we don’t live in some sort of isolated silos, if we want to progress the patient advocate agenda, or our own agenda, we need to have a voice at the table. Sometimes that means taking a role in the political process. Because that’s how the system works. Elected officials help direct the agenda of the province in the country and if we want to change that agenda or help it pivot, then we need more than a voice in an echo chamber that is the OR lounge or the coffee lineup or wherever.

Ameer Farooq  35:28

Your comment, Dr. Furey, about people complaining about politics and the situation in the system in the OR lounge rings true for anyone who sat in an OR lounge for any period of time. For those of us, and for our listeners who might actually be interested in getting more involved, whether politically or even locally in your hospital, what advice would you have for those folks who are interested in getting a bit more involved?

Andrew Furey  35:58

Just do it. There are all kinds of different ways to be involved within the leadership of the hospital, the leadership of your residency program. And then within the political system itself, like I said, you don’t have to put your name on a ballot to try to influence the process or influence your elected officials. And by influence, I mean in a good way, right? And I’m not talking about lobbying or anything like that. I mean, that’s the way democracy works. You put forward ideas and whoever’s ideas are the best, get elected. That’s the ideal notion. So if you’re involved in helping scope, in helping shape those ideas that are being presented, then you can really change the way your province or your country looks. So I would suggest if anyone’s interested, there are physician leadership courses available. There’s even, I think, a political program within the Canadian Medical Association, which allows you to help talk to your MPs and others, through some… I’m just drawing a blank on the name of it right now. Or if you’re so inclined, help out with the next election campaign, doesn’t matter the party really or any of that, it just matters that you’re involved. Because once you’re involved, you get a better understanding for how the process works. You get a better understanding for how you can help shape the process, help influence the process, and ultimately help lead to decisions that you think are best for the people in your province or in your country.  Yeah, I think it’s just that initial leap of putting yourself out there that unnerves a lot of us, and particularly trainees.

Chad Ball  37:52

Yeah, but like I said, you can just volunteer on the next, I don’t know, your next Alberta provincial election, for example. Be a part of one of the parties there, where your ideology is most aligned. I can tell you that they’re always looking for smart people, like doctors, and people who understand the healthcare system, to be involved. Without a doubt. Because we bring a unique perspective, a little perspective that’s not always seen as doctors, to the table.

Ameer Farooq  38:31

This conversation has been really fascinating. And it’s been a real pleasure to talk to you Dr. Furey. In closing, I was hoping that you could give some advice that maybe you wish someone had given you during your residency, and I’m being a bit selfish here, given that I’m just about to finish. So if there was anything that you wish someone had told you during residency, what would that have been?

Andrew Furey  38:57

I think the take home lesson for residency for me, if someone could have articulated perhaps a bit better, was that the exam at the end is only the beginning. So don’t put too much pressure on yourself for the exam. I mean, of course, you want to pass but really the true education begins after you start. Because there is a whole other series of pressures and concerns when it is your patient, your practice. That isn’t captured by any sort of examination process. And I think the shock of that for me a little bit, and I think it’s probably true for all surgeons, if you’re being honest, was a little bit more than I would have thought. So that would be one thing. The other thing I would say, again, it’s the same thing, but it’s just the start You can do all kinds of incredible things once you’re finished. I think you feel like you’re in a silo, you’re so concentrated on the subspecialty or the specialty, but medicine has incredible opportunities beyond the walls of the hospital. You just got to keep your eyes open and keep looking for them. Whether it’s being involved in global medicine, or your local community, or giving back in a nonprofit, political or any other realm, but don’t be locked into the four walls of the operating room. Make sure that you keep your head up and look for opportunities. Because at the end of the day, 10, 12, 15 years in, the job is still awesome and fun, and love every second of it. But a lot of what’s exciting initially, becomes routine, and I think you need self-fulfillment from other opportunities as well.

Ameer Farooq  41:02

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.