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 Mark Baillie speaks to Euan Frew, the RCSEd Fellow who emigrated to Canada over 30 years ago.
With Fellows and Members in almost 100 countries worldwide, it’s no surprise that the reach of the College extends to some of the most far-flung corners of the globe.
However, Euan Frew, Specialist General Surgeon at Nanaimo Regional Hospital, BC, could stake a claim as the current most north-westerly based Fellow.
Graduating from Aberdeen Medical School in 1968, Mr Frew went on to a post as Junior Lecturer in Pathology before entering surgical training in Glasgow in 1970.
The move with his young family to Canada in spring of 1974 came about through an offer of summer locum work from a friend in Alberta. “We felt this would be an ideal summer vacation as neither of us had been to Canada before and we jumped at the opportunity,” he remembers. “We had a wonderful time on the trip with marvelous weather and everyone was extremely kind to us.”
Mr Frew was offered surgical privileges in Lethbridge, Alberta, contingent on completing an extra year of training and passing the Canadian Fellowship examination. Being young and adventurous, he and his wife decided to take the plunge and moved to Canada in November of that year.
Despite excitement of the move, there was a new culture to adjust to – not just socially, but also professionally: “On entering practice in Canada the most noticeable difference was the competitive environment that existed between physicians, especially surgeons, as they were essentially competing for work.” He goes on: “The situation was even more complex as physicians tended to be organised in groups or clinics which in turn competed for the available patient load. At that time there was a relative surplus of physicians for the patient base so the competition could be unpleasant at times.”
In 1981, Euan and his family moved to Nanaimo on Vancouver Island. “When I arrived here and there were far fewer medical services available on Vancouver Island. There was also a shortage of specialists and for a number of years I travelled one day a week to outlying areas to do outpatient clinics.”
This brings him to one of the most stark differences between healthcare delivery in Canada and his home country: “Because Canada is so vast, the delivery of healthcare has to be rather different from that in the UK. As specialist care increases in complexity there has been an inevitable centralisation of services in the major urban areas with attendant difficulties in access from outlying areas. This situation is compounded by the often very difficult weather conditions of the Canadian winter. As such, there there remains a real need for the well trained general surgeon and programmes are being developed to train general surgeons for work in the outlying community.”
As a general surgeon, he has seen many improvements and changes in practice over the years, from the dramatic reduction in trauma resulting from RTAs following the introduction of seat belt legislation to the discovery of Helicobacter pylorii and its role in ulcer disease. He continues, “By far the biggest impact I've seen personally is in the development of colonoscopy and its ability to remove premalignant lesions. When I first began in surgery, polyps had to be symptomatic and visible on barium enema to be discovered at all.”
Thirty-seven years on from his move to Canada, he can look back on a distinguished career that has included serving on the Council of the Royal College of Physicians and Surgeons with close involvement in the development and standardisation of the national specialty training programmes.
“Medical politics, like regular politics, is the art of doing the best you can in the circumstances that exist at the time”
Of his work with the Canadian Royal College, he says: “Medical politics, like regular politics, is the art of doing the best you can in the circumstances that exist at the time.” He continues, “Change is slow but inexorable; when you look back, the changes have been dramatic and, medically speaking, usually for the better.”
Of course, his first involvement with a Royal College was as an exam candidate at the RCSEd in the early years of his career. For Mr Frew, it was a family connection that made his choice of college affiliation an easy one: “With my father being a Fellow of The Royal College of Surgeons of Edinburgh there was no doubt in my mind that my first choice was to do the Edinburgh Fellowship.”
He recalls that gaining the Fellowship represented a major hurdle in the surgical career path and that sitting it brought pressures like no other exam: “In those days the names of those who had passed were read out to the candidates who were packed into a narrow hallway next to a staircase. It proved a very tense and anxious experience and then, on being successful, you were led into a reception room for a glass of Sherry. It felt as if one had entered the halls of Heaven itself, such was the relief.”
With around 4500 miles between Mr Frew and Edinburgh, he explains why remaining a Fellow of the College is still important to him: “In order to practice as a specialist in Canada you must have passed the Canadian LMCC (Canada’s basic medical qualifying examination) and to have passed the Canadian Fellowship in your specialty. At that point, maintaining Fellowship in the Edinburgh College is redundant in practical terms but, like many from overseas, we are proud to be Fellows of the Edinburgh College and still recognise Edinburgh as of great historical importance in the development of surgery. For me personally, with my father being a Fellow of the College, it has been an important achievement in my surgical career and a reflection of my Scottish surgical heritage."
After such a long and productive career that was first motivated by a desire to contribute to society and make direct interventions in the disease process, what’s been Euan Frew’s personal highlight? He puts it quite simply: "I have derived the greatest satisfaction from the intrinsic nature of surgical care in achieving the speedy resolution of serious illness and, especially, in situations where a patient does well against all the odds."
The RCSEd is known for its pioneering spirit, dedication to patient care, and, of course, exporting the highest surgical skills from Scotland to far-away parts of the world – Euan Frew embodies the spirit of RCSEd.
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