The big picture

Recently I visited the Goya exhibit at the National Gallery of Art, in Washington.1 The throngs were obviously thrilled by the vast collection of his works, including the evocative Majas. I wondered, though, whether they fully appreciated his planning, his choice of materials and the mentoring of others, including Velázquez, who enabled him to become the great court artist.

On my return to the Department, an impromptu visitor, a member of a health care forum, wanted to see firsthand our centre and its links with regional partners. In the short “gallery tour,” how could he and the administrators understand the complexity of what we do? There are years of experience and culture behind the scenes. A financial team and technical support staff in clinical engineering keep the tools of our discipline functional. Ophthalmic staff, including clerks, secretaries, technicians, nurses, residents and physicians, provide care in a team approach. Too often, a discussion ensues on the cost per case for procedures and whether a private or public model for the care is cheaper. Administrators tend to miss the big picture that care is comprehensive and interdisciplinary. The relationship of ophthalmic centres as a support to the community ophthalmologists and physicians appears lost along with the role of the centres in teaching and research.

As departments continue to be lumped in with the global budgets of hospitals, we are going to be disadvantaged. We are training young ophthalmologists who have no room to return to practice. Operating room time and resource bases are limited, while government is cautious about allowing private care to emerge. Most certainly, another model will need to emerge soon. Departments are now stifling in the restrictive environment of fiscal restraint at a time when we need to be growing, training physicians and taking advantage of new opportunities in research.

The new mandate of the Canadian Institutes of Health Research focuses on four pillars of research: biomedical, clinical sciences, health systems and services, and the health of populations.2 It is important to remember these pillars and the real influence they will have on the direction of research in the near future — with a deemphasis on basic mechanisms and weighting on clinical research and clinical trials. With very few trainees entering ophthalmology, we will need to encourage and mentor a few to learn the tools of clinical research and clinical trials for the future, perhaps leaving the basic biomedical research to better-positioned and better-trained basic scientists.

With this issue, I am passing the mantle to my successor, Dr. Miguel N. Burnier, Jr. I have thoroughly enjoyed the opportunity and privilege of acting as your Editor-in-Chief. I have made many mistakes and regret these sincerely, but I hope I have brought forward some positive changes to the Journal that have built on the work of my predecessors.

Dr. Burnier is Chair of the Department of Ophthalmology, McGill University, Montreal, where he holds the rank of Full Professor of ophthalmology, pathology, medicine and anatomy and cell biology. He is Ophthalmologist-in-Chief for the McGill University Health Centre and the Sir Mortimer B. Davis–Jewish General Hospital, Montreal. An active researcher, Dr. Burnier has a particular interest in uveal melanoma.

We welcome Dr. Burnier as our new Editor. I am certain that you will enjoy his leadership, his energy and enthusiasm, and the worldly view of ophthalmology that he will bring.

Ian M. MacDonald, MD, CM
Editor-in-Chief

References

1. Goya: Images of Women. National Gallery of Art, Washington. http://www.nga.gov/exhibitions/goyainfo.htm.
2. Canadian Institutes of Health Research. http://www.cihr.ca.