“When you’re driving down the highway on a motorcycle, you experience the environment in a way you just don’t in a car. You can smell the spruce trees,” Dr. Preston Smith says, his voice taking on a note of nostalgia as he reminisces about the hilly, windy roads he used to ride along the ocean in the Maritimes.
Dr. Preston Smith by the ocean
That was before he, his wife and one of his three daughters moved from New Brunswick to Saskatchewan. It was 2014 and he had just accepted a position as the dean of medicine at the University of Saskatchewan. Today, he is also one of two physician board members on the Saskatchewan Health Authority’s (SHA’s) board of directors.
“I’m really impressed with the level of experience around the board table,” says Dr. Smith. “There’s a nice mix of people who were board members in former health regions and some who are new to hospital boards, but they all bring a lot of experience and knowledge. I’m quite excited about the team we have in place. I think we’re off to a great start.”
“I’ve already lived through health care system amalgamations,” he adds of the years he spent in New Brunswick and Nova Scotia in senior leadership administrative positions as each of these provinces were transitioning their health systems.
“One of the things we really need to understand about change is that it’s a long-term investment. The fact that the SHA has made this change without disrupting the system or harming day-to-day health care is impressive,” he says. “I think the very best example of this is the Humboldt Broncos tragedy and the remarkable response to that. The fact that this province, in the midst of reorganization, could mount a world-class response to a multiple trauma situation is an amazing testimony to how things are going.”
A passion for inspiring and participating in change
One of Dr. Smith’s defining characteristics is his passion for inspiring and actively participating in change in the health care system.
“I like seeing change. I like helping people work together to make things better,” says Dr. Smith, who has been involved in health care as a family physician since 1982. “I really believe that the advantage to one health care system is that we can start working on finding the best way to do things. If we can get to the point where everyone in Saskatchewan has the best approach to disease x and y, I think the health of Saskatchewan people will benefit.
“I also believe that the more people we can get involved in teaching and research, the more we’ll improve health care in this province,” he says from his perspective as the dean of the College of Medicine. “Research shows that doctors who are involved in teaching and research are quicker to adopt innovations, have greater career satisfaction and are more likely to stay in the community they’re in. That’s really important for rural Saskatchewan. So, the more we can get doctors involved, the better our health system will be.”
Discovering family medicine
Dr. Smith didn’t always know he wanted to be a doctor. His first year of university was spent in the College of Engineering as a civil engineering student in New Brunswick, where he moved as a teenager from Prince Edward Island.
“I knew that engineering wasn’t for me after the first year,” he says. “I needed to do science and it needed to be with people. That led me to medicine.”
It took him another few years to realize that family medicine was where he was meant to be.
“I always thought obstetrics and gynecology would be the specialty I would choose,” he says, “but then I did a locum for a family doctor in Moncton who was taking a year sabbatical and realized that I loved the variety of family medicine. I loved the fact that it was always something different. One of my relatives was a family doctor, and he said to me one day early on in my career, ‘The thing about family medicine is that it’s like Christmas morning every day. You never know what’s under the tree.’
“That kind of variety and novelty of family medicine really attracted me,” he continues, adding that being able to develop a relationship with patients over 20 years is also one of the highlights of family medicine.
“At one point, I had five generations of one family in my practice,” he says, smiling. “To know a family from a one-year-old to a 99-year-old and all the generations in between was very cool. The neat part about that family is that I delivered the one-year-old and I also delivered her mother.”
His most memorable patient was a 35-year-old woman who was born with a problem in her heart.
“If she had been born after 1990, she’d probably still be alive but, at the time, her condition couldn’t be fixed and she died the first year I was in practice,” he says, adding that after she died, her family gave him a picture of The Doctor. The painting depicts a Victorian doctor sitting by a child’s bedside at a critical stage in the child’s illness.
Thirty years later, the picture still hangs in his office at home. It is a reminder of why research is so important to advancing medical care.
“By the time she was 30, the technology existed to fix what couldn’t be fixed when she was young,” he says. “If she had been born 20 years later, she would have had a 70- or 80-year lifespan.”
He also remembers a time when HIV was a disease that people died from rather than lived with because there were no effective treatment options.
“Today, with antiretroviral medication, HIV is a chronic disease like diabetes in the sense that if you manage it well you can have a normal lifespan; that’s in the space of 30 years, and it’s research that has made this amazing change possible in that short amount of time,” he says.
A love of research and innovation
It’s because of his enthusiasm for research and innovation that Dr. Smith says the most interesting job he’s held in his career is his current posting as dean of medicine with the U of S.
“There are a lot of things I like about being dean of a medical school,” he says. “It’s an opportunity to be right at the centre of our future profession and at the centre of research discoveries that are improving health care and making people live longer and healthier because of the science of medicine. It’s that combination of teaching, research and delivering health care that I love.
“Every doctor who teaches in our medical school is also providing care to patients in Saskatchewan,” he continues. “It’s that ability to be involved as a leader in both teaching and clinical care that is creating our future doctors. There’s no doubt that a better quality learning environment for students and residents is a better patient environment. That’s why medical schools are usually associated with hospitals that provide great medical care.”
During his tenure, Dr. Smith has seen the College of Medicine receive full accreditation of its undergraduate medical program.
“For Saskatchewan, a fully accredited medical school means that the College of Medicine meets the standards of North American medical education, which is widely regarded as some of the best medical education in the world,” he says, with a hint of pride in his voice.
“But accreditation is just a starting point,” he quickly adds. “We want to have more than an accredited medical school. We also want to train superb doctors and scientists, and we want to do important research, so being accredited is not the end of the journey. It’s the beginning of the journey to become a great medical school.”
His Maritime roots
Prior to coming to Saskatchewan, Dr. Smith worked in Moncton, N.B. for 24 years and in Halifax, N.S. for seven years as both a family physician and health system administrator in various positions. As a young practicing physician of 31, he received his first senior administrative leadership position as the vice president of medicine at Moncton Hospital.
While in Moncton, he also had an appointment with Dalhousie University’s medical school in Halifax to teach students and residents in his practice.
“The patient comes first is the most important lesson I hope my students have learned from me,” he says. “We need to examine everything we do through the patient lens so that we can better understand how the care we’re providing impacts their lives and their families.”
Eventually, Dr. Smith moved to Halifax to become the department head of family medicine at Dalhousie University. While at Dalhousie, he says his proudest moment was launching a new medical campus in New Brunswick: Dalhousie Medicine, New Brunswick. The campus allows aspiring doctors in New Brunswick to be taught the Dalhousie curriculum and complete hospital training in their home province.
“I was working as senior associate dean of Dalhousie’s medical school at the time, but I had been part of a group of doctors in New Brunswick who was lobbying for a medical campus there. When I took the job of associate dean in Halifax, I was able to work on it. That was probably one of the coolest things I ever did,” he says. “A lot of the things you start you think are never going to happen, but you plug away at them until you can look back and say, ‘Wow, this was really cool.’
“And you never do it by yourself,” he adds. “There are so many people along the way who help you do it. “
The importance of team work
Throughout his career, Dr. Smith says that what he has liked most about working in a hospital is the teamwork.
“I used to love working in the hospital with other health professionals, administrators and leaders,” he says, explaining that as a family physician in Moncton with a roster of 1,500 to 2,000 patients in his private practice, he spent a lot of time in the hospital delivering babies and treating patients who had been admitted with ailments like croup or asthma.
Since becoming dean of medicine at the U of S, he has reduced his clinic hours to one morning a week.
“The work I’m doing on the Saskatchewan Health Authority board is my hospital fix,” he says with a chuckle. “To be part of something new – a single, provincial health authority – makes it even more exciting.”
How a busy man keeps his head
To stay sane, Dr. Smith says he runs marathons.
“It started as a New Year’s resolution when I turned 40,” he says. “I like the solitude of running. Despite my job, I’m a bit of an introvert – some people would say a lot of an introvert! I also like the challenge of running and the racing itself.
“There’s something really cool about running 42 kilometres with 30,000 of your best friends,” he jokes.
Since taking up the sport, he’s run 13 marathons in Canada and abroad.
“I’ve run the Boston marathon three times, the Big Sur marathon two times and the New York marathon once. A couple of years ago, I also ran the Dublin, Ireland marathon with my daughter,” he says.
Dr. Preston Smith at the Big Sur Marathon this past spring
Family is the one thing Dr. Smith can’t live without.
“My wife, kids and grandson are incredibly important to me,” he says, adding that his wife’s therapy dog, Murphy, is also part of the family.
“My wife, Jane, is part of a dog therapy team with Murphy,” he says, explaining that they visit hospital emergency rooms, the Dubé Centre and long-term care homes in Saskatoon to provide pet therapy to patients and residents.
“They’re the first dog therapy team anywhere in Canada to work in an emergency room,” he says proudly of his wife of 39 years and their English springer spaniel.
Dr. Preston Smith with Jane and Murphy