In this wide-ranging conversation, Dr. Robin Richards reflects on navigating political upheaval in Ontario’s health system, where austerity measures, clawbacks, and soaring malpractice premiums pushed high-risk surgical specialties to the brink. He describes uniting orthopedic, obstetric, neurosurgical, and general surgery groups into a forceful negotiating bloc, eventually shifting public opinion, compelling renewed government engagement, and securing a stable agreement. Richards also offers grounded leadership advice—emphasizing walking the “shop floor,” stakeholder analysis, realism about trade-offs, and commitment rooted in genuine motivation. Clinically, he cites the reverse shoulder arthroplasty as the most transformative advance in shoulder surgery, redefining treatment reliability and expanding options for patients once limited to ineffective procedures. He closes by reflecting on steady growth and purpose of JBJS Open Access, focused on publishing high-quality second-tier manuscripts and contributing to a broader, increasingly diverse suite of orthopedic literature.