Evolution of the AANS
The evolution of neurosurgery has been remarkable. And, the pace of that evolution is accelerating. We are blessed to be part of a specialty that attracts dynamic and visionary colleagues and allows our daily work to offer us a unique perspective on neurological disease, new possibilities for treatments and on how patients react to these illnesses and their therapies. We have often heard that many or even most of the operations and interventions we offer our patients during our careers were not learned during residency training. This is the way it should be. No one would want to be treated with techniques that are several decades old if newer, safer and more effective alternatives have been developed.
Some of our most notable life-altering advances include the development of radiosurgery and exploration of its indications; deep brain stimulation (DBS) for movement disorders and, perhaps soon, for other conditions; complex and minimally invasive spinal reconstruction and neuroendovascular approaches to disease. Although we have not moved the needle as much in traumatic brain injury (TBI) or malignant glial tumors, promising advances in these areas give us hope that these patients will soon share in the benefits of new therapies.
Evolution of the AANS
In parallel with these clinical advances, the American Association of Neurological Surgeons (AANS) has reinvented itself several times in order to keep up with changes in its own environment. A few years ago, the AANS separated into two entities. The AANS became a 501(c)(6) corporation, named after the relevant section of federal tax law. This is a trade organization that serves the practice interests of AANS members and is legally permitted to engage in advocacy, lobbying and regulatory and legislative activity. The 501(c)(3) corporation that operates exclusively for charitable, educational and scientific purposes was created as the American Association of Neurosurgeons (AAN). The separation between these two organizations is invisible to AANS members, as it should be. AANS member surveys consistently tell us that advocacy and education are the two most highly valued benefits of AANS membership. This innovative corporate structure allows the AANS to offer unparalleled educational programs while simultaneously engaging in a very active advocacy program.
More recently, the AANS spun off to create the Neurosurgical Research & Education Foundation (NREF) and NeuroPoint Alliance (NPA) as legally separate entities that still retain close ties with the AANS and with each other. This separation provides greater flexibility for the NREF and NPA as they carry out their missions. The NREF has evolved greatly since this separation. It serves as the hub for all development and for corporate, foundation and individual philanthropy. The “Honor Your Mentor” funds have been highly successful. Student, resident and fellow educational programs are organized through the NREF. While research support for residents and junior faculty remains a core part of the NREF mission, the NREF strategy also places a priority on education and research benefiting practicing neurosurgeons. It is funding NPA quality improvement initiatives and recently held its first symposium for mid-career neurosurgeons in conjunction with the Western Neurosurgical Society’s annual meeting.
The creation of a separate corporation to house NPA reflects the growing importance of high-quality data collection and analysis in the practice of medicine. Third-party payors increasingly want proof that our interventions help patients. At the level of the individual or group practice, neurosurgeons may be asked to document their quality and safety. The best way to respond to such efforts is to provide reliable data. The Quality Outcomes Database (QOD) now has information on more than 40,000 lumbar spine surgeries. Importantly, these data include patient-reported, long-term outcomes, such as functional status at 12 months after surgery or even longer.
Modules for other types of spine surgeries, cerebrovascular, stereotactic radiosurgery and other diseases are being rapidly developed or are already enrolling patients. A simplified version of the lumbar spine module that is easier for smaller practices to use is under development and will be offered through collaboration with the American Academy of Physical Medicine and Rehabilitation (AAPM&R). AANS and AAPM&R have worked together to create a registry to collect data on patients with low back pain, including those who do not undergo surgery. This and other collaborations with different specialties prompted the name change to QOD to make this registry less neurosurgery-specific. NPA manages several other registries and databases in addition to QOD.
Evolution occurs most rapidly when environmental changes are most extreme. Medical organizations are no exception. Industry support of meetings and other educational programs represents a major revenue source that keeps costs low for medical society members. However, these sources of income ebb and flow. An additional major source of income for many medical organizations is their journals and other publications. But just as newspapers and magazines had to either adapt to electronic readership or go out of business, medical journals are also struggling with the growth of online and mobile readership.
Another concern is that the growing numbers of hospital-employed physicians may find that their employers set strict limits on the amount of money allocated for professional travel and other discretionary expenses, which may further erode revenue streams for medical organizations. As a result, meetings and journals may shrink as sources of income. One potential mechanism by which the AANS might be able to offset these potential losses is the NPA’s database and analytic services, which may ultimately generate sufficient revenue to offset decreasing income in other areas.
Last year, the AANS initiated a comprehensive strategic planning process. The increasing numbers of challenges, opportunities and requests coming before the AANS make it easy to want to support feel-good proposals without fully grasping their overall context or ramifications. Some of the major issues that have recently come under discussion include:
- Relationships with other neurosurgical and medical societies;
- Interactions with industry;
- Shared initiatives with the international neurosurgical community;
- Education at all stages of neurosurgeons’ careers;
- Research support; and
- Neurosurgical workforce and advocacy.
Such decisions need to be evaluated against the framework of the AANS mission and goals, which represent a North Star to guide organizational decision-making. We will begin implementation of the plan this year. Ultimately, it will influence the AANS’ committee structure, administrative systems, budget, meeting agendas and other areas.
The theme of the 2018 AANS Annual Scientific Meeting is “Neurosurgery: The Privilege of Service.” The accelerating pace of change in the therapies we can offer our patients, in the systems by which we deliver and are paid for that care and in patients’ expectations can all seem overwhelming. Our days are becoming increasingly fragmented as we rush from one mundane, but necessary, task to another. It is easy to give in to cynicism or anger. Yet, these are precisely the moments in which we need to step back and recognize the enormous privilege we have been given: to treat diseases of what is both the body’s most complex organ system and one of nature’s most profound mysteries. People trust us to cure disease, to relieve pain, to restore life. Such a perspective makes it easier to put up with the many frustrations of trying to make things better for our patients and for our specialty in an increasingly bureaucratic system. It also makes us better physicians.
The AANS has been blessed with outstanding physician leadership, from the first president, William P. Van Wagenen, in 1932, to last year’s president, Frederick A. Boop, MD, FAANS. Rick spent countless hours on our behalf, including innumerable evening and weekend phone calls and more plane rides and frequent flyer miles than he’d care to remember. Watching him in action has been a pleasure. This year’s Executive Committee, Board of Directors and committee members are top-notch individuals who give selflessly of their time and energy. Kathleen Craig, AANS executive director, and the rest of our staff at the AANS office in Rolling Meadows, Ill., and Washington Office, including Katie Orrico, director, and her staff provide unparalleled service. No other organization has such dedicated and high-quality people working for its members and their patients. I’d pick our team over anyone else’s any day.
The health care environment is changing. Quickly. The AANS has always responded well to change. Although we cannot know what the future looks like, the membership and leadership of the AANS will always adapt and evolve to stay ahead of the curve. It is a tremendous privilege to lead such a dynamic organization.
2017 AANS/CNS Section on Pediatric Neurological Surgery
Nov. 28-Dec. 1, 2017; Houston
2nd Homburg ICP and Hydrocephalus Workshop
Nov. 28-30, 2017; Germany
22nd Instructional Course and 45th Annual Meeting of the Cervical Spine Research Society
Nov. 29, 2017 - Dec. 2, 2017; Hollywood, Fla.
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