Not long ago the 1995 Interim Meeting of the AANS Board of Directors was held in Chicago. A significant portion of our agenda dealt with the 1996 budget. Members of the Finance Committee, as well as full Board, spent nearly four days discussing the projects, programs and services proposed for implementation in 1996.
The discussions were spirited and not without some passion. However, I was struck by two things: First, all of those participating exhibited the utmost concern that AANS resources be allocated responsibly and to their greatest effect. Second, the volume and diversity of the Association’s activities and programs are extraordinary. For your leadership, balancing member needs with fiscal restraints continues to be a challenge.
Demand for Service is Great
The AANS is operating in an environment of great contradictions. At a time when resources must be carefully managed, our membership cries out for more services. For example, the educational activities of the AANS are its foremost responsibility, but maintaining solid accreditation for continuing medical education (CME) and assuring the finest of hands-on courses and publications requires continual subsidization from other AANS sources of income.
I receive letters daily from members asking why the AANS is not more active in the global issues of medicine, representing neurosurgery at federal, state and local levels. Even now there is a great cry from members to raise additional funds through a foundation or political action committee (PAC) to further the interests of neurosurgery. I believe that is an unwise course to take since I doubt that 4,000 members of the medical community can exert much financial influence on a legislative body that is bent upon substantially reducing medicine as an economic entity.
The Professional Conduct Committee activities, alone, have cost the organization hundreds of thousands of dollars in the past several years, none of which can be recouped from the parties involved.
The impact, however, on liability issues is significant. No longer can a neurosurgeon offer expert opinion, for the defendant or the plaintiff, without doing substantial homework and research about an issue. There is the awareness now that outrageous testimony for either side is subject to review by Neurosurgical peers. This has effectively established that testimony is a part of the practice of neurosurgery and open to the same critical analysis as is clinical judgment or surgical technique. Support of organizations seeking tort reform, direct contact with legislators and attempts at education of the public, together, have not had the productiveness of this single Association activity.
Maintaining the competitive position of neurosurgery and marketing neurosurgeons to the general public and to referring physicians and organizations is another expensive service which benefits all of neurosurgery and is costly.
Obtaining representation from all over the country, and for that matter the world, in order to maintain the prestigious aura of neurological surgery is not a budget neutral operation. Communication with individual members about rapid changes in government rules and acceptance of devices (through Changing Times in Neurosurgery) and legal representation in court appearances to justify the use of technology, all drain resources of the organization to serve the interests of practicing neurosurgeons. Maintenance of research activities and planning of educational seminars, in order to keep neurosurgery at the peak of medical practice, honored and respected by all of medicine, each requires a constant infusion of revenue.
The new 1995 Comprehensive Neurosurgical Practice Survey of economic indicators in neurological surgery once again received a 40 percent response from the membership. Its cost has provided a clear picture of real-world economics. For example, it demonstrates that, although practitioners in New England and Southern California have been hit hard with an 8 to 15 percent reduction in income, overall income for neurosurgeons in the United States was up 8 percent during the past three years.
Funding Sources
How is this broad spectrum of activities funded? You should know that dues represent a very small portion of the income of the AANS — approximately 14 percent (which is among the lowest dues assessment of any medical association). General revenues account for 33% of income and The Journal of Neurosurgery advertising constitutes 26%. Other sources of income include exhibit fees from the Annual Meeting, interest on investments, and rents from tenants in our National Office building.
Be assured that your entire Board of Directors looks very carefully at the Association’s sources of income, especially including the dues structure. The specter of managed care has become a reality and the financial status of the membership is a very sensitive issue.
Volunteers Make the Difference
Representation in reimbursement issues and responding to challenges of managed care are important services which result in no income to the Association, but are of immeasurable benefit to individual members. Were it not for volunteerism, these costs would be so high as to render impossible the attainment of these successes in a constant battle with third-party payers.
These volunteers forfeit tens of thousands of dollars from their practices while attending meetings with RUC, PPRC, HCFA and many other Association activities, which together require weeks away from their practices each year.
This is your organization and I have made your wishes and mandates my highest priorities. My goal has been to try to hold an even keel during my year at the helm. Elimination of waste and conservation of resources has been the watchword of the Board, as we try to reflect the demands of the membership. Every year, many requested programs are approved, but not funded. We also are very fortunate to have a staff that not only considers economies of scale, but also acts to be certain every penny you invest in your Association is used in the most efficient manner.
The credibility of neurological surgery is higher than that enjoyed by any other medical organization,including the American Medical Association and the American College of Surgeons. We have earned that position through strong patient advocacy, the efforts of a very dedicated group of volunteers and through the responsible expenditure of AANS resources, including your dues.
As valuable, active members of a viable and successful Association, I encourage your ongoing evaluation of the organization’s activities. When you are in the Chicago area, please visit the AANS National Office. Look around, talk to the staff, review our activity and give us some positive, constructive comment about how things can be improved. We are small enough so that every member should be an activist.