One of the most important roles played by The American Association of Neurological Surgeons (AANS) is that of spokes-organization for organized neurosurgery. In that capacity we seek to collaborate with, learn from and educate our colleagues in neurosurgery and related practice. In that regard, the AANS has embarked upon a more aggressive path to achieve these objectives over the past several years. We have launched several outreach programs – both in the U.S. and overseas – that I believe will have a positive impact on neurosurgical practice as a whole.
Primary Care Outreach
Changes in the political environment in the US have altered the way every neurosurgeon must market and build his or her practice. The AANS recognizes the importance of building strong referral relationships and is building a campaign to develop a consistent and vital communications flow between neurosurgery and the primary care physicians. I feel this “primary care outreach” program is one of the AANS most important projects considering the current managed care environment most of us operate our practices in.
For the past three years, the AANS and CNS have co-sponsored an exhibit at the Scientific Assembly of the American Academy of Family Physicians. The purpose of our booth is purely to educate and reinforce to family physicians the different aspects of neurosurgery and how their patients can benefit from neurosurgical treatment and consultation. This project has been extremely well received by the family physicians and we plan on expanding these efforts over the next several years. The AANS and CNS will sponsor a similar booth at the American College of Physicians – Annual Session in April, 1999, and the American College of Emergency Medicine Annual Meeting in September, 1999.
A new project developed by the NEUROSURGERY://ON-CALL® staff entitled “Chat with a Neurosurgeon” debuted at the AAFP meeting in September. The program involves a monthly open “chat” on our Web site and is especially designed for family physicians. More than 200 family physicians signed up to be involved in the project.
In addition, the Publications Committee has also recently released two new books designed especially for family physicians – The Guide to the Primary Care of Neurological Disorders by A. John Popp and The Treatment of Carotid Disease: A Practitioner’s Manual by Joshua Bederson. Both of these publications are designed to facilitate the diagnosis, management and referral of the neurological patient while in a primary care setting.
Another outreach tool the AANS and CNS are producing is the Getting SMART About Neurosurgery project. This is a marketing tool that is especially designed to help individual neurosurgeons forge relationships with primary care practitioners in their local communities. The first SMART project focused on lumbar spinal stenosis and was an overwhelming success. Round two focuses on cerebrovascular disease and will be released at the end of January, 1999. The neurosurgery “ambassador” package includes public education slides, a public education brochure, teaching slides designed at the primary care level, a referral booklet for primary care physicians and stroke team/ stroke center development guidelines.
The AANS is also making an extensive effort to place speakers on the program of the AAFP Scientific Assembly. I have personally invited Lanny R. Copeland, MD, current President of the AAFP, to attend the scientific and board sessions of our next Annual Meeting in New Orleans. We are in the process of developing an afternoon scientific session at the New Orleans meeting specifically geared toward primary care physicians.
All of these projects help highlight the importance of a strong relationship between neurosurgery and the primary care physician, especially in a managed care market. Almost all non-trauma patients come to neurosurgeons through primary care referrals and it is essential we build a strong pathway for the flow of information and understanding about new procedures, initiate “outreach” programs within your own local area – whether it’s lecturing on new treatments in stroke care to primary care physicians, presenting new research at a local medical meeting or simply being available for a consult, these are the programs that will make a difference in the long term.
Other Medical Specialties
In our daily practices, the relationships with primary care physicians are crucial. However in the political arena, neurosurgery often finds it beneficial to align itself with other specialty groups. Almost all of the socioeconomic issues that are addressed by our Joint Washington Committee, lead by our Washington Office Director Katie Orrico, involve either outreach or collaboration with other medical specialties.
Recent projects include our leadership role in developing a specialty coalition to successful reduce the proposed reductions in Medicare reimbursement to specialty services. Even though neurosurgery represents less than one percent of the healthcare dollars in the US, our organization spearheaded this effort and played a crucial role in bringing together other specialty groups with a common interest. We continue to work with these other specialty organizations to defend the rights of the medical specialties and are much stronger as one strong group instead of 20 individual organizations.
We also continue to work closely with the American Medical Association and American College of Surgeons on CPT coding, E/M documentation, Medicare fee schedules, graduate medical education reform and other issues facing neurosurgeons.
Our work with other organizations expands beyond public policy as we form joint projects with organizations to write practice guidelines, increase disease awareness and advocate for prevention.
International Outreach
Over the past few years medicine as a whole has taken on a more global approach. Not only can research and operative techniques be shared at the press of a button, but the flow of information and standards of care are becoming more internationally-oriented. Extensive outcomes studies and global research projects are underway and medicine promises to take on a more international flavor in the years to come as national borders become near invisible in the eyes of physicians and researchers.
For the AANS, we feel it is pivotal that we make a strong presence in the international arena and now is the time to push forward with this effort. John Jane, MD, and his team at the Journal of Neurosurgery and the AANS marketing staff have made a concerted effort over the past several years to increase awareness, participation, and contributions by international neurosurgeons. We have taken AANS text books and other publications, the Journal, Annual Meeting information, Professional Development Program course brochures and other information to meetings in Germany, Japan, Denmark and Turkey. We will be returning to Japan this fall, and, for the first time, visiting our colleagues at their meeting in South America.
It isn’t necessarily how many books we sell or Journal subscriptions we process that are the important factors at these types of meetings. It is the process of building long-term relationships with our international colleagues that is important. I traveled to Germany in June and had the opportunity to forge relationships with leaders in neurosurgery from all over Europe. We have extended an invitation to these neurosurgeons to attend the AANS 1999 Annual Meeting in New Orleans.
The scope and reach of the AANS has surged beyond the borders of American neurosurgery. This is a trend that can be seen in just about every industry in the United States. Neurosurgeons now must become involved and must make time to communicate with primary care physicians, work with other specialists and interact with international colleagues. It is the wave of the future and key to how we must position ourselves for success.
One of the most frustrating lessons to be learned by any neurosurgeon, not just the young, but unfortunately many of the middle and older practicing neurosurgeons, is that we can no longer simply dedicate our time and efforts to doing what we totally enjoy – operating and caring for neurosurgical patients. Our world has been encroached upon by a changing political and industrialized medical world. To survive in neurosurgery, as we wish it to be, each of us must pull with our national organization in every outreach program available. The AANS/CNS can develop the programs, but unless the membership carries them forth, they are to no avail.