Dear Colleagues:
I’m pleased to report to you on the operation and activities of our organization during the past year in its role as the spokes organization representing the interests of North American neurological surgery. In this capacity, there has been a dynamic and continuous reassessment of the needs of our membership as reflected through the multiple channels of communication established between the membership and our various levels of administration in an effort to address numerous issues that impact upon all of us.
Membership
The total membership of the AANS now stands at 4,546. In response to a proposal by the Membership Committee, the Board of Directors approved changes in the By-Laws to create two new membership categories: International Associate, which replaced our previous Corresponding Membership category, and Associate Member, to include neurosurgical nurses and neurosurgical physician assistants.
During the past year, the International Associate membership ranks grew by 18%, reflecting the growing recognition of our organization around the world. The number of Associate members grew by some 86%, accompanied by a continued significant interest in participation in the activities of our organization.
Strategic Planning
The Association’s primary assessment vehicle is our strategic plan, which was initially crafted and adopted in 1990, and remains a living document designed to guide us into the future. In 1994, the AANS began the critical process of building a new strategic plan to direct the Association into the 21st Century.
This new plan consists of two major phases. Phase 1 involved gathering members’ feedback concerning current and future assumptions about neurosurgery and the AANS. A comprehensive strategic planning survey questionnaire was developed and distributed to the entire AANS membership.
Almost 1,5000 questionnaires were returned by the members and tabulated at the National Office to provide a comprehensive analysis of the concerns of the membership. Respondents reported that the most significant trends, challenges, and environmental changes facing neurosurgeons include the following factors:
- Continuing governmental and insurance industry encroachment and interference in the practice of medicine.
- Continued sub-specialization within neurosurgery.
- Erosion of neurosurgical practice bases by HMOs and managed care networks.
- The impact of health care reform.
- Tort reform.
Subsequently, the Strategic Planning Committee of the AANS Long Range Planning Committee received a detailed briefing on the results of the strategic planning survey in November 1994. This enabled the initiation of Phase 2, which presently is in process, the development and application of this new strategic plan. To date, the following activities and components have been completed:
- The development of a long range vision that has identified where the Strategic Planning Committee believes the AANS should be in the year 2000.
- Development of four long-range goal statements that form the core of the strategic plan.
- Development of strategies for implementing each goal.
- Establishment of checkpoints for monitoring and evaluating progress in achieving each goal.
- Review of the AANS infrastructure to determine what changes, if any, will be required to better align resources with the strategic plan.
The membership has been informed of this strategic planning process with a series of detailed articles in The AANS Bulletin. Copies of the strategic planning survey report have been made available upon written request to those members desiring more comprehensive information.
The draft mission statement and proposed long-range goal statements, as well as the document outlining the strategic assumptions made thus far, have been distributed to the AANS Board of Director for their feedback. The Strategic Planning Committee intends to bring its recommendations to the Board of Directors for ratification in November.
Professional Development
One of the most important programs to emerge from the strategic plan ratified in 1990 — Professional Development — has proven to be amongst the most productive activities presently offered by the AANS.
During 1994, the Professional Development Program (PDP) presented a series of 26 educational courses covering the broad spectrum of neurosurgical practice which were attended by almost 1,300 of our members, a significant increase when compared with past years. Plans are in place for 25 course offerings to be presented this year, ten of which have already taken place with excellent member participation.
Publications
Our publications efforts focus in three directions — scientific, membership and public policy.
In the scientific arena, the Journal of Neurosurgery remains the premiere neurosurgical journal in the world, with more than 12,000 subscribers. A recent analysis by the Citation Index which charts the frequency with which articles appearing in given refereed journals are quoted, the Journal of Neurosurgery was mentioned most frequently of all international neurosurgical journals, enjoying reference citations in excess of twice those of any other similar publication.
The Citation Index also computes an impact scale which refers to the impact of any article appearing in a peer reviewed scientific journal; and the Impact Index for the Journal of Neurosurgery was also at least twice that of its nearest competition, well beyond all other neurosurgical journals combined. The Journal remains the resource for the most significant clinical and research information.
The AANS Bulletin continues to grow in size and readership appreciation. The Bulletin is published four times a year and provides continuing communication between the officers, Board of Directors, National Office and the membership. The growth of our Bulletin reflects the desire of the officers and board to enhance communications with the membership.
In addition, in the interest of continued communication within the organization, the Board of Directors established a fax broadcast system to provide immediate information via facsimile distribution with respect to urgent public policy issues dealing with practice patterns at all levels.
Governance
While he was president of the AANS, Julian T. Hoff, MD, appointed a Task Force on Governance and charged it with evaluating and enhancing the interaction between our membership and the board. Chaired by Charles Rich, MD, our President-Elect, the task force has been actively assessing current policies as well as examining potential modifications in the best interest of the AANS.
The recommendations of the task force were presented at the Association’s Annual Business Meeting in Orlando and accepted by the Board of Directors. A summary of that report appears elsewhere in this issue of the Bulletin.
Practice Issues
During the past year, a number of issues concerning potential practice “turf” infringement have arisen in response to which our organization has worked in cooperation with the American Board of Neurological Surgery and the Residency Review Committee for Neurological Surgery in defending the traditional position of neurosurgery with respect to clinical competence.
There have been vigorous and sometimes forceful interactions with our colleagues in otolaryngology in the development of a certificate of added qualifications in otology and neuro-otology, and with our colleagues in orthopedic spinal surgery in the evolution of the Council of Spine Societies and the North American Spine Society. The representation of neurosurgical interest in the acute care of spinal cord injury as the specialty of PM & R has evolved into a CSQ for spinal cord medicine was also advanced and the development of program requirements for endovascular neuroradiology/neurosurgery was addressed to ensure access for neurosurgeons to this emerging discipline.
This activity has involved time-consuming negotiations to firmly maintain the posture of neurosurgery within the realm of emerging disciplines in order to assure that the specialty will retain its role in these clinical arenas.
Professional Conduct and Practice Assessment
Two particular committees of the board have played an increasing role of service to the membership. The first is the Practice Assessment Committee, which provides a review of the professional practice profile as well as an evaluation of the efficiency of staff management in office practice. The committee is organized to provide either or both of these assessment profiles which is of particular significance in these times of re-engineering or right-sizing office practices to insure maximization of economic structures.
The Professional Conduct Committee continues to serve as a valuable resource to our members who may have been aggrieved by another member of the organization in a tort proceeding. It saddens me to report that the board acted to censure one of our members on the basis of a grievance brought before the Professional Conduct Committee. This censure activity was published in the Bulletin.
Public Affairs
The Washington Committee remains extraordinarily active in representing our organization before various governmental agencies. The committee has interfaced with members of Congress on issues of professional liability, anti-trust, Medicare payment and graduate medical education. There is wonderful interaction between our Washington Committee and other specialty societies in the support of mutual interests in these areas.
The Changing Times in Neurosurgery broadcast fax mentioned above recently urged our members to contact their representatives in the House of Representatives regarding health liability reform measures which undoubtedly contributed to the passage of the House bill establishing a cap on non-economic damages in civil litigation.
Conclusion
Finally, we are particularly proud of the vigorous activities of the National Office on behalf of all members of the AANS. The outstanding staff efforts were recognized nationally by their recent receipt of two management achievement awards from the American Society of Association Executives. The AANS also received the coveted Wizard Award from the Professional Convention Management Association for its innovative computerized convention registration system. The Wizard Award is one of only four ever given.
With a close eye to carefully minimizing expenditures, this dedicated group of individuals have served us well as we all work to move forward together for the future of neurosurgery.