As neurosurgical attendings with academic responsibilities, we have obligations and mandates from the American Board of Neurological Surgeons (ABNS) and the Society of Neurological Surgeons (SNS) to provide adequate and informed socioeconomic and medicolegal education to our neurosurgical residents. Exactly what this education should entail has long been debated among the leadership and boards of the national organizations. The Council of State Neurosurgical Societies (CSNS) is the Joint Section of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) that represents grass root neurosurgery and addresses the socioeconomic and medicolegal issues relevant in neurosurgery today.
While we have long acknowledged the importance of socioeconomic and medicolegal education and delivering educational content to neurosurgeons in a meaningful and efficacious manner has proven difficult over the past few decades. While the CSNS has excellent educational content, often the CSNS talks sessions at the national meetings are not well attended, because most residents and attendings opt to attend their surgical subspecialty section meetings. Additionally, even live webinars and archived, on-demand talks are often underutilized. I benefitted significantly by attending the Neurosurgeon as CEO courses provided by the AANS and by studying data provided by the Neurosurgery Executives Resource Value & Education Society (NERVES).
What Residents Need to Know about Socioeconomics
There are a wide range of important topics residents need to have some understanding of when they enter practice. Some of those include:
- Coding and billing with relative value unit (RVU) and Common Procedural Terminology (CPT) codes
- Medicare and Medicaid reimbursement at national and state payment rates with their rules and regulations
- Management and review of accounts receivables
- Review of profit and loss statement
- Costs associated with running a department or practice
- Common malpractice rates, trends and regional differences
- Contract negotiation with private insurers, hospital contractors and future employers, to include an understanding of the common elements of a contract
Medicolegal Considerations
Neurosurgical residents should understand the nuances and importance of protecting intellectual property and the development of entrepreneurial skills. They should be aware of the rules and regulations within hospitals, hospital bylaws, and professional ethics and behaviors that will be expected of them. While it is challenging to “teach” ethics, hopefully through our own ethical and professional behavior, we provide the behavior we want our residents to emulate. With recent cases of neurosurgeons “in-the-news”, perhaps we should develop a more structured ethics curriculum.
Being a Good Citizen in the Neurosurgical Community
Activism and advocacy are also important topics for discussion, since they are ways that we as neurosurgeons can make a positive impact in the world around us. Being a mentor for those behind you and seeking the sage advice of mentors more senior than you, are important responsibilities of all neurosurgeons. I was very fortunate that one of my mentors, Dr. David Adelson, promoted my involvement in the CSNS and CNS as well. So, very early in my career, I started serving on committees and boards; those experiences and friendships are often that I have developed over the years have been invaluable.
Resiliency
We should also be discussing time and stress management, burnout, suicide prevention and emotional issues. We should not hesitate to discuss substance abuse, the “impaired” physician and issues that affect our ability to operate and manage our patients. Although not really an important issue for residents, long term planning and discussions about estate planning, the importance of life and disability of insurance, and loan repayment and savings/ investments should be introduced.
In summary, we have a serious obligation to teach our residents about the socioeconomic and medicolegal aspects of neurosurgery. As much as we enjoy teaching them to clip an aneurysm, resect a tumor, navigate the skull base, and place a pedicle screw, we need to help our residents become well-rounded, responsible, ethical and politically involved professional neurosurgeons. We must realize that our young trainees look to us as role models. Our failings will become their burdens, so we need to behave professionally, act ethically, and treat all of our colleagues with kindness and respect.
