Sidney Tolchin, MD, of La Mesa, California,became the 63rd President of the American Association of Neurological Surgeons (AANS) during ceremonies held at the Annual Meeting in Orlando, Florida. Dr. Tolchin has been an active member of the AANS since 1970, holding a number of committee appointments including terms as Chairman of both the Professional Conduct and Practice Assessment Committees. He has also held such top leadership positions as Vice President (1992-93), Secretary (1987-1991), and member of the Board of Directors (1987-1993).
In 1957, Dr. Tolchin received his medical degree from Hanemann Medical College in Philadelphia, Pennsylvania. He completed his internship at Chelsea Naval Hospital in Boston and served his residency in general surgery at the Portsmouth Naval Hospital. From 1961 to 1965, he was a Resident, then later a Clinical Instructor in Neurological Surgery at Vanderbilt University Hospital in Nashville, Tennessee.
He currently holds an academic appointment as Clinical Professor of Neurological Surgery in the Department of Neurosurgery at the University of California, San Diego School of Medicine.
In addition to his private neurosurgical practice, Dr. Tolchin had a long and distinguished career as a naval officer and surgeon. He went on active duty as an Ensign in the United States Navy beginning in 1956. He completed active duty billets as Lieutenant Officer-in-Charge at the Amundsen-Scott Geographic South Pole Station (1958-59); as Lieutenant Commander, Staff Neurosurgeon, Department of Surgery, Section of Neurological Surgery at the United States Naval Hospital in San Diego (1965-67); as Commander, Staff Neurosurgeon, on the USS Sanctuary, Republic of Vietnam (1967); Staff Neurosurgeon, Naval Support Activity in Da Nang, Vietnam (1968); and as Staff Neurosurgeon, on the USS Repose, also in the Republic of Vietnam (1970).
He left active duty in 1971 and served a reserve billet as Captain, MC, USNR Senior Consultant Neurosurgeon, at the Naval Hospital in San Diego (1971-92). He retired from the Navy as a Captain in 1992. In recognition of his military service, Dr. Tolchin received the Distinguished Public Service Award from the Secretary of the Navy in 1990.
Dr. Tolchin has also played active leadership roles in several other professional organizations, including terms as Vice-Chairman of the American Board of Neurological Surgery; Chairman of the San Diego County Medical Society Medical Review Committee; Chairman of the San Diego Chapter of the American College of Surgeons Emergency Medical Services Committee; President of the California Association of Neurological Surgeons; and Co-Director of THINK FIRST, the National Brain and Spinal Cord Injury Prevention Program founded by the AANS and the Congress of Neurological Surgeons. In addition, Dr. Tolchin is a member of the American College of Surgeons, the American Heart Association Stroke Council, the American Medical Association, and the Society of Medical Consultants to the Armed Forces.
A trained pilot, Dr. Tolchin built a Rutan Long EZE, which he flew to Ireland via passage over the Arctic Circle. He also owns and flies a Cessna 210 and a Rutan Vari EZE. He and his pilot wife, Penny — a hospital system risk manager, enjoy exploring new locales in their aircraft. Dr. Tolchin is the father of four grown sons and grandfather to two young granddaughters.
Q: Describe your current practice, including any special interests.
A: I would have to be considered as being in general neurosurgical practice, doing everything from aneurysms through intra-cerebral lesions and spinal, carotid and peripheral nerve surgery. I enjoy all and do not subspecialize.
Q: You had a long and distinguished career in the Navy, how does your current practice differ from that experience?
A: At the time I was on active duty in the Navy, neurosurgeons were expected to do everything that we’d been trained for and more. For example, not only were we supposed to handle all the trauma and the brain tumors and aneurysms and peripheral nerves and back and neck problems, we also were expected to hold neurology clinics and general practice clinics.
It differs a lot now, in that I am doing neurosurgery primarily. But I’m still dabbling a little bit in general practice. We see patients with diabetic conditions, for example, prostate tumors and back pain presenting with neurological disorders.
Q: What is your view of the practice of neurosurgery in the military today? Has it changed a great deal over the years?
A: It depends. For example, in vascular surgery endarterectomies were done almost entirely by neurosurgeons in the past. I think very few extra-cranial vascular procedures are now done by surgeons in the military. A lot of orthopaedic involvement has occurred since I left the service and the experience that neurosurgeons in the military are having now with spinal surgery has also been impacted. But generally, I think they still have to deal with the trauma and with the brain tumors and aneurysms and such. I would expect that the numbers that they are seeing now are somewhat diminished in the face of the peacetime economy.
Q: You’ve been a driving force behind getting the AANS on line. Why do you believe it’s so important that neurosurgery become part of the Internet?
A: Communication in general has become extremely important in all phases of medicine. Technological and methodological changes have occurred so quickly that it would be impossible for surgeons to keep up unless they have some access to a communication medium which is geared to the rapid development of multi-media technology.
We have to advance in order to stay competitive in neurosurgery, not only individually but also globally. Deciding whether the types of procedures we do generally in neurosurgery are worthwhile and how much effect they have on the community is important. We have to determine how we are doing individually compared to other neurosurgeons as well as in comparison to other specialists. In terms of our involvement in the spine, how much better we should be doing it than orthopaedists who have lesser training must be measured. The vascular surgeons treat carotid disease just the same as they treat aortic or peripheral vessel disease in other parts of the body. We recognize it to be an integral disease process involving the brain.
Outcome studies such as these can be accomplished well through computer technology and the Internet. Coding for reimbursement, consultation services — including imaging study transfer, on-line chats and E-mail, rapid networking regarding important issues in neurosurgery all lend themselves naturally to electronic communication.
Q: Do you have any specific goals you would like to accomplish during your tenure as President?
A: I am not sure that I can accomplish every one of my goals during my time as President. I would like to get some of the more important projects initiated. Number one is to make certain all neurosurgeons are computer literate. I think the majority of neurosurgeons are now able to use computer technology to some extent. I want them to be able to turn on their machines at the end of the day, after they have seen patients, to review their activities, to contact other neurosurgeons regarding their cases, and to view new technology rapidly. I want them to be able to use computers as they are using their dictating machines, that easily, as an addition to all of the excellent educational opportunities they now enjoy. Secondly, I want them to see the business side of their practices improved in conjunction with continued improvement in the quality of neurosurgery they provide.
The third thing I want is for them to realize there is a life beyond neurosurgery. I hope that they will start enjoying life and not make neurosurgery the whole crux of their lives. I’d rather they start thinking about their families and how they spend their spare time, to be doing things they enjoy.
Q: You seem to have a very broad range of interests and, of course, one of them is flying. How did you got started with that?
A: I don’t think anybody can put a finger on when you first develop an interest. Airplanes intrigued me as a child. By the age of 16, I was flying and I’ve never given it up. It’s a lot cheaper than seeing a psychiatrist regularly.
Q: What is the “Menu for Success?”
A: Unfortunately, neurosurgery is involved in the same problems that all of medicine is, competition. The “Menu for Success,” therefore, is a concept aimed at giving people input regarding how they can maximize their ability to compete in today’s ever-changing environment. The “Menu for Success” includes learning to do things better, and developing new techniques in practice.
In addition, the “Menu for Success” includes using marketing techniques. That may feel uncomfortable to us, but that’s what we have to do in order to sustain our practices and to do the procedures we’ve been trained to do so well.
Overall, therefore, the “Menu for Success,” means excellence in training and continuing education as well as in marketing and business acumen.
Q: So, are you proposing that the AANS undertake some projects that would tie into this concept of “Menu for Success?”
A: We already have. The success we have had in training post graduate neurosurgeons in new techniques is that model. Recently, the AANS has offered hands-on courses on spine, carotid endarterectomy, skull base surgery, temporal bone surgery, all in an effort to enhance the education of neurosurgeons and to perfect their expertise to an even greater degree than they had enjoyed in their training program. We have also offered managed care courses, coding courses, courses in contracting, as well as courses in financial management. I think these courses are all very important in ensuring the success of neurosurgeons, but we have to continue them and develop new ones.
Q: You have been closely involved in the AANS Strategic Planning process. Do you have some thoughts on where the AANS will be in a few years?
A: For any organization, strategic planning is designed to identify strengths and weaknesses and, hopefully, to use the results of that strategic planning to expend resources in a reasonable fashion.
Our resources are limited. We need to know that those activities we can accomplish must be done very well. We can’t accomplish all of the things we’d love to do, but those we do must be done very well. The strategic plan is one method that we have to identify which way we should be going.
Past-President David Kelly was instrumental in developing a strategic plan that resulted in measurable effects on the teaching programs and the changes that occurred in the relationship between academic and general practice of neurosurgery. It also had a tremendous impact on the relationship between the AANS and the CNS and it supported the concepts that we believe in very strongly now in our interactions with the government and other outside agencies. We’re going to continue that process. The strategic plan we’re working on now is a continuation of what he initiated.
The strategic plan initially defined some of the weaknesses in our organization. Ed Seljeskog identified these in his Presidential Address. We must understand our relationship with other societies, especially the Congress, and be able to draw upon the strength of those organizations and not allow the divisive notions to impair what we must do to improve neurosurgery.
Q: As you start off your Presidential year, do you have any message for members of the AANS?
A: The message I would like to give would be that neurosurgery is still the cream of medical practice. Neurosurgeons are going to make a living, they’re going to do well with their abilities, and they’re going to enjoy their practices and they should never feel that there is any reason for thinking otherwise. It’s taken a long time for people to get there. And in their training and in their experience they’ve given up an awful lot to arrive there. Patients are out there that need neurosurgical treatment. We must never lose sight of the fact that the only people who can give that treatment satisfactorily and to the greatest benefit of the patient, are neurosurgeons.