AANS Neurosurgeon | Volume 28, Number 4, 2019


2033: Will We Have the Answer?

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Where were you in 1999? Were you practicing neurosurgery? What are your most poignant recollections of that time in your life? Clearly, for many of us, it felt like a watershed time for medicine, especially for neurosurgery. In this way (sans the threats of collapse after Y2K), neurosurgeons are facing remarkably similar challenges in 2016. All the adages about the importance of history (must remember, doomed to repeat) prompted a look back to the last AANS Neurosurgeon issue (then known as The Bulletin) that addressed the issue of
“Subspecialization.” Three features addressed this challenging topic from varying perspectives:

  • Is subcertification good for neurosurgery? This was covered by Barbara Peck.
  • Point/Counterpoint pieces were provided by Kim Burchiel, MD, (The Inevitable Road We Must Travel) and Edward R. Laws Jr., MD, FAANS(L), (At What Cost)
  • Katie O. Orrico, JD, interviewed the president of the American Board of Facial Plastic and Reconstructive Surgery, “How One Specialty Experiences Subspecialization and Certification

It is instructive to note that the concepts bear remarkable resemblance to those confronting our specialty today. Then and now there is the concern about quality, fragmentation, excellence, research, loss of perspective and encroachment of our services poignantly outlined in the Point/Counterpoint. Dr. Laws concluded, “Neurosurgery is a great profession and it should be for all of us. Part of the fun is the daily challenge of confronting difficult disorders affecting the nervous system.” In contrast, Dr. Burchiel eloquently stated, “…advancement in our specialty can only be fostered by a concentration of intellectual and creative effort in each of the discrete subspecialties that comprise our field.”

Other salient points noted in the issue include:

  • Delineation of the American Board of Medical Specialties (ABMS) and the American Board of Neurological Surgery (ABNS) in their charge, function and certification
  • Alternative means of subspecialty recognition ranging from creation of a separate board; offering of different primary certifications (radiology offers several); delineation of subcertification from a primary board (after passing the primary boards and completing specific criteria); or development of joint certification (an example would be hand surgery or sports medicine)
  • Accreditation of neurosurgical fellowships (which has become a reality)was proffered as a necessity 
  • the indication that health care insurers were pushing against specialization to help contain costs while other were advocating that subspecialization would improve patient quality and outcomes

Taken together, the conclusions eerily and poignantly reflect today’s subspecialty challenges, nearly two decades later. It was noted, “With all that is happening in today’s fast-changing health care environment, the debate surrounding subspecialization will continue to be a source of controversy for years to come.” In 2016, there have been notable changes as outlined, but many of the same questions still remain. Do you think in another 17 years (2033) we will have all the answers?



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