This has been an especially challenging and difficult year. Internally, the AANS National Office is undergoing a change in leadership with the departure of our Executive Director, Robert Draba, PhD. Although finding Dr. Draba’s replacement continues to be a top priority, longtime AANS staffers, Laurie Behncke and Robert Cowan, will serve as exceptional interim directors. Russell Travis, MD, 1998-99 AANS President, has exhibited the incredible strength of character necessary to lead a determined search for the most qualified candidate — this is no easy feat given the vast intellect, expertise and innovation we expect from our Executive Director. We must find someone able to carry us into the next millennium and beyond in a health care environment that is usually hostile and always changeable, but we are confident that our efforts will be successful (see late breaking announcement on the new AANS Executive Director on page 4).
Another challenge we are facing is the recent decision by the Congress of Neurological Surgeons (CNS) to divest themselves from the AANS for their Meeting Planning and Exhibit Management. This divestiture will occur after the 2000 meeting, and is a development that greatly troubles the entire AANS Board. Our Board believes that this schism will benefit neither organization. Despite many efforts to negotiate a mutually acceptable solution, we have been unable to reach a compromise with the CNS. The AANS Board, however, will continue to pursue opportunities to integrate the activities of the two organizations, and we have left an offer on the table that would allow the CNS to share office space and fixed facilities, which would provide savings for both groups. In addition, we are committed to a joint strategic planning process that we believe will best serve our future membership needs (read more on this issue in an article on page 25).
It is unfortunate that these sorts of issues arise at such a difficult time in the field of medicine, since they distract from more important tasks at hand. Luckily, our committee leaders and members have continued their efforts to influence the future of neurosurgery, and we can thank them for their many accomplishments over the past year.
Membership
The AANS membership has continued to increase, climbing 2.4 percent from last year’s count of 5,263 to this year’s total of 5,387. Most notable was the increase in our Candidate (Resident) and International Associate categories, up 5 percent and 11 percent, respectively. These increases are particularly encouraging, not only because more members lead to a stronger organization, but because they indicate that we are reaching beyond age and geographical boundaries. Since the average age of our Active member is 49, we seem to be having some success at attracting younger neurosurgeons to the AANS, something that will have to continue if the organization is to survive into the next millennium.
Education
Supporting the continuing education of young neurosurgeons is one of several ongoing initiatives of the Neuroendovascular Task Force, headed by Mark Mayberg, MD. Through the combined financial support of the AANS and CNS, three fellowships will be funded this year, as opposed to the two that were available last year. Members of the Task Force believe that these fellowships have promoted interest in the field, especially among graduating residents pursuing academic careers, and hope that the fellowships will be supported for an additional two years. The Task Force also continues to work on establishing training guidelines.
Meanwhile, the Neurosurgical Surgery Residency Review Committee (RRC) has successfully revised their program requirements for residency training. Robert Ojemann, MD, and his committee were able to get these revisions accepted by the Accreditatioon Council for Graduate Medical Education (ACGME), and the revisions will become effective on July 1, 1999. This committee also has worked with the Sections to develop guidelines for fellowship training, and is currently distributing their suggestions to the appropriate organizations for comments. This sort of exchange, inviting new ideas as well as revising old ones, is vital to the improvement of our specialty.
The exchange of ideas and the commitment to excellence are always at the heart of our Annual Meetings. This year’s meeting in New Orleans featured a top-notch Scientific Program, showcasing contemporary innovations and research advances from all realms of neurosurgery, as well as a spectacular line up of social activities. Annual Meeting Chair, L.N. Hopkins, MD, and those who comprised his committee, deserve to be applauded and praised for their tremendous efforts on putting together another memorable meeting.
Research
Research is the basis of our specialty, defining where we have been and where we are going. Julian Hoff, MD, one of two neurosurgical representatives to the National Institute of Neurological Disorders and Stroke (NINDS), reports that there has been considerable enthusiasm recently regarding the appointment of NINDS Director, Dr. Gerald Fischbach. Administrative changes initiated by Dr. Fischbach have been well received and should allow for increased involvement of the neuroscience community, especially on the Study Section level. These developments, as well as significant funding increases and internal changes within the National Institutes of Health, led Dr. Hoff to conclude that the environment for both neuroscience and neurosurgery is highly favorable.
Dr. Hoff also reports that the Executive Council of our own Research Foundation plans a major fund-raising campaign. These plans will consist of focus groups, a survey, and a report, and will assist the Foundation in developing effective fund-raising strategies. The target of the study will be our own membership, who shockingly have donated only 4 percent to the endowment in recent years, and who must be encouraged to contribute much more substantially in the future if we are to expand our grants and fellowships awarded to young neurosurgeons. The Executive Council also is considering co-sponsorship of additional grants with any or all of the Sections.
Finally, research continues in the development of neurosurgical outcomes under the direction of Robert Harbaugh, MD. Studies in carotid endarterectomy and aneurysm surgery are being developed and should ultimately improve the quality of care of these patients. The Outcomes Section on N://OC® also has been enhanced to include information and links to an online outcomes reporting database.
Communications
Research is of little use if it is not properly disseminated, a fact which makes the Journal of Neurosurgery a vital link between neurosurgeons and the cutting edge. To increase readership worldwide, Journal editor John Jane, MD, reports that an aggressive marketing campaign continued in Turkey, Germany, Chile, Japan, and Asia during 1998. This, along with the introduction of the Journal of Neurosurgery: Spine and the success of Neurosurgical Focus on our Web site, represents an exciting expansion of our scope.
To meet the growing needs of our members, NEUROSURGERY://ON-CALL® has implemented several new additions in the past year, including: a new outcomes section; world directory of neurological surgeons; education section; new Web server, which has improved the search function; expanded Section pages; upgraded online abstract center; site called Young Neurosurgeons Online for residents in training and recent graduates; updated look for the Public Pages; online chat educattional service; and a new socioeconomic section. To make the most of these incredible improvements, a Web site promotion plan also is being developed in order to increase traffic on both the Public and Professional Pages.
In direct response to membership suggestions, the Bulletin has become the socioeconomic and professional quarterly for AANS members. New features include a Coding Corner; Practice Management Column; Practice Profiles; and an Editor’s Perspective. This shift in direction will help all of us stay abreast of the complicated “business” of neurosurgery.
Communicating with patients is the “business” of the Lumbar Stenosis Getting SMART program, which has been the most successful product in the history of the AANS or CNS. To date, we have distributed 98,550 patient brochures; 52,500 physician brochures; 424 slide sets; and 482 press kits. This successful marketing tool is just one of the many ways to increase the visibility of neurosurgeons while helping our patients better understand their treatments. Phase II of this marketing campaign, “Getting SMART About Cerebrovascular Disease: An Educational Program on Stroke” was unveiled at the 1999 AANS meeting.
Socioeconomic Issues
Because neurosurgical practices have become so complex, it is necessary for us to have a strong presence in Washington capable of defending our specialty in an environment that favors primary care. Art Day, MD, and Katie Orrico continue to fight the battle, along with our Washington Committee and Robert Florin, MD. At issue, among other things, is the current Medicare Fee Schedule determined by the Health Care Financing Administration (HCFA), which we feel grossly miscalculates practice expenses for neurosurgeons. This issue has been, and will remain, a top priority for our Washington Committee, as they collect the data necessary to argue convincingly in our favor.
In addition, the Washington Committee spearheaded a letter to the Department of Justice and the Federal Trade Commission objecting to the impending merger between Aetna and Prudential, a merger which could “pose a threat to patient care by limiting patient and employer choice, reducing competition and further eroding the ability of physicians to deliver medically necessary care.” Russell L. Travis, MD, 1998-99 AANS President, and Hunt Batjer, MD, 1998-99 CNS President, signed the letter.
Professional Conduct
Supporting our committees and one another is critical to our continued success as professionals. There are times, however, when some neurosurgeons step outside the lines of professionalism and when we must take disciplinary action against them. The AANS Professional Conduct Committee, headed by W. Ben Blackett, MD, has the difficult task of conducting hearings in such cases, then making conclusions and recommendations to our Board of Directors.
Summit
Once again, our Annual Meeting was the site of a “summit conference” for the leadership of the AANS, CNS, Senior Society, American Board of Neurological Surgery, and the RRC. At this meeting, discussions continued regarding issues such as neurosurgical fellowships, the timing of board certification, and recertification. This meeting was an excellent opportunity for our leaders to get reacquainted and network.
Other Notable Activities
Following are a few other important developments that are currently underway.
- Bob Page, MD, and A. John Popp, MD, are analyzing and updating our policy manual;
- David Jimenez, MD, and the Young Neurosurgeons Committee have volunteered to help serve the THINK FIRST Program;
- James Ecklund, MD, is revitalizing the Committee of Military Neurosurgeons;
- The AANS National Office has rallied and united even without thedirection of an Executive Director, and
- Our Sections are vibrant, alive and functioning well.
Stan Pelofsky, MD, is President of the Neuroscience Institute. Dr. Pelofsky, a 23-year member of the AANS, is Past President of the Council of State Neurosurgical Societies and currently serves as AANS Secretary.