It is an honor for me to take on the job of President of The American Association of Neurological Surgeons (AANS), and to follow the outstanding leadership team Dr. Chuck Rich put together during the past year. Our organization is stronger than ever, and despite a variety of problems, I am optimistic about organized neurosurgery’s ability to address the issues and to make our specialty more vital and productive than ever before.
From an organizational standpoint, neurosurgery has never been stronger. The AANS and the Congress of Neurological Surgeons (CNS) are working together in a harmonious fashion, with each organization taking advantage of the strengths of the other. Virtually all of the major initiatives have joint support from both the AANS and the CNS. This unified voice is a tremendous advantage when we deal with external forces attempting to control our methods of practice, our educational programs, our residencies, and other aspects of our professional lives.
The Joint Officers of the AANS/CNS have been working to provide oversight and guidance for a large number of joint projects. The harmony and symbiosis in the Joint Officers has improved the speed and quality of the response to a number of exciting initiatives that benefit all of Neurosurgery. The subspecialty Sections are strong and active, and each has been able to contribute to the basic missions of the AANS and to improve the levels of science and practice in the respective special areas of interest represented.
The Young Neurosurgeons have been another source of ideas and activities that have enhanced the entire Association. This committee has been an effective method for the involvement of younger neurosurgeons in the activities of the AANS, and having Young Neurosurgeon liaisons to many of the committees and activities of the AANS has improved both the relevance and the functions of these facets of our organization.
Washington Activities
Neurosurgery’s representation in the political scene in Washington, DC, is absolutely superb and is becoming increasingly important as we address issues like the Health Care Financing Administration’s (HCFA) proposed reimbursement changes, managed care, graduate education certification, and other issues that influence neurosurgeons. Our Washington representative, Katie Orrico, JD, is a seasoned and highly respected member of the Washington community. Her contacts and her ability to work closely with other organizations having the same interests have offered us a new and effective avenue of activity in Washington.
Our Joint Washington Committee, under the able leadership of Arthur Day, MD, has put forth a number of initiatives that have been surprisingly successful, especially considering the size of the neurosurgical community. Hopefully this influence will continue to be felt and will be enhanced by the creation of the American Neurological Surgery Political Action Committee, which is an activity independent of the AANS.
Robert Florin, MD, has been a tireless worker in Washington helping all of neurosurgery with revisions of the CPT coding and with the RUC. His honest and even-handed approach has gained the admiration of many of the important bureaucrats at HCFA, and he has done an outstanding job in helping to prevent the dismantling of neurosurgical reimbursement.
Grassroots Efforts
Representation within organized neurosurgery at the “grass roots” level has become increasingly effective over time thanks primarily to outstanding leadership in the Joint Council of State Neurosurgical Societies (JCSNS). The Council is more effective and vigorous than ever, becoming a truly meaningful avenue for new ideas and new concepts to be spread through the organization and to the Board of Directors.
This conduit, however, is only as effective as the members make it, and we hope the individual state neurological societies will continue to be active, representative, and eager to contribute to the efforts and activities of the JCSNS. The success of several of our top priority projects, including the joint communications effort, rely on the involvement of the majority neurosurgeons at the “grass roots” level.
Legal Issues
Legal issues such as the pedicle screw litigation and Professional Conduct activities have been supported in an outstanding fashion by our legal council, Russell Pelton, JD. His wisdom and expertise, and the courage of our Professional Conduct Committee, have made our activities in this area the envy of the American College of Surgeons and other surgical specialty societies, none of whom have been willing to take the kind of strong action that has occurred within the AANS. Although we are currently still being named in the pedicle screw case, we will continue to appeal and fight this lawsuit. In a related matter, we filed a petition with the U.S. Food and Drug Administration (FDA) asking the agency move forward and reclassify pedicle screw spinal systems to Class II from Class III. The FDA has been paralyzed by the multi-district litigation in Philadelphia and needed to be reminded that the medical community needs to have timely decisions made on matters of this type.
Board Activities
The Board of Directors of the AANS has been, and continues to be, a highly representative body. It incorporates individuals of unusual talent from the areas of private practice and academic neurosurgery and from all parts of the United States. This Board deals directly with many thorny issues and has been characterized by full and open debate.
One of the most recent Board-directed activities has been the development — jointly with the CNS — of a Task Force to study subspecialty issues in neurosurgery. There are many aspects to this issue and we will attempt to clarify them as the year develops and the Task Force researches the various specific challenges that need to be met.
Educational Activities
Providing a forum for our members to develop new skills and review research outcomes remains one of our top priorities and objectives. The AANS educational programs have become increasingly more comprehensive and effective. The Annual Meeting each year is a stellar event from a scientific standpoint, and attendance at the scientific sessions continues to rise. The feedback with regard to the quality of the programs, speakers, and educational opportunities has been outstanding. The Professional Development Courses (PDP) courses, in a focused way, allow individual members to enhance their knowledge base in areas of practice and in socioeconomic issues as well. Four new PDP classes were added last year to better meet the needs of our members and we will continue to evaluate our course offerings.
N://OC®
During the year ahead, we have plans to expand and enhance NEUROSURGERY://ON-CALL®, the official Web site of the AANS and CNS. Since its inception in early 1996, N://OC® has established itself as the premier resource for neurosurgical information on-line. Recent additions include Real Audio, which allows us to provide recordings of selected Annual Meeting presentations through the site, and Push Technology, which gives an Internet user the ability to automatically receive informational updates on the topic(s) of choice directly into his or her computer. We will continue to enhance the site, particularly in the areas of outcomes management, resources, patient education, and non-neurosurgeon physician resources.
This project is potentially one of the most important initiatives for all of organized neurosurgery in terms of communication and information transfer. Our efforts to innovate in this area are a credit to the energy and foresight of the leadership group that was responsible for development of N://OC®.
Research
Neurosurgical research and its financial support are both growing, despite the reality that funding from the federal government is in jeopardy. Each year we see more in the way of research awards for neurosurgical investigators. The individuals and the projects for which these awards are given are astoundingly excellent, and provide a glimpse into the intellectual vitality of our specialty. In addition to funding for basic research, support for clinical research and for outcomes studies is rapidly growing and these endeavors will hopefully be just as profitable in obtaining new knowledge as basic research has been over the years.
Optimism for Future
The American Association of Neurological Surgeons works hard to represent all of Neurosurgery, to improve education and research in Neurosurgery, and to deal with pressures from without that have improved our cohesiveness and our ability to act in a decisive and effective fashion. Along with your State Society leadership, the entire Board of Directors and the National Office staff are at your disposal, and appreciate and seek input from members. Our goal is to provide effective, intelligent, and carefully considered leadership, and we depend on the membership and its input to help us do that. The 1998 Annual Meeting in Philadelphia, April 25-30th, will mark the end of my year as President of the AANS. I hope that by that time the optimism with which this year is approached will be justified.