The Annual Clinical Congress of the American College of Surgeons took place on October 12 – 17, 1997. There were meetings of the Regents, the Governors and the various advisory councils, including the Advisory Council for Neurological Surgery. The financial status of the ACS is quite satisfactory. The new building at 633 St. Clair in Chicago has been fully committed with five floors for the ACS, including the new Clinical Trials Unit. There will be several floors occupied by an advertising company and the first 17 floors by a Wyndham Hotel.
Neurosurgery continues to be active in almost all areas of the College.
Clinical Congress
The Clinical Congress Meeting was a great success with some 12,000 attending. The program was well designed with most of the presentations pertinent to neurosurgery occurring on Monday and Tuesday during the meeting, as usual. Dr. Eugene Flamm gave the History of Surgery Lecture, supported by the Advisory Council for Neurological Surgery, and it was an outstanding lecture, which was very much appreciated by the membership. The Panel on Current Standards in the Management of Acute Head Injury, organized by neurosurgery, was a huge success and this type of interdisciplinary program has been highly successful at the College previously.
On Tuesday, there were panels relating to peripheral nerve entrapment and injury, and to the methodology for the evaluation of carotid occlusive disease. The Neurosurgical Motion Picture Session was outstanding and the Surgical Forum Session devoted to neurosurgery was most impressive with a large number of highly sophisticated scientific presentations. John Atkinson, MD, is our neurosurgical liaison to the program committee of the ACS and continues to provide excellent input into these educational sessions.
Surgical Research and Education Committee
The Surgical Research and Education Committee has put on conferences and courses on clinical trials methods and also sponsors the Young Surgical Investigators Conference, both of which have been well received and over subscribed. There is a course on Surgeons and Educators that is sponsored by the Graduate Medical Education Committee and this committee has also put forth a series of prerequisite objectives for Graduate Surgical Education broken down into subspecialty areas, including neurosurgery. Philip Gutin, MD, serves on the Surgical Research and Education Committee, and Howard Eisenberg, MD, on the Graduate Medical Education Committee. The Committee on Young Surgeons has a separate meeting as well, and will produce a program in conjunction with each of the Clinical Congresses. The Courses given by the ACS for teaching new technology require a certain degree of oversight similar to that which we have provided for practical courses and professional development courses in neurosurgery. A series of principles has been established very similar to those that we have adopted.
Socioeconomic Issues
With regard to professional liability activities, the ACS is attempting to negotiate with the National Practitioner Data Bank to keep residents from being listed. The current compromise is that residents listed will be removed from the list if they successfully complete their training.
With regard to reimbursement issues, a prediction was made that the conversion factor will be $31 by the year 2007 and the suggestion was also made that restructuring Medicare may be the best new initiative to maintain satisfactory reimbursement levels for surgical services.
Specialty Board Concerns
Reports were heard from each of the Boards of the specialties covered by the ACS, and many of the concerns were shared. John Van Gilder, MD, gave the report of the American Board of Neurological Surgery. Most of the boards are using a test consultant with the hopes of making the oral examinations more objective, and virtually all of them have utilized the same method that the ABNS is currently testing. Each of the boards discussed its re-certification procedures, most of which involved maintaining an active license, obtaining adequate evidence of CME activity, some sort of practice review, and a test usually given in a modular fashion so that individuals could appropriately tailor their tests to their practice situations.
The AMA Accreditation Program was discussed, and most of the specialty boards were a bit skeptical about it and noted that there were 100,000 AMA members who are not board certified for whom this program is of considerable interest. In Urology, there had been a decrease noted in the number of cases done by candidates during their first 18 months in practice and this decrease was attributed to the impact of managed care. The American Board of Urology is wrestling with a request for a CAQ in Pediatric Urology.
Neurosurgeon Involvement
The program of the ACS meeting included the following neurosurgeons as presenters of papers: Eugene Flamm, Joseph Maroon, Issam Awad, David Kline, Chris Ogilvy, Jack Wilberger, Laurence Dickinson, Alex Valadka, Joseph Hahn, Richard Rovit, Hunt Batjer, Ivan Ciric, David Frim, Gerard Dr Brun, John Shea, John Atkinson, Gordon Deen and Bryce Weir. The Surgical Forum in neurosurgery had 11 scientific papers. Among the leadership of the ACS we count Edward Laws as Regent, Charles Drake as Past President, Frank Padberg as a senior member of the executive staff of the ACS, John Atkinson on the program committee, Herbert Engelhard on the Commission on Cancer, Jack Kushner and Richard Penn on the Committee on Emerging Surgical Technology and Education, Howard Eisenberg on the Graduate Medical Education Committee, James Boggan and Edward Laws on the Committee on Medical Motion Pictures, Michael Rosner of the Pre and Postoperative Liability, Edward Laws on the Scholarships Committee, Fran Conley on the Commttee on Surgical Education in Medical Schools, Philip Gutin on the Surgical Research and Education Committee, Thomas Luerssen and Raj Narayan along with Howard Eisenberg, Jack Wilberger and Tom Saul on the Committee on Trauma, and Iain Kalfas on the Committee on Young Surgeons. He will be joined by Steve Haines on this committee. Edward Laws is also a member of the Central Judiciary Committee of the ACS. Issam Awad, Glen Morrision, Bryce Weir and Richard Winn all serve the College as Governors.
The impact of neurosurgery is quite visible and hopefully will continue to benefit all of organized American Surgery.