In this issue of the Bulletin, our featured topic explores the history and future of neurosurgery . While the subject raises many questions, such as how will neurosurgery be practiced in the new millennium, what external influences will impact our practice; and how can we as individuals and a specialty prepare ourselves for the future, it also demonstrates the strides we have made over the past century to enhance our profession.
A Look Back
For most of this century, technological and scientific advances have driven our specialty’s progress. The introduction of the CT scan and the use of the operating microscope are two examples of such advances that radically changed the way we practice neurosurgery.
Moreover, neuroscience research was an important element in residency training and discoveries by neurosurgeons in the laboratory lead to improved patient care. Admittedly there were clues–the growth of governmental insurance programs, the development of managed care and the increase in the number and cost of malpractice cases–that presaged a period of dramatic change in the specialty caused by external forces.
While exciting clinical and research advances have continued during this past decade, most neurosurgeons have become preoccupied with external influences on the practice of our specialty. At present, it often seems that HMOs, reductions in reimbursement, workforce size, and the potential erosion of the specialty market share–particularly in the area of spine surgery– engenders more concern from the neurosurgical community than the actual practice of neurosurgery. Through these economic developments, we have learned that we can no longer be insular protected by the sanctity of our specialty. Instead, as a small specialty with less than 1 percent of the physician workforce, we must actively and persuasively participate in the conclaves where policy influencing neurosurgery is determined.
Predicting the Future of Neurosurgery
While one may hesitate to predict future trends in medicine, it is safe to augur that a return to simpler times is unlikely to happen. Furthermore, in moments of nostalgia for the “good old days,” the comforting thoughts that emerge from such reflections are illusionary–earlier times were often just as complex, but different because the complexities were different. In fact, to the young practicing neurosurgeons and to those currently training, the present state of our specialty will, too, be remembered as the “good old days.”
From my personal perspective, the best way to prepare for the new millennium is to be an active participant in shaping both our specialty and ourselves. We, as neurosurgeons, must establish personal and professional goals that serve to enhance our knowledge, our clinical and surgical skills, our ability to analyze outcomes and our participation in the greater neurosurgical community on a local, state and national level. By taking an active role, we will empower ourselves and our organizations in determining the future of neurosurgery.
AANS Works For You
The AANS is working to help its members maintain control over their profession as we approach the new millennium. For example, the AANS is formulating a strategic plan to position organized neurosurgery to be highly responsive to the environment and to its membership. We are refining strategies to represent neurosurgical interests in issues concerning physician reimbursement, practice expense RVU’s, E&M documentation, medicare coverage policy, CPT coding, graduate medical education, biomedical research, collective bargaining, quality assurance, tort reform and fraud and abuse–an imposing list of initiatives that serve as evidence that the AANS is working for organized neurosurgery and for neurosurgeons. To ensure the success of these efforts, the current leadership of the AANS needs more than your tacit support, they need your involvement and energy if we are to be viable presence in the new millennium.