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| Fremont P. Wirth MD |
Meriwether Lewis thus recorded the arrival of the Corps of Discovery expedition at the junction of the Missouri and Yellowstone rivers in what today is Montana thinking his company was closing in on its goal of finding a water route to the Pacific Ocean. Though they would not attain their goal for many months, Lewis’ journal entry of April 26, 1805, describes a point at which to reflect on the wonders of the journey so far and prepare for the yet unknown challenges that lay ahead.
As the nation commemorates the bicentennial of Lewis and Clark’s influential journey, the AANS prepares for celebration of its 75th anniversary, acknowledging an expedition of a different kind. It seems an appropriate time at which to pause and take stock of what our association has accomplished and what it seeks to accomplish in the future.
Numerous wonders in neurosurgery have come to pass since the association’s inception in 1931 as the Harvey Cushing Society in homage to that first “neurosurgeon.” The venerable icon himself is explored in a new biography that reveals fresh insights into Cushing’s progress in neurological surgery. In many ways, his professional journey is early neurosurgery’s own.
Initially the association’s primary goal was to serve as an infrastructure for meetings that involved “investigation and advancement in the fields of neurosurgery, with the fundamental needs of establishing methods of early diagnosis and postoperative treatment, directed toward the protection of the patients, and a decrease in mortality,” according to Temple Fay, a AANS founder.
Like the Corps of Discovery members who equipped themselves for an arduous journey and expected the unknown and unforeseen — wooly mammoths and pure salt mountains were considered among the possibilities — the AANS founders prepared themselves for an expedition into the establishment and development of a new and demanding surgical specialty. Though surely they could not have anticipated the astonishing technological advances available to us today — functional magnetic resonance imaging, artificial lumbar discs, robotic surgery — the mission they articulated pointed the organization in the right direction.
Revitalized Mission, Focused but Flexible Goals
Over the years the AANS has formalized and expanded upon its founders’ ideas. The current mission and vision statement is accessible at www.aans.org/about, and we anticipate release of a revitalized mission and vision statement during the 75th anniversary year. However, that the founders’ concerns remain at the core of the AANS today is apparent in the association’s annual meetings, as the 2006 AANS Annual Meeting will exemplify.
In April, the AANS will convene in San Francisco to present its 74th annual neurosurgical event under the direction of James T. Rutka, MD, annual meeting chair, and Mitchel S. Berger, MD, scientific program chair. A total of 646 abstracts have been selected for presentation at the meeting. Over the years the meeting has grown to encompass plenary and scientific sessions, AANS/CNS subspecialty section sessions, breakfast sessions and special lectures. Hands-on practical clinics hearken to the AANS founders’ concern for improved patient outcomes through refinement of surgical technique, and enjoyable social activities continue to foster a collegial spirit.
While the meeting itself will focus on scientific advances that promote quality patient care and safety, its theme, Challenges of Neurosurgery: Expanding Resources for a Growing Population, was chosen to ensure that the meeting also incorporates valuable information regarding the impact of current societal influences on the practice of neurosurgery. I selected this theme because issues underlying workforce and other concerns that are significantly challenging our profession now and in the next 10 years must be uncovered and addressed today.
To that end, the AANS Task Force on Neurosurgical Care and Physician Workforce Issues met for the first time in November. I asked several neurosurgeons, chosen for their seniority and representation of various practice situations across the nation, to join me in this endeavor: Paul J. Camarata, Mark H. Camel, Martin B. Camins, Stewart B. Dunsker, Robert Grubb, Hal L. Hankinson, Julian T. Hoff, David L. Kelly Jr., Lawrence H. Pitts, Donald O. Quest, Robert A. Ratcheson, Jon H. Robertson, Richard A. Roski, Alex B. Valadka, and Martin H. Weiss.
After reviewing available information, the task force identified distribution of neurosurgical services and organization of neurosurgical care as areas in need of further inquiry. Therefore, the AANS is conducting an online workforce survey in early 2006; if you are contacted, I encourage you to help us in this important effort. The task force plans to report on its findings in April.
Another group, the AANS Physician Extenders Task Force, spearheaded a survey conducted last fall to discover how neurosurgeons are using or would like to use nurse practitioners and physician assistants in their practices and to discern how they are, and should be, trained. Charles Hodge, MD, led the effort, the results of which are featured in this Bulletin issue.
Workforce was one of three issues identified in my fall column as top AANS concerns; the other two topics, medical liability reform and physician reimbursement, surely are among the forces that are stressing the neurosurgical workforce. All three areas remain top priorities, and they will be addressed in detail in future issues of the Bulletin as well as at the annual meeting.
Progress According to Plan
Provisioned with a clear mission, today’s AANS leadership employs a detailed document, the AANS Strategic Plan, which maps the way to ensuring that our profession maintains excellence in providing our patients with high quality neurosurgical care while simultaneously addressing professional issues such as workforce. The strategic planning process was formalized in 2003 by A. John Popp, MD, leading the Long Range Planning Committee. Since then the successive plans have articulated goals aligned with the AANS mission, with specific tasks then assigned to specific committees and tied to the budget.
For example, in the tradition of professional education at the core of the AANS mission, a plan goal of developing member services and benefits specified a task that called for the AANS to reassess benefits for young neurosurgeons — our profession’s future workforce. Today residents in North America not only attend the annual meeting at no cost to them, they also receive free AANS membership and the AANS Journal of Neurosurgery. Another task called for the AANS to establish a central repository for continuing medical education and maintenance of certification. The AANS has since worked closely with the American Board of Neurological Surgery to meet this goal and others in advance of the board’s MOC program launch in January, and today CME credits for MOC are tracked at www.MyAANS.org. ABNS directors discuss MOC implementation in this issue of the Bulletin.
The plan also called for the development of member services and benefits via a biennial member needs assessment that would “assure that members’ feedback is continually factored into leadership decision-making.” AANS leadership, including all the committee volunteers who make this organization work, can attest to the value of this data in tailoring an association that works for you.
The updated AANS Strategic Plan, currently in development by AANS President-Elect Don Quest and the Long Range Planning Committee, will address financial, organizational, customer service and advocacy areas of the association. The new plan will be detailed in an upcoming issue of the Bulletin.
By providing a consistent yet flexible base, the AANS Strategic Plan is an essential element for meeting the needs of our members and our profession today and anticipating the needs of our successors another 75 years hence. It also serves to remind us that challenges such as workforce, medical liability reform and physician reimbursement — as I write this, we may or may not have staved off the 4.4 percent reduction in Medicare physician reimbursement scheduled to take place in January — need not deter us in pursuing what we know to be a worthwhile, stimulating profession that provides essential services to our patients.
Taking stock of the AANS’ first 75 years inspires great confidence that the organization, volunteer leaders and members are equipped with the tools, sense of purpose and fortitude to meet the challenges yet to be imagined and faced. I believe that our planning will prove to be as prudent, responsible and visionary as that of our forebears.
With appreciation for the journey we have taken together and in anticipation of what is to come, I thank you for your involvement in the AANS and invite your future participation in our organization.
April 26, 2006, exactly 201 years after Lewis paused to reflect on his journey at the confluence of two great rivers, coincidentally will mark the conclusion of my sojourn as AANS president. The entire AANS leadership team and I are working to launch the 75th anniversary year memorably at the 2006 Annual Meeting. I hope you will join me in San Francisco April 22-27 not only for superlative science and celebration, but also in feeling much pleased at having arrived at a long-wished-for spot.
Fremont P. Wirth, MD, is the 2005-2006 AANS president. He is in private practice at the Neurological Institute of Savannah in Georgia.
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