Aneurysm coils, pedicle screws, and ventriculoscopes are not the only new tools neurosurgeons are learning to use. While the economic stress on neurosurgical practice is an obvious motivation, neurosurgeons today are demanding, and getting, the opportunity for education in such diverse subjects as leadership, politics, business planning, practice management, marketing, and career planning. Neurosurgeons increasingly are taking time out of their practices to earn master’s degrees in business administration just to run their practices and help with hospital and insurance negotiations.
So along with watching “Masters Operate in 3-D,” neurosurgeons are filling the classrooms to master these new tools of the trade. With such a high demand, organized neurosurgery has responded with a rapid growth of special courses and seminars at national meetings and throughout the year. The scope of opportunities currently available to neurosurgeons deserves highlighting.
Coding courses were among the first to emerge, influenced by the rapid changes in national and insurance company regulations in the 1970s and 1980s. Byron C. Pevehouse, MD, conducted presentations on coding at breakfast seminars during annual meetings of the American Association of Neurological Surgeons before 1990, when he organized the first pre-meeting AANS coding course covering International Classification of Diseases and Current Procedural Terminology. That 500 people showed up when only 100 were expected to attend attests to the intense interest in and need for such courses. Since then, these courses have become a staple of neurosurgical education, with more than 40 courses devoted exclusively to coding and reimbursement. Both the AANS and the Congress of Neurological Surgeons now offer courses in neurosurgical coding.
In 2000, Women in Neurosurgery sponsored a leadership seminar during the AANS Annual Meeting. The seminar included talks on career promotion, time management, and conflict resolution. Edie E. Zusman, MD, codirector of the seminar, said “The response to this educational offering was tremendous. The program was sold out, the evaluations were excellent, and nearly all the participants wanted more time and more programs like this one.” Based on this success, two subsequent leadership skills seminars have been held. Most recently, the Advanced Leadership Skills session was held during the 2004 Annual AANS Meeting.
Another venue for developing leadership skills is the Leibrock Leadership Development Conference. The program, developed initially by the Council of State Neurosurgical Societies and the AANS/CNS Washington Committee, responded to the desire to build a core of neurosurgeons who could become involved in political issues that affect healthcare delivery. This year, the conference was held July 18-20. James R. Bean, MD, a participant and speaker, noted that “The interactive sessions on recent Medicare law, media messaging, medical liability, new EMTALA regulations, and the current political situation in the run-up to the presidential election were priceless [and] worth every bit of the time spent.”
At the training level, the Accreditation Council for Graduate Medical Education now expects residents to gain an understanding of all aspects of healthcare delivery, extending well beyond mastering surgical and diagnostic skills. Recent educational requirements during residency training include ethics, communication, professionalism, leadership, and administrative skills. The complexity of resident education and evaluation even has led to the establishment of advanced degrees in surgical education.
Residents also have recognized the difficulty of choosing jobs and career paths. Beginning in 2001, the AANS held is first course devoted exclusively to guiding early-career neurosurgeons in taking these critical steps. Beyond Residency: The Real World, focuses on preparing residents for their future practice opportunities by addressing issues such as: choosing a practice setting; negotiating contracts for joining a practice; preventing medical liability claims; recognizing applicable regulatory requirements; coding effectively; and analyzing and maximizing reimbursement.
An AANS course offered for the first time this fall was designed to meet many of the same needs for seasoned neurosurgeons. Representing academic practice and private practice, respectively, Samuel Hassenbusch, MD, and Stan Pelofsky, MD, led an experienced team in the presentation of the Neurosurgeon as CEO: The Business of Neurosurgery. The course focused on strategies for building revenue streams, increasing business, enhancing performance, and improving the bottom line. That the course filled completely several weeks in advance speaks to the fact that economic and practice management issues currently weigh heavily on the minds of many neurosurgeons.
The experience of many suggests that taking the time to master these new tools of our trade may pay off handsomely in job satisfaction. Organized neurosurgery should continue to provide innovative educational programs, embedded within our annual meetings, with expert instruction modified specially for neurosurgical practice.Deborah L. Benzil, MD, is associate professor in the Department of Neurosurgery at the New York College of Medicine, Valhalla, N.Y.