There are a few things in particular I appreciate about the late Bob Hope. Besides the veteran performer’s admirable longevity-he performed for 60 years and celebrated his 100th birthday in May-he was always journeying somewhere, or I should say, he was always “on the road”; he routinely opened his radio broadcasts with, “This is Bob [fill in name of remote location] Hope.” Throughout his career, he exhibited a remarkable ability to adapt to change. At about the same time neurosurgeons were organizing the Harvey Cushing Society, Hope already was trading vaudeville for Broadway. Utilizing the wonders of technology, he advanced his career by reaching burgeoning audiences through radio, film, television, and now, DVD.
Perhaps most importantly and certainly most memorably, Hope was able to combine creativity with impeccable timing to help the nation address serious concerns during difficult times. Take, for example, this pithy parable as remembered by a Marine nearly 30 years after he heard it at a USO show in Da Nang:
“Boy, that road is really muddy between here and the airstrip. (pause)
In fact, we were driving over here today when we passed a soldier buried in the mud up to his neck! (pause)
We offered to dig him out and give him a ride, but he turned us down. (pause)
“He said, ‘Thank you sir, but I’m not supposed to leave this jeep I’m sitting on.’ “
By drawing a few parallels between a venerable comedian and our profession, I am not suggesting humor as a cure for the ills currently facing neurosurgery-although I will allow that a good dose of it is welcome on occasion. As I look forward to a year serving as the 73rd president of the American Association of Neurological Surgeons (AANS), it seems that the formidable challenges to our profession are commensurate with the scientific and technological advances that are available now and in the near future for aiding our patients.
On Our Road
Professional Liability Insurance Crisis. At the forefront of these challenges surely is the crisis of rapidly escalating professional liability insurance (PLI) premiums. This challenge goes straight to the heart of whether or not a neurosurgeon is able to practice, not 20 years from now, but tomorrow. Many neurosurgeons are modifying or moving their practices to reduce premiums, practicing without insurance, or retiring, and people in communities across the United States subsequently are finding themselves without neurosurgical coverage when they need it. Organized neurosurgery must work intelligently and aggressively and in collaboration with other medical specialties for passage of federal tort reform that will help end the PLI crisis.
Neurosurgeons to Preserve Healthcare Access Campaign. Toward this end the AANS, together with the CNS, launched Neurosurgeons to Preserve Health Care Access (NPHCA), neurosurgery’s new 501(c)(4) tax-exempt entity whose sole purpose is to spearhead our aggressive public education and lobbying campaign for federal medical liability reform. Already the AANS has contributed $100,000 to NPHCA, and every member of the AANS Board of Directors personally has committed to initially giving at least $1,000 every year for three years. Other contributions, including respective $100,000 donations from the CNS and the AANS/CNS Spine Section, as well as gifts from board members of the Council of State Neurosurgical Societies, AANS/CNS sections and other neurosurgical societies, demonstrate neurosurgery’s commitment to this crucial campaign. Contributions from individual neurosurgeons-the AANS is asking each member to join in the effort by giving $1,000 each year for three years-will serve as a grassroots mandate for this important, all-out effort for federal medical liability reform that already is underway.
Continuing Medical Education Requirements. Another issue of immediate and intense concern is that of evolving requirements for neurosurgical continuing medical education (CME). As reported in the Winter 2002 issue of the Bulletin, changes in CME requirements, stemming from the influential Institute of Medicine report that challenged all physicians to demonstrate competence and verify performance throughout their careers, are imminent. In brief, in a bid to meet this challenge and preempt external oversight of neurosurgical medical education, the American Board of Neurological Surgery (ABNS) initiated development of its maintenance of certification (MOCTM) program.
To help AANS members meet the MOC requirements set forth thus far, as well as the elements that have yet to be defined, the AANS is reinventing its education component and realigning its neurosurgical CME requirements to mesh with the ABNS requirements. The AANS absolutely is dedicated to marshaling all of its resources so that complying with the myriad complexities involving neurosurgical CME is rendered a simple matter for AANS members.
… And More. An additional concern facing neurosurgery is the restriction on resident work hours. The Accreditation Council for Graduate Medical Education decision, effective as of July 1, has implications beyond who will cover when residents are not available and how the cost of that coverage will be paid. The deeper questions involve the very nature of what is required of a neurosurgeon today and how a resident can be adequately prepared to meet those challenges; the AANS will continue to participate in debate on this subject that has great impact on the future of our profession.
Adequate reimbursement for neurosurgical services remains near the top of our agenda. Not only must we continually work to stem the tide of declining reimbursement, we must act to ensure that new technologies, procedures, and medications which help our patients are covered by insurance and that the work to implement them is correctly valued. Working primarily through the Washington Committee, the AANS remains ever vigilant on this front.
Mapping the Route: The AANS Strategic Plan
As this brief review of topical issues attests, the AANS is always “on the road,” constantly leading, reacting and adapting. The question is, what destination is our objective? Is it a destination of our choosing, reached through our input and influence, or instead imposed upon us?
Not one of us would wish to go into surgery without a thoroughly conceived plan of action, a knowledgeable, accomplished team and appropriate instrumentation. Similarly, a cohesive methodology that fully utilizes all of our resources and allows the AANS to act in a timely fashion is necessary for achieving neurosurgery’s current agenda and the long-term goals we say we cherish.
With the aim of developing a strategic plan, a thorough evaluation of AANS infrastructure was conducted last year. This effort might be characterized as a continuation of the rebuilding process that the AANS has undertaken during the last few years, a process that has resulted in restoring the AANS to fiscal health.
During this evaluation, abundantly in evidence was our membership’s impressive array of talent, ideas and experience; several ways to maximize these resources became apparent, particularly with regard to our committees. Those who have served on a committee in the past few months already are acquainted with this portion of the strategic plan, which ensures that each committee has developed clear charges that are synchronized with the AANS’ goals, as well as a work plan that utilizes the creativity and energy of every member. Overall, the new strategic plan, to be released in the next few months, will allow the AANS to focus the considerable energy and collective intelligence of our members, together with our resources at the AANS Executive Office, on achieving our association’s goals.
Meet Me in Orlando
In the short term, my presidency will culminate in the 2004 AANS Annual Meeting. This brings me to the subject that is closest to my heart and at the corre of our association’s very existence: our patients. It is my hope that this meeting will not only uphold the high standards set by past meetings-the stellar meeting that just concluded in San Diego under the leadership of Roberto Heros, MD, immediately springs to mind-but will serve as a nexus of leading-edge neurosurgery, technology and the creativity that we must employ in providing exemplary patient care. I hope you will plan now to join me for the 2004 AANS Annual Meeting, “Advancing Patient Care Through Technology and Creativity,” May 1-6 in Orlando.
Dear Prez, I Wanna Tell Ya
I am thankful for the opportunity to serve as your president at a time when the AANS is poised to achieve so much for our members and our patients. The AANS is “on the road” to progress on many initiatives. With this in mind, I hope you recognize that your participation as well as that of AANS leadership is absolutely critical for the success of our association. Are you interested in serving on a committee? Do you have a particular facility for writing, an affinity for public speaking, or an aptitude for working with the media? Can you contribute financially to research through the Neurosurgery Research and Education Foundation (NREF) or to our campaign for federal medical liability reform?
Bob Hope, whom President Ford called $the only person I know who says that the White House is his favorite Bed and Breakfast in Washington, D.C.,$ joked about his experiences with 12 U.S. presidents in his book, Dear Prez, I Wanna Tell Ya. With this touch of levity, but in all seriousness, I invite you to share with me your suggestions regarding the AANS. Your concern for and involvement in the AANS will ensure that we stay the course on our road to success.
A. John Popp, MD, is the 2003-2004 AANS president. He is Henry and Sally Schaffer Chair of Surgery at Albany Medical College in New York.