This task force was organized by AANS past-president Julian Hoff, MD. It arose out of discussions surrounding the concept of instituting an AANS House of Delegates. We did not know where the task force would go in terms of the issues and concerns that had been raised. We certainly did not know either the conclusions or our points of agreement.
As chosen by Dr. Hoff, the members of the Task Force were MDs Merwyn Bagan, Daniel L. Barrow, Ralph G. Dacey, E. Fletcher Eyster, Dave Kelly, George H. Koenig, Philipp M. Lippe, Stanley Pelofsky, Dr. Hoff as an ex officio member, and myself as Chairman. Edward L. Seljeskog, MD, our immediate past-president also participated in the discussions.
Different Perspectives
One of the things that became apparent during our first meeting was that those on the task force — and perhaps those in neurosurgery generally — didn’t see this governance issue through the same set of experiential lenses. In other words, we were not all coming at this question based on the same paradigm. And so, we chose to establish a format for our meetings that would allow us to resolve some of the conflict. We had four basic goals:
- Achieve better understanding of issues so that each of our task force members could see the problem more clearly and emphatically from the other point of view.
- Identify the key issues and concerns (not positions) that needed to be addressed.
- Determine what results would constitute an acceptable solution to all parties.
- Arrive at a consensus statement regarding a solution.
We began by allowing each task force member to air their feelings, frustrations and problems regarding AANS governance. Second, we summarized these discussions to identify the key issues and concerns that led to the positions that caused disagreement. At our second session, with Dr. Hoff at one easel and with Dr. Dacey at another, each participant gave opinions as to what the problems were, detailing the issues affecting how we should be governed. We discovered that insufficient communication — particularly between and among the Joint Council of State Neurosurgical Societies (JCSNS), the Congress of Neurological Surgeons and the AANS — in its various forms was a big part of the problem.
As a result of these discussions, the task force agreed upon the need to address the following issues and concerns:
- How can we better communicate?
- How can a more disciplined and efficiently functioning JCSNS achieve a stronger, more contributive role in AANS leadership, and thereby insure both the consent of those governed and active participation by their representatives in the decision-making process?
- What can be done to improve AANS Annual Meeting logistics so as to allow JCSNS leaders and AANS Board of Director Quadrant Representatives to discharge their responsibilities?
- Together, with whatever governance changes that may eventually be suggested, how do we continue to maintain an effective governing coalition inclusive of all American Neurosurgery’s interests?
- The Task Force on Governance was convened in response to, and as an alternative to, an initiative from the California Association of Neurological Surgeons that would have asked for — by national direct mail vote from the AANS membership — the establishment of an AANS House of Delegates. The questions of to whom authority to govern our specialty is granted should be extensively discussed and clarified.
- What governance methodologies are being employed by other comparable-to-us surgical subspecialties and why have those governance forms been chosen?
Other Groups
We took an in-depth look at four other medical specialties to see how they handled governance. The groups included the American Academy of Otolaryngology – Head and Neck Surgery, American Urological Association/American Association of Clinical Urologists, American Society for Thoracic Surgery/Society of Thoracic Surgeons, and the American Society for Plastic and Reconstructive Surgery.
In our research of these groups we found that their governance structures provided for a variety of representative-type legislative bodies. The ENT group has an active, well-organized Board of Governors that functions strictly in an advisory capacity. The Governors advise the Board of Directors, but hold no position on that board, nor do they have the ability to set policy.
The urologists are primarily an academic group that formed a separate organization, the American Association of Clinical Urologists, that focuses on socioeconomic activities and functions mostly as a political action committee. The thoracic surgeons have a non-participatory and somewhat undemocratic structure. Their leadership does not really attempt to solicit advice or input from its membership.
The plastic surgeons have three different organizations, representing a variety of settings, encompassing both private and academic settings.
It was the task force’s assessment that, with our sharing of power and unique organizational structure, we probably have a more effective and participatory form of governance than some of the other surgical specialty societies.
Cost Factor
We also discussed the financial implications of establishing a representative Legislative Assembly or House of Delegates. David Martin, AANS Assistant Executive Director, prepared a report that examined some of the fiscal notes that would come with such a change in governance structure. He estimated that annual costs of administering such an operation would range between $135,000 and $350,000, depending on the amount of travel and other expenses incurred by the delegates.
It was the opinion of most task force members that, if a House of Delegates was actually implemented, costs would be even higher than those estimated just because of the level of staff support that would be required.
JCSNS Reform Measures
The JCSNS, under the leadership of Dr. Pelofsky, has been working on a series of reform measures that are aimed at making organized neurosurgery more responsive to surgeons’ concerns. It has proposed five so-called “reform measures” to achieve that goal. They include:
- Strengthening the state neurosurgical societies.
- Reforming the method of AANS and CNS leadership appointee selection.
- Enabling AANS Board Quadrant Representatives to attend JCSNS meetings.
- Allowing the JCSNS chairman to be a voting member of the AANS Board of Directors.
- Encouraging the AANS Board and CNS Executive Committee to attend the Plenary Sessions of the JCSNS held during the AANS Annual Meeting.
Conclusions
The members of the task force agreed that the lack of effective communication between the various components of the neurosurgical community was a problem and needed to be addressed and rectified. We agreed that the current and ongoing reorganization of the JCSNS was both beneficial and likely to result in improved governance and improved communication. We agreed with the five points of reform that JCSNS recommended. We agreed that the ultimate governance authority of the AANS should remain in the Board of Directors. We certainly agreed that, compared to other similar surgical sub-specialty organizations, we had a more participatory and democratic form of governance.
Finally, although we agreed that the AANS should continue to monitor the needs of its membership and the governance of this organization, we came to believe that — at present — it was not necessary to establish an AANS House of Delegates nor significantly alter our governance structure.
In his original charge to the Task Force on Governance, Dr. Hoff asked us to build on the strengths of the AANS. I think everyone who has worked within the AANS realizes that its strength lies in the fact that it is indeed — as Dr. Hoff mentioned in his Presidential Address — a four-legged stool. It has concerns that range from science and education to practice concerns and socioeconomics. It is this cohesive effort that holds the whole body together.
We think that this is the strength of the AANS — one that should not be weakened by a change in governance.