Dear Colleagues:
As my term as Secretary of the AANS came to a close during the Annual Meeting in Denver, I was pleased to report at the Business Meeting on the activities of our organization during the past year. Overall, we are focused on our mission as the spokes organization for North American neurosurgery, and maintain our progress toward providing members with opportunities for scholarship, education, service, and a voice in socioeconomic affairs.
Membership
Our organization continues to experience steady growth, with membership increasing by 5.4 percent during 1996, bringing the total to 5,086 members at year’s end.
In accordance with the bylaws change of 1995, permitting certificants of the Mexican Council of Neurological Surgery, A.C. to become Active members of the AANS, we began to welcome into our ranks a number of colleagues from throughout North America. In addition, the ranks of our Associate and International Associate member categories continued to grow vigorously, reflecting the global influence and stature of our Association.
Publications and Professional Development
The SCI Journal Citation Reports, which annually ranks all peer-reviewed journals on the basis of their effectiveness and influence, rated the Journal of Neurosurgery third in impact among surgical journals. Whereas the next best competing neurosurgical journal ranked 26th, the Journal of Neurosurgery is the most widely read neurosurgical journal in the world and continues to be the primary source of clinical and basic neuroscience reviews.
Neurosurgical Focus The AANS Bulletin, published quarterly, continued to focus on practice management, socioeconomics, and reports on the Association many actions on its members behalf. The Bulletin also contains practitioner information regarding the new managed care environment. I am pleased to report that a number of changes were made in the Bulletin’s production process, resulting in significant cost savings. Two new books from both the Neurosurgical Topics and the Special Topics series were published and volume five of the Neurosurgical Operative Atlas was completed. Professional Development Program courses continued strong in 1996, attracting more than 1,100 registrants. A total of 21 courses are currently planned for 1997. The Annual Meeting remains the crown jewel of our educational effort. Over 850 completed abstracts were submitted for consideration at the 1997 meeting. The final program consisted of 127 papers, 73 of which were assigned discussants, and 550 poster presentations. Neurosurgery’s site on the Internet, NEUROSURGERY://ON-CALL®, continued to grow and improve, providing many useful resources for our members. Neurosurgeons can now order educational texts through Amazon.com, the Internet’s largest bookstore. Resident Corner, provides information for current and future neurosurgical residents, including a complete listing of accredited residency programs throughout the U.S. The Outcomes and Guidelines Committee of the Joint Section on Cerebrovascular Surgery has developed Outcomes Reporting Instruments for carotid artery surgery and intracranial aneurysm surgery. These instruments will be available for downloading to individual computers so members can build local databases. Other recent enhancements include a new section dedicated to providing neurosurgical information to patients, referring physicians, and the overall health care community. It is gratifying to note that an increasing number of young neurosurgeons are participating in AANS’ activities, such as the Annual Meeting Scientific Program Committee, the Publications Committee, the Research Foundation, and as ad hoc members of the Board of Directors. The actions of the Young Neurosurgeons Committee have been successful in achieving representation on the governing bodies of every Section. Increasingly, our younger colleagues are making presentations at Annual Meeting breakfast seminars, special courses, and at various other scientific programs. This involvement bodes well for the future of our specialty. A major new thrust has been undertaken by the AANS in moving to develop a series of guidelines and outcomes instruments relative to patient management and referral sources. The Guidelines Committee has developed a Practice Parameter Guidebook and tutorial program to assist sections in the development of practice guidelines. Practice guidelines for the management of severe head injury have been distributed to all members. Meanwhile, guidelines for the management of low grade gliomas are almost complete. Additional guidelines in production include those for carotid endarterectomy, severe head injury in children, spinal cord injury, lumbar fusion, pedicle screw fixation, and cervical spondylitic myelopathy. AANS/CNS Section representatives have assembled to develop recommendations for primary care physicians concerning patient referrals for neurosurgical consultation and treatment. Neurosurgeons also attended the Annual Scientific Assembly of the American Academy of Family Physicians to communicate the importance of neurosurgical management of back pain and carotid endarterectomy. It was reported that the majority of complaints reviewed by the Professional Conduct Committee involved biased legal testimony made by neurosurgical-expert witnesses which attempted to benefit one party. According to the AANS Code of Ethics, various guidelines and position statements, expert neurosurgical testimony must be fair and unbiased regardless of prior relationships and underlying case merits. Statements which would not be made before the AANS Board of Directors by neurosurgeons should not be made in depositions or before a jury. Currently, the AANS and the CNS are the only specialty societies processing legal testimony complaints and applying sanctions when indicated. However, as other specialty organizations become aware of the AANS’ activities, they have expressed interest in developing similar committee procedures. The Washington Committee was a prime mover in the development of the Practice Expense Coalition, a multi-specialty effort which is aimed at preventing implementation of a plan developed by the Health Care Finance Administration (HCFA) for new relative value units for the practice expense component of the resource based relative value scale (RBRVS). The proposed changes threaten serious reductions in income for many specialty practices, especially neurosurgery. Under their hard leadership, we have taken a tough stance on this issue and continue to fight for defeat of this unacceptable proposal. Socioeconomic issues continued to generate controversy for organized neurosurgery during the past year and the AANS has served as an effective and vigorous advocate on behalf of our members. We have risen to face a number of tough challenges — from HCFA’s proposed changes in practice expense reimbursement to the pedicle screw litigation. It is impossible to know exactly what the future holds for our specialty, but I am certain that the AANS will be there to lead the debate.N://OC®
Young Neurosurgeons
Guidelines and Outcomes
Professional Conduct
Washington Committee
Conclusion