Dear Colleague, My first year as secretary for The American Association of Neurological Surgeons (AANS) finds me ever more respectful of the extraordinary organization to which I volunteer my time and energy; it is with a sense of accomplishment and pride that I share with you some of the main features of this year’s activities. During this year, I have witnessed first-hand the commitment, intensity, and intellect inherent within the leadership and membership of this organization, and I have marveled at the many volunteer hours to which our colleagues throughout the field of neurosurgery have gladly devoted their many talents. Each of us benefits immensely from the wisdom of others in the field, and the AANS brings structure and purpose to our sharing of ideas in a way that motivates and encourages us to be more than we ever thought we could be. This wisdom and purpose is evident in our fundamental desire to provide leadership in academic, research, and daily practice issues and in our focus on service to one another.
Organizational Issues
Our pool of talent expanded this year as membership to the AANS continued to grow — our members now total 5,263, up from last year’s count of 4,992. This new total reflects membership from the United States, Canada, and Mexico, and most certainly maintains a healthy status organizationally. The AANS is truly an international organization that affects the practice and the profession of neurosurgery everywhere.
Not only does membership seem firmly grounded, but our financial status also appears to be solid. Stewart Dunsker, MD, working closely with our financial advisors and in-house personnel, has integrated our organizational strategic plan with our financial plan and has created a sound fiscal strategy of which membership can be proud. Of course as the AANS embarks upon new (often more expensive) responsibilities and functions, the fiscal impact of these activities becomes a major concern. Our membership can feel confident that cost-saving measures are always considered when financial decisions are made.
Education
This year the Board has undertaken some exciting new projects. Under the leadership of Edward Laws, MD, the AANS, in close cooperation with the Congress of Neurological Surgeons (CNS), has declared that neurosurgery must once again assume world preeminence in cerebrovascular disease. Training neurosurgeons to become experts in the treatment of carotid disease, intracranial vascular disease, and endovascular technology has, therefore, become the focus of the Neuroendovascular Task Force, chaired by Mark Mayberg, MD. This Task Force has recently formulated a list of recommendations for neurosurgery program directors and large practice groups which encourages increased resident exposure to neuroradiology and endovascular training. Members of the Task Force are hopeful that the definition of neurosurgery will change to include neuroendovascular surgery and radiosurgery, and that documentation of experience in these areas will eventually be required for Board Certification.
The demands for advanced training in all fields of neurosurgery require even stronger fellowship training programs. In response to a resolution proposed at the Council of State Neurosurgical Societies, the AANS/CNS Joint Task Force on Fellowships was formed and is currently headed by Julian Hoff, MD. Charged with defining criteria for neurosurgical fellowships, this Task Force has recently submitted its executive summary which offers conclusions and recommendations for upgrading our fellowship standards, making them more precise and consistent. Currently, there are more than 127 neurosurgical fellowships in the United States, lasting from three months to two years, in 10 different areas of subspecialization. In an effort to rein in our definition of fellowship, the Task Force has recommended that written guidelines be developed for each fellowship, and that formal fellowships be at least 12 monthss in duration. They also recommend that the Residency Review Committee (RRC) be obliged to establish faculty qualifications and responsibilities, as well as institutional requirements for fellowships, in order to monitor their quality and their impact upon residency training.
Research
Neurosurgeons have never underestimated the importance of research; indeed, the AANS and CNS, as well as other neurosurgical organizations (e.g. Joint Sections) sponsor a diverse range of grants each year totaling over $280,000. Many of these opportunities offer incentives to neurosurgical residents and young neurosurgeons to pursue clinical or basic science research in fields such as neurotrauma or critical care, underscoring the importance of expanding our knowledge base in these crucial areas. At least thirty neuroscience research grants, fellowships, lectureships, or awards were available last year, ranging from an honorarium for the Donaghy lectureship, to the Young Clinician Investigator Award of $40,000, sponsored by the Research Foundation of the AANS. By recognizing and embracing those of us who emerge at the top of an already exceptional group of professionals, we simultaneously lift all of us up to the height of possibility.
Discovering what is possible, and then measuring it, is the purpose of the AANS/ CNS Outcomes Committee, led by Robert Harbaugh, MD. During their meeting last fall, this committee approved a mission statement which recognizes the increasing importance of assessing quality of care in our rapidly changing health care environment. In addition, the committee set goals for 1998 which include, among other things, developing a plan for data collection, management, analysis and auditing; beginning Pilot Projects I and II which target Intracranial Aneurysm and Carotid Endarterectomy, respectively; developing educational materials for members including articles, information on the Web Site, and programming opportunities; and establishing an interface with the Joint Sections to assist in the development of disease specific outcome instruments. Clearly, the work of this committee is invaluable to maintaining and enhancing our already high standards of excellence.
Communications
The Journal of Neurosurgery continues to expect and deliver the very highest standards of scholarship available in neurosurgery. One of the most widely read neurosurgical Journals in the world, the Journal provides neurosurgeons in all phases of their professional lives with the scientific and research knowledge needed to maintain a high quality practice. In 1997, the Journal began an aggressive campaign in Europe and Asia in order to maintain and increase readership worldwide, and their total number of new submissions reached a record-breaking 1,118. In addition, plans are underway to create a new spine Journal which will join the Journal and Neurosurgical Focus as an official AANS publication.
Another notable accomplishment this year has been the rising status of NEUROSURGERY://ON-CALL® (N://OC®), which was recently selected as one of the top 250 sites for the 1997 American Society of Association Executives (ASAE) Foundation Study, World-Class Web Sites. John Oro, MD, has led his Editorial Board to create this cutting-edge Web site, praised by the ASAE as having “bold graphics, a well organized and designed side coupled with rich information content and a full compliment of value-added applications….Original content that is well documented along with extensive cross-references and links to other resources [which] give great depth to [this] site.”
Although the Journal of Neurosurgery, Neurosurgical Focus Neurosurgical visibility and patient information are at the heart of the AANS/ CNS efforts to create the marketing communication campaign called “Getting Smart About Neurosurgery.” Phase I of this campaign focused upon lumbar spinal stenosis and has been a huge success, with over 400 neurosurgeons purchasing the package consisting of two slide sets, physician referral brochures, and patient information brochures. Phase II of the campaign will target cerebrovascular disease and stroke and will once again provide neurosurgeons with a sophisticated approach to expanding their practice opportunities. These excellent marketing tools are available to all AANS/CNS members and represent the beginning of an important new method for making our services more accessible. Keeping our visibility high and our voices unified during Medicare’s ongoing assault on surgical specialists are more important than ever if we are to maintain reasonable reimbursement rates. As most of us know, the Health Care Financing Agency (HCFA) has proposed cuts in the practice expense portion of the Resource Based Relative Value Scale (RBRVS), the way neurosurgeons are reimbursed for treatment of Medicare patients. Once Medicare institutes such cuts, managed care companies are soon to follow, and the dominoes begin to fall. Our Washington Committee, led by Arthur Day, MD, and Washington Office Director Katie Orrico, has had the challenging task of representing organized neurosurgery in the fight against actions which are not based on practice expense data at all, but rather are based on HCFA’s desire simply to cut reimbursement rates. By testifying before Congress and leading the Surgical Specialty Coalition, Dr. Day and Ms. Orrico have refused to give in to cuts which could cost neurosurgeons millions, if not billions, of dollars in lost revenue. In addition, Robert Florin, MD, has developed a methodology for obtaining real neurosurgical practice data, so that any future changes in reimbursement will be based on actual numbers, not smoke and mirrors. Medicare cuts aside, many other factors influence our socioeconomic status, one of which is our Current Procedural Terminology (CPT) Coding. In response, the Joint Officer’s Task Force on CPT Coding has been charged with establishing a new infrastructure for CPT Coding within organized neurosurgery. The task force has set out to address issues such as reviewing existing CPT codes, educating neurosurgeons in proper CPT Coding, incorporating a dedicated staff person to the project, and establishing a contact point for all HCFA and AMA inquiries regarding neurosurgical CPT Coding. There is no doubt that Richard Roski, MD, and his task force will assist neurosurgeons immeasurably to clarify and navigate this complicated system.Socioeconomics
Secretary, AANS