Our Association’s Not Inclined to Rest Its Laurels
We are symbols and inhabit symbols…being infatuated with the economical uses of things, we do not know that they are thoughts.”
-From “The Poet,” Ralph Waldo Emerson
Emerson’s words spring easily to mind at midwinter, a time awash with the symbols of celebration: ringing bells, family gatherings, lights illuminating darkness. The year cycling anew inspires a Janus-like gaze upon both neurosurgery’s past and its future.
Since ancient times the pledge to act always for the good of patients-the Hippocratic oath-has been recited by physician initiates, providing a moral framework for the duration of one’s career. Similarly, the caduceus has symbolically connected doctors both with notions of the divine and renewal. More recently, with the advent of neurosurgery as its own specialty a new symbol emerged: Harvey Cushing, widely recognized as the founder of modern neurosurgery, who serves today as the symbol of the American Association of Neurological Surgeons (AANS).
Cushing himself knew well the importance of symbolism to the profession. As he observed of the Hippocratic oath in a 1926 address to graduating medical students, “There are certain things which concern the code of the doctor, handed down to us from ancient times, which … deserve reiteration on occasions such as this…for there is nothing that expresses so well, as does this justly famous credo, the ideals which from the first have actuated the doctor and have led to the solidarity of the profession you are entering.”
By organizing the Society of Neurological Surgeons and inspiring creation of the Harvey Cushing Society, now the AANS, Cushing nurtured the framework that would help neurosurgeons advance their clinical knowledge and also address the numerous challenges that face us today.
One such issue, workforce, has been a subject of intense interest for me over the years. It presents a formidable challenge, this estimation of what prodigious strides in neuroscience will occur, how the market forces might shift, and how neurosurgery might continue to attract and train high quality people. Since its inception neurosurgery has been highly selective-for training directors the quest for the “best and the brightest” is essential in order to assemble a workforce fit for an intellectually challenging and highly demanding specialty. It is certain that neurosurgery will be able to welcome increasing numbers of qualified women and minority physicians in the coming years; it is less certain, given the pressures currently bearing upon us, that neurosurgery will be able to keep sufficient numbers of neurosurgeons available to serve the needs of the U.S. population.
Topping the list of pressures on the profession certainly is the medical liability crisis. Just today I heard from a 52-year-old neurosurgeon who is retiring-quite young considering that most neurosurgeons attain board certification in their mid-30s. He attributed his untimely retirement in large part to medical liability insurance rates that more than doubled within two years. Because his experience is emblematic for neurosurgeons across the United States, passing meaningful medical liability reform is at the top of the AANS agenda. AANS is diligently working through Neurosurgeons to Preserve Health Care Access to increase awareness of the issue nationwide and effectively apply pressure for medical liability reform during this politically charged election year.
The ability of the AANS to renew itself in order to successfully address new challenges is greatly dependent upon its underlying committee structure. The AANS is an organization created by and for neurosurgeons, and neurosurgeons not only govern the organization, they effect change through numerous AANS committees.
This committee-based structure in turn allows the AANS to address issues with which neurosurgery has been concerned from the beginning, namely advancing the specialty through education. Committees play a vital role in all four of AANS’ peer-reviewed journals, including the new Journal of Neurosurgery: Pediatrics, as well as in the upcoming 2004 AANS Annual Meeting, “Advancing Patient Care Through Technology and Creativity,” May 1-6 in Orlando, Fla. Looking ahead to 2009, committees will help plan the XIV International Congress of Neurological Surgery in Boston, hosted by the AANS for the World Federation of Neurosurgical Societies.
With a firm grounding in its past, the AANS proceeds to the future ill-content to rest on its laurels. From Hippocrates to E-pocrates, change is constant. Today qualifying for AANS membership symbolizes attainment of a milestone in one’s neurosurgical career, but the challenges we face beg for more grassroots involvement. Such solidarity in the AANS is the means by which the specialty will advance and its challenges will be resolved.
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.