At the March 2000 Executive Committee meeting of the Council of State Neurosurgical Societies (CSNS), a resolution was proposed to poll AANS and CNS members on merging the infrastructure of the two organizations. The resolution was presented to the CSNS Assembly at the Plenary Session of the April 2000 CSNS meeting. It was passed with a modification that required the survey tool be given to the AANS and CNS leadership for review and comment prior to dissemination. The development of the survey was assigned to the Medical Practices Committee of the CSNS.
The Yale School of Medicine Biostatistics Section was consulted for assistance in developing the initial survey. Once completed, the survey was submitted for review to the AANS and CNS leadership. The survey instrument was then presented to the CSNS Executive Committee meeting in August 2000. The CNS was represented by Dan Barrow, MD, and the AANS was represented by Stan Pelofsky, MD. After extensive discussion, the survey was revised and simplified. The emphasis on merger was changed to levels of integration: merger, joint-venture or no change in current status. The abridged survey was then presented to the membership of the CSNS with the leadership of the AANS and CNS in attendance. After intensive criticism and eloquent discourse, a final survey document was adopted.
The survey was distributed during November 2000. A total of 5,809 questionnaires were mailed to AANS members (Active, Senior, Provisional, Lifetime and Candidate) and to CNS members (Active, Senior, Transitional and Resident). A total of 1,849 surveys were returned, a 32 percent response rate. (Forty-one surveys were returned as undeliverable by the U.S. Postal Service.) The replies were collected, tabulated, and analyzed employing Chi-Square methodology. The statistical analysis was performed at the University of Nebraska School of Medicine.
| Wishes of Constituent Neurosurgeons |
|
| Joint Venture | 25.9% |
| Current Status | 11.8% |
| Merger | 62.3% |
| (Sample = 1849) | |
In summary, the survey respondents favored change. A merger of the two organizations infrastructure was favored by 62.3 percent. A joint-venture that would maintain the individual organizations but integrate aspects of leadership, meetings and mission was favored by 25.9 percent. The maintenance of the current status was preferred by 11.8 percent.
The demographic profile of the respondents corresponded quite well with those of the parent organizations. For respondents with an AANS affiliation, there were 894 active members, 64 lifetime members, 72 provisional members, 27 candidate members and 28 resident members. For respondents with a CNS affiliation, 832 were active members, 12 transitional, 70 senior and 43 resident. The median age of the respondents was near 50, with those 50 and above numbering 989 and those younger than 50 numbering 860. Male respondents numbered 1,755, while females numbered 84. As for practice affiliation, 1,164 respondents were in private practice, 468 were in full-time academics and 145 were in neither category (retired, residents, etc.).
A cross tabulation between demographic subgroups and opinion responses was evaluated by employing Chi-Square analysis. Comparison of AANS membership categories failed to show significant subgroup differences.
However, if the subgroups were manipulated by combining the Provisional, Candidate annd Residents, there was a significantly smaller majority favoring an organizational merger. Analysis of the CNS membership also failed to demonstrate significant differences of opinion across membership categories.
Dividing the respondents at age 50 also failed to demonstrate significant differences of opinion. Gender analysis also showed a near congruence of respondent distribution.
Analysis of practice affiliation did demonstrate a significant difference among the subgroups. The difference being that a greater percent of private practice favored merger than their counterparts in academia. Nevertheless, the academic respondents favored merger by greater than 50 percent.
The issues surrounding organizational integration between the AANS and CNS are numerous. Although this survey may have design or analytic flaws, it does exhibit that more than 88 percent of respondents favor organizational change. The degree that organized neurosurgical leadership can work toward these ends will be followed closely by their constituents.
Gary M. Bloomgarden, MD, is Chair, Medical Practices Committee, Council of State Neurosurgical Societies.