I recently addressed the Council od State Neuroligical Societies on a topic that has been discussed for years and that lately has recieved a great deal of attention… unifying the AANS and CNS. This topic is of such importance that I want to essentially present that talk in thi s column.
Neurosurgery faces great challenges due to managed care and reimbursement cutbacks. Yet I am confident it is up the challenge, thanks in part to the AANS. Our organization is constantly evaluating what we do and how best to serve neurosurgery. We aim to be ahead of the curve, to anticipate and then surmount the obstacles that would harm neurosurgeons in the practice of their profession.
Our Bulletin is full of stories highlighting innovative and timely member benefits. The benefits will keep coming. In November the AANS held a planning meeting on being an efficient and cost-effective organization.
All this serves as a preface to what I really want to talk about. Just like the past, the future of neurosurgery will be linked to the AANS. Of course, we also need to consider the CNS, another vehicle for advancing our profession. The question is whether we need two separate vehicles to drive our profession forward.
No one thinks more highly than I do of the dedication and the abilities of the CNS leaders. You may have heard from them that it is desirable to keep two organizations because of tradition and because of culture.
But many of us see solutions to problems in different ways. Therefore I hope they will not be upset if I present a different opinion. The question of how to unify the activities of the AANS and CNS is very important to all of us, and I will speak frankly. I am in favor of working together. I have advocated that and have worked for that. But I am for more than working together. I am for moving together. Regardless whether you call it a “joint venture,” or a partnership, or a merger (a dreaded word to some)-regardless what you call it I am for joining together, so long as we represent the interests of all neurosurgeons and so long as we do not destroy and waste AANS assets.
The cry is there is no economy of scale, but for starters the two organizations could save more than $100,000 by combining board meetings. The cry is that we must maintain the culture and traditions of the past. This is not an issue of culture, efficiency or tradition. It is an issue of working for members. It is an issue of advocacy for neurosurgeons. It is an issue of support of members’ needs. It is an issue of what that takes to address them.
Two Comparable Groups
Are the AANS and the CNS really comparable and interchangeable? They are comparable. They are different, but they are not the same organizations. Let me emphasize that this is not an issue of superiority, but it is a very important issue of differences between our associations.
You have heard before and you will hear again how the CNS has a wonderfully low dues structure and supports many joint programs.
What do AANS dues pay for? What do members need and want?
Our members need and want an organization to call. How do I know that? Because neurosurgeons call the AANS more than 400 times a day.
Who wants his office to answer 400 calls per day for American neurosurgery? When a CNS member wants information on neurosurgery, he or she often calls the AANS. That requires infrastructure, and we must pay for it. Yet we are told the AANS money is not spent wisely, and the money, we are told, has not served us well.
We need an organization ready to stand up when the call arises. Several years ago the pedicle screw issue arose. The AANS President and Executive Director leapt into the fray. That was a member need. Our AANS president (Dr. Sidney Tolchin) stood up and mobilized the AANS. Our attorney, Mr. Russell Pelton, effectively led all the medical organizations in fighting the plaintiffs. That fight took several years and many AANS dollars, but it led to dismissal of the suiits against all medical organizations.
That preserved our ability to use the pedicle screw and it preserved our patients’ access to it. That successful stance for pedicle screws required the help of staff to coordinate those activities. That required an infrastructure with costs, an infrastructure we hear we do not need and we hear has not served us well.
When the rules changed for awarding CME credits for meetings, the AANS sent administrative staff away for more than a day to learn the intricacies. The next year other neurosurgery organizations needed to set up their CME accreditation process. They came to our expert and paid for a few hours of work. Who paid for the few days of work to gain that expertise? The AANS did. That is the infrastructure we hear we do not need and we hear has not served us well.
The very active AANS Professional Conduct Committee, which is a national model for associations, helps prevent inappropriate testimony by experts in court and helps protect all of us. That costs more than $50,000 per year. Once we went to the U.S. Supreme Court to uphold neurosurgery. That is an infrastructure and a cost we hear has not served us well.
To use an analogy of Dr. Roberto Heros, the AANS Treasurer, the AANS is like a hotel that has rented services such as rooms to other neurosurgery organizations whenever they needed them. When the organizations go away, the AANS still has the hotel services to maintain so they are available the next time an organization wants to rent one of our service rooms.
But the AANS is not just an infrastructure; it is an organization working for neurosurgery. It is ready to meet challenges unnamed. We have a professional organization that is prepared to address the issues that we all face.
We in the AANS are for unifying those activities with a common board of directors, a common building and a common organization. Why unify? To make the house of neurosurgery stronger!
We are a profession of neurosurgeons and we must address all the concerns of neurosurgery-concerns that affect patients, concerns that embrace research, politics, economics and healthcare delivery.
The cry is that in the past the AANS has been too expensive. We cannot escape our history, but we are not living in it. The AANS’ Board of Directors has hired an efficient Executive Director (Dave Fellers, CAE) to manage the operations.
CNS Model Won’t Work
What has the CNS proposed for a unification model?
CNS proposes we build a third corporation in addition to the office staffs of the CNS and the AANS. Supposedly, we should be able to do this cheaper than the current scenario. Moreover, the new corporation should be beholden and responsible to two different board of directors.
Why will that not work? No one can serve two masters. This is more than a conflict between physicians; this is a conflict between organizations. Trying to have a third corporation beholden to two competing organizations is a divisive design destined to fail.
The AANS can downsize and can provide fewer services. But we cannot dismantle just part of an organization any more than you can remove some of the rooms from a hotel. We cannot fire one-third of a secretary, one-third of a typist and one-third of an accountant to save an employee’s salary.
The office space, the computer and the telephone do not disappear proportionately. The CNS proposal to gradually put items and responsibilities into a new corporation will be a gentle growth for the CNS but will saddle the AANS with double costs.
One Organization Needed
Is the AANS perfect? No! But, in my judgment, it will not be made better by a series of amputations in order to form an additional infrastructure. What we need is:
- a merging of interests,
- a merging of assets,
- a merging of work.
We need to stop hearing about preserving a culture. We need to hear about preserving neurosurgery.
We can still have two meetings and two journals. After all, those are the real cultures of the two organizations, and we can still have room at the table for younger neurosurgeons.
The relations between the CNS and the AANS have consumed the activities of both boards of directors and both sets of leaders. That is a waste of precious time and precious money.
Advocate Instead of Bickering
We need to spend more time advocating for our neurosurgeons, not more time advocating for our associations.
We need to spend more time advocating for our patients, not advocating for a leader because of age.
We need to spend more time exploring new ways to educate our members, not exploring smaller buildings to house a new infrastructure.
Do you want to see neurosurgery work together and stop bickering? Do you want to keep dues as low as possible?
Do you want to see us concentrate on education and advocacy and not on squabbling? It is time to stop worrying about losing identity and start worrying about our patients and our neurosurgeons.
What we want and what we need is one organization that blends the best of both the AANS and CNS. Let me emphasize this is not a “takeover.” Those who describe a merger as a “takeover” are trying to hide the true events behind a pejorative smoke screen. We are talking about a true merger of interests and a true a merger of work, so that the AANS and the CNS can concentrate on neurosurgical problems and not on relations between two organizations.
Let us have two journals and let us have two meetings, but let us have one fighter for neurosurgery. Let us have one board of directors to work together. Let us have one champion, an AANS/CNS for all of neurosurgery. With one organization and with one board we can build neurosurgery for today and for tomorrow!
Stewart B. Dunsker, MD, is a practicing neurosurgeon at The Mayfield Clinic, Professor of Clinical Neurosurgery, Vice Chairman of the Department of Neurosurgery and Director of the Division of Spine Surgery at the University of Cincinnati. This editorial is adapted from a talk given by Dr. Dunsker to the Council of State Neurosurgical Societies September 23 in San Antonio.