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When asked to choose the area of greatest anticipated clinical change, a slight majority (27 percent) of respondents selected stereotactic and functional neurosurgery over tumor (24 percent). Other responses included spine and peripheral nerves (17 percent), neuroendovascular (12 percent), cerebrovascular and neurotrauma/critical care (each at 8 percent), and pediatric (1 percent). Of the 2 percent selecting “other,” one respondent suggested neuroaugmentation as the area of greatest clinical change.
When asked to choose the area of greatest anticipated socioeconomic change, more than half of respondents selected reimbursement. Other responses included practice type (21 percent), workforce composition (16 percent), and training (11 percent).
A total of 88 percent of respondents foresaw a greater role for physician extenders in neurosurgery compared with 12 percent who did not.
Prognostications
| Random Sample, a regular feature of the AANS Neurosurgeon, engages AANS members to assess their views and practices related to a topic of current interest. |
Our biggest challenge is to continue to attract bright, motivated and earnest
applicants in neurosurgery while offering the quality-of-life expectations
(family time, wage expectations) that the next generation demands. The second
challenge is confronting the regulatory and financial constraints imposed by
government and private insurers. It is a fantastic profession full of some
of the most innovative and brilliant minds. I am confident we can meet these
challenges.
-J. Nozipo Maraire, MD, Klamath Falls, Ore.
Neurosurgery without economic protection will continue to be diluted by extraspecialty
competition and central reimbursement compression. Until existing neurosurgical
societies recognize the responsibility to represent the economic survival of
the specialty, we will be relegated to the road to serfdom. Ask yourself, should
the neurosurgical specialty be seen as eloquent esoteric philosophers, servile,
submissive and spineless? I fear the road we are on foretells our destination.
-Mark E. Anderson, MD, Irvine, Calif.
For the last 30 years neurotrauma has progressed a lot but our understanding
of basic pathophysiology of head injury still is in its infancy. The challenging
job of the new generation of neurosurgeons is to find out how we can set back
the cascades of events and improve the outcome of head injury. This progress
has already started and it’s getting more advanced every minute. Head injury
has been the greatest challenge for neurosurgeons from prehistoric times until
now.
-Kambiz Kamian, MD, FRCS(C), Ancaster, Canada
The term “physician extender” implies the hard-earned title of “physician”
and can be misleading when used to describe nonphysicians. Nuances of best
neurosurgical practice ranging across all aspects of patient evaluation and
management are gained from rigorous application and experience unique to neurological
surgeons; for that reason the best practice of neurological surgery does not
conform well with a physician-extender paradigm.
-Timothy M. Wiebe, MD, Hattiesburg, Miss.
Methodology and Demographics
Randomly selected AANS members with e-mail addresses were asked in April 2009
to participate in this online survey. Invitations were sent by e-mail to 300
individuals, and 84 members participated in the survey for a response rate
of 28 percent. Most respondents were neurosurgeons or residents (98 percent),
while 2 percent were non-MD neuroscience professionals such as nurse practitioners
or physician assistants.
A majority of respondents were affiliated with a private practice (35 percent) followed by those in full-time academic practice (23 percent), those in private practice with academic affiliation or appointment (18 percent), hospital employees (13 percent), other (11 percent), and federal government employees (1 percent). Survey participation was distributed among the age groups: Most were between the ages of 56 and 65 (32 percent), followed by those between 46 and 55 (29 percent), 35 and 45 (20 percent), 34 and younger (11 percent), and 66 and older (8 percent).