As AANS President for the past nine months, I have observed that some of the biggest threats to neurosurgery are not coming from outside our specialty. Rather, I am seeing mounting competition from within the family of neurosurgery that I believe, in the end, will benefit no one. We are seeing an increasing fragmentation within the specialty — and danger lurks there.
Danger of Fragmentation
The question of segmentation is not new in neurosurgery. This is a battle we have been fighting among ourselves for nearly 20 years. We have seen the advent of special interests in pediatric neurosurgery, trauma and critical care, spine and peripheral nerve surgery, cerebrovascular and stroke care, and pain management to name a few. Our Sections have been successful in harnessing and enhancing these subspecialty interests and have certainly enriched the practice of neurosurgery. However, while this sub-specialization can help improve the quality of care for patients, there can be an unwanted side effect if we are not careful — the splintering of neurosurgery into narrow interest factions.
We face several big battles over the next couple of years including reimbursement and coding, research funding, manpower, and encroachment from other specialties. We also are seeing threats of fragmentation as a result of attempts to create subspecialty professional credentialing. The most recent manifestations of this have occurred in the area of spine surgery. You may have been solicited by the American Board of Spine Surgeons to pursue certification as a spine surgeon. Your Board of Directors opposes this program and has developed an official position statement on the topic.
With other organizations lobbying hard and fast for influence and reimbursement advantage, it is up to organized neurosurgery to hold onto its own piece of the pie. We have to put away our individual differences and work together as colleagues for the benefit of the profession as a whole.
Working Together
Over the years, organized neurosurgery has worked very hard to come closer together and, as a consequence, the AANS and Congress of Neurological Surgeons (CNS) are now working together in stronger alliance. The result has been the development of many joint projects between the two groups including our Web site; the SMART marketing communications program; several outcomes projects; the Washington Committee; the CPT Coding Task Force; and the Fellowship Task Force. This is the direction in which I believe organized neurosurgery should continue to move and is the philosophy that I will continue to endorse as long as I’m an AANS Officer. The relationship between the AANS, CNS, and the Sections is complex and far from perfect. But, I believe that there is a place for each within neurosurgery and these groups should continue to work together.
I view organized neurosurgery as one big family. And, like most families, there are going to be sibling rivalries and rough moments. One of the most important jobs the President of a spokes-organization has is to encourage consensus. After taking the reins of President last April, it did not take long to remember what I had learned through my years of service on the Council of State Neurosurgical Societies (CSNS) and the Washington Committee:
The job of the AANS President is not just to express an opinion, but also to help blend the views of our members together and then speak for organized neurosurgery with one voice. I frequently remind myself of the much – quoted sentence from Emerson’s Self Reliance,”A foolish consistency is the hobgoblin of little minds.” The leadership of the AANS is committed to represent your best interest with a united voice, but only after careful debate.
Transitions
Looking to the future, we have undergone a number of changes at the national organiization level that will improve service to members in the future. First, you will notice that the Bulletin has taken on a new persona. In response to changing member needs, it now has a greater emphasis on socioeconomic issues. My thanks and kudos go to John Popp, MD, and Jim Bean, MD — Editor and Co-Editor, respectively — for their vision and commitment to making our membership magazine one of the best in the field.
On a more somber note, the AANS National Office also has undergone some challenges. During 1998, we lost some key staff members, including Robert E. Draba, PhD, the AANS Executive Director. But, rest assured, the AANS is alive and well. My thanks to Laurie Behncke, Associate Executive Director of Programs, and Robert Cowan, Associate Executive Director of Administration, who have worked hard to keep the National Office services on track during this transition. If some of you have suffered inconveniences as a result of these recent changes, we appreciate your indulgence.
It will ultimately be the members, not the leadership who decides the fate of organized neurosurgery. Leaders are elected to represent the membership and we need to hear from you about the direction and focus you believe organized neurosurgery should be taking. This is a critical time for neurosurgery and for medicine, and we need your input.
Russell L. Travis, MD, is President of the AANS and a neurosurgeon in private practice in Lexington, Kentucky.