One Neurosurgery Movement Since October 2012 T. S. Park, M.D. Chairman, One Neurosurgery Advocacy Committee Shi H. Huang Professor of Neurological Surgery Washington University In St. Louis Neurosurgeon-In- Chief, St. Louis Children’s Hospital park@wustl.edu
Zachary T. Levine, MD T. S. Park, MD, Chair Bethesda, Maryland St. Louis, Missouri Robert L. Martuza, MD John R. Adler, MD Boston, Massachusetts Palo Alto, California Ann M. Ritter, MD Anthony M. Avellino, MD, MBA Richmond, Virginia Peoria, Illinois Charles L. Rosen, MD, PhD Johnny B. Delashaw, Jr., MD Morgantown, West Virginia Seattle, Washington Mark R. Shaya, MD J. Paul Elliott, MD Miami, Florida Englewood, Colorado Eric W. Sherburn, MD Tulsa, Oklahoma Douglas J. Fox Jr., MD Austin, Texas Gerald F. Tuite, MD St. Petersburg, Florida Arno H. Fried, MD Hackensack, New Jersey David A. Vincent, MD Norfolk, Virginia M. Sean Grady, MD Philadelphia, Pennsylvania Christian G. Zimmerman, MD, MBA Boise, Idaho Matthew A. Howard, III, MD Iowa City, Iowa Dong H. Kim, MD Houston, Texas
Disclosure • ONAC receives no external financial support. • I have no political aspiration. • I serve on ABMS Board of Director and represents ABNS My One Neurosurgery Advocacy is completely unrelated to service on ABMS and ABNS.
• Self-organized committee composed of both academic and private practice neurosurgeons • Advocate to create “One Neurosurgery, One Meeting, One Voice”
If you consider taking part in the landmark grassroots movement, please sign up. http://www.oneneurosurgery.com/ Nearly 600 neurosurgeons signed up as of June 30, 2015
We Recognize • AANS and CNS have contributed to our specialty since they were founded in 1931 and 1951, respectively. • CNS and AANS are led by extraordinarily talented and dedicated individuals. • The time and effort they spend on our two national organizations is admirable.
Question is “How Can We Do Better?”
Cost is not only factor. In the current challenging healthcare environment, having one unified voice will benefit us .
Why neurosurgeons before 1950 would require two societies? • There was a complete lack of fast and inexpensive transfer of information with one's colleagues. • Access to continuing education was limited to mailed paper journals and word of mouth. • A small number of neurosurgical training programs - Techniques and treatments were highly regionalized and differed greatly around the country. - Necessary cross-pollination of ideas and techniques could only occur at large national meetings.
What Are Reasons for Having Two Societies Today? • This is a hard question to answer. • CNS is a leadership training ground - True • Two organizations give stronger political voice – Questionable (4,000 neurosurgeons/1 million physicians - 0.4%) • Any other reason?
Truths • Time away from work and family during the AANS and CNS annual meetings is important to neurosurgeons. • Many neurosurgeons go to the meetings for a day or a few days to get CME and meeting attendance credit, and rarely stay for the whole meeting.
Truths • AANS and CNS meetings discuss essentially the same topics and have almost identical presentations. “The circle of innovation does not justify 2 annual meetings.” • The most robust education comes from smaller meetings, rather than the large meeting format.
Truths • The annual cost of AANS and CNS to neurosurgery community is huge and unsustainable. • The time and money our members have to attend meetings decreased and will likely further decrease. • Vendor support (the bedrock of the financial stability of both national meetings) is decreasing.
Truths • Neurosurgery has two primary societies, two annual meetings and two journals • About 70 neurosurgery societies, including state neurosurgical societies, and subspecialty societies • One society for 57 neurosurgeons!
Truths Meeting Attendance For Membership • You need to attend AANS and CNS meetings to keep membership. • All other primary societies – No meeting attendance requirement.
Truths • One Primary Society, One Annual Meeting, One Primary Journal OB/GYN (43,000 active practitioners) Anesthesiology (34,000) Orthopedic Surgery (24,000) Ophthalmology (15,000) Urology (10,000) Otolaryngology (10,000) Plastic Surgery (4,000) • CT surgery (3,000)- two primary societies, two annual meetings and one journal
Truths • The Great Majority of Neurosurgeons Favors One Neurosurgery Society. • 100% of Vendors Favor Supporting A Single Annual Meeting.
Neurosurgeons Poll January – March, 2013 Are you in favor of combining the AANS and CNS into one society? Yes 1,836 90.4% No 196 9,6% Total 2, 032 100%
Vendors Poll July, 2013 Would you prefer to support one annual major Neurosurgery meeting? Yes 100% 29 vendors Do you anticipate or have you implemented more restrictive budgets for Neurosurgery meeting support and attendance? Yes 93% 27 vendors No 7% 2
Vendors Comments • Both societies overlap in too many areas and industry can not continue to support so many societies that appeal to their customer bases. It reduces what we can do within that segment of our business. This is a great initiative – and long overdue. • A great idea to improve education, focus messaging, and improve advocacy for neurosurgery.
Opinions of Neurosurgeons In Favor of One Neurosurgery
In Favor • Too many dues/meeting requirements. We should not have to go to meetings for our CME’s. There are other (sometimes even better) ways to get CME’s than AANS meetings. • The circle of innovation does not justify two neurosurgical meetings per annum.
In Favor • Would like to see a combined neurosurgical voice and less ego-driven sub-compartmentalization of neurosurgical societies. • Even though both societies have done a fine job for us, I think we would be better served at lower cost by a unified organization.
In Favor • Seems archaic to have 2 identical organizations at this juncture • There are several advantages to have only one main professional society. • One organization is enough. • Our community is too small to necessitate two nationally-run organizations.
In Favor • One society will have better political power and better attendance at meetings. • Save sometime and money with 1 organization. • Combine. • Together we fall, united we stand.
In Favor • There are benefits to having two professional societies, most notably the innovations that are driven by healthy competition between the organizations. Having said that, it does seem reasonable to have an open discussion that engages our members to examine whether or not the obvious benefits of a single organization outweigh the advantages of the current situation.
Opinions of Neurosurgeons Opposing One Neurosurgery
Oppose • I think neurosurgery is complex and benefits from having two major societies. The original vision for the CNS was to be a forum for neurosurgeons at earlier stages of their career to be involved in organized neurosurgery and neurosurgical education. I think that this is just as important now as it was then.
Oppose • As a CNS member, I would be concerned that consolidating with AANS would raise the cost of membership in the combined organization, with no good alternatives and less voice for the individual member in a large organization.
Oppose • Society leadership tends to develop into a very inbred system with the power of leadership in a very few hands. With multiple societies, this is less an issue. With one society, I fear most neurosurgeons would be out of the loop of leadership circles.
Oppose • While I see how combining the organizations could streamline the organizations, having two conferences a year allows for more presentations by trainees, more opportunities for individuals to get involved in organized neurosurgery, etc
Oppose • It has been my opinion that having two national organizations would give neurosurgery more influence at some places like the RUC, etc. If this is the case, it may worth keeping both organizations in light of the changes coming with Obamacare etc., where we need as much representation as possible.
Finance Information
If we do not change, the expense of maintaining these two separate societies is >$ 1 billion in the next decade. UNSUSTAINABLE
How did we calculate the expenses?
NERVES Data Neurosurgery Annual Collections per Neurosurgeon Median $942,399 52 weeks per year x 5 days 260 Less: Average Days Away (44) Holidays (9) Total Working Days/Year 207 $942,399/207 days = $4,553 per day
AANS Meeting Cost To Neurosurgery 2010 2011 2012 2013 US Neurosurgeons 2,178 1,627 2,271 2,421 International Neurosurgeons 173 141 126 229 Non-Neurosurgeon Clinicians 867 941 833 945 Meeting Cost to US Neurosurgeons $38.1 m $28.5 m $39.7 m $42.4 m (Travel expense $2,500+Lost Revenue $15,000 for 3 days) Cost to International Neurosurgeons $1.4 m $1.1 m $1 m $1.8 m ($8,000, Travel Expense + Lost Revenue) Cost to Non-Neurosurgeon Clinicians $2.2 m $2.4 m $2.0 m $2.4 m ($2,500, Travel expense) Total Meeting Cost $ 41.7 m $32 m $42.7 m $46.6 m
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