One Neurosurgery Movement Since October 2012 T. S. Park, M.D. - - PowerPoint PPT Presentation

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

• T. S. Park, MD, Chair
• St. Louis, Missouri

John R. Adler, MD Palo Alto, California Anthony M. Avellino, MD, MBA Peoria, Illinois Johnny B. Delashaw, Jr., MD Seattle, Washington

• J. Paul Elliott, MD

Englewood, Colorado Douglas J. Fox Jr., MD Austin, Texas Arno H. Fried, MD Hackensack, New Jersey

• M. Sean Grady, MD

Philadelphia, Pennsylvania Matthew A. Howard, III, MD Iowa City, Iowa Dong H. Kim, MD Houston, Texas Zachary T. Levine, MD Bethesda, Maryland Robert L. Martuza, MD Boston, Massachusetts Ann M. Ritter, MD Richmond, Virginia Charles L. Rosen, MD, PhD Morgantown, West Virginia Mark R. Shaya, MD Miami, Florida Eric W. Sherburn, MD Tulsa, Oklahoma Gerald F. Tuite, MD

• St. Petersburg, Florida

David A. Vincent, MD Norfolk, Virginia Christian G. Zimmerman, MD, MBA Boise, Idaho

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
• rganizations 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
• nly 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
• r 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
• f 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

• ther (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
• rganizations 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
• rganization.
• 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

• rganizations. 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

• utweigh 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

• f 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 (Travel expense $2,500+Lost Revenue $15,000 for 3 days) $38.1 m $28.5 m $39.7 m $42.4 m Cost to International Neurosurgeons ($8,000, Travel Expense + Lost Revenue) $1.4 m $1.1 m $1 m $1.8 m Cost to Non-Neurosurgeon Clinicians ($2,500, Travel expense) $2.2 m $2.4 m $2.0 m $2.4 m Total Meeting Cost $ 41.7 m $32 m $42.7 m $46.6 m

CNS Meeting Cost To Neurosurgery

2010 2011 2012 2013 US Neurosurgeons 1,498 1,681 1,461 1,620 International Neurosurgeons 727 445 906 838 Non-Neurosurgeon Clinicians 427 436 833 945 Meeting Cost to US Neurosurgeons (Travel expense $2,500+Lost revenue $15,000 for 3 days) $26.2 m $29.4 m $25.6 m $28.4 m Cost to International Neurosurgeons ($8,000, Travel Expense + Lost Revenue) $5.8 m $3.6 m $4.4 m $4.2 m Cost to Non-Neurosurgeon Clinicians ($2,500, Travel expense) $1 m $1.1 m $2.3 m $2.1 m Total Meeting Cost $33 m $34.1 m $32.3 m $34.7 m

Total Cost of AANS and CNS To Neurosurgery Community

Year 2010 Year 2011 Gross Receipts (AANS & CNS) $39.6 million $39.9 million AANS & CNS Meeting Cost $74.7 million $66.1 million Total $114.3 million $106 million Meeting Expenses of Vendors: Unknown

Assume Neurosurgeon Annual Collection $621,000

• Daily Collection $3,000
• Lost Revenue During Meeting $9,000

Total Cost of AANS and CNS To Neurosurgery Community

Year 2010 Year 2011 Gross Receipts (AANS & CNS) $39.6 million $39.9 million AANS & CNS Meeting Cost $43.5 million $37.9million Total $83.1 million $77.8 million Based on Lost Revenue During Meeting $9,000 Meeting Expenses of Vendors: Unknown

Duplicated Expenses of AANS and CNS

Duplicated Expenses of AANS and CNS in 2011

• The total number of paid employees in AANS & CNS

– 97

• Combined employee compensation - $8 million

Compensation for Executive directors: 834K (AANS 524k; CNS 310k)

• Combined travel expenses - $1.37 million
• Combined office expenses - $1.68 million

Expenses of CNS in 2011

• CNS spent 476k for catering services.

AANS – not listed.

• CNS spent 130k for honoraria and awards.

AANS – not listed.

• CNS spent 123k for lobbying to influence public
• r legislation. AANS – not listed.

If You skip one of any other national meetings, and invest the saving in your retirement fund every year

Investment Total Meeting Expenses $5,000 Investment Total Lost Revenue $3,000 for 5 days $15,000 Grand Total 10 years $78,574 $235,721 $314,295 20 years $209,713

$1,239,256

$838,851 25 years $309,814 $929,442 $1,239,256 30 years $443,457

$1,330,371

$1,773,828 Assume annual return 7% and inflation rate 3%

Past Communications with AANS & CNS

March, 2013

• One Neurosurgery Committee wrote a letter to the

to presidents of AANS and CNS about the survey results and requested a teleconference.

• There was no acknowledgement of receiving the

letter or formal feedback about the letter from AANS or CNS.

June 2013

Hundreds of neurosurgeons emailed presidents and presidents-elect of AANS and CNS. AANS President Response, June 3, 2013 “The material differences of mission, culture and governance structure rendered the possibility of a true merger impossible.” CNS President Response, June 28, 2013 “Neither the CNS nor the AANS supports such a merger – for many good reasons.”

March 21, 2014 ONAC Wrote to AANS and CNS

• In order to assess the value of services of AANS and CNS to

neurosurgeons, the One Neurosurgery Advocacy Committee (ONAC) has been looking into the cost for neurosurgeons to attend the annual meetings and support the two societies.

• To our surprise, the estimated cost was $121.8 million in 2010 and $110.1

million in 2011.

• Based on the cost analysis, we can project that the cost of AANS and CNS

to neurosurgery and vendors over the next decade will exceed $1 billion.

• The ONAC would appreciate if the AANS would review the attached cost

analysis information and let us know if we need to make changes in the analysis.

AANS and CNS Presidents Joint Response

• As a starting point, we fundamentally disagree with the premise that your

cost analysis provides an accurate basis by which to assess the value of the services and other benefits provided by the AANS and the CNS to their

• members. Moreover, we are deeply concerned with the material

inaccuracies and faulty assumptions that underlie your analysis. By way of example, your cost analysis is based on the gross receipts of the AANS and the CNS. However, you make no attempt whatsoever to account for the cost of the services that the AANS and CNS provide for their membership, including but not limited to the advocacy efforts of the Washington Committee, our respective medical journals, and educational

• pportunities outside of the AANS and CNS Annual Meetings. This is one
• f many flaws in your analysis.

AANS and CNS Presidents Joint Response cont’d

As you know, individuals in our leadership group have discussed these issues with you and we attempted to engage you at the CSNS Plenary Session in New Orleans. The One Neurosurgery committee chose not to discuss this with us in an open forum before the AANS and CNS delegates. We then sent a letter in June of last year to the membership, informing them that this issue had been thoroughly vetted as a resolution presented at that CSNS Session, and that the resolution was subsequently

• withdrawn. We have no confidence that any further data that AANS or

CNS shares with your organization will be presented accurately. Therefore, we choose not to share any additional data in this regard.

AANS and CNS Presidents Joint Response cont’d

Rather than engage in a written exchange based on what we believe is a clearly inaccurate and misleading cost analysis, we invite you to attend the Annual Meeting of the CSNS to be held on Saturday, April 5th in conjunction with the Annual Scientific Meeting of the AANS. This will enable the leadership of One Neurosurgery to participate in a public forum with the leaders of the AANS and the CNS to discuss the value of services provided by the AANS and the CNS. We look forward to participating in this discussion with the leadership

• f One Neurosurgery and hope that you will accept this invitation.

March 2014

• ONAC proposed an in-person meeting with AANS

CNS leadership.

• AANS leadership disagreed with meeting agenda.
• No in-person meeting occurred.

ONAC Recommended To Neurosurgery Colleagues April 2014

ONAC Recommendation, Aril 2014

Neurosurgeons “Evaluate”, “Decide”, “Take Actions” and Sign Up. I will take action by

• Not attending AANS meeting
• Not attending CNS meeting
• Not renewing AANS membership
• Not renewing CNS membership

Neurosurgeons Response to ONAC Recommendation

Nearly 600 neurosurgeons signed up ONAC YouTube Videos - >2,000 views

Thank you

“One Neurosurgery, One Meeting, One Voice”