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Cross-Post: Neurosurgery’s glass ceiling: Addressing the gender imbalance in the field

By Career, Cross Post, Women in NeurosurgeryNo Comments

Our current series on Making and Maintaining a Neurosurgeon discusses how one transitions from student to resident to practicing neurosurgeon. In particular, we highlight what our field is doing to improve diversity and the importance of mentorship to those considering neurosurgery. How impactful can mentorship be? Incredibly.

This cross-post highlights the recent article in The Varsity, the University of Toronto’s Student Newspaper by Parsa Babaei Zadeh, Veronica Papaioannou, Zahn Bariring and Lauren Shaw titled, “Neurosurgery’s glass ceiling: Addressing the gender imbalance in the field.” The authors discuss how mentorship is crucial for guiding prospective applicants to competitive specialties and fostering an inclusive space where applicants do not feel alienated.

The authors interview neurosurgeon Gelareh M. Zadeh, MD, PhD, FAANS, FRCS, an advocate for change, actively engaged in mentoring young women. “A lack of mentors, role models, and the sense of having allyship and having people that are similar to you in the field… is one of the biggest factors [preventing women from pursuing neurosurgery], so increasing [the] number of people from diverse backgrounds whether it’s females or others is really important,” Dr. Zadeh states.

Click here to read the full article published by The Varsity.

Editor’s Note: We hope you will share what you learn from our posts in the Making and Maintaining a Neurosurgeon series. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #Neurosurgery.

Cross-Post: Medicare cuts ensure disaster to doctor-patient relationship

By Congress, Cross PostNo Comments

On the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. In case you missed it, we wanted to bring attention to a recent op-ed by Reps. Greg Murphy, MD, (R-N.C.), Brad Wenstrup, DPM, (R-Ohio) and Michael Burgess, MD, (R-Texas) in Washington Times titled, “Medicare cuts ensure disaster to doctor-patient relationship.” On Jan. 1, 2024, the Centers for Medicare & Medicaid Services cut payments to physicians by nearly 3.4% for services rendered to Medicare patients, which will cripple independent physicians and rural health care providers across the country.

Reps. Murphy, Wenstrup and Burgess, members of the GOP Doctors Caucus, are greatly troubled by another round of payment cuts to the Medicare Physician Fee Schedule, “It is our goal to navigate the ever-increasing challenges facing those who try to provide care for Medicare recipients.” In anticipation of this rule, the GOP Doctors Caucus introduced legislation seeking to reform the physician fee schedule, prevent extreme fluctuations in future reimbursement and update how costs are determined.

Efforts continue to press Congress to halt these cuts as soon as possible.

Click here to read the article.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixMedicareNow.

Cross-Post: Gender Differences in Medicare Practice and Payments to Neurosurgeons

By Cross Post, Medicare, Women in NeurosurgeryNo Comments

From time to time on the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. Today, we wanted to bring attention to a recent publication in JAMA Surgery.​ The article — “Gender Differences in Medicare Practice and Payments to Neurosurgeons” by Temitope O. Oshinowo, AB, et al. compares practice metrics and earning potential between female and male neurosurgeons and examines gender disparity in Medicare reimbursement.

The authors state that despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges. Females account for approximately 50% of medical school graduates but comprise just 18.2% of neurosurgery residents and only 6% of board-certified neurosurgeons. Female physicians in the U.S. are estimated to be compensated 25% less, or the equivalent of $2 million, in career-long earnings.

Using Medicare data across practice settings, the authors examine patterns of significant disparity in procedural volume and payments and found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons for performing the same primary procedure. “While there has been a trend of increased female representation in neurosurgery, women continue to face challenges in establishing, maintaining, and progressing within their neurosurgical careers,” according to Oshinowo et al.

Click here to read the full article.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @WINSNeurosurge1 and using the hashtag #WomenInNeurosurgery.

Cross-post: Fix the broken Medicare physician payment system that threatens patient access  

By Access to Care, Cross Post, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items published elsewhere that we believe will interest our readers. Today’s post originally appeared in The Hill on Oct. 17. In the op-ed, Reps. Larry Bucshon, MD, (R-Ind.), Ami Bera, MD, (D-Calif.), Raul Ruiz, MD, (D-Calif.), and Mariannette Miller-Meeks, MD, (R-Iowa) state that the Medicare payment system fails to reimburse physicians adequately for the critical services they provide. Unlike other providers, the Medicare Physician Fee Schedule (MPFS) does not have an automatic inflationary update and physician payments declined by 26 percent from 2001 to 2023 when adjusted for inflation.

To address this flaw, Reps. Bucshon, Bera, Ruiz and Miller-Meeks introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474) to modernize the Medicare physician payment system while protecting patients’ timely access to care. This bill would apply a permanent, inflation-based update to the MPFS.

Click here to read the full op-ed and here to contact Congress and urge your representatives to co-sponsor H.R. 2474. Additional information and resources are available at the American Medical Association’s (AMA) Fix Medicare Now website.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) endorse H.R. 2474. The AANS and the CNS also joined several coalition letters endorsing the bill, including the AMA, Alliance of Specialty Medicine and a coalition of more than one million physician and allied health professional groups.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Cross-Post: ‘No other industry would tolerate this’: The problem with prior authorization in spine surgery

By Cross Post, Prior Authorization, Spine CareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Becker’s Spine Review on Sept. 25. Neurosurgeons Anthony M. DiGiorgio, DO, MHA, FAANS; Praveen V. Mummaneni, MD, FAANS and Luis M. Tumialán, MD, FAANS discuss prior authorization and the significant problems physicians face when it comes to receiving fair payments for services offered.

Denial of payment after prior authorization has become a grim reality in American health care. Insurance companies authorize procedures, and surgeons perform them as approved. Then, the insurance company denies payment. The authors state, “No other industry would tolerate this system. Yet, in healthcare, physicians, bound by their oaths to care for patients, endure a system that withholds payment.”

Ultimately, patients bear the brunt of this charade. The authors conclude the article by stating that patients deserve insurance companies that fulfill their contractual obligations.

Click here to read the full article.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixPriorAuth.

Cross-Post: Improving Health Care Quality Measurement to Combat Clinician Burnout

By Burnout, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Journal of the American Medical Association (JAMA) on Sept. 1. Neurosurgeon Anthony M. DiGiorgio, DO, MHA, FAANS, Jesse M. Ehrenfeld, MD, MPH and Brian J. Miller, MD, MBA, MPH discuss the impacts and causes of burnout, which affects up to two thirds of physicians.

Although the causes are multifactorial, the authors state that one of the key causes for clinician frustration is quality metrics. Administrative burdens from poorly designed systems and ineffective regulatory policies are central to clinician frustration. Improving these metrics could reduce clinician burnout, with studies indicating that physicians spend less than 15% of their day in direct patient contact. “A living system of quality metrics with a ceiling on their quantity, as well as a metric life cycle with continuous assessment and improvement, would significantly reduce burdens on clinicians and administrators alike” according to DiGiorgio et al.

Click here to read the full article in JAMA.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Cross-Post: A Pediatric Neurosurgeon Reflects on His Job and the Post-Roe Landscape

By Cross Post, PediatricsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. Today’s post originally appeared in NPR’s Fresh Air on July 28. Dave Davies interviews pediatric neurosurgeon John “Jay” Wellons, III, MD, FAANS, about his memoir “All That Moves Us,” which reflects on his experiences operating on children facing critical illnesses and injuries.

Dr. Wellons relays the story of a 9-year-old pediatric patient in an auto accident in Alabama who had a blood clot pushing her brain. Due to the weather, medevac helicopters weren’t running. Dr. Wellons recounts he arranged for a military Blackhawk to bring her to Birmingham, Ala., for surgery. The surgery was successful, according to Dr. Wellons, “The flicker of the eyes open – that’s a miraculous feeling, Dave, you know, to see somebody wake up after something like that.”

Dr. Wellons also describes an operation on a fetus in the womb, the spine he describes as the size of three grains of rice stacked together. This was surgery to correct a condition that leads to spina bifida.

When asked what he thinks will happen in the post-Roe landscape, Dr. Wellons states, “I can’t tell you how much I think that this ruling is going to affect what it’s like for families to have these substantial — neurologic, cardiac, urologic — encephaloceles where the gut’s outside the body that is hard to be fixed sometimes. Like, we’re going to see a lot more of these now, and we’re going to have to, as a society, understand that we’re going to have to take care of these children. That’s our job. So, yes, I think it’s going to have an impact.”

Click here to access the full interview.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

Cross-Post: Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis

By CNS Spotlight, Cross PostNo Comments

From time to time on the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. Today, we wanted to bring attention to a recent publication in Neurosurgery, the official journal of the Congress of Neurological Surgeons, which provides multimedia, prompt publication of scientific articles on clinical or experimental surgery topics important for the brain, spine, and peripheral nerves, reviews, and other information of interest to readers across the world.​ The article — “Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis” — is published as part of Neurosurgery’s High-Impact Manuscript Service (HIMS).

Published online on June 13 and expected in the September issue of Neurosurgery, the article addresses odontoid fractures, common in elderly patients after a low-energy fall. “Given the increasing incidence of odontoid fractures with the aging population, we believe our findings could assist with neurosurgical decision-making for an increasingly common and complex problem,” the researchers say.

According to the Wolters Kluwer press release, “Michael B. Cloney, MD, MPH, of the Department of Neurological Surgery at Northwestern University in Chicago, and colleagues have published evidence that surgery should be considered the initial approach for many patients. Compared with nonoperative approaches to treatment, surgical stabilization of the fracture was associated with less myelopathy (mobility impairment due to spinal cord damage), and lower rates of fracture nonunion, 30-day mortality, and one year mortality.’”

To read the full Neurosurgery article, click here.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NeurosurgeryCNS and using the hashtag #neurosurgery.

Cross-Post: A new crisis at the border: Traumatic injuries caused by falls from Trump’s 30-foot wall

By Cross Post, Spine Care, TraumaNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other publications that may interest our readers. Today’s post was first published in The Hill on July 6, titled “A new crisis at the border: Traumatic injuries caused by falls from Trump’s 30-foot wall.” In the op-ed, Alexander Tenorio, MD, a neurological surgery resident at the University of California San Diego, discusses the injuries and economic burden of height extensions of U.S.-Mexico border wall barriers.

“As a physician, it is my duty to reveal this unnecessary harm and strain on hospital resources. As the son of Mexican immigrants, it is my duty to continue to fight for this vulnerable population,” states Dr. Tenorio.

Dr. Tenorio recently joined human rights leaders as the physician representative to brief members of Congress and President Biden’s domestic policy advisors on the public health crisis occurring at the U.S.-Mexico border.

Click here to read the op-ed.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #neurosurgery.

Cross-Post: When Insurance Fails

By Cross Post, Health Reform, Prior AuthorizationNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared in The Lincoln Journal Star, titled “When Insurance Fails.” In the op-ed, neurosurgeon Jeremy Hosein, MD, discusses the misuse of prior authorization, which delays care, prolongs suffering and adds significant administrative costs to health care.

Dr. Hosein relays a story of a 47-year-old female with nagging pain in her hip who was sent by her primary doctor to physical therapy and given pain medicine. When the pain persisted and caused difficulty walking, she was referred to an orthopedic surgeon who ordered an MRI. The insurance company denied the MRI, stating that the scan was not medically necessary and that she had not yet completed physical therapy. Her orthopaedic surgeon appealed the denial, and the MRI was eventually performed nearly six weeks later. Her cancer doctors said she could have avoided surgery had the tumor been discovered only weeks earlier.

According to Dr. Hosein, prior authorization is increasingly being used to deny or delay basic medical care such as blood tests, imaging and other medically necessary procedures. A 2023 Kaiser Family Foundation analysis found that 82% of appeals in Medicare Advantage resulted in overturned denials. Fortunately, some hope may be on the horizon, states Dr. Hosein. The Centers for Medicare & Medicaid Services issued rules to reduce the burden of prior authorization with an automated electronic process and to add transparency to the process.

Click here to read the op-ed and here to read more about CMS’ proposed rules.

Editor’s Note: Organized neurosurgery aims to protect patients’ timely access to care by streamlining the prior authorization process. Patients experience significant barriers to medically necessary care due to prior authorization requirements for items and services that are eventually routinely approved. In the 2023 Legislative & Regulatory Agenda, the American Association of Neurological Surgeons and the Congress of Neurological Surgeons outline health policy action items the neurosurgical societies plan to advance with Congress and the Biden Administration.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixPriorAuth.