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Neurosurgeons Putting Patients First

By Access to Care, Faces of Neurosurgery, Health Reform, MedicareNo Comments

The Medicare physician payment system is on an unsustainable path that has failed to keep up with inflation over the years, threatening patient access to care. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are actively engaged in preventing steep Medicare payment cuts and preserving patient access to care through the Surgical Care Coalition. The coalition is in year three of its campaign to stop these cuts and implement lasting changes to the physician payment and quality improvement systems.

On Jan. 1, 2023, neurosurgeons face a minimum 8.5% Medicare payment cut, including a nearly 4.5% cut for all Medicare Physician Fee Schedule services and a 4% Statutory Pay-As-You-Go Act cut, triggered due to new federal spending. After successfully protecting patients’ timely access to quality surgical care in 2020 and 2021 by securing Congressional action to mitigate proposed cuts to Medicare, the coalition is fighting against similar cuts proposed for 2023. The AANS and the CNS are also working with Congress on long-term solutions to fix these broken systems. To that end, we submitted detailed comments in response to a Congressional request for information.

The people who the proposed cuts will most impact are our patients. Every day, neurosurgeons take care of some of the sickest patients who face painful and life-threatening neurologic conditions. Alexander A. Khalessi, MD, FAANS, John K. Ratliff, MD, FAANS and Maya A. Babu, MD, FAANS, share their experiences as neurosurgeons and how the cuts will impact neurosurgical practices and their patients. The videos are available as follows:

Patient Process

Why I Became a Surgeon

Earning a Patient’s Trust

Medicare Cuts are Back

Patients Deserve Timely, Quality Care

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 @SurgeonsCare.

November 9, 2022
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Cross-Post: Why Is It Hard for Grandma To See Her Doctor?

By Cross Post, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may be of interest to our readers. Today’s post originally appeared on AL.com on Nov. 1, titled “Why is it hard for grandma to see her doctor?” In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses how steep Medicare physician payment cuts scheduled to go into effect on Jan. 1, 2023, are not a good prescription for a healthy physician workforce.

The average physician will receive 8.5% less for providing the same services they did last year. While adjusting for inflation, Medicare payments to physicians have declined 22% from 2001-2021. According to Dr. Menger, “The people most impacted by these cuts will be our Medicare patients. In the backdrop of inflation, practices will not be able to sustain themselves by treating Medicare patients.” Dr. Menger concludes by stating that this puts seniors at risk for reduced access to care.

Click here to read the full article.

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.

November 3, 2022
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Cross-Post: It’s Never Too Late to Pivot From N.F.L. Safety to Neurosurgeon

By Career, Cross PostNo 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 be of interest to our readers. Today’s post originally appeared in the New York Times on Oct. 11 as part of the “It’s Never Too Late” series. The article discusses how Myron Rolle, MD, a PGY-6 neurosurgery resident at Massachusetts General Hospital in Boston, Mass., transitioned from playing in the NFL to neurosurgery.

Dr. Rolle notes that he was inspired to become a neurosurgeon by the book “Gifted Hands” by Benjamin S. Carson, MD, FAANS (L) — a memoir that detailed how Dr. Carson went from being an inner-city youth with poor grades to the director of pediatric neurosurgery at Johns Hopkins University Hospital. Dr. Rolle’s long-term goal is to practice neurosurgery in the U.S. and spend a portion of the year in the Caribbean, developing neurosurgical services in the Bahamas and member states of CARICOM, an organization of Caribbean countries.

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 @MyronRolle and using the hashtag #Neurosurgery.

October 28, 2022
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Cross-Post: Neurosurgery Announces Global Neurosurgery ‘Moon Shot’ with New Editorial Board Section

By CNS Spotlight, Cross Post, Guest PostNo Comments

From time to time on Neurosurgery Blog, you will see us highlighting items from other places when we believe they hit the mark on an issue. To this end, we want to bring attention to the new Neurosurgery Editorial Board Section, “Global Neurosurgery,” highlighted by Section Editor Gail L. Rosseau, MD, FAANS, FACS, in the October issue of Neurosurgery.

As highlighted in a recent announcement about the new feature, “Despite rapid advancements in neurosurgical techniques and capabilities, much of the world’s population has limited or no access to modern care for brain and spinal trauma, stroke, tumors, and other neurological conditions.” To remedy this inequity, the Editor-in-Chief of Neurosurgery, Douglas S. Kondziolka, MD, FAANS, introduced this new section to help advance timely, safe and affordable neurosurgical care to all who need it. Comprised of experts from every generation and continent where neurosurgery is practiced, this new Neurosurgery feature is working to attract the highest-quality global neurosurgery manuscripts, emphasizing policies to assure equity in authorship, access and use of local data.

Dr. Rosseau likens the Global Neurosurgery initiative to President John F. Kennedy’s commitment to land American astronauts on the moon, “no specialty and no nation which expects to be a leader can expect to stay behind in the quest for highest quality health care for all people.”

To read the full Editorial in Neurosurgery, 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.

October 19, 2022
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Neurosurgical Oncologists as Champions of Diversity, Equity and Inclusion

By DEI, Neuro-oncology, Tumor SeriesNo Comments

Recent events of systemic discrimination have led to national introspection on the importance of tolerance and diversity. The tragic killing of George Floyd in May 2020 was a sentinel event that raised awareness of the pervasive nature of systemic discrimination and served as a significant impetus for positive change. This was a clear reminder that we still face substantial challenges to tolerance and equal treatment for all as a society. It is also a unique opportunity to reflect on our common purpose as humanity.

In the immediate aftermath of Mr. Floyd’s death, many organizations issued statements reaffirming their commitments to promoting and advancing diversity through anti-discriminatory policies and initiatives. On their part, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released the following joint statement:

As a profession, we in neurosurgery aim to promote the highest quality of patient care and advance the specialty of neurosurgery and neurosurgical education while espousing the values of integrity, leadership, excellence, and professionalism. As organizations and as a profession, we are committed to inclusion and diversity within our neurosurgical community. As neurosurgeons, we are committed to providing the highest quality of care to all segments of our society. Indeed, our principles are only relevant to the extent they apply to the most disadvantaged in our society.

The Society of Surgical Oncologists (SSO) also released a similar statement:

The Society of Surgical Oncology condemns racism and violence in all forms. We recognize racism as an underpinning to health disparities, and recent events serve as a clarion call to all of us that there is a need to do more than what we do on a daily basis — provide the best cancer care to individual patients regardless of race, ethnicity, gender, sexual orientation, or socioeconomic status.

Diversity requires the core elements of equity and inclusion. Equity requires deliberate, fair and just treatment of our patients and colleagues irrespective of their background. Inclusion requires a conscious effort in thoroughly engaging diverse patients and colleagues in all aspects of the care we deliver and the decisions that govern our care through tolerance. Through equity and inclusion, our colleagues and patients feel respected and valued.

A firm commitment to the core elements of diversity is critical to the impactful delivery of neurosurgical care to society’s most vulnerable members. In treating life-threatening disorders of the nervous system, neurosurgeons can positively impact patients from all works of life. To render the best possible care, neurosurgeons should understand the diverse patient population they serve in the context of race, gender and ethnicity. When we deliver neurosurgical care in an atmosphere of tolerance and understanding, we serve as role models to those who look up to us.

Neurosurgical oncologists are integral to cancer care in the central nervous system, one of the most critical battle lines in the fight against systemic cancer-related morbidity and mortality. Despite advances in oncology, there is still a considerable disparity in cancer care. Racial and ethnic minorities and lower socioeconomic patients are disproportionately impacted by cancer. As part of the multidisciplinary management of diverse patients with central nervous system tumors, neurosurgical oncologists perform surgeries, stereotactic radiosurgery and clinical trials. Therefore, it is imperative for neurosurgical oncologists to incorporate diversity-informed clinical decision-making approaches to positively impact cancer patients who are affected by health disparities. Moreover, neurosurgical oncologists should be mindful of the barriers and challenges to recruiting underrepresented minorities into clinical trials, given historical precedence of mistrust. Identifying, acknowledging and addressing such barriers would undoubtedly enhance participation.

From a workforce perspective, organized neurosurgical oncology should strive to reflect the diverse cancer patient population they serve. Concerted efforts are needed to diversify the pool of neurosurgeons. We should strive to attract, train and mentor neurosurgeons from under-represented groups into the subspecialty of neurosurgical oncology. If we embrace diversity efforts, we should also establish benchmarks to assess progress in this journey. Beyond diversity in its members’ composition in general, neurosurgical oncology should strive to include diverse membership and leadership in committees. Such diversity efforts will strategically position us to address the neurosurgical oncologic needs of a multifaceted society uniformly.

As a profession, we should strive for the ideals of diversity and its associated tenets of equity and inclusion. Neurosurgical oncologists are in a unique position to understand and reduce health disparities. Our patients deserve that from us. We should never forget that our future is only as bright as the future of the patients whom we serve.

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

Arnold B. Etame, MD, PhD, FAANS

Moffitt Cancer Center

Tampa, Fla.

February 2, 2022
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Introduction to Tumor Focus Series: Bringing “Better” to Our Patients in Multiple Ways

By Tumor, Tumor SeriesNo Comments

Neurosurgery has historically been a uniquely wide-ranging and varied specialty. Unlike other specialties that focus on a particular organ system or body region, neurosurgery is quite literally a “head-to-toe” specialty dealing with the brain, spinal cord, peripheral nerves and the other organs intimately related to the nervous system. Neurosurgeons classically had to be experts in a wide variety of surgical procedures and disease processes. As medical knowledge and technology have advanced, neurosurgeons have evolved with medicine to become experts in particular disease processes, leading to a reorganization of neurosurgery into sub-specialty disciplines.

Over the years, the Neurosurgery Blog has partnered with various neurosurgery subspecialty sections to provide an update on the state of the subspecialty, highlight current issues, add to the conversation and portray their concerns to a non-specialized audience. Today’s neurosurgeon must be facile in many different areas — both medical and non-medical. As medical care and health care delivery have grown increasingly complex, neurosurgeons must wear several hats: surgeon, team-member in multi-disciplinary care teams, teacher, scientist and advocate.

We partnered with the AANS/CNS Joint Section on Tumors for the following series of blogs. Under the guidance of Tumor Section chair, Jason P. Sheehan, MD, PhD, FAANS, and AANS/CNS Washington Committee representative, Michael A. Vogelbaum, MD, PhD, FAANS, members of the section came together and produced a sweeping overview of ongoing topics:

  • Arnold B. Etame, MD, FAANS, leads us off with a piece about diversity in neurosurgical oncology. Isabelle M. Germano, MD, FAANS, FACS, then tackles disparities in access to care and outcomes in brain tumor patients.
  • Ricardo J. Komotar, MD, FAANS, FACS, reports on efforts in education and collaboration on an international scale. Edjah E. Nduom, MD, FAANS, speaks to brain tumor advocacy, providing an overview of the outward-looking direction of some of our efforts.
  • Michael Lim, MD, FAANS, and Nader Sanai, MD, FAANS, bring us two pieces highlighting the ability of neurosurgeons to translate discoveries from the lab into patient care and back again and how neurosurgeons contribute to drug development in the increasingly complex fight against brain tumors. These pieces are complemented by an article by Manish K. Aghi, MD, PhD, FAANS, updating the role of neurosurgeons in clinical trials and research in neurosurgical oncology.

Academic publishing, the Journal of Neuro-Oncology, and the dissemination of scientific results, particularly in the era of the COVID-19 pandemic, are at the center of a piece by Dr. Sheehan and Christopher P. Cifarelli, MD, PhD, MMM, FAANS, FACS. Dr. Vogelbaum presents “A Neurosurgical Perspective on Multidisciplinary Care for Patients with Brain Tumors,” emphasizing the team-based nature of neuro-oncology care today.

In the era of a worldwide pandemic and an increasingly complex care delivery environment, neurosurgeons are playing more and more roles in delivering better care to our patients. This is especially true in the field of neurooncology. We hope that these blogs inspire you to join the efforts of this important field. The amount of work that the members of the section and the authors, in particular, put into these issues outside of patient care is astonishing and deserves credit!

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

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

January 20, 2022
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Faces of Neurosurgery: An Interview with Kim J. Burchiel, MD, FAANS, FACS

By Career, Faces of NeurosurgeryNo Comments

In Episode 3 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with Kim J. Burchiel, MD, FAANS, FACS, about his passions, his early mentors and what has driven him throughout his career. Dr. Burchiel is currently John Raaf Professor and Chairman Emeritus of the Department of Neurological Surgery at Oregon Health & Science University (OHSU).

Dr. Burchiel is most proud of his contributions to trigeminal neuralgia and deep brain stimulation, as well as building the department at OHSU. His favorite neurosurgical instrument is the computer, something that has changed the field more than anything else.

To the neurosurgeon in need of a book recommendation, he suggests “Undaunted Courage” by Stephen Ambrose — a book about the Lewis and Clark expedition to the west.

When asked about advice for individuals starting a neurosurgery residency, Dr. Burchiel said, “It’s very much like Lewis and Clark. It is a voyage into the unknown — a lot of difficulties lay ahead, and you need to be able to persevere, be resilient and you have to take it one day at a time.”

The full interview is available here and on Neurosurgery Blog’s YouTube channel.

Editor’s Note: We hope that 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 #FacesOfNeurosurgery.

July 13, 2021
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Faces of Neurosurgery: An Interview with R. Michael Scott, MD, FAANS (L)

By Career, Faces of NeurosurgeryNo Comments

In Episode 2 of Neurosurgery Blog’s Faces of Neurosurgery interview series, we spoke with R. Michael Scott, MD, FAANS (L), about his early mentors, proudest achievements, and musical hobbies. Dr. Scott is currently Neurosurgeon-in-Chief-emeritus at Boston Children’s Hospital and Christopher K. Fellows Family Chair in Pediatric Neurosurgery.

Dr. Scott says that one of his proudest achievements is leaving behind an extensive legacy of patients throughout his career, as well as the residents he helped train. He is also proud of helping to better define Moyamoya disease and its surgical treatment.

He offers the following advice for neurosurgery residents, “Becom[e] an expert in something that interests you as you’re getting into residency.”

The full interview is available here and on Neurosurgery Blog’s YouTube channel.

Editor’s Note: We hope that 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 #FacesOfNeurosurgery.

June 21, 2021
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Honoring Those Who Have Served

By Military Faces of NeurosurgeryNo Comments

Each year on Veterans Day, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) pay tribute to the contributions of the many military neurosurgeons who have made significant contributions and sacrifices. Whether on the battlefield, in the operating room or research lab, neurosurgeons have served our country with distinction and grace throughout history.

ICYMI, Neurosurgery Blog has featured many of these stories, and we encourage our readers to take a trip down memory lane. Read how former AANS president Roberto C. Heros, MD, FAANS(L), volunteered for the ill-fated Bay of Pigs invasion. Remember the horrors of the Vietnam War, as seen through the eyes of Patrick J. Kelly, MD, FAANS(L), while he was stationed in Da Nang during the bloodiest year of that conflict. Learn how neurosurgeons, like COL (ret) Rocco A. Armonda, MD, FAANS, have taken their skills from the operating room into the battlefield. Recall the recent efforts of the U.S. Comfort and Mercy, and how neurosurgeons came to the aid of Los Angeles and New York City as COVID-19 stressed the hospital ecosystem in the early days of the pandemic.

Thank you to these and all other veterans who have served our nation with selflessness and dignity to protect the freedoms we have all come to take for granted. Your service can never be honored enough. Happy Veterans Day, one and all.

November 11, 2020
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Physician Burnout in Neurosurgery: An Under-Recognized Phenomenon

By Burnout, Health, Work-Life BalanceNo Comments

As conversations about work-life balance are becoming more prevalent, and given the stresses associated with the COVID-19 pandemic, there has been a renewed interest in the issue of physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. In recent years, the rising prevalence of burnout among clinicians — more than 50 percent according to a Medscape report — has led to probing questions on how it affects access to care, patient safety and care quality. Burned-out physicians are more likely to leave their practices or the practice of medicine altogether, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients, and when burned-out physicians suffer from impaired attention, memory and executive function.

In addition to the impact of burnout on physicians and patients, according to a recent study published in the Annals of Internal Medicine, the health care system loses more than $4.8 billion a year due to this phenomenon. Although neurosurgeons work long hours, balance outpatient and inpatient practices, and deal with life and death issues, we have paid limited attention to burnout in this field.

For the next few weeks, Neurosurgery Blog will highlight the issue of burnout — including in the field of neurosurgery. Here are some staggering facts about burnout in neurosurgery:

  • A recent survey of 783 neurosurgeons found the rate of burnout to be 62.9 percent among nonacademic neurosurgeons and 47.7 percent for academic neurosurgeons;
  • Poor work-life balance, health care reform and financial uncertainty were the major factors contributing to career dissatisfaction; and
  • Burnout and depression — sometimes associated with emotional exhaustion — were a significant predictor of preventable major medical errors in a study using data from 7,905 members of the American College of Surgeons.

Among neurosurgeons, many factors were found to lower the chances of burnout. High volume surgeons, with stable families, who are intellectually challenged, with leadership roles and a good work-life balance, are more effectively shielded against burnout.

Understanding burnout will push more health care organizations to adopt strategies to protect their members from this phenomenon. Physician engagement will undoubtedly be crucial to the prevention of burnout. We must take the lead by being active and vocal for ourselves, our colleagues and our patients and fight against the forces that erode our mental health and the quality of our work.

Join us in an insightful journey, understanding burnout as it pertains to the field of neurosurgery. We aim to identify the reasons behind this phenomenon and the best strategies to prevent it or minimize its impact on the careers of neurosurgeons.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Kimon Bekelis, MD
Vice-chair, AANS/CNS Communications and Public Relations Committee
Catholic Health Services of Long Island
West Islip, N.Y. 

 

 

Kristopher T. Kimmell, MD, FAANS
Vice-chair, AANS/CNS Communications and Public Relations Committee
Rochester Regional Health
Rochester, N.Y. 

 

 

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

September 3, 2020
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