Editor’s Note: Adapted from the Chair Report, CSNS Fall 2011, Washington, D.C.

Right now, the socioeconomic stress on each and every neurosurgeon — private practice and academic, solo practitioner/group practice/hospital employee/or multispecialty group, male or female, resident or retired — is greater than ever.

• More than 19 percent of all neurosurgeons settle or close a malpractice case each year (the highest of any specialty).
• The rise in physician payments has been below the cost of living for the last three years, with only those in multispecialty groups coming close to keeping up with inflation.
• RUC and CMS controversies tear at the fabric of the long-established system of determining the Medicare fee schedules for all physicians.
• There is a dramatic decline in resident work hours as well as in available GME funding.

Despite these and many other challenges, I know that neurosurgery can:

• Train and educate better — at all levels.
• Respond to the changing environment of social media in a useful and productive way.
• Improve our knowledge of how to best treat our patients and get the right treatment to the right patient at the right time.
• Be a part of determining a more economical delivery of care that honors the long hours, hard work and expertise of specialty care.
• Recognize how to optimize the environment for healing our patients while minimizing the environmental impact on our community.

All this and more is the mission of the Council of State Neurosurgical Societies (CSNS), underscoring the importance of the CSNS to organized neurosurgery and to each individual neurosurgeon. Over the last few months, I have worked along with all the elected officers of the CSNS to assemble an outstanding team to take on the ambitious program we have set for the coming two years. These are the individuals who will be diligently working to help neurosurgery navigate the rough socioeconomic waters during the coming months.

The Officers:
Vice Chair: Mark Linskey, MD, FAANS
Recording Secretary: Ann Stroink, MD, FAANS,
Corresponding Secretary: Alan Scarrow, MD, JD, FAANS
Treasurer: Josh Rosenow, MD, FAANS

Quadrant and Caucus Chairs:
Southwest: Moustaphe Abousamra
Northwest: Holy Gilmer, MD, FAANS
Southeast: Charles Rosen, MD, PhD, FAANS
Northeast: Cathy Mazzola, MD, FAANS
American Association of Neurological Surgeons (AANS): Susan Pannullo, MD, FAANS
Congress of Neurological Surgeons (CNS): Darlene Lobel, MD

Committee Chairs:
Workforce: Robert Heary, MD, FAANS
Trauma and Emergency Neurosurgery: Shelly Timmons, MD, PhD, FAANS
Coding and Reimbursement: Ed Vates, MD, PhD, FACS
Medicolegal: Nicholas Bambikedis,
Medical Practices: Joseph Cheng, MD, MS, FAANS
CEC: Mike Steinmetz, MD, FAANS
Website: Tom Yeo; and John Ratliff, MD, FAANS, FACS
Publications: Karin Schwartz
Young Neurosurgeons: Chaim Colen, MD, PhD

Other members of this outstanding team are:
Historian: John Kusske, MD, FAANS
Parliamentarian: Phil Tally, MD, FAANS
Administrator: Sandy Meyer

Certainly, I cannot know what crisis or crises may arise during the next 18-24 months, which may demand significant effort by the CSNS on behalf of all of neurosurgery; nonetheless, I have set the following goals for my two-year term as chair of the CSNS:

1. To establish long-term financial stability for the organization

2. To foster a unique atmosphere of creativity and diversity that will become strong enough to transcend individual leaders

3. To build stronger bridges between academic and private-practice neurosurgery through new program initiatives

4. To help empower every neurosurgeon through socioeconomic education and CSNS activity

I already have appointed a Finance Committee under the leadership of David Jimenez, MD, FAANS, FACS, to work closely with our treasurer, Dr. Rosenow, and myself.  We have initiated a more proactive budgeting process that more closely anticipates our expenses over several years. I will continue to encourage development of new, non-competitive (with the CNS and AANS) sources of income to support the mission of the CSNS, such as the significant expense of supporting 13 SE Fellows each year. I will ensure fiscal responsibility in all our expenditures through forward planning and efficiencies. And I encourage all of you to make a meaningful contribution to the Melany Thomas Endowed SE Fellowship. (To contribute, go to www.csnsonline.org.) We already have raised several thousand dollars toward our goal of $75,000, which would provide perpetual funding for one Fellowship position and clearly demonstrate our commitment to this competitive, highly successful program.

Within the CSNS, there always has been a strong core of active participants representing a wide diversity in terms of geography, age, practice, etc. I will strive to further enhance this welcoming and open environment because irrefutably, through diversity comes strength, creativity and greater opportunity. As award-winning author James Surowiecki stated: “Experts, no matter how smart, only have limited amounts of information. They also, like all of us, have biases. It’s very rare that one person can know more than a large group of people, and almost never does that same person know more about a whole series of questions. The other problem in finding an expert is that it’s actually hard to identify true experts. In fact, if a group is smart enough to find a real expert, it’s more than smart enough not to need one.”

There are slightly more than 3,000 active neurosurgeons. Despite this, too often, there is conflict between different factions within our specialty. The most evident is probably the relative distrust and misunderstanding that exists between the academic and private-practice community. The rise of hospital-employed neurosurgeons has further aggravated the sense of segregation rather than unified purpose of the neurosurgical community. During the coming months, I have asked my leadership team to develop strategies to better understand the foundations of this problem and to design unique programs that build bridges.

Through education, we gain strength. It was not so many years ago that proposals to devote a part of the AANS and CNS meetings to topics such as coding, negotiation, advocacy or regulatory mandates were met with skepticism. Now a significant portion of each meeting is devoted to these and many other topics. Through the devoted efforts of the CSNS, these educational opportunities continue to expand and also have been integrated into all levels of neurosurgical education — from medical school through residency and MOC. Through last spring’s resolutions, the CSNS was given the opportunity to develop a comprehensive SE curriculum for incorporation into the Matrix Project for resident training. Mike Steinmetz and Edie Zusman, MD, FAANS, FACS, led a small workgroup that included Drs. Colen Scarrow and myself, and in an incredibly short time, we drafted the requested curriculum that was presented yesterday. Once finalized, this will be submitted through the SNS to be incorporated into the comprehensive curriculum. Over the next two years, I will look to bring innovative educational opportunities to the CSNS and have the CSNS design and implement state-of-the-art didactic projects.

Clearly, it will be an exciting two years. I look forward to working with all neurosurgeons and all of organized neurosurgery to address the many important socioeconomic issues of the coming months.

Deborah L. Benzil, MD, FAANS, FACS, is a neurosurgeon with the Mount Kisco Medical Group (MKMG) in New York. She also is director of restorative neurosurgery at Putnam Hospital Center in Carmel, N.Y. In addition, Dr. Benzil serves as chair of the Council of State Neurosurgical Societies (CSNS). The author reported no conflicts to disclose.