CANS NEWSLETTER—MARCH 2006

1.  All is well on Work Comp provider scene—for now.
2.  President’s Message
3.  Report from Executive Secretary
4.  CSNS Resolutions

1.  CWCI finds no Work Comp physician exodus—yet.
It is noted that the California Workers Compensation Institute has released a study indicating there has been no exodus of providers to care for injured workers.  Duh!  They should have waited to conduct that study until after the new Official Medical Fee Schedule (OMFS) is in place.  Since we expect a major reduction in what we are paid either due to the cuts imposed by the Medical Provider Networks for allowing us the privilege of treating these patients or by the OMFS itself, it will be interesting to see how many of us will be willing to take care of the injured worker once the pay scale approaches Medicare rates.  Their report that the sky isn’t falling may not appreciate some real clouds gathering.   Interestingly, California regulators on Tuesday, 3/28/06, announced minor changes to the medical equipment and laboratory portion of the Official Medical Fee Schedule, but any major changes to physician fees will likely wait until next year, so the clouds are a bit further off. 

2.  President’s message for March: Transitions in Neurosurgery--III
As spring approaches it allows us to participate more easily in non-medical avocations, such as tennis, golf, running, photography, more vacation choices or just outside projects that need attention.  Swimming and other water sports will soon become more easily accomplished, but this puts behind us snow skiing and most types of hunting.  Most enjoy extra curricular activities usually involving our families, all which make life more fun and worth living.  The advent of spring reminds us that life progresses.

With life progressing, we note more of our colleagues retiring, and it appears that currently, at least in California , more are leaving the active practice of our profession than entering it.  We all recognize the “manpower” (including “womanpower”) problem that we face, mainly manifested by the ER crisis so often discussed and written about.

Unfortunately this also means that valued colleagues like Bob Florin and Byron Pevehouse decide to leave board and consultant positions, removing invaluable judgment and experience and guidance that we all value and will miss.  These two physicians are just examples of the leadership qualities that become less available with the march of time.  We do miss them but hope that they and others who are making this change will continue to attend our meetings and interact socially and personally and be available so that we can tap their ideas and wisdom when necessary.  This is certainly a transition which some of us look forward to, while others dread.

This also brings up the subject of the aging physician, one that appears to be getting more attention recently.  The January 2006 Medical Board of California Action Report featured this topic in an article entitled “Toward a More Accountable Profession:  The Case of the Aging Physician.”  There currently is no official policy regarding health and competency screening of physicians but the very attention of the medical board makes me aware of the possible future course.  In the article it encourages the profession itself create and implement the development of a uniform and validated assessment of health and general competency of licensed physicians who wish to continue practice beyond the age of 65 or 70 and perhaps this would be even more true of specialties such as our own that require good judgment and a steady hand.  The board encourages organized medicine to take action prior to governmental intervention.  I am aware of some local physicians in their 80s who practice in a very responsible and competent fashion, but I am sure we all are aware of some who should have phased out prior to doing so.  Obviously age is not the only or major factor, and certainly we should not be made subject to arbitrary standards such as those airline pilots have.  (Recently, there have been considerations of establishing an arbitrary limit for private pilots).

Is this a subject CANS should become involved in?  I welcome any discussion of this and other issues.  So far my mail box remains mostly empty.

John Bonner, M.D., F.A.C.S., President 

3.  Report from the Executive Office
a.         Membership
Dues have been received from approximately 50 % of the membership with 5 members (2 active and 3 senior) who have rejoined after a lapse in membership.  Second notices will be mailed out in mid-April.
b.         Board Meeting
The next Board meeting will be held in Los Angeles on April 8, 2006 ; if you have an item for discussion, please submit it no later than April 5 so that it can be included in the late agenda items.
Contact janinetash@sbcglobal.net with your input on any of the above items.

4.  CSNS to consider Resolutions
You probably know about the Council of State Neurosurgical Societies (CSNS) but for those in doubt here is a short course on what it is.  Formed many years ago under another name, the group was the result of the desire by grass roots neurosurgeons to have a voice in determining the policies of the AANS and CNS.  It is the joint child of the AANS and CNS and is composed of delegates appointed or elected by the various state neurosurgical societies with each state’s delegate number based upon its size.  California has 6 delegates, Washington State 2, New York 5 and so on plus a number of delegates appointed by the AANS and CNS.  The Council meets twice a year just before the annual AANS and CNS meetings to consider resolutions submitted by various delegates and/or states.  If a resolution is adopted, it is forwarded to the AANS and CNS for their consideration which can be as much as adopting it as national policy or as little as declining to act on it.  The annual budget of the CSNS is about 100K and is funded by the AANS and CNS.  The CSNS has over its lifetime suggested, among many other ideas, the inclusion of regional directors nominated by them to serve on the Boards of the AANS (which adopted the idea) and the CNS (who rejected the concept) and was instrumental in creating NERVES (Neurosurgery Executives' Resource Value and Education Society) the first neurosurgery practice manager and administrator society in the United States.

The resolutions to be considered at the CSNS meeting in April follow.  If you want to give some input about these resolutions, please contact the CANS Executive Secretary, Janine Tash, via E-mail (janinetash@sbcglobal.net), fax (916-457-8202) or telephone (916-457-2267).

Resolution 1—to have a number of socioeconomic questions created by the CSNS appear in the ABNS/MOC re-certification exam.

Resolution 2—to have the AANS and CNS endorse the scope of practice of PA’s and advanced NP’s guidelines created by an ad hoc committee of the CSNS.  These guidelines, among many non-controversial recommendations, do support the placement of parenchymal ICP monitors and ventriculostomies by such personnel without the supervising neurosurgeon being physically present.

Resolution 3—to have the AANS and CNS selectively schedule their “national conferences” in states that have adequately addressed the issue of medical liability.  

Resolution 4—to endorse the concept that clinical practice guidelines, no matter who publishes them, are optional and if to be used in pay for performance or public reporting programs, must be based on Class I scientific evidence and/or consensus position statements of specialty societies.

Resolution 5—to create a data bank of all medical liability lawsuits brought against neurosurgeons over the past 10 years to delineate the most common areas and causes for such suits.

Resolution 6—to require that all neurosurgeons seeking elective office in the CSNS, AANS or CNS have circulated autobiographical material to include university and hospital affiliations, licensure status, commercial affiliations, disciplinary disclosures and expert witness activity.

Resolution 7—to have the AANS and CNS, when they publish evidence based clinical practice guidelines, include a prominent disclaimer indicating the individual neurosurgeon’s judgment is not superseded by such guidelines.

Resolution 8—to have the CSNS formally endorse the guidelines addressed in Resolution 2.

Randy Smith, M.D., Editor

The newsletter is a mix of fact, rumor and opinion.  The facts are hopefully clearly stated.  The rest is open to interpretation.  The opinion is mine.  R.S.

The assistance of Janine Tash and Jack Bonner in the preparation of this newsletter is acknowledged and appreciated.