CHAPTER 33

EDWIN

W.

AMYES,

l\;I.D.

National neurosurgical organizations such as the American Association of Neurological Surgeons and the Congress of Neurological Surgeons have until now limited their activities to matters that are educational and scientific. Because of political events beyond our control, it has become necessary for both of these organizations to turn their attentions to matters socioeconomic. Physician influence upon socio-economic matters is basic to maintaining quality patient care. Although socio-economic matters are important, however, they should be secondary to our major concern-the practice of good medicine. The federal government now requires the help of specialty organizations in preparing the Professional Standards Review Organization (PSRO) program. If federal agencies become more directly involved in paying for medical care, as expected, further aid from specialty societies will be necessary. The relationship between neurosurgery and governmental agencies is and hopefully will remain cordial. However, past experience suggests that the major thrust of PSRO legislation will be cost control. Some efforts at cost control will be wise. Other economic efforts of the government may cause deterioration of patient care. When this happens it will be necessary for physicians to take action to prevent such a decline. This action will require legal counsel and perhaps litigation. Even if the major neurosurgical organizations do not engage in activities which are beyond those legally permitted, it will undoubtedly be true that the legal status of these organizations will be questioned and perhaps placed in jeopardy. It is important that neurosurgery speak with a unified voice in socioeconomic matters. In such a unified effort, for example, all California physicians supported the California Medical Association when it sued the State of California for the benefit of those patients in medical aid programs financed and regulated by the State of California. As you see, an adversary relationship did develop between the California Medical Association and the State of California. Therefore, in anticipation of similar circumstances developing on the national scene, consideration should be directed to whether or not the two major national neurosurgical specialty organizations should create an entity with authority to represent neurosurgery in socioeconomic matters, being so structured as to be able to litigate. 524

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Are Organizational Changes Needed in the Structure of Neurosurgery?

ORGANIZATIONAL CHANGES IN NEUROSURGERY

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If an entity is developed appropriate for the representation of all neurosurgeons, study must be made as to the appropriate type of organizational structure. It would be helpful to the Joint Socio-Economic Committee if neurosurgeons who have opinions regarding this proposal would make them known. So far, two types of vehicle have been considered. The first would be controlled by physicians through a board designated by the leadership of both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. This board could in turn choose the executives of a corporation separate and distinct from the two parent bodies, but whose policies would be supervised by the appointed board. A second type of vehicle could use the present structure of the National Neurosurgical Advisory Group with members chosen by the state neurosurgical societies. The Co-Chairmen of the Joint Socio-Economic Committee, Dr. Russel Patterson and I, plan to ask the advice of the Counsel of the American Medical Association before a final decision is made. It is our intention to present our recommendations at or before the next national meeting of the American Association of Neurological Surgeons. It is important, if the Joint Socio-Economic Committee is to represent your socio-economic interests to the American College of Surgeons, the American Medical Association, and the Department of Health, Education and Welfare, that our lines of communication and authority are clear and that we can be seen as speaking for the neurosurgical community of the entire United States. In scientific and educational matters, the American Association of Neurological Surgeons is the designated national spokesman for neurosurgery, and it is the wish of the leadership of the Joint SocioEconomic Committee that scientific and educational matters continue to be our primary concern as physicians.

Are organizational changes needed in the structure of neurosurgery?

CHAPTER 33 EDWIN W. AMYES, l\;I.D. National neurosurgical organizations such as the American Association of Neurological Surgeons and the Congres...
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