President's Message

Colleagues and friends, I am grateful for the opportunity to address you as the 64th President of the Congress of Neurological Surgeons. The CNS is a unique organization within organized neurosurgery and, to a great extent, within organized medicine. The CNS was the first neurosurgical organization with an open membership policy. Up until the founding of the CNS in 1951, neurosurgical societies were small, exclusive, and closed to all but the elite. The Society of Neurological Surgeons was the first neurosurgical society and was founded in 1920. The primary mission of the SNS was to promote and develop neurosurgery as a specialty distinct from general surgery. However, due to a restrictive membership policy, within just a few years the society had alienated enough neurosurgeons to form the second North American society in 1931, the Harvey Cushing Society. Dr. Cushing himself blessed the new society, however, cautioned them that due to their membership structure, in 10 years, they would be the "senile and antiquated" society, and another society would come along. Dr. Cushing was mistaken, however, and the next closed society, the American Academy of Neurological Surgery, made up primarily by those excluded from the other two societies was formed only seven years later, in 1938. The American Board of Neurological Surgery was formed two years later in 1940, and began certifying neurosurgeons soon thereafter. Existing organizations promptly required board certification for full membership, thereby excluding younger neurosurgeons. This "organization through exclusion" process continued through 1948, when the fourth closed society, the Neurosurgical Society of America was founded. Of interest in 1948, Dr. Mayfield led the first of many efforts to combine all of the neurosurgical societies. Things may have continued this way indefinitely, and we may have had dozens of small cliques of neurosurgeons operating independently if one critical event in world history had not occurred.

World War II was associated with an un- precedented demand for medical, surgical and neurosurgical expertise to deal with hundreds of thousands of casualties of modern war. During the war years, medical school curricula were altered and residency training was abbreviated in order to get medical care to our soldiers in an expedited fashion. These surgeons returned after the war with a wealth of experience and, in fact flooded, the marketplace to some extent, competing with newly graduating students for residency spots and jobs. There now existed a group of young, energetic, and, to some extent, experienced neurosurgeons that were not eligible for membership in any of the established organizations. Even if they were eligible, they were unlikely to gain entry due to the closed membership policies and requirements for board certification.

The Congress of Neurological Surgeons was formed in 1951 with three principles which set it apart from all previous organizations. The CNS was inclusive, open to all neurosurgeons upon completion of their training. The CNS focused on education and, in fact, one of its original missions was (and remains to present day) is to help train neurosurgeons for board certification. Finally, the CNS was international. The name “Congress of Neurological Surgeons” was chosen specifically to reflect an international perspective; something important to those who had returned from overseas having been exposed to European and other influences.

Over the last 60 years, there has been some mission drift amongst neurosurgical organizations. The Society of Neurological Surgeons is now considered the “program director’s society.” The SNS provides an essential service and forum for those hundred or so of us involved in resident education. The Cushing Society renamed itself the American Association of Neurological Surgeons in the mid-1960s and it assumed the role of “spokes- organization” for neurosurgery and elected to operate under a specific tax code that allows for significant advocacy work. In order to promote this mission, the AANS opened its membership such that all board-certified neurosurgeons could become members. The “Academy” remains an influential academic force in neurosurgery whose mission statement reads very similar to that of the original SNS mission. It retains a closed membership structure, and a very limited membership. The NSA is still going strong as a closed-membership society, with a limited membership and a focus on travel and fellowship. A number of new organizations have arisen, and some have fallen by the wayside. From a practical standpoint, the Congress of Neurological Surgeons has not changed its mission since the day it was founded and has continued to develop creative ways to meet its mission and serve the neurosurgical community.

Today, the CNS is the established leader in innovative education in neurosurgery and continues to provide educational content for surgeons at every stage in their career. I pulled the 1965 (year of my birth) CNS Annual Meeting program from the archives and was amazed to see televised live surgery prominently featured every day of the meeting! The drive to improve educational offerings continues to this day. The SANS product is specifically geared towards preparing for both the primary board and maintenance of certification examinations. Soon, the CNS University will be able to assess members’ educational needs and deliver customized educational content based upon measured knowledge gaps – one size does not, in fact, fit all. The CNS simulation curriculum creates a structured learning environment where trainees of a variety of skill levels can master specific operative skills outside of the stress of the operating room and without endangering patients. Guidelines production provides critical lessons to practicing neurosurgeons and provides crucial information for payment and policy decisions, which affects the ability of neurosurgeons to complete their individual missions on behalf of patients. The CNS embraces lessons learned outside of North America and continues to have great success and feedback from webinars and collaborative courses drawing faculty and participants from all corners of the globe.

Now and over the next several years, the Congress of Neurological Surgeons is investing heavily in an enhanced IT infrastructure de- signed solely to provide enhanced educational opportunities for our members in the United States and abroad. We continue to participate in and fund significant activities of the Washington Committee and support each and every one of the joint sections. We have deep collaborative relationship with our sister society, the AANS, in order to avoid duplication of services and unnecessary waste, yet at the same time derive great benefit from a longstanding and competitive sibling rivalry. The Congress of Neurological Surgeons exists in order to serve its mission on behalf of its members. I am grateful to have the opportunity to see to it that the CNS continues to pursue its mission with all possible energy.