Seven CSNS resolutions up for debate The Council of State Neurosurgical Societies will conduct a virtual meeting on April 23-24 at which the
following submitted resolutions will be considered. CANS BOD has voted to submit resolution VI for
consideration. Any CANS member who would like to comment on any of the resolutions should contact
our Secretary Joe Chen at jctchen@yahoo.com
RESOLUTION I
TITLE: Understanding and Facilitating the Process of Retiring From a Career in Neurosurgery
SUBMITTED BY: Gary Simonds MD MS FAANS
WHEREAS, a growing number of neurosurgeons are reaching the age of retirement, or are seeking to retire
early; and
WHEREAS, there will likely be increasing societal and legal pressure for neurosurgeons to retire from surgical
and clinical duties in their early senior years; and
WHEREAS, retirement is a major epoch in a neurosurgeon’s life and can be fraught with psychological
destabilization, loss of a sense of financial security, loss of motivation, loss of direction, loss of selfworth, loss
of identity, loss of sense of purpose, and more; and WHEREAS, retired neurosurgeons can be anticipated to
remain highly creative, highly productive, highly motivated, highly invested, and highly contributory,
potentially for decades following their retirement; and
WHEREAS, retired neurosurgeons constitute a relatively “untapped” resource in graduate medical, resident,
medical student, allied health, undergraduate, patient and community education; medical-legal analysis
and advising; research; socioeconomic analysis and advocacy; practice advising; wellness promotion;
ethics analysis and advising; public relations and more; and
WHEREAS, the CSNS has committed by resolution to create a Senior Neurosurgeons Representative Section
within CSNS, “so that Senior Neurosurgeons may continue to contribute to Neurosurgery, our Societies, and
the next generation;” therefore
BE IT RESOLVED, that the CNS commits to studying, through surveys, interviews, analysis of scholarly material
and discussion with experts, the overall impact of retirement on neurosurgeons, the experience of retiring
from neurosurgery, the disengagement pathways chosen by retiring neurosurgeons, and the postneurosurgical career and lifestyle choices made by retired neurosurgeons; and
BE IT FURTHER RESOLVED, that the CSNS generates an index of retired neurosurgeons who wish to advise
and assist newly retiring neurosurgeons; and
BE IT FURTHER RESOLVED, that the CSNS commits to a regular educational program on the process of
retirement from a career in neurosurgery, the maintenance of well-being and resilience after retirement
from a career in neurosurgery, and the potential career, lifestyle options, and activity pathways available
to the retiring neurosurgeon.
RESOLUTION II
TITLE: A Call for Organized Neurosurgery to Divest Itself of any Relationship with Elected Officials Who
Helped Incite the Violent Civil Unrest of January 6, 2021
SUBMITTED BY: Gary Simonds MD MS, Cara Rogers DO, Richard Ellenbogen MD, William Monacci MD,
Stephen Ondra MD
WHEREAS, on January 6, 2021, a violent insurrection took place in the United States Capitol building; and
WHEREAS, said violent civil unrest was at least in part incited by the words and behaviors of various
members of the executive and legislative branches of our federal government; and WHEREAS, the insurrection was at least in part a result of a persistent false messaging to the American public that the 2020 Presidential Election was fraudulent and invalid; and WHEREAS, persistent disingenuous assertions about the
validity of the 2020 presidential election has contributed to public distrust in the electoral process and
democracy as a whole, and has contributed to a dangerous sense disenfranchisement amongst a
considerable percentage of the electorate; and
WHEREAS, various neurosurgical organizations have known ties and affiliations with several politicians who
in one form or another contributed to this cynical false narrative about the 2020 Presidential Election
and/or to the violent civil unrest of January 6, 2021; and
WHEREAS, various neurosurgical organizations have made financial contributions to politicians who in one
form or another contributed to this cynical false narrative about the 2020 Presidential Election and/or to
the violent civil unrest of January 6, 2021; and
WHEREAS, it is unconscionable for our representative neurosurgical organizations to be affiliated with or
support any governmental actor(s) who has or will perpetuate such false narratives about the 2020
Presidential Election, promote rejection of the results of the presidential election, and/or contribute to
violent civil unrest in the name of said false narratives; therefore
BE IT RESOLVED, that the CSNS asks its parent organizations to publicly divest themselves of any official
relationship with, or support of, any elected official who helped incite the insurrection of January 6, 2021,
officially contested the validity of the results of the 2020 Presidential Election, and/or have repeatedly
asserted that the presidential election was fraudulent, and its results illegitimate; and,
BE IT FURTHER RESOLVED, that the CSNS requests that the Neurosurgery PAC ceases any relationship with,
and financial support of, any elected official who has helped incite the insurrection of January 6, 2021,
officially contested validity of the results of the 2020 Presidential Election, and/or have repeatedly asserted
that the presidential election was fraudulent, and its results illegitimate.
RESOLUTION III
TITLE: Establishing Curriculum for the Practice of Neurological Surgery During Residency Training
SUBMITTED BY: Nitin Agarwal, M.D., Robert F. Heary, M.D., John K. Ratliff, M.D., Praveen V. Mummaneni,
M.D., M.B.A.
WHEREAS, the practice of medicine is continuing to evolve with a greater focus on value-based care; and
WHEREAS, trainees may not be exposed to formal training regarding neurosurgical practice either at their
local training program or as part of boot camps; and
WHEREAS, a solid foundation is essential for success as an independent practitioner as identified by prior
resolutions with interest from members to create surveys and fund workshops; therefore
BE IT RESOLVED, that the CSNS work with the parent bodies to establish and distribute a formal curriculum
for trainees geared towards neurosurgical practice management, including billing, coding, and
compliance; and
BE IT FURTHER RESOLVED, that the content from this curriculum be incorporated into the written ABNS
primary examination and further emphasized in the oral examination to highlight the importance of this
knowledge; and
BE IT FURTHER RESOLVED, that in the meantime the CSNS work with the parent bodies to integrate chief
residents and fellows into ongoing practice management and coding courses.
RESOLUTION IV
TITLE: Defining Veritable Legal and Fiscal Counseling
SUBMITTED BY: Nitin Agarwal, M.D., Ann R. Stroink, M.D., Catherine A. Mazzola, M.D., Robert F. Heary, M.D.,
on behalf of the Medico-Legal Committee
WHEREAS, many trainees may not be well versed in contract negotiation or wealth management; and
WHEREAS, upon transition from residency and fellowship to the workforce, trainees may seek legal counsel
or financial advice but do not know where to find veritable information or advocates; and
WHEREAS, all healthcare providers should have easy access to a true fiduciary; therefore
BE IT RESOLVED, that the CSNS form a task force to identify veritable sources of legal and fiscal counseling
for trainees and those transitioning jobs; and
BE IT FURTHER RESOLVED, that the CSNS works towards dissemination of these resources both through
training programs but also online within the dedicated education sections of the parent bodies
RESOLUTION V
TITLE: Publication of Patient Generated Outcome Measures
SUBMITTED BY: Mick Perez-Cruet, M.D., M.S., Ann Parr, M.D., Catherine Mazzola, M.D., on behalf of the
Medico-Legal Committee
WHEREAS, Patient generated outcomes and surveys are rapidly becoming standard of care in many
neurosurgical practices and are particularly important in validating spinal procedures; and
WHEREAS, Quality improvement methods to improve health care quality and safety often do not require
Institutional review board (IRB) approval; and
WHEREAS, Data and publications that demonstrate the effectiveness and safety of neurosurgi- cal
treatment is paramount to payers (insurance companies) reimbursement for neurosurgical services; and
WHEREAS, Many neurosurgical practices, both academic and private, do not have ready access to
administrative personnel for internal review board (IRB) peer review publication of patient generated
outcomes focused on quality improvement of patient care and safety, and are uncertain which types of
patient generated data/ surveys need IRB approval; therefore
BE IT RESOLVED, that the CSNS form a task force to identify IRB requirements for neurosurgical practice
publication of patient generated outcomes and surveys; and
BE IT FURTHER RESOLVED, that the CSNS works towards mechanisms that facilitate publication of patient
generated outcomes studies and surveys without administrative demands required by IRB approval.
RESOLUTION VI
TITLE: IMPROVING DIVERSITY, EQUITY AND INCLUSION WITHIN THE CONGRESS OF NEUROLOGICAL SURGEONS
(CNS) LEADERSHIP
SUBMITTED BY: The California Association of Neurological Surgeons (CANS)
WHEREAS, in Article III, Executive Committee (Board of Directors), Section 2, Number and Election,
paragraph C, the Congress of Neurological Surgeons (CNS) bylaws states that ….” No person shall be
nominated as a member of the Executive Committee after such person reaches the age of forty-nine (49)
years”, and
WHEREAS, age is considered a protected category against employment discrimination under most Equal
Employment Opportunity Laws with age discrimination illegal for employment and frowned upon for
service organizational inclusion purposes, and WHEREAS, age cut-offs disproportionately negatively impact,
and differentially discriminate against, the professional service careers of women in neurosurgery as they
often delay professional and service itineraries for personal and family reasons, whereas men in
neurosurgery do not usually suffer from similar constraints and/or choice requirements, and
WHEREAS, the CNS has never had a woman neurosurgeon President, and
WHEREAS, none of the eight current CNS officers are woman, and
WHEREAS, only three of the current 12 voting members of the CNS Executive Committee (EC) are woman,
and
WHEREAS, the historical reason(s) for this age criteria cut off, to create a professional society allowing
access and priority to younger neurosurgeons where those opportunities did not exist elsewhere in
organized neurosurgery, no longer exists, as the American Association of Neurological Surgeons (AANS)
now offers classes of membership as well as leadership potential to neurosurgeons of all ages, and
WHEREAS, even the CNS, themselves, has within the recent past “moved the goal posts” for EC age cutoff
several times using bylaws changes to extend the age cutoff to allow selected members of the CNS EC to
ascend to the Presidency position in the CNS, and
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WHEREAS, a CNS EC age cut-off is not only no longer necessary, but actually robs the CNS of the potential
executive committee and leadership service of some highly experienced, talented, and servicededicated neurosurgeons who are Active Members of the CNS, but happen to be over age 49; therefore
BE IT RESOLVED that the Council of State Neurosurgical Societies formally petition the Congress of
Neurological Surgeons (CNS) to eliminate their current age restriction for CNS Executive Committee
membership from their bylaws to allow potential CNS leadership position access, and EC service
opportunities to all Active CNS members regardless of age.
RESOLUTION VII
TITLE: Maintaining Surgical Cadaveric Training
SUBMITTED BY: Cletus Cheyuo, Redi Rahmani, Kris Kimmell, Bharat Guthikonda WHEREAS, there is an
increasing reliance on imaging and navigation for procedures in neurosurgery eroding knowledge of
anatomy; and
WHEREAS, an increasing number of surgical specialties, including neurosurgery, are experimenting with 3-D
printing and virtual simulators for surgical teaching; and
WHEREAS, these technologies while adaptive, will not be able to, in the foreseeable future, mimic real
tissue qualities and normal anatomic variants of cadaveric specimen or the ability to dissect surrounding
anatomy with alacrity; and
WHEREAS, the continued push for technology-based learning will lead to a decrease in cadaveric learning,
leading to loss of benefits of such learning; therefore
BE IT RESOLVED, that the CSNS conduct a survey to evaluate the number of cadaveric learning
opportunities each program has over a one-year period; and
BE IT FURTHER RESOLVED, that the CSNS encourage the parent bodies to work with the SNS to create a
standardized cadaveric curriculum for neurosurgery programs.