Volume 49, Number 5

Inside This Issue

Picture of Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

Wow! What a change in only four weeks! Whatever happened to the goal of herd immunity??? In my last newsletter message Governor Newsom had only two weeks previously finally allowed hotels to re-open under significant protocol restrictions for counties who had reached either Orange or Yellow Tier status. These included face coverings and social distancing as well as a host of other regulations. Now, without any changes in these industry re-opening regulations which still exist, within that same two weeks, the Governor announced that masks will no longer be mandated or social distancing required throughout the state as of June 15, 2021. Huh???… Now I recognize that “consistency is the hobgoblin of little minds”, but this is really confusing. Neither potential hotel venues, nor professional societies trying to plan meetings in California have any idea right now what to make of this, or how to proceed with meeting space proposals or contract design. At the same time hotels are so hurting for business right now that surprising actions are taking place. Within three weeks of the Governor’s industry re-opening for private events announcement, one of our four potential venues that we had been working with for our January 15-16, 2022 CANS meeting, had already given away our dates to a larger group. These are a real problems.

It seems as though within only two weeks all brakes came off, everyone had seemingly reached lock down tolerance saturation, and the hands simply went up in the air. At this point, it is entirely possible that by June 15, the colored tier system may be gone and anything will go from that point onward. With only ~50% of Californians now having had full vaccination (both shots for Pfizer and Moderna), I sure hope that we do not have a third surge. I also hope that this virus does not turn out to be just as seasonal as the flu. A surge in the Fall of 2021 would seriously disrupt meeting plans after contracts had already been signed, and deposits paid. Let’s cross our fingers, say our prayers and light some candles.

Dr Smith reports in his section of this newsletter that Stanford University is keeping their emergency travel only, restricting travel approval and reimbursement through the end of September. Surprisingly, the University of California which includes six medical schools and five neurosurgery residency training programs, and which is usually the most paternalistic of California schools, and historically very slow to relinquish authority and control, ended their travel moratorium on April 28. This was only 12 days after the Governor opened the hotel industry for private events!

However, please do not worry. Despite the rapidly shifting sands under our feet, the CANS 2022 Annual Meeting Committee is striving to move forward with finalizing our venues for our planned in-person meeting January 15-16, 2022 in a way that mitigates financial risk to our organization should things not turn out as hoped. Finalizing the program will not be far behind. The meeting theme of the “Challenges of Corporate Employment” promises to be a very timely theme as the Covid pandemic has markedly increased the collapse of traditional private practice medicine and accelerated the move towards hospital-affiliated-foundation, Kaiser, and/or University employment. Please mark your calendars for the Saturday and Sunday of Martin Luther King’s birthday weekend January 15 and 16, for our next CANS meeting. We will certainly keep you posted as details are finalized via this newsletter.

On other fronts, in our last newsletter we alerted you to the California Assembly Bill AB 615, [Higher education Employer – employee relations act: procedures relating to employee termination or discipline] introduced February 12, 2021 by Assembly Member Rodriguez. As of the writing of this message, no new information is available regarding this bill on the website. We will need to watch this bill closely as it will have potential significant effects on our California neurosurgery residency training programs.

We are all aware that the California Bar Associations and Trial Lawyer Associations have never stopped attacking the 1975 California MICRA tort reform legislation. The goal is to eliminate, or find a way around, the $250,000 cap on non-economic damages which is part of MICRA and which normally pays lawyer contingency fees. While these attacks often take the form of ballot measures, including a new measure expected to be put in front of voters for the upcoming Fall 2022 election, it also includes potential new precedent lawsuits. Many of these involve trying to sue physicians outside the malpractice arena by getting cases heard under other areas of law. In the past this has included criminal assault assertions, or suing for ordinary negligence. Fortunately, so far none of these “end arounds” have gained traction or success. The latest attempt was an attempt to sue a physician for contract negligence (negligence in performance of a contract). The case involved a patient seen by a physician assistant (PA) student supervised by a licensed PA who’s practice was linked to a physician’s medical license at Barkersfield Memorial Hospital. The claim involved failure to diagnose bacterial meningitis and the physician who did not see the patient, was sued for ordinary negligence and negligence in performance of a contract, rather than medical negligence. Fortunately, the California appellate court upheld a lower court decision that the physician could not be sued under those areas of the law. We must all begin to prepare for what will likely be another tough ballot measure fight in the Fall of 2022. It is not too early to begin donations to the CMA PAC to assist with this upcoming battle. Smaller donations in many installments is an easier cash flow pressure than one lump sum. You can be sure that the trial lawyers will not hold back in their generosity for their side.

I would like to once again remind all CANS members of their 2021 Annual Dues commitment. Many of us use the CANS Annual Session registration opportunity as the time where we pay our outstanding CANS dues to allow us to register. This year we did not be have a 2021 formal CANS Annual Session, and as a result, many members missed this opportunity this year. We derive a significant income for our operational budget from our Annual Meeting which did not occur. Thus, this year it is extremely critical that every member take the time to follow this hyperlink to our CANS website and pay our CANS annual dues I would ask every CANS member to please do this right now as you are reading this in order to help our organization remain fiscally healthy going forward. This is extremely important, and your participation and support of our organization is greatly appreciated!

I continue to hope that all of our members continue to remain healthy and safe during this trying time with Covid-19. We remain interested in learning about any cases of Covid-19 among individual California neurosurgeons to measure and document the direct personal impact of the pandemic. Anyone who knows of a CANS member, or any California neurosurgeon, for that matter, who has been sick with Covid-19, please contact our executive secretary Emily Schile with the particulars at .

Please stay safe everyone. Please support CANS and the CMA, they are fighting for you. All the best!

Picture of Randall W. Smith, MD

Randall W. Smith, MD


Two Stupid Decisions

Both decisions were made by adults who should know better.

The first was a decision I made to bad mouth golfer Phil Mickelson as being over the hill and not really qualified to compete in the 2021 PGA tournament. As we all know, Phil played very well and won the darn tournament. My apologies, Phil. I should have known better.

The second stupid thing is the pandemic generated you-may-not-travel-on-our-dime many academic organizations have mandated out of some misguided mother/child relationship they seem to have with their medical faculty and residents. The travel monies “belong” to the faculty but are housed in academic bank accounts so the power of the purse rests with the bureaucratic types that run certain universities.

As a prime example of such overbearing motherliness, Stanford University has prohibited using any funds for uninvited travel to professional meetings until the last part of September which will preclude support of any of Stanford’s neurosurgeons and residents from attending the AANS meeting in Florida in August or the Western Neurosurgical Society meeting in New Mexico in early September.

To what end does this banishment serve? Certainly, the docs involved will all be vaccinated by July if not sooner as will a distinct majority of the USA populace. The meetings mentioned will be observing whatever local gathering rules are in place. It is hard to fathom what passes for justification of these academic restrictions other than administrative hubris.

In the meantime, those neurosurgeons who do not live under the thumb of academia, namely independent private practice neurosurgeons, will go to the meetings as it suits them and be thankful they don’t have to deal with academic mafia.

Picture of Deborah C. Henry, MD

Deborah C. Henry, MD

Associate Editor

Brain Waves


May has May flowers from April showers, May Day, May the 4th be with you, Cinco de Mayo, Tax Day (May 17 this year), and Memorial Day. I’ve heard from Star Wars fans that there is now a May the Sith Day too. But for many of us the most memorable day is Mother’s Day. Mine was more difficult this year as it was the first one both without my mother and without my son. My son was in the New Hampshire woods on a University of Michigan program studying New England literature (Thoreau, Emerson, Dickinson etc.) a la Walden, without the aid of technology. No computers. No cell phones. He was allowed to call home on a landline for a few minutes to wish me a happy Mother’s Day, so at least I knew the ticks had not eaten him alive yet. Part of motherhood is learning to kick the birds out of the nest and letting them fly, knowing that you’ve prepared them well.

But the harder part of my Mother’s Day was not buying a Mother’s Day card, sending flowers, and talking with my mom. She passed away on April 18, my dad’s birthday. He has been gone over 4 years, and she was ready to go. Our neurosurgical careers are enveloped in dealing with death and dying and perhaps that is why I have yet to cry. After all, she lived a wonderful 95 years. Perhaps I am at peace with her leaving this earth for a better place.

Suddenly, I realized that I am no longer part of the sandwich generation-caring for a child and a parent concurrently, all the while working fulltime. It is a strange sensation after having been both caretakers for 20 years. The death of any parent, but especially one’s mother, puts a hole in the heart that is there to stay. For me, it is also a period of reflection that our time on this earth is finite and now that I am no longer a primary caregiver, what is it that I want? If I were diagnosed with a glioblastoma tomorrow, would I be satisfied with what I have accomplished? I have not been able to ask myself these questions in so long.

Therefore, after more than 16 years serving on the CANS Board at almost every position, serving nearly as long as delegate to the CSNS, plus composing more than 130 monthly Brain Waves op-ed pieces over the past 11 years, I am taking a break to see where my journey goes. My first Brain Waves was published May 2010. My last one (unless my editor allows me to guest write from time-to-time) will be this one, May 2021. Look for my writing in other places. I know at least part of my journey takes me in that direction. After all, it’s time to let the new CANS birds fly too.

And call you mothers. Today.

Picture of Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

Associate Editor

Take this Mask and Shove It!

The CDC issued its long-awaited directive on wearing masks and physical distancing now that the pandemic is retreating and since 40% of the population is fully vaccinated. “Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” I love these exemptions.

I was surprised to read that those of us who are fully vaccinated no longer need to wear a mask indoors. I thought the decision was a bit premature. How do we know who is not vaccinated and even more importantly who amongst us is immune suppressed?

Joanie and I are visiting the Texas Hill Country. Before the CDC’s decision, everyone- well almost everyone- wore a mask at the supermarket. After the CDC’s decision, and even though the supermarket continues to require a mask, virtually no one wore one. Except for me. I continue to feel that my mask protects others. I don’t leave home without it.

Last Sunday Joanie and I had lunch at Opie’s, our favorite BBQ restaurant in Spicewood, TX. The place was full. No masks in sight. Everyone seemed to enjoy the delicious and decadent food. Things seemed to have returned to “normal.” A guitar player was playing some Country standards. He was good and quite entertaining. He introduced his last song as being appropriate for the COVID-19 time in which we live.

“Take this mask and shove it, I ain’t wearing it no more!” It was a clever twist on the 1977 David Allan Coe’s song that was made famous by Jonny Paycheck, “Take This Job and Shove it.” This was met by the loudest applause. I guess most people are tired of wearing a mask and tired of the pandemic. And let’s face it, some people never believed in wearing masks, and some people decided never to wear a mask as a political expression. If I were to guess how many people were not vaccinated at Opie’s, I’d say at least 60%. Oh well. But we felt safe since we are fully vaccinated.

This was cute enough, even humorous. But the fun dissipated when I heard the next verse. It related the decision to reject the vaccine, opting instead for a morning dose of moonshine …

It is a relief that we are gaining on the pandemic. But if more Americans do not get vaccinated, we will not reach the elusive herd immunity and we will not get the pandemic behind us. And why won’t we do that since the vaccine is widely available for everyone over the age of twelve? Politics? Ignorance?

The fact is: this pandemic is not over. The vaccine has been extremely effective, but even though the overall numbers are down, we are still suffering a COVID-19 related death every few minutes in our Nation. And we can’t afford to let our guard down.

Unfortunately, the anti-vaccination attitude is not only a Texas thing: it is a national phenomenon that we also experience in our own Golden State of California.

Governor Gavin Newsom announced last month that California would fully reopen its economy in June if Covid-19 hospitalizations stayed low and the vaccine supply remained high. The guidelines issued by the State Department of Public Health indicate: — “all sectors listed in the current Blueprint Activities and Business Tiers Chart may return to usual operations.” In general, this means that we are going back to “normal” except for mass events, transportation, and healthcare facilities.


What does this mean? As usual, it is up to the individual. For me, and until the pandemic is over for good, I’ll continue to wear my mask whenever I am indoors with people I do not know. So, I am not quite ready to say: Take This Mask and Shove it!

Picture of Donold Prolo, MD

Donold Prolo, MD

CANS-Past President

Guest Editorial - Homelessness after Closure of State Hospitals

~Donold Prolo, MD

Congratulations and thanks to Doctor Abou-Samra for raising the issue of homelessness before the California neurosurgical community (CANS newsletter, April 2021—on Website Although advancing societal causes is not directly (or inherently) a concern of practicing neurosurgeons, our magistracy of the brain and its healthy status allows us to comment about maximizing its optimal functionality.   A contemporary environment of endless street chaos and desecration is neither healthy for members of a society or humane for those who suffer directly its consequences and indignities.

Please allow me to dispel myths of causation and attribution of this chaos to Ronald Reagan as Governor of California in 1967 and subsequently as President of the United States in 1981. He was not the first leader to sign a proclamation ending state responsibility in California for caring for and housing in government hospitals those citizens with mental disorders. The advent of the psychoactive drug chlorpromazine in 1954 brought hope, especially to the psychiatric profession, that psychoactive medications plus community psychiatric outpatient clinics would provide sufficient care for those with disabling mentation. California Governor Edmund G. Brown in 1966 had signed a bill terminating the state stewardship of hospitals in the care of patients with mental disorders. State hospital population in California under Governor Brown had fallen from a 38,000 high to 22,000. The enabling, subsequent 1967 Lanterman-Petris-Short Act in California was a legislative consequence of Governor Brown’s earlier decision to close state hospitals, that was ratified by then Governor Reagan.

Previously, in 1963 President John F. Kennedy had instigated and signed the Community Mental Health Act, which diverted responsibility for care of the mentally ill patients from states to the federal government. JFK wanted to create a network of community mental health centers, where encumbered citizens with mental disorders could live in communities while receiving care. Kennedy’s motivation in part arose from his experience with his sister Rosemary, who had been hospitalized and had undergone a prefrontal lobotomy for her disorder. Less than one month after signing this legislation he was assassinated and the political forces to close state hospitals for the mentally ill continued at full speed including in California.

In 1967 California Governor Reagan signed the Lanterman-Petris-Short Act, ending the practice of institutionalizing patients against their will. In 1969 Reagan increased spending by the California Department of Mental Hygiene by a record $28,000,000. By 1973 California State Mental Hospitals’ census fell to 7000.   In 1980 President Carter signed the Mental Health System Act to further Kennedy’s dream. In 1981 Carter’s legislation was repealed by the Omnibus Budget Reconciliation Act, which returned responsibility for the mentally ill to the states with creation of block grants for outpatient care.

In 2015 the San Francisco Homeless Count Survey revealed 55% of people with chronic homelessness reported emotional or psychiatric conditions. Among this population the use of street drugs, not physician prescribed and responsibly administered medications, is endemic. Methamphetamine abuse is especially rampant. Chester, who encamps on our property in downtown San Jose, awakened and arose from his tent at 1 p.m. His eyes were glazed, he muttered an unintelligible, incomprehensible word salad. Low-income housing for The Homeless will never mollify Chester’s plight and psychiatric condition.

Closure of the state hospital system for the mentally encumbered was a dramatic societal mistake in the early 1960’s. Restoration of these hospitals is an urgent necessity. Humanity and civil society cannot further endure perpetuation of this tolerated disgrace any longer.  

Let California neurosurgeons rise to lead the way toward a redeeming crusade to institutionalize professional care for our brethren with major psychological illnesses.

Alternative measures will certainly fail and the blight of a civil society tolerating homelessness will continue. The BRAIN of humans to which we devote our lives must capture our resolve to ameliorate the suffering of patients and families in whom its malfunction seeks ameliorative redress.~

Picture of Brian Gantwerker, MD, FAANS, FACS

Brian Gantwerker, MD, FAANS, FACS

CANS-Director South

Put Up or Shut Up: A Story about an Involved Neurosurgeon

When I was growing up in the Chicago suburbs in the late 70’s and 80’s, it was clear we were not well-to-do. While other people had brand new Chryslers, Volvos, and Mercedes, my dad was pop-riveting sheet metal onto the rusted-out door panels of our gold Mercury Maverick. We were not well to do albeit still middle class. It was obvious, especially in the economic uncertainty of the times. The Iran hostage crisis, the gas crunch, and generally bad wages made for a hard time.

My parents were optimistic that the world would change. My parents bought the proverbial humblest house on a good block for their children to get a good quality public education. My dad could get a masters, make some extra money teaching and mom would work overtime at her overnight job at National Data Processors. Ends were met, and we were optimistic things would change. We might get a nice tax refund, or gas would get cheaper. Mom used to fill up pages and pages of legal pads to determine which bills we could afford to pay and which we would have to “float.” These were the days before Excel, or even its predecessors. Things did get better, but we were at the mercy of the whims of the economy and the presidential administration du jour. Trickle-down economics trickled nothing to us. It was a slog. And it never stopped.

One of the reasons I chose medicine was to provide some sort of economic security and stability for me and my future family. Maybe I would be able to help out my mom and dad. “Buy me a condo in Hawaii” mom would say. Doctors at the time made a good living. Most physicians we knew had a summer home, sent their kids to good schools, and did not think twice about affording college tuition. They had nice offices, well-paid staff, and busy practices.

Things began to change with the rise of HMOs and managed care. I was in medical school and I started hearing the attendings complaining. One of the pulmonologists, who looked a lot like TVs “Alf” issued a warning: things are changing and will be different when you get out. Cancer would not be cured, and HIV/AIDS was just becoming a thing. What would change, he intimated, is that doctors would no longer be looked upon with the same eyes.

The Affordable Care Act in the late 00s promised a sea-change. We would have better coverage, insurance companies would be brought to heel, and doctors could keep seeing their patients. What happened instead, as many people correctly predicted, is that few, if any actually practicing doctors participated in the drafting of that voluminous bill. Insurance companies reached record profits and their CEOS cuddled up with their large retirement packages and golden parachutes. Doctor’s reimbursements were slashed, right in time for me to open up my own practice in Los Angeles.

The next administration, despite having nearly a decade to formulate an alternative focused on dismantling, with no idea of what to put in its place. Demolishing rather than refining seemed to be the thematic approach this time. One decisive vote by a lone senator from the state of Arizona, who later died ironically of a glioblastoma, stopped the effort.

And here we are again, this time Congress focusing again on squeezing money out of the medical side, trying to squeeze more blood out of the physician stone, this time with bundled payments. Leaving the rats to guard the proverbial cheese, with hospitals doling out what they think doctors should be paid for their services.

There is inevitably a learned helplessness that we as doctors feel. Decisions are being made in some faraway ivory tower, beyond our reach, and against our collective wishes. The insurance lobby, with its massive multimillion dollar PAC seeping deep into the pockets of members of Congress who in turn pass bills, which become law and make our jobs that much harder.

We have all seen and felt the swell of administrative burden and development of cookbook medicine. We can all of us cite examples where doctors are disenfranchised of the ability to make patient care decisions yet are all held liable for it when things go sideways. Physicians have always welcomed the burden of the decisions and outcomes we make, now we are holding less and less onto the steering wheel. Quality improvement projects, which all started out with good intentions, have lent nothing more than clicking more boxes. The masks are coming off and the QI has become the almighty dollar. If it costs more to take good care of patients, the systems and conglomerates have actually discarded the physicians for less expensive “providers.” Private practice doctors in all aspects of healthcare have been pushed to the brink. My own practice had suffered and reached a low at one point, such that we were considering other options.

Maybe it’s just my stubbornness, or my idiotic optimism – maybe my love for what I do. And I am sure not a small amount of strength is from the encouragement from my wife, who has stood by me come hell or high water, and my family.

Disaffection with the system as it is, is a natural, and common response. We just go with the flow, praying more legislation does not come, like a crew of a sub at the bottom of the ocean, with chilly ocean water seeping in the breeches of the hull, with less and less air to breathe. The reason I became involved in political action and grassroots efforts was my desire to no longer be the Gregor to this Kafkaesque story. It’s been five years now, and I have gone from frustration to hope. Many of my preconceptions about representatives and senators have been replaced with a much more nuanced view of the tight rope they all have to walk.  

My membership on two political action committees, NASS Spine PAC and Neurosurgery Washington Committee (essentially the political arm of AANS), and now on the CSNS has made me more resolute than ever. The bills we have supported have gotten the ear of our state and federal officials and we have made a difference. I have met incredibly erudite and seemingly inexhaustible folks wearing many hats in order to keep our collective lackadaisical attitude from being our own end.

It was my dissatisfaction with “that’s the way things are” that drove me to get involved. One of the things my little league coach used to tell us when we would complain was “quit your bitchin’”. Forgive the crass language, but that is what I had to do.  

I joined the NASS Spine PAC and was immediately put in the legislative action committee. I cold called my congressman’s office; I got a meeting. He later came to my office. I talked to him. He was smart. Not a physician by any stretch, but I told him many stories about my patients getting denied coverage for surgery, and their endless shenanigans. He listened; his staff followed up. Later, due to a ridiculous paperwork problem in the vast labyrinth of the Medicare PECOS system, Noridian stopped paying my Medicare claims. I did not get paid by Medicare for 3 months with Noridian flipping me the bureaucratic bird. It took a rep from the CMA and my congressman’s office on a five-way call to Noridian in South Dakota to get it fixed.

Social media for politics, aka Twitter, has been a mixed bag. There are hundreds of carnival barkers and trolls, vying to get their voices to trend. But through the years, I have been able to connect with other doctors who are trying to protect our patients by maintaining our vital autonomy that is under assault from so many sides. Social media amplifies noise, good noise, and can actually break past the siloed walls of the political because more and more doctors realize it is only by being vocal that we can shape our collective destiny.

Going to DC several times, I would visit with our senators’ staff, and even went to a couple fundraisers with one for our senior Democratic Senators. I also met members of the GOP “Doc Caucus” and found most of them, especially Dr. Bill Cassidy (who actually looks a lot like Jim Carey in person) to be intelligent and reasonable. I have even been to the RNC clubhouse on Capitol Hill – my mother, a lifelong Democrat – asked if I was being held hostage.  

There are only 17 physician members of Congress (13 in the house and 4 in the Senate). If you want to talk about lack of representation for us – start here.

It has been a trip, but honestly it is quite doable. Unlearning what I have learned, I have been able to see myself imploring Congress people to listen and actually seeing things like Surprise Billing being steered away from falling off the cliff by telling my own stories. I have collected many patient stories about how insurance companies fleece the public.

It has only been by being part of the process that I have been able to change the narrative. This is the only way we can steer clear of our health care system imploding and ending up as employed drones, still pretending like “quality improvement” actually means making things better for patients, instead of it actually being “cost improvement” and making things cheaper for insurers or for Medicare.

The independent, and critical thinking aspect of who we are as neurosurgeons has always asked us to think smarter, and to question everything. When we lose that, we lose ourselves.

Get involved here:

SpinePAC/NASS Advocacy:


Neurosurgery Advocacy:


Get to know the Surgical Care Coalition, which tweets out surgery-pertinent news:


Brian Gantwerker MD

CANS Board Director, South

Tidbit 1- Surgical Neurology International’s free Educational Summit

Below is the Web site to register for the SNI Digital™ Neurosurgery World Education Summit — free for all people worldwide. It will be held live, from 6:00 A.M. to 9:00 A.M. PDT on Saturday, June 5, 2021, and from 6:00 A.M. to 9:00 A.M. PDT, on Sunday, June 6, 2021. It will have an international faculty of 50 distinguished discussants, including experienced neurosurgeons, neurologists, orthopedic surgeons, and pediatric specialists.

During this SNI Digital™ Education Summit, there will be Round Table case-based discussions on spine (2 sessions), pediatric tumors, adult tumors, critical care (stroke and ICH), epilepsy, and stereotactic and functional. There will be a unique “Scrub with me” cerebrovascular video session with Juha Hernesniemi, MD, PhD, a world-leading vascular neurosurgeon, going step-by-step through his surgery, answering your questions. There will also be two 30-minute “Frontier Neuroscience”  lectures on each day. The first will be on new advances in acute spinal cord repair by Sergio Canavero and Xiaoping Ren, and the second lecture will be on “Software and Programming the Brain” by Itzhak Fried. There will be time for questions. 

This Summit is uniquely interactive, so you can learn what the experts do and why, and ask questions. In the event that you are unable to attend the Summit, all of the sessions will be recorded, translated into multiple languages, and made into podcasts to listen to at your convenience. All of the sessions will be on the SNI Web site (, under SNI Digital™. It is free for everyone. 

To register for the Summit and receive continued updates, click this link:

Tidbit 2 - CSNS Meeting on April 23rd & 24th

Another virtual meeting but well attended by Council of State Neurosurgical Societies officers, delegates, and guests. Of the 13 resident fellows, only 7 made it implying that one’s day job can be demanding. All eight of CANS delegates attended.

Elections were held for officers with Joe Cheng being elected President, our John Ratliff elected Vice-chairman and Jeremy Phelps, Luis Tumialan and Cathy Mazzola respectively elected to Recording Secretary, Corresponding Secretary and Treasurer.

Each quadrant held a meeting and the Southwest quadrant in which CANS is a member chose three new resident fellows for the forthcoming year: Jordan Xu from UC Irvine, James Caruso from Univ. of Texas Southwestern, Akal Sethi from the U. of Colorado and Mauricio Avila from the U. of Arizona as an alternate.

There were 8 resolutions presented and debated and the following were the outcomes (CANS BOD position in bold italics)

RESOLUTION I (Adopted amended resolution) CANS–support

TITLE: Understanding and Facilitating the Process of Retiring From a Career in Neurosurgery

Original resolution

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 post-neurosurgical 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.

Adopted amended resolution

BE IT RESOLVED, that the CSNS completes a systematic review of the processes and impact of retirement in neurosurgeons; and

BE IT FURTHER RESOLVED, that the CSNS maintains a contact list of retired

neurosurgeons who wish to continue as resources for organized neurosurgery; and

BE IT FURTHER RESOLVED, that the CSNS develops an educational program on retirement in neurosurgery.

RESOLUTION II (Adopted amended resolution) CANS—evenly divided

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

Original resolution

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.

Amended resolution

BE IT RESOLVED, that the CSNS ask the Neurosurgery Pac to strongly consider, in their financial support of elected officials, the role of certain specific officials in perpetuating the claims that the results of the 2020 presidential election were fraudulent and invalid.


RESOLUTION III (Adopted amended resolution) CANS–support

TITLE: Establishing Curriculum for the Practice of Neurological Surgery During Residency Training

Original resolution

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.

Amended resolution

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 CSNS petition the parent bodies (AANS/CNS) to work with the SNS and ABNS to incorporate content from this curriculum into the written ABNS primary examination and further emphasized in the oral examination to highlight the importance of this knowledge


RESOLUTION IV (Adopted amended resolution) CANS–opposed

TITLE: Defining Veritable Legal and Fiscal Counseling

Original resolution

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

Amended resolution

BE IT RESOLVED, that the CSNS form a task force to develop educational materials for neurosurgeons so that they can better identify FIDUCIARY and VERITABLE sources of legal and financial counseling

RESOLUTION V (Refer to committee) CANS–support

TITLE: Publication of Patient Generated Outcome Measures

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 (Adopted) CANS was author of resolution


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 (Adopted amended resolution) CANS–support

TITLE: Maintaining Surgical Cadaveric Training

Original resolution

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.

Amended resolution

BE IT RESOLVED, that the CSNS conduct a survey of residency programs to evaluate the number of cadaveric learning opportunities each program has over a one-year period; and

BE IT FURTHER RESOLVED, that the CSNS provide the SNS the results to identify opportunities for developing a cadaveric curriculum in residency programs.


BE IT RESOLVED, that the CSNS urges its parent organizations to require attestation of full Covid-19 vaccination from all personnel planning in-person attendance at the 2021 AANS and CNS Annual Meetings

Tidbit 3 - Another gift from CAP—human resources manual

Whether you employ a staff of one or 100, every medical practice needs an up-to-date human resources manual to stay on top of the latest in HR best practices and legal guidelines. The Cooperative of American Physicians (CAP) is pleased to offer you a free customizable, Word formatted HR manual adaptable to your practice’s specific needs. Written by HR professionals, the 2021 Human Resources Manual has been fully updated to reflect 2021 laws, many of which are new or have changed due to the ongoing pandemic.

Download Now

Having structured HR policies and procedures in place in your practice can help you avoid employment-related lawsuits and support a positive and productive work environment. CAP’s 2021 Human Resources Manual for medical practices includes:

  • Changes to unpaid leave laws
  • Updates to minimum wage regulations
  • Employee Manual in a customizable Word format
  • Manager’s Handbook providing HR best practices and guidelines
  • And more!

CAP, a leading provider of medical malpractice coverage for California physicians, offers a wide array of risk management and practice management benefits, such as these free resources.

To learn more about becoming a CAP member, please call 800-356-5672.

Best Regards,

Cooperative of American Physicians
Membership Development

Tidbit 4 - Independence seems to be on the wane

The majority of patient care physicians worked outside of physician-owned medical practices in 2020, according to a newly released biennial analysis (PDF) of physician practice arrangements by the American Medical Association (AMA). This is the first time the share of physicians in private practices has dropped below 50% since the AMA analysis began in 2012.

Although data collected by the AMA from 3,500 U.S. physicians through the 2020 Physician Practice Benchmark Survey show the continuation of shifts toward larger medical practices and away from physician-owned practices, the magnitude of change since 2018 suggest these trends have accelerated. The survey was conducted from September to October 2020, roughly six months into the COVID-19 pandemic, and therefore may not reflect the full impact the pandemic will have on physician practice arrangements.

Employed physicians were 50.2% of all patient care physicians in 2020, up from 47.4% in 2018 and 41.8% in 2012. In contrast, self-employed physicians were 44% of all patient care physicians in 2020, down from 45.9% in 2018 and 53.2% in 2012. The percentage of physicians who were independent contractors has been steady, fluctuating in the narrow band between 5% (2012) and 6.7% (2018).

With the steady decline since 2012 in the share of physicians working in private practices, there has been a concurrent increase in the share of physicians working directly for a hospital or for a practice at least partially owned by a hospital or health system. Almost 40% of patient care physicians worked either directly for a hospital or for a practice with at least partial hospital or health system ownership in 2020, up from 34.7% in 2018 and 29% in 2012. 

The Observation for the Month

“What do you want to be when you grow up”, asked the mole.

“Kind” replied the boy—excerpt from The boy, the mole, the fox and the Horse by Charlie Mackesy


Meetings of Interest for the next 12 months:

Neurosurgical Society of America: Annual Meeting, June 20-23, 2021, Lake Tahoe, NV

Rocky Mountain Neurosurgical Society: Ann. Meet., June 19-23, 2021, Jackson, WY

New England Neurosurgical Society: Annual Meeting, June 2021, Wequassett, MA

AANS/CNS Joint Cerebrovascular Section: Annual Meeting, July 26-30, 2021, Colorado Springs, CO

AANS/CNS Joint Spine Section: Annual Meeting, July 28-31,2021, San Diego CA

AANS: Annual Meeting, August 21-25, 2021, Orlando, FL

CSNS Meeting, August 20-21, 2021, Orlando, FL

NERVES Annual Meeting, August 18-20, 2021, Orlando, FL

Western Neurosurgical Society: Annual Meeting, Santa Ana Pueblo, NM, September 10-13, 2021

North American Spine Society: Annual Meeting, September 29-Oct. 2, 2021, Boston, MA

Congress of Neurological Surgeons: Annual Meeting, October 16–20, 2021 Austin, TX
CSNS Meeting, October 15-16, 2021, Austin, TX

International Society for Pediatric Neurosurgery: Annual Meeting, November 14-18, 2021, Singapore

AANS/CNS Joint Pediatric NS Section: Ann. Meeting, December 7-10, 2021, Salt Lake City, UT

Cervical Spine Research Society: Annual Meeting, December 2-4, 2021, Atlanta, GA

CANS, Annual Meeting, January 15-16, 2022; Location TBA

North American Neuromodulation Society: Mid-year Meeting, July 15-17, Orlando, FL

Southern Neurosurgical Society: Annual Meeting, February 17-19, 2022, Hollywood, FL

California Neurology Society: Meeting, November 12-15, 2021, Santa Barbara, CA

AANS/CNS Joint Section on Pain: Annual Meeting, TBA



Looking for a new partner or position?

Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter.  Submit your text to the CANS office by E-mail (

To place a newsletter ad, contact the executive office for complete price list and details.


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