Volume 49, Number 11

Inside This Issue

Picture of Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

This will be my penultimate newsletter message as President of CANS. The January 15, 2022 limit for the terms for President, President Elect, and Vice Presdient is fast approaching. I am really excited to hear from Dr Javed Siddiqi as he outlines his vision for his upcoming one-year term as CANS President at our CANS Annual Session Saturday night banquet January 15, 2022.

As pointed out and first discussed in our October newsletter, In December 2020 congress passed the Surprise Billing Act as part of the year end omnibus spending bill. The law allows an out-of-network provider to invoke arbitration if they are dissatisfied with the amount offered by a third-party payer for their services. The arbiter would then select between the final offer submitted by each party (based on arbitrated fairness, not on which was the lowest). On September 30, 2021, the Biden Administration via the departments of the Office of Personnel Management (OPM) and Health and Human Services (HHS), issued an interim final rule that essentially changes and violates the original law. Instead of the arbiter choosing one or the other of the best final offers of the two parties concerned, the rule requires the arbiter to choose not the arbitrator-determined fairer of proposals, but the lesser of either (a) the billed charge, or (b) “the median payment amount for the same or similar service in the geographic area”. This Administration final rule is in direct conflict with the letter of the law passed by Congress. If we cannot get members of Congress support to push back on this administrative final rule, then our only recourse will be to take legal action to stay its enforcement as potentially illegal. Both efforts require that our NeurosurgeryPAC have the necessary resources right now to gain access to be heard by our congressional representatives as well as potentially help support the initiation of legal action(s) if they become necessary. The consequences for neurosurgery may be dire indeed. This administration’s final rule if allowed to stand would eliminate all incentive for third party payors to fairly contract with physicians. Why would they, when they can now unilaterally lower payments for services at their whim and then force physicians who refused their contracts to accept these reduced rates under the new final rule for misapplying the Surprise Billing Act. Our Washington Office is already hearing of potential actions of Medicare Regional Carriers to unilaterally sharply drop their contracted rates in response to this new unintended scenario. This is very serious. As a profession, we need to take a stand now to fight this injustice before it can take hold and become established. The good news is that we are not alone, and we have many allies in this cause. This Administration’s final rule is a potential disaster for all surgical and emergency services. Nevertheless, our NeurosurgeryPAC needs all the resources we can supply right now in order to fight this on our behalf and that of our patients.

I would ask each of you to please take a moment to search your own heart and step forward to demonstrate personal dedication and commitment to our profession and our patients. The time sensitive crisis is real and the issues at stake are very important. If you have not yet donated to the PAC for 2021, please act today. If you have already given to the PAC for 2021, then please consider giving more today. Regardless of where you stand for 2021, I hope that everyone will make your 2022 donation in January 2022, rather than waiting till later. The process is simple and can be done right now as you are thinking about it. Please just go to and click on the “Donate to Neurosurgery PAC” blue button.

As you probably know, only 4 ½ weeks from now, on Jan. 1, 2022, neurosurgeons face a 10% Medicare payment cut. The combined cut is due to several factors, including the:

  • Expiration of the 3.75% payment adjustment for Medicare Physician Fee Schedule (PFS) payments that were included in the Consolidated Appropriations Act, 2021;
  • Expiration of the moratorium on the 2% Medicare payment sequester; and
  • Implementation of a 4% statutory Pay-As-You-Go (PAYGO) Act cut.

The AANS/CNS Washington Committee and our Washington Office team are working with key members of Congress to identify sustainable solutions to address the ongoing systemic problems with the Medicare PFS. In the interim, however, we need short-term stability in the payment system — particularly with the resurgence of COVID-19 across the country — to allow more time for these ongoing efforts to continue.

To help mitigate these cuts, Reps. Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) have introduced H.R. 6020, the Supporting Medicare Providers Act. This legislation would extend the 3.75% payment adjustment through 2022 to help provide continued stability for physicians and other health care professionals. Please contact Congress right now and ask your Representative to co-sponsor H.R. 6020. Click here  to go to neurosurgery’s Advocacy Action Center to email your member of Congress asking them to co-sponsor the legislation. A sample message, which can be personalized, is provided. Let’s show our support for Dr. Bera’s efforts by delivering co-sponsors from the California Congressional delegation!

As we began to discuss in September’s CANS newsletter, our upcoming annual session January 14-16, 2022 will be a very special CANS Annual Session as work our way towards the 50th Anniversary of the largest state neurosurgical society in the United States, and we have a very special program prepared. The theme of this Annual Session is the “Challenges of Corporate Employment”. In the September and October newsletters we focused on two sessions (Sessions 3 and 5) that will be unique and new topics of interest to all CANS members that, to my knowledge, have never been put together for any other neurosurgery professional meeting presentation. These sessions are Session 5 – Challenges of Corporate Employment, and Session 3 – The Future of Telemedicine in Neurosurgery. In this newsletter we will focus on our State and Federal Health Policy and Legislative updates and our clinical spine innovation session.

On Saturday, Session 2 (Socioeconomic, State & National Neurosurgery Updates) will feature timely key updates from our state and national organizations. In her last presentation before leaving CANS for Oregon, our former Director South, Dr Esther Kim will present an update of the current status, agenda, and key issues from the CA Medical Association (CMA). This will be followed by a similar presentation regarding the American Medical Association (AMA) which just held its Fall special session by former CANS President and Neurosurgery AMA Delegate, Dr. Ken Blumenfeld. This will then be followed by an AANS/CNS Washington Committee update by our Washington Committee Chair and former CANS President, Dr John Ratliff.

We are also very honored this year to have the Chair of the Council of State Neurosurgical Societies (CSNS) Dr Joseph Cheng, the President of the Congress of Neurological Surgeons (CNS) Dr Nicholas Bambikidis, and the President of the American Association of Neurological Surgeons (AANS) Dr. Regis Haid, all joining us in person at our CANS meeting. Rather simply updating us on the structure and initiatives of their respective organizations, they have been asked this year to give focused addresses. Each has agreed to reflect on the theme of our meeting (the uncertainties and dangers of changing neurosurgeon employment paradigms in our future) and deliver a down-to earth, heart-felt reflection on how their respective organizations see this emerging future and how they are positioning their respective organizations to advocate for, and serve, the needs of neurosurgeons in the trenches in California as this change evolves. We specifically have asked them to help us understand how their respective organizations sees state neurosurgical societies and how CANS can best assist their respective organizations in mutually beneficial initiatives working together going forward.

On Sunday morning Session 7 (Advances in Spine Surgery: Technology and Techniques) will be moderated by former CANS President Dr. Langston Holly as well as one of our new CANS members, Dr. Leslie Robinson.

This session on innovations in spine surgery will include talks on “Awake TLIF” by Dr Robinson, “Advances in Neuromonitoring” by Dr Ratliff, “Cervical Laminoplasty vs Laminectomy/Fusion” by Dr Mummaneni, “Spine Trauma: Falls in Yosemite” by Dr Helbig, “Spine Trauma: Open vs Percutaneous for 3-Column Spine Fractures” by Dr Dhall, and Thoracolumbar: Navigation and Robotics in Spine Surgery” by Dr DiGiorgio. This session promises to be very exciting and informative.

This Annual Session will also mark the beginning of a one-year run up to the 50th Anniversary of CANS as an organization in 2023, and as such we have a very special Saturday pm banquet planned with its own dinner program as outlined below:

6:30 Cocktails
7:00 Dinner

  1. CANS Historical Vignette – Austin Colohan, MD
  2. Formal Presentation of New CANS Members – Joseph Chen, MD
  3. Byron Cone Pevehouse Distinguished Service Award
  4. CANS Lifetime Service Award
  5. Randy Smith, MD, In Memoriam – Moustapha Abousamra, MD
  6. Randre Grace – Mark Linskey, MD
  7. Avant-Premiere CANS 2022-23 – Javed Siddiqi, MD

As you can see, everyone will get a chance to meet, introduce yourself, and chat with each of our new members and their families in person, we will get a chance to honor two of our very well deserved members with CANS awards, we will be able to celebrate the life of one of our greatest members, Randy Smith with his family joining us, and Dr Javed Siddiqi will have an opportunity to lay out his vision for his presidential term 2022-2023 as the new CANS President and perhaps foreshadow some of his priority initiatives as well as his January 2023 Annual Session. We would ask everyone attending our upcoming CANS meeting to please purchase a banquet ticket so that we can get a proper head count for this special evening event.

I am also very pleased to announce that our 2022 Annual Meeting Committee, Vendor Subcommittee, ably led by Dr Anthony DiGiorgio, has been working hard to prepare two special “off-site” laboratory and certification opportunities for CANS members who are interested and come a day early to the annual session. The first opportunity has been confirmed, and we hope to be able to announce the second very soon. One of our corporate vendor partners, NuVasive will be sponsoring a lab during the day Friday January 14, 2022. We will be exploring the future of cervical spine surgery, including the Simplify Cervical Disc Replacement. The lab will include the required FDA training to use the device, along with tips & tricks from experts in the field. This off-site lab will be free for those attending the 2022 CANS meeting, including round-trip transportation to the lab from the meeting hotel. A formal invitation from NuVasive will be forthcoming later this week.

Proof of Covid-19 vaccination or a pre-entry negative test result within 72 hours of registration, will be required for members, guests and vendors to attend our 2022 Annual Session. Proof of vaccination either in the form of a completed HHS/CDC Covid-19 Vaccination Record Card or a California Digital Covid-19 Vaccine Record ( ), or a copy of the negative test result, will be needed at registration in order to obtain a colored sticker indicating your vaccination status which will be placed on your meeting badge and allow access to all venues. Masking and social distancing requirements will conform to those officially in effect for the San Diego County Department of Public Health at the time of the meeting. Currently for indoor events in SD County, masking and social distancing is recommended, but not required.

The CANS Annual Session will be held the weekend of Martin Luther King’s birthday January 14-16, 2022 in La Jolla, CA. We will be holding our meeting at the Hilton La Jolla Torrey Pines hotel . This venue is only 16.3 miles from the San Diego airport and is easily accessed. It is adjacent to the Torrey Pines State Nature Reserve with beautiful hiking trails and views and is 5 minutes from Torrey Pines State Beach . It is only 7 miles from Sea World and is close to La Jolla village and Birch Aquarium. The hotel overlooks the famous Torrey Pines golf course and all rooms have pacific ocean views. The hotel itself has hosted multiple US Open Championships including the 2021 US Open. It provides exclusive access to daily tee times but also has its own spectacular outdoor pool and pool area as well as tennis courts. This venue promises to be a terrific outing for our members as well as our families. Please be sure to book your rooms in the CANS room block as soon as possible to enjoy the whole 3-day holiday weekend The more people who sign up and book rooms for both evenings as soon as possible, the better the deal that CANS will enjoy on our venue contract. We really would like to see everyone at the meeting. The support of each of our members is really important and certainly needed at this time.

Registration for our meeting is also now open. I would encourage every CANS member to register for this special and historic meeting in this beautiful location ASAP REGISTER HEREWhen you register, it would also be a terrific time to update your CANS membership dues so that they are current RENEW or JOIN!

I would once again like to take this opportunity to ask all CANS members to please consider getting involved. We need your thoughts, ideas and input. Please do not hesitate to contact me if you would like to get more involved with CANS at Even if you cannot dedicate your own time and effort, please consider financially supporting CANS, the national Neurosurgery Political Action Committee (Neurosurgery PAC) (, and the CMA Political Action Committee (CalPAC – ). Please do whatever you can to support CANS, the NeurosurgeryPAC and the CMA, they are fighting for you.

All the best!

Picture of Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

CANS Past President

Acting Editor's Corner

Our President’s message is as usual very detailed, and is full of useful information, particularly regarding our upcoming Annual Meeting in La Jolla. I, too, encourage you to attend and stay longer if you can. If you haven’t already registered and or made your hotel reservations, please do so now.

Please also note crucial information about surprise billing, Medicare payments cuts and the need to stand together. Our president’s appeal to support the NeurosurgeryPAC is timely.ur President’s message is as usual very detailed, and is full of useful information, particularly regarding our upcoming Annual Meeting in La Jolla. I, too, encourage you to attend and stay longer if you can. If you haven’t already registered and or made your hotel reservations, please do so now.

When our late Editor, Randy Smith, assigned me the task of writing a monthly column in the fall of 2017, I took over from the late Jack Bonner whose column was titled “Transitions.” I did not feel comfortable using the same title, so my column remained untitled. Only the topic introducing my essays were listed. Debbie Henry, by contrast, had the clever title of “Brain Waves.”

During the past spring, and while going through some papers in our home in Texas, I ran across a newspaper clipping that reproduced my presidential address to the Ventura County Medical Association thirty years ago. I ran it by Randy, who encouraged me to write an essay about how things changed. Unfortunately, he did not get a chance to read my essay entitled “How things changed in thirty years.”

Upon further thought, I plan to label my columns going forward “Changing Times.”

I know that some of you may not agree with my assessments, but please write back. I hope to publish in the next issue some of your responses.

Finally, please remember that we are planning to publish a commemorative newsletter dedicated to Randy Smith and his many, many accomplishments and the amazing person he was. Our hope is to publish this special issue in mid-December. Please submit any remembrances you may want included to me or Emily Schile at or, no later than December 4.Thank you!

Picture of Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

CANS Past President

Changing Times : How Things Have Changed in Thirty Years

I was honored to serve as the president of the Ventura County Medical Association for the term 1991-1992. I was the youngest president to assume this role. In my presidential address, given exactly thirty years ago and included for your review, I touched on few issues. Here is the way I see them now. The list is in no particular order.

Independence- Physicians are definitely less independent today; there is a much higher percentage of us that are employed.was honored to serve as the president of the Ventura County Medical Association for the term 1991-1992. I was the youngest president to assume this role. In my presidential address, given exactly thirty years ago and included for your review, I touched on few issues. Here is the way I see them now. The list is in no particular order.

  • Bureaucracy- Not only has dealing with insurance companies’ bureaucracy increased, but also dealing with hospital bureaucracy is a major part of our headache.
  • Rationed care- this continues, though we never call it rationed care. There seems to be many more obstacles to a significant segment of patients accessing care. This came under sharp focus during the pandemic.
  • Euthanasia- it is now the law of our State and that of several others. But we just call it Death with Dignity. I have come to accept this as a right, that a rational patient with a terminal illness should have. I am glad, however, that the law does not require physicians, who have a moral objection to this practice, to participate in it.
  • Technology- the technological advances continue to make rendering of care more and more complex. While information is readily available at our fingertips, dealing with EHR has created a real barrier between physicians and patients; the widespread use of EHR has created a real concern about privacy and how patients’ information is handled. Additionally, and since the pandemic, telemedicine and zoom have created further barriers between a physician and a patient. I am afraid that these changes are here to stay.
  • Universal health care- has not been accomplished. I personally have moved in a much more liberal direction and now fully support Medicare for All, but I know that a plurality of physicians are not supportive.
  • Malpractice- We are still fortunate in California. The MICRA cap on non-economic damages that was passed in the 70s has stabilized this problem. It has been threatened on several occasions, but so far, we have prevailed. A major new threat is on the horizon. The cap may need to be raised, but there several other issues of concern.
  • Public image is worse- in fact during the pandemic physicians and hospitals were accused of inflating the numbers of COVID-19 deaths to get paid more. Add to that the fact that physicians have less time to spend with patients, the uncaring image is being reinforced.
  • Our physical and mental health- the burnout rate amongst physicians is higher than ever before. A variety of reasons are cited: EHR, lack of support from hospitals and employers, patients’ expectations, managing conflict of interest, and dealing with very ill patients without the proper equipment.

I invite my dear readers to comment.


Picture of Arvin Wali, MD

Arvin Wali, MD

CANS Resident Consultant South

The Endless Heights of Neurosurgical Excellence

The transition into the New Year is a natural opportunity to express gratitude and consolidate lessons learned. On January 1st  2022, I will have completed 1,280 days and nights of neurosurgical residency. This number marks the three and a half year midpoint of the classical seven year summit to graduate residency training.  All neurosurgeons can acknowledge this milestone as they cross the halfway mark and transform from a neurosurgical junior resident to a senior. Moreover, this period is further filled with reflection as I have embarked on an enfolded fellowship in Endovascular Neurosurgery, become a father, and supported my wife as she started her own surgical journey as a resident in Obstetrics and Gynecology. 

On paper, the number of 1,280 could never encapsulate the innumerable experiences working with patients, families, and health care staff as we rallied our efforts to mitigate unforgiving disease and suffering. Through this period, apprehension in face of harsh diseases became a dedicated focus to do everything within our power to enable people to live and enjoy life. The transition into the New Year is a natural opportunity to express gratitude and consolidate lessons learned. 

I remember the intention of what made me embark on my journey in neurosurgery– to give people (someone’s mother, father, daughter, son, loved one, role model and mentor) every possible chance to preserve and restore their functional status and capacity to enjoy life. That resolve has grown into a passion for advocacy, health equity, and mentorship. That original intention has gradually become a series of experiences of taking care of patients and their families. This number, 1,280, also captures so many sacrifices – big and small. My family, my wife, my son, and my parents have supported me both loudly and silently as I continue this journey. To my mentors who have enabled me to pursue neurosurgery, I have endless gratitude. To my fellow residents, nurses, technologists, scientists, custodial staff and the countless health care heroes, I am inspired to continue to do my part to learn, innovate, and teach to make the practice of neurosurgery better with each day.

As I look back on my internship in neurosurgery and the fundamental lesson learned from that year, I appreciate the wisdom and strength in asking for help. When pathology becomes increasingly complex, it is a strength to assemble the appropriate resources and expertise to be able to tackle pathology to bring the best outcome for patients. 

My second year taught me the true value of courage. Hope, not irrational wishful thinking, gives us the capacity to continue to strive to improve our science and surgical techniques to one day overcome the diseases that are devastating and without cure today. 

My third year, especially during the height of the COVID-19 pandemic, taught me that medicine is a universal mission to mitigate suffering and something that we as a global society all take part in. We are members of a diverse and complex ecosystem and our actions impact every other member of society. It was with the cumulative courage of individuals in and out of the hospital, in and out of Science, that we are bringing this pandemic under control. While the journey in neurosurgery can be at times lonely, never before as health professionals had we been so interconnected and united to bring our best to overcome the global pandemic and combat inequity in access to health care. 

My early reflections in fatherhood have taught me to appreciate what my parents have given me and how to value my own mentors. I hope to give my son a strong example of efforts dedicated out of compassion to other people. 

As I reach further milestones in neurosurgical training, I realize the end goals are less about reaching the summit of excellence: there is no definite peak of the mountain of knowledge and wisdom, but only smaller peaks that make me realize how infinitely high the summits of excellence really go. I am learning the quiet joy in appreciating the journey of each day. I thank my mentors and teachers for empowering me to make it this far, and hope to honor your lessons each day as I complete my training and take these lessons forward throughout my life.  

Tidbit #1- Pandemic


  • COVID 19 mortality in the world exceeded 6 million people.
  • Nearly 1.6M people in U.S. who had COVID-19 may have chronic olfactory dysfunction lasting more than six months, research suggests.
  • S. overdose deaths topped 100K during COVID-19 pandemic, CDC data show
  • Pfizer Vaccine was approved by the CDC for children 5-12. Federal workers may take paid time off to get their kids inoculated.
  • No, the COVID-19 vaccines don’t affect fertility.
  • Los Angeles, Sacramento, San Diego, and Oakland are the first large school districts in the country to require students to be vaccinated against Covid-19.
  • US opened its land and air borders to fully vaccinated foreigners after 20 months restrictions- November 7
  • CMS requires health care workers at participating facilities to be fully vaccinated by January 4 -November 5
  • Federal government set January 4 as deadline for companies that employ 100 people+ to implement COVID-19/Testing guidelines.
  • Pfizer announced that its pill to treat COVID-19 had been found in a key clinical trial to be highly effective at preventing severe illness among at-risk people who received the drug soon after they exhibited symptoms, making it the second antiviral pill to demonstrate efficacy against COVID. The treatment “appears to be more effective than a similar offering from Merck, which is awaiting federal authorization-November 5.
  • Pfizer requests emergency authorization for five-day COVID-19 drug regimen November 16.
  • All American adults are now eligible for coronavirus vaccine boosters- November 19.
  • And now comes “Omicron” a new COVID-19 Variant “of concern” from South Africa. The concern is that it may evade immunity. US promptly re-closed its borders for travelers from several South African Countries. Hopefully, we won’t see this variant here.

Tidbit #2- Other News

  • Study examines relationship between sleep onset timing, risk of developing cardiovascular trouble- It turns out that ideal sleep time is 10-11PM.
  • CDC advisory committee recommends that all adults under 60 years old receive Hepatitis-B vaccines.
  • More than 22M infants globally did not receive first dose of measles vaccine in 2020, WHO-CDC report finds.
  • Obesity rate among emerging adults in the US increased more than 26 percentage points over a 42-year span, data indicate.
  • Patients with NASH -nonalcoholic steatohepatitis- and obesity who undergo bariatric surgery may significantly lower risk for liver disease, CV events.
  • Medicare premiums for physician, outpatient services to increase 15% in 2022, CMS says.

Quote of the Month

“No one has ever become poor by giving.”
– Anne Frank


Calling all exhibitors! Sign up today to secure your company’s table at our Annual Meeting! Please find information here to do so:  

We appreciate and welcome you all!


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; San Diego, CA

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

Neurosurgical Society of America: Annual Meeting, June 12-15, 2022, Maui, HI

Rocky Mountain Neurosurgical Society: Ann. Meet., 2022, TBA

New England Neurosurgical Society: Annual Meeting, 2022, TBA

AANS/CNS Joint Cerebrovascular Section: Annual Meeting, 2022, TBA

AANS/CNS Joint Spine Section: Annual Meeting, February 23-26, 2022, Las Vegas, NV

North American Neuromodulation Society: Annual Meeting, January 13-15, 2022, Orlando, FL

CSNS Meeting, April 28-29, 2022, Philadelphia, PA

AANS: Annual Meeting, April 29-May 2, 2022, Philadelphia, PA

Western Neurosurgical Society: Annual Meeting, September 9-12, 2022, Kona, Hawai’i, HI,


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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