Good afternoon. I'm Patrick Vlodka, and I'm joined here by my sister Jacqueline. If you couldn't tell by our unique last name, we are Alex Vlodka's children. We are incredibly excited to be here for the 2018 annual scientific meeting to introduce our dad. Before his presidential address on the privilege of service, we'd like to present some of our personal observations of our father and how he has personally embodied the theme of service. When talking about our dad, it's hard not to start with his parents' history. Our grandparents were from Lithuania, and living there in the late 1930s was turbulent, to say the least. Stuck between Stalin and Hitler, our grandparents decided to flee to Chicago, where our dad and his siblings grew up. Our grandparents set examples for their kids and grandkids to be resilient, resourceful, patient, and brave. As a kid, our dad enjoyed adventuring outdoors and playing sports with his siblings and friends. He has two brothers and two sisters, so skills in diplomacy and collaboration were requirements from a very young age. These skills were especially important during competitive hockey games with his brothers and friends in the basement of their home. He was raised a supporter of Chicago sports teams and, despite their recent struggles, remains a steadfast and loyal Bears and White Sox fan. Our dad's own father and grandfather were doctors, so pursuing a career in medicine seemed like a natural decision for him and his siblings. Not surprisingly, our dad succeeded at all points of his academic career. At the end of his residency, he found himself with two tempting job offers, one in Michigan and one in Houston. He says he was a better fit for the Houston job and preferred the weather there, but we think he really took the Houston job because it was located right across from the Houston Zoo. Our dad is a huge animal lover, and some of my favorite childhood memories involved parking at his office, walking across the street to the zoo, and spending hours observing, and if we were lucky, interacting with the animals. My dad explained fun facts about them. Patrick and I were told that we could have any pet we wanted, within reason, as long as we researched his care and assumed responsibility for it. So we took full advantage of that rule and created a little zoo of our own in our house. Our dad encouraged us to explore activities that excited us and was, along with our mom, our greatest cheerleader and supporter along the way. As we grew up, he instilled in us the values of hard work, tenacity, and superhuman time management skills. In lower school, I remember seeing him sick at home only one time and grew up thinking that it was unusual to actually take a sick day and not go into work. He maintained a busy and what some might call a hectic schedule, but this busy schedule allowed for valuable opportunities for exposure to his hard work at the hospital. And watching him interact with his patients from all walks of life at Ben Taub Hospital was personally impactful for me. He was diligent in completing his work while still allotting time to maintain an engaging bedside manner and earnestly listening to his patients' feedback regarding comfort and pain levels. This dedication to his proving his craft and community has helped reinforce the values of service that we have witnessed and learned from him. Though we've learned a number of things from our dad, such as how to be giving, thoughtful, and responsible, the biggest thing I've learned from our dad is how to be analytical. He taught us the merits of learning how something works, what it was like in its early stages, how it could be better, and most importantly, what we could do personally to make it better. Our dad is a role model to us in many ways, but perhaps the most important and impactful way is his altruistic nature and commitment to improving the lives of others. Without further ado, please join us in welcoming our father and the current AANS president, Dr. Alex Vlodka. Thank you. Great job. All right. You guys are great. Thank you. Thanks a lot. Isn't it just amazing sometimes how well kids can turn out despite their father's influence? Well, thank you for making them feel comfortable. And thank you for the privilege of serving you all for this past year as the president of the premier society and the premier specialty in all of medicine. Serving you all in this capacity has been the greatest honor of my career. And I've thought often of the past presidents of this society as you see the list displayed behind me. And the ones at the very beginning of this list, the earliest presidents, were the founders not only of this society, but of this specialty in our country. The more recent ones are the current superstars of our specialty. And I'd like to thank all of them for all their service to the AANS and to neurosurgery, not only while they were moving up in the organization, while they were presidents, but even afterwards. Now normally, I'd say that it's a bit humbling for me to think that my name would be up on that list. But I was reminded of a great quote by Golda Meir when she was prime minister of Israel. This quote was given to me by my dean, of all people, my boss. He said, don't be so humble. You're not that great. But all of us here who serve in the AANS, especially when you reach this office, you're very much aware of all the people who helped you get through both this year and along your career path. Certainly to start with the office in Rolling Meadows, and Kathleen Craig and I, your executive director, have gotten to be quite frequent buddies with lots of phone calls. And everyone else on that in the executive team is excellent. Some of them have only been there a short time. Some, like Chris Phillips, have been there 30 years this summer. But all of them are outstanding people whose only goal is to do the best thing for the AANS and for all of you. A few people who aren't on that list, Tom Marshall, Kathleen's predecessor. Also, Joni Shulman, who many of you know from her educational work. She retired. And Ron Englebright, who sadly passed away at far too young an age a few years ago. They've all been incredibly helpful, as has everyone else in Rolling Meadows. We also have a great crew in Charlottesville, where the Journal of Neurosurgery is published. And again, it's a leading journal in our specialty, and they work quite hard to make everything happen. Also, of course, we have an outstanding crew in Washington. And I've gotten to know all these people quite well. And I will stack them up against any other medical society's Washington operation, and I know we'll come out ahead if we do that. And finally, of course, the many physician volunteers who make all this happen. The executive committee is almost a pure democracy. No egos, a very flat hierarchy, and everyone is totally free to say what they want. And it's one of the groups I will enjoy working with my last year, and then I'll miss them when I'm gone. And of course, the board of directors, all the other physician volunteers, everyone else who makes the AANS work. And lots of people helped me along the way. I started at the University of Chicago where Sean Mullen was the chair, and Fred Brown is my advisor. And Fred is the one who suggested I go to Medical College of Virginia for my residency because of my interest in neurotrauma and critical care. When I matched there, Harry Young promised me the best six years of my life, and he may have been right. And Harry, along with John Pavlishak on the research side, have had a huge impact on me. And again, I was incredibly fortunate after finishing residency training to get a job at Baylor College of Medicine and could not have had a better chairman than Bob Grossman. And likewise, Claudia Robertson was a phenomenal partner and still is, both clinically and on the research side. And after leaving Houston, I went up to Austin to help the Seton Health Care family try to reposition itself to become the academic partner for the new medical school that was being built in Austin. And there I learned a huge amount about governance and management and leadership and administration. I need to thank all my friends at Seton and at Dell Medical School, which came into existence while I was there, and especially my former partners, the neurosurgeons and all the other physicians in the Austin community. And now I'm back in Richmond with a lot of old friends as well as some new colleagues, and it's great being there. But I especially need to thank my family. Those of us who embark on a career in neurosurgery know that although we're focused on service, it means we're not going to be home very much. And although our children have to pay the price for that, they didn't get to vote in that process. That's why it was so important for me to have my kids introduce me here for this talk. And most of all, I need to thank Patty. Now, Patty's a nurse, so she had some idea what she was getting herself into. We got married more years ago than she cared to admit. But even she couldn't quite understand what it was like to be home by herself so many nights and weekends, and I was either in the hospital or out of town. So Patty, thank you for everything. I love you. Now, there's one story that I need to tell you about Patty that kind of typifies how our families learn to do quite well when we're not around. We moved back to Richmond a few years ago, as you know, and we were lucky to get a nice house in a very nice neighborhood. And then Patty woke up one morning to find out that her car had been stolen right out of our driveway. So you call the police, you call the insurance company, she's not expecting much. Then she remembered, she can go online and track the position of her car. So she does that, sees the car just a few miles away from the house, so she whips out her phone, gets a ride from Uber, Uber driver takes her to the car, and she steals it back from the thieves. So that's how the Vlodka family does things when I'm not home. But I'm going to talk today here mostly about service, but there are a couple of things I want to talk about first. And one is that we all get busier and busier every year, and it seems there are more and more things that just get in the way of our ability to care for patients. And it's easy to get discouraged in the middle of all this, but I think it's important that we step back and develop a sense of gratitude for the incredible work that we're able to do. I mean, think about it, we relieve pain, we relieve suffering, we restore function, we get people back to their lives. We actually save lives. In one of my previous jobs, I was working with my administrative counterpart, trying to bring a lot of change to the clinical neurosciences in our healthcare system, and it really wasn't going very well. We were both getting discouraged. And I happened to be on call one night during this stretch, and it was a pretty busy night on call. The next morning, I texted her, and I said, I saved two lives last night. Maybe this job isn't so bad after all. You know, I'm not a doctor, but maybe this job isn't so bad after all. You can all say that, but not many other people can. And finally, one other thing to be grateful for is that we are part of a very unique group. Neurosurgeons are different, and I've had long talks with leaders in other specialties, and they say that we are natural leaders, we're go-getters, we understand how to make things happen, we're focused on the goal, but at the same time, we can kind of get down to details and adjust things to make it work. We truly are a band of brothers and sisters, and there's no doubt that the best part of a career in neurosurgery is the people you get to meet along the way, both patients as well as our colleagues. So, let's talk a little bit now, starting to discuss service. And I like to couch this in the term of the classic triple threat, and we all know what that is. That's someone who exceeds at being an excellent clinician, researcher, and educator. There's always been kind of a idealized way to look at things, but it is a useful construct to think about the skill sets by which people are judged nowadays. So, how do you evaluate how an academician performs? We all know the answer, right? Papers, grants, maybe number of patents you get, number of presentations you give, number of prestigious research bodies you serve on. And how do all of us get judged, whether you're in academics or employed or private practice? Clinical productivity, right? We all know the metric. How many cases you do, how many patients you see, how many work RVUs or dollars that you generate. Well, what's one problem with all these metrics? They're all individually focused. It's all about me and what I do. And this kind of inward focus can really diminish the good that we as neurosurgeons can do in our communities and our service to others. So, I've often thought that there should be another kind of triple threat, a new layer of competencies that we can layer on top of the first and run in parallel with them. I call these the three A's. They're administration, advocacy, and altruism. And we're gonna talk about each of these in turn. So, when I said administration, you can almost feel the air go out of the room, right? And your surgeons don't like to do that. And you can understand why, because at the end of the day as a surgeon, you're happy, you're driving home, because maybe you've done two or three or four operations, maybe five or six or more if you do procedures. Or maybe you've seen people in clinic who you've operated on and now they're doing great, they're back to normal. Or you've seen people who need your services and you have set them up for surgery and you know you're gonna make them better. That's all great, but that's very different from what happens in administrative work. So, I got a question for you. What don't you like about being a neurosurgeon? It's not the patient care. And even if we're on call at night or on a holiday weekend, we signed up for that. That's part of the job. What gets people annoyed is all the incredible bureaucratic administrative hassles and frustrations. You know, we see how the operating room could be run more efficiently. We see how the hospital needs work. We see how our employer can do things so much better. Another question. Do you really think you're gonna solve those problems by complaining to each other in the operating room and in the hospital hallways and the doctor's lounge? So, you actually need to be there, engaged, talking to administrators, going to the meetings and finding out how to make changes happen in your hospital. And I would submit to you that no one is better qualified to do this than we are. Because we are all over the hospital, right? We're not just in the operating room. We're in the ICU, the emergency department, the wards, the clinics, the satellite clinics. We're a part of trauma systems and stroke networks and cancer collaboratives. We interface not just with other surgeons, with the anesthesia folks, with the ICU docs, the ER docs, radiology, pathology, referring docs. And again, not just other physicians, but advanced practice providers, nurses. No one has the depth and breadth of insight into the healthcare system that we do. And also, as Angela Duckworth might say, if we have the grit to get through a neurosurgical training, we certainly can figure out what it takes to be effective administrators. Because remember, these decisions are made every day. And if you're not taking part in them, then someone else is taking your role as a decider in deciding things that affect you. Now, a key point here, though, is that administration is not the same as leadership. Although we know many good administrators help us get things done, we also know lots of people who are really in it just focused on their title and their turf. And it's pretty obvious those people are in way over their heads. Well, the good news is that you can actually be kind of outside the org chart and still get things done. Here's a typical org chart. This one happens to be for AANS. But every organization has these things. And it's often said that most of the work in any organization gets done outside these boxes and lines. So if you have someone who's in one of those boxes who's getting in your way, you can find a way to work around them. And just as importantly, even if you're not in one of those boxes, you can still have tremendous influence if you figure out how the system works. Here's a great quote from a leadership consultant named Rosamund Zander. She said, when leadership is defined not as a place you hold, but as a way of being, you discover that you can lead from wherever you are. So what kind of leader are you? Do people wanna be in your operating room or would they rather be anyplace else? When they see you coming down the hall, do they wanna stop and chat and engage or do they try to turn and hide? After they talk to you, do they feel enhanced or diminished? If you're not thinking about these things, then maybe it would be good for you to work on some self-awareness and situational awareness that can help you become the most effective leader you can possibly be. So we've talked about administration. Let's talk about advocacy. And we usually think about this in terms of the political, the regulatory process, the people who pass laws and make rules that affect us. And that's important. As I said, we have a great team in Washington that helps us in this area. But I'm talking about something much bigger. I think that we actually need to advocate for our profession to the public because they're paying for it. Let's talk about some numbers here. How much money are we gonna spend in healthcare on this country this year? It's about $3.2 trillion or so. That's a big number. It's too many zeros for most of us to think about. So another way to think about this is what percent of all our economic activity goes to healthcare? And we usually think about this in terms of gross domestic product, which is, they define that as the total of all the services provided and goods produced in an area in a given amount of time. So United States 2018, think about every bit of economic activity you see out there, whether it's huge or tiny. And what percent of all that goes to healthcare? This year, it's probably about 18% or so. And pretty soon, it's gonna be 20%. That means 20 cents of every dollar, a penny out of every nickel that's spent in this country is gonna be spent on healthcare. And how much of all this does the government pay for? Government at all levels, federal, local. Well, you can think about direct government expenditures like paying for the healthcare system or for city or county hospitals. You can think about the tax write-offs that non-profits get when they provide healthcare. You can think about the part of government employees, health insurance premiums, if they buy private insurance in their employer, the government pays for that part of it. So add all this up collectively, how much of all this comes from the government? About 64%. And pretty soon, it's gonna be more than two-thirds. And what about that remaining third? Well, you pay for that directly with your out-of-pocket costs, or you pay your part of health insurance premiums, and again, that winds up coming out of your pocket. So bottom line, the public are the ones who pay for this, either through their taxes or directly. And when they have that much skin in the game, they have a right to know where their money is going to make sure their money is being used as effectively as possible. Now, there are many other types of advocacy we can talk about, but I'm just going to cover one more here today. I think we need to advocate for our patients' health to our patients. So what does that mean? Well, we just heard a fascinating discussion from Dan Ariely when he talked about some of the bad health habits that we do. And so many of our patients seem to think that a lifetime of bad health habits can be fixed with a simple operation or a simple pill. Well, we all know that's not the case. I think patients need to be taught to be responsible for their own health care, and it's our job to teach them. As a matter of fact, words are important. Words mean things. So I think we should even change our language and talk about ourselves not as health care providers, but as medical care providers. Because when their health goes off track, then we can get them back on track and restore them to a position where they can manage themselves. We can't be there all the time to make sure they exercise and eat right and don't text and drive and make sure they brush and floss and do all those things. And I think if we could get people to recognize this and take more ownership of their health, certainly their health would be much better, and as a result, the health of our country is going to be much improved as well. So we've talked a lot about administration, we've talked about advocacy. Let's talk about altruism. And again, you all know what this is. It's volunteerism or community service or giving back, you know, lots of names. And this is nothing new. I mean, this is a concept that's basically as old as civilization itself. If you look at Hinduism and Buddhism, they have this concept of karma, right? And karma just says that the sum total of a person's actions determine his or her fate. Another religion is Christianity, which has the well-known story of the Good Samaritan from the Gospel of Luke, in which a Jewish person was beaten up and left for dead on the side of the road, and leaders of his own faith community came upon him and didn't want to get involved. You know, they did one of these numbers. They just ignored him and kept going. The person who stopped the health of him was a Samaritan. To put this in context, you need to understand that 2,000 years ago, Jews and Samaritans were bitter enemies. They were not going to stop and help each other out. So you can imagine how the people listening to that parable 2,000 years ago were scandalized to think about what they were being told. Now, religion aside, I think a lot of us have this idea that there's some kind of universal justice out there. You know, we all heard the phrase, what goes around comes around. Well, actually, that's just a restatement of karma. But if people want to think about it as a non-religious statement, you know, that's okay. Now, even though I'm talking about selflessness, there are also a couple of really important selfish reasons to be altruistic. One is that it's good for you. Many of us have read Stephen Covey's classic book, The Seven Habits of Highly Effective People. Do you remember his seventh habit? It's called sharpening the saw, taking some time out periodically to kind of refresh yourselves. And he especially thought that community service was a great way to obtain spiritual renewal and help keep you vigorous and strong and able to continue in your job. A more contemporary reason along the lines of selfishness is that it seems that volunteerism or community service is a great way to prevent and maybe even treat burnout. Not always possible. If you're so burned out, you're too exhausted to do anything. But if you feel yourself heading in that direction, it may be a good idea to try to, you know, think about looking outward. I want to take a minute to talk about my university. I went to College University of Dallas, which was a great school. And one of my English professors, a guy named Gene Kurtzinger, and one day he launched into this fascinating discussion about activities that kind of take us out of ourselves or things we do which we can lose ourselves. So for example, art. I think everyone here has gotten so lost in a song, a movie, a book, a painting, a sculpture, a dance performance, an opera, that you kind of lose track, or as I think of it, you lose yourself in space and time. Another activity is religion. A third is sex. With my kids sitting here, we're not talking about that one anymore. And a fourth is sports, whether you're participating in some sort of athletic event or watching one. We've all been there, where suddenly you look up and you realize an hour has gone by, and you didn't even know it. Someone in class asked about the heroic act, you know, running in front of a speeding car at the last minute to pull some kid out of the way, and he thought that was a good example. And years later, I would add surgery to that list, because I realized once you're in the OR and everything is just clicking and going along, you really can kind of lose yourself there for a while. Years later, there's a well-known psychologist, Mihaly Csikszentmihalyi, he would coin the term flow to describe the same state. We also think about it as being in the zone. Well, this is all great, but what's one problem with all these things? They're all temporary. Maybe we can kind of reach some sort of higher level, but then the event ends and we come back down to earth. But wouldn't it be neat if there was some sort of way to keep this kind of humming along in the background all the time? Maybe not up to here, but maybe down to here. And I'd like to think that service might be one way for us to get there, that for constantly kind of thinking outward and thinking about other people, maybe it would help us, like I said, reach somewhat a higher level and have a better outlook on things. And there are plenty of examples to serve. You all know them. I don't have to tell them to you, right? There's things like homeless shelters, crisis centers, other community or faith-based organizations, volunteering at a child's school, certainly helping in professional societies like the AANS and many others, or advocacy work on behalf of your specialty or your profession or anything else that's important to you. Certainly spending time with students, residents, other colleagues who may need your help, that's important. I think maybe one of the most important and kind of unique ways that we can help, given our job as neurosurgeons, is spending time with patients and families who really need it. So if you just told a father of young children he's got a glioblastoma, or you just come into the hospital at 3 o'clock in the morning and had to tell a family that their loved one has had a severe brain injury or massive stroke, you've just turned these people's lives upside down. And certainly you have to tell them the diagnosis, the prognosis, what the treatment plan is. But it would be an incredibly altruistic thing to do to spend even more time with them, whether they want to talk or cry on your shoulder or just sit with you in silence. And no one else can do that. You're the one who's giving them the news. You're the neurosurgeon. You need to be the one who does that for them. Now certainly at a meeting devoted to service, we can't think of any better Cushing order than General Stan McChrystal. I'm looking forward to hearing him tomorrow. And on Wednesday, we'll hear from a couple other fascinating people. These are both neurosurgeons. Merwin Bagan. He's a past president at AANS. Merwin had a very successful career. He's actually our single largest donor to NREF. But when he retired, he didn't choose a comfortable life. He and his wife went to Nepal to build neurosurgical infrastructure there in a part of the world where it was sorely needed. Mike Hagelin's a faculty member at Duke. So of course, this is a high powered academic place. He's got to do the usual grants and papers and all that. He also has a busy clinical practice. In spite of all that, he finds a lot of time to go to Uganda and do work similar to what Merwin had. So we'll hear from them on Wednesday. I remember a talk I had this year at the New England Neurosurgical Society. They invite the AANS and CNS presidents every year. And Andy Wakefield from Connecticut is convinced that neurosurgeons and other physicians taking time out of their practices to go volunteer overseas for a short period of time. He's convinced that happens a lot more commonly than people recognize. He thinks it happens all the time. I'll never forget what he said. He said, we make a difference. It's the right thing to do. One of the most inspiring people I met this year is Key Park. Key is a Paul Farmer Global Surgery Scholar at Harvard. There was another one of these kind of casual conversations that really left a big impression on me. Key was worried how he was going to be able to maintain his certification by the American Board of Neurological Surgery because he's not going to practice in this country. All this clinical work is going to be done overseas. He's also gotten into some global surgical health policy work, which is fascinating. These are all kind of big things I'm talking about. Taking time out and going overseas and stuff you can plan, but it's possible to serve on so many ways on such a smaller scale. And sometimes you don't have time to think about the opportunity. So yesterday afternoon we had a fascinating session with people right here in this community who had the option of stepping up or going away when Katrina came. And they all stepped up from very different walks of life, and it was a great session. So one of our very own neurosurgeons, Nate Seldin, was driving through downtown Seattle last December with his son when they came across a scene of a horrible train accident in which several people died and scores were injured. Nate and his son could have kept going, but they stopped, and they got there before many of the first responders did. And Nate's a busy guy. We're all busy people, right? We've got places to go. But he stayed for a few hours while every patient had been triaged and taken away. So a question for you all. Later today or tomorrow or Wednesday, you're going to be flying home. And what do you do when you're on the airplane and a flight attendant asks if there's a doctor on board? Do you ring the call button, or do you sink down lower in your seat and hope no one bothers you? So a couple other things to talk about here. Let's talk about priorities, and specifically the cost of service, because right now cost is a huge topic of discussion in our healthcare system, especially as neurosurgeons are big rainmakers for our employers and our hospitals. There's this idea we should just be in the OR all the time operating. Well, that's not a good idea for several reasons. We're starting to see lots of literature that people who are actually involved in things like research and quality performance initiatives actually have better outcomes than those who aren't. And also, it really kind of diminishes the total contribution we can do to our patients and our healthcare systems. So let's start thinking about this in a different context. What's the World Bank's definition of extreme poverty? Well, in 2005, it was $1.25 a day, and if you play that forward for inflation, it's about $1.60 a day. So what does that mean? That means that extreme poverty means you live on less than $1.60 a day. Now, think about that. That's less than you spend on a soft drink or a cup of coffee. How many people live below that threshold? About 1.3 billion people. Billion with a B. That's one out of every six people living in the world lives on less than $1.60 a day. Now let's turn this around. How much money do you need to be happy? Maybe you should have had Daniel Ariely talk about this. But there was a fascinating paper written in 2010 by a couple of Princeton economists, Daniel Kahneman and Angus Deaton, and they've each won a Nobel Prize, but not for work they did together. But in their paper, they came up with a figure of $75,000. And basically, the idea is that once you can cover the basics, you know, food, clothing, shelter, extra income above that doesn't make you happier. As I said, we conclude that high income buys life satisfaction, but not happiness. And again, it might be interesting to hear what someone like Ariely would say, considering how he showed us how we have very distorted views of looking at things. Now please don't get me wrong. Neurosurgeons absolutely deserve to be compensated for all the many years of grueling effort we put into learning our specialty. Long after our friends from high school and college are already established in their careers, we're still training. And we have a very complex body of knowledge to master, and that keeps changing all the time. So we have to study for the next 30 or 40 or 50 years. Then we have to develop the manual skills and the ability to think in three dimensions about how to solve some of these problems surgically. And the hours don't get any better. Maybe residents only work 80 hours a week, but there's no limit when you're in attending. And finally, perhaps the biggest drawback is that the emotional toll can be huge, because we deal with some of the most tragic and desperate circumstances people can face. So no problem at all with neurosurgeons being compensated for what we do. As a matter of fact, money can be a remarkable force for doing good in the world. If you don't believe me, you may have heard of a guy with a small startup company called Microsoft. And Bill Gates had a great idea, worked incredibly hard, became one of the richest people in the world. And then in the middle of his career, he reinvented himself and became one of the greatest philanthropists in the world. Millions of people have benefited because of what he's done. At a much smaller scale, many, many other business people, entrepreneurs, and others are able to do the same thing. And we, as neurosurgeons, are in a position to serve others not only through our craft and our skill, but through our generosity. Now, we often hear that money is the root of all evil. That's not true. Here's the full quote. The love of money is the root of all evils. And there are some who, pursuing it, have wandered away from the faith and so given their souls any number of fatal wounds. You can't say it any better than that. So given their souls any number of fatal wounds. This is how some of our colleagues get into big trouble, right? I mean, think about it. If you're a star athlete and you suddenly start worrying more about your salary and about endorsement deals than about your sport, you're sunk. If you're an artist and you suddenly get more caught up in fame and perks and lifestyle than you are about your art, you lose your edge. Well, likewise, if you're a neurosurgeon and you let anything come between you, any oath you took to take care of your patients, you are flirting with disaster. And that's how some of our colleagues get into trouble. Priorities become distorted, decision-making goes off in crazy directions, and pretty soon you wind up on the front page of the local paper or as a lead story on a local news website for all the wrong reasons. You don't want to be there. None of us in this room wants you to be there either. And tomorrow we'll hear Dan Pink talk about what really motivates us, and it's not money. And on Wednesday, we'll hear Gary Green talk about athletes who are at the height of their sport and because of some distorted priorities and bad decision-making, they wind up in big, big trouble. Now, I need to make something perfectly clear. I realize that a lot of what I'm saying here sounds very naive and idealistic. Well, I am firmly grounded in reality. And I often say that even Mother Teresa had to balance her checkbook. And unfortunately, the healthcare space is very crowded, and there are a lot more needs than there are resources, so there's competition. And it can get pretty ugly and nasty and muddy sometimes. I mean, I used to be chair of the Washington Committee. I know how this works. And even though there's lots of competition and we may be very much in the arena, as Teddy Roosevelt would say, all we need to do is keep thinking why we're there. We're focusing on what's best for our patients and our ability to educate the next generation and do the research that'll make our care even better. And if we stay focused on that and don't get involved in any of the mud, we'll do okay. And I've seen firsthand how, unlike some other groups, we as neurosurgeons get a lot of respect because we have principles and we stick to them. And even those people who may disagree with us at least respect us, not only because of our principles, but of course, our consistency. So what have I talked about here today? Well, I started by giving a lot of thanks to people who helped me along the way, and I tried to convey a sense of gratitude that we're able to do this incredible job in this country of limitless opportunity. And I've tried to convey the idea that service is really not only the core of our profession, but the core of our humanity, and introduce a concept of a new triple threat, someone who can excel in administration and advocacy and altruism, because that's how we're going to survive, not just in our individual practices, but as a specialty as a whole. And I think in this context, you realize that the costs of service are nothing compared to the many benefits. But I firmly believe that the best reason to serve is it's the right thing to do. And doing the right thing for the right reasons makes all the difference. It's interesting that also doing the right thing for the right reasons makes us not only better doctors, but better people as well. Now, some of my comments may have been unconventional or maybe even uncomfortable reminders of the enduring virtues that are necessary for it to be good doctors as well as decent human beings. Well, if I've made you uncomfortable, use that as an opportunity to look inward and reflect upon what really motivates you, and then also reflect on the deeper meanings of those motivations and their rewards, not just for yourselves, but for other people as well. You know, it's important to remember that the work we do has real meaning, and doing that work makes us some of the luckiest people in the world. As I've challenged you, I also challenge myself to try to use all our many talents, our compassion, our work ethic, our intelligence, our incredible life experience to make this world a better place. Remember that the privilege of doing this work makes us the luckiest people in the world. So what's the bottom line here? It's simple. Pay it back. You know, from those to whom given, much is expected, and I think we are some of the most fortunate people in the world. I also, again, would try to get you to focus all your many talents on making this world the best possible place it can be, not just for you and your patients, but for future generations. Remember, the need is great. The opportunity is even greater, and it's available to every one of you. Thank you for the privilege of serving you. Thank you.

Dr. Alex Vlodka

service

resilience

career in medicine

animals

patients

administration

advocacy

neurosurgery