To start off our session, Dr. Alex Vlodka, who is the current president of the AANS will open our session. Thank you. Good morning. Thank you all for coming to New Orleans, and thank you for getting up so early on a Sunday. You know, I never worked with an advanced practice provider until I was about 13 years into my career, and it really was an eye-opener for me. And I remember numerous times when I've sent a nurse practitioner or PA down to rescue patients from residents who didn't quite know what they were doing, although they thought they did. And as you think a lot about the problem we're going to have providing health care to people, not just in this country but around the world, as the population ages, their health care needs are going to increase, and our opportunity to offer more treatments for them will also increase. There's no way we're going to meet that need without a lot more help from other physicians, but especially help from you all. So thank you all for coming and showing an interest in neurosurgery. So I'll talk a little bit about AANS and then a little bit about this particular meeting. Not many people know this, but AANS is now actually a conglomerate. We have three different entities. We split this out a couple of years ago. So AANS is the one you're all familiar with, and that includes the Journal of Neurosurgery as a part of that. NREF is our foundation. You know, if people want to get a tax rate off to give something to sponsor research and education, they go there. NPA is kind of our data storage and analysis operation, and this future is certainly going to be there. And we split them apart a few years ago when I was treasurer. And it's interesting, just like they say the universe is still expanding at an accelerating rate, so I think the distance between these three entities is expanding, which is good. It means that if NREF and NPA started as children, they're growing up and rapidly becoming independent. And if you look down the horizon, the way meetings like this are financed, exhibitors don't want to spend as much money on exhibit space, and that's a big source of revenue for us. Our Journal of Neurosurgery also generates revenue, but what's the future of print media? We all know what's happened as other newspapers have had to transition to digital. So it's possible that NPA may actually become the driver that fuels all this stuff by the end of our careers. I don't want to make you a tax attorney, but we're actually two separate tax structures. A 501c3 is that part of the Internal Revenue Service Code that lets you perform charitable work. So that's how we can work with things like NREF and offer research grants and things. But the 501c6 allows us to do lobbying and political advocacy and be a for-profit corporation. And the union between those two is seamless, but we make sure we stay on the right side of the law. When I was president-elect, we started a strategic planning initiative, and this is our mission statement. Highest quality of patient care and advanced specialty of neurological surgery. And these are our values. Now, this looks pretty silly, unless you've ever been involved in one of these, because what's just as important as what's on that screen is what's not on that screen. So, for example, there's nothing there about how we're going to try to maximize every neurosurgeon's revenue. We all want to make $10 million a year. But we're not going to destroy people who compete with us in border areas like orthopedic spine or neurology for endovascular. If we just focus on this and take care of our patients, the rest will fall into place. Here's our goals for our strategic plan. We don't need to go into that. Now, you may be familiar with the fact that the ANS and CNS are the two big what we call apparent organizations, but they combine for eight different sections. Section on tumors, section on cerebrovascular, section on spine, section on trauma. It has become increasingly clear over the last few years that the sections are really where the action is. And the CSNS stands for Council of State Neurosurgical Societies. That's sort of our grassroots lobbying sort of operation. And, again, that's member-driven. In any big organization, not many good ideas come out of headquarters. You kind of push it down to the people who actually do the work. So that's where the different sections are generating a lot of the innovative ideas and ways to solve problems and offering some of the most popular CME in the whole neurosurgical universe. This is our executive committee and a great group of people. A lot of people think that as president I get to do whatever I want. And it may have been that way in years past, but I can assure you these people never let me get away with anything. It's a very flat hierarchy, and there are no egos involved here, which means that if somebody wants to say you're stupid, they do that, but in a very diplomatic and politically correct way, and no one gets upset. By the way, Shelly Timmons on the left side, she takes over from me in about three days, I think. It's a little bit confusing. She's the first female neurosurgeon to be president of ANS, but she will not be the first female. Does anybody know who the first woman president was? Louise Eisenhardt. Louise Eisenhardt. Yeah, she started, I think, when Harvey Cushing's secretaries or something went to med school, became a great neuropathologist. So she was the seventh president, I believe, of AANS, and then she became editor-in-chief of the Journal for 20 years. Remarkable person. You consider even way back then when women didn't even go to med school, she had some very prominent leadership roles. Here's our management team. Excellent people. Everyone from Beth at the top right, who joined in January, to the bottom middle, Chris Phillips, this summer will celebrate her 30th anniversary with AANS. That's longer than I've been a neurosurgeon. And for better or for worse, lobbying and advocacy is a big part of medicine nowadays, and we have an outstanding team in Washington. And finally, I know I was talking about the sections and the importance of kind of pushing things down to the local level. Well, at the same time, it's become apparent that we need to look up and deal with the rest of the world, and the world gets smaller every year. So the World Federation of Neurosurgical Societies is broken up into five big continental societies. Australia and Asia are combined, and Antarctica doesn't get one. So the AANS is the North American continental society, and we are increasing our collaborations with others. So at this particular meeting, the European and African societies are our partnering societies. And next year in San Diego, we'll have the Asian-Australasian group and FLOC, the Latin American group. So again, welcome to New Orleans. And some of you who were here the last time AANS was here in 2013 may remember a horrible downpour. The heavens opened right at about 6 o'clock on Sunday afternoon when we were supposed to end their opening session and walk to places to block away. But literally, it was one of these things where probably two inches of rain fell in an hour. So there's a mad scramble to get buses and get people over there, and it was a bit of a Charlie Fox triad, as they say in the military. Well, just to prove to you how influential and powerful the AANS has become, we got perfect weather for this meeting, so no chance of a downpour. Tomorrow at 5 o'clock, the session is going to focus on people who helped this area recover after Katrina, because in a meeting focused on the privilege of service, these people were living their lives one day, and the next day they had to help their community, or they could have just walked away. So Bill Cassidy is a senior United States senator from Louisiana, and I got to know him years ago. I'm a past president of the Washington Committee, and he and I actually get along pretty well. So he'll be there. At that time, he was a state senator out of Baton Rouge, and he helped organize a lot of places for the Katrina evacuees to hang out. Tommy Smetanovic is a restaurateur, and somehow, even though the rest of the area was underwater, his restaurant was still opening and had power. And instead of using that to consolidate, he actually opened up his kitchen and everything to his competition in the area and helped everyone survive and help feed the people who were here. Bendy Boyblock is an intensivist who was faced with taking care of dozens of patients at Charity Hospital with no power, people on ventilators and in ICUs. Arnie Fielkow was working with the New Orleans Saints at the time, and there was talk at the time of just moving the Saints out of New Orleans altogether and putting them in San Antonio. And against his leadership's wishes, he was a vocal opponent of that. And it sounds like a small thing, but when your community has been totally wiped out, you need something to rally behind. And sports is one of those things that everyone from the lowest person on the socioeconomic scale to the richest guy in town can rally behind. And the moderator is going to be Norm Robinson, who was the local New Orleans news media anchor for many years, great guy. We're in reception a couple blocks away. You'll be able to walk there without getting soaked. What we did this year is we moved the Louise Eisenhardt lecture, which has historically been on Wednesday, moved it to Monday, because we get some great speakers there, and by Wednesday a lot of people have left. So we're having Angela Duckworth lead off. Has anyone heard of Angela Duckworth, the grit lady? She wrote the book Grit. And, you know, the nice thing nowadays is you can vet all your speakers by looking at them on YouTube. And I like to run in my spare time. If I'm running outside, I listen to podcasts, and that's where I got most of my speakers from. So you think this person would be interesting. You go home and you cyberstalk them on YouTube and make sure they can speak well. And she's a wonderful lady. I talked with her a few weeks ago. Dan Ariely, particularly irrational. I don't know if you people have heard of him or read any of his stuff. He's one of these psychologists who designs these simple little experiments, and they give you some profound insights into human nature. So, for example, we all cheat. But we only cheat a little bit, and that makes us feel better about it. So we'll see what else he has to talk about. Dan Pink is a business author, and he's a fascinating guy. He'll talk about what motivates people. And the idea that if you let people try to solve a puzzle just out of the intrinsic challenge, they'll jump on it. But then if you offer them money as a reward for doing it, their performance drops off. So I talked to him just the day before yesterday, and I gave a copy of his book to all my faculty when I took over the chairmanship of VCU a couple years ago. So Stan McChrystal is the Cushing Order. That's our premier lectureship. So a little secret just between those of us in this room. When we were trying to think of who the Cushing Order should be, I thought you want people who have devoted their lives to service in keeping with the theme of the meeting. And the best examples of service are either people in the military or people who devoted their life to religion and their faith. And I thought, you know, there's a retired pope floating around the Vatican. He can't have too much on his calendar right now, but we decided not to go there. So our first choice was actually reaching out to the Dalai Lama. So I got to indulge my childhood fantasy for those of you who have ever seen Caddyshack and Bill Murray, the Dalai Lama himself. And his embassy said that His Excellency is actually getting old and doesn't travel very much anymore, but he's a great speaker. If you ever get a chance, look him up on YouTube. So we figured we better get away from a man of peace. We went to a man of war, then got General McChrystal. And he's spoken and written eloquently on leadership and service. So Gary Green is a name you may not know. He's the medical director of Major League Baseball. I've been a consultant to the commissioner of MLB for a while for concussion. And Gary's a great guy. He's an expert in performance-enhancing drugs. He's out of UCLA. He's got a good sense of humor. But he's got this fascinating talk about the things athletes will do to try to game the system and up their performance and some of the consequences of it as well. So at a meeting focusing on service, we'll feature on Wednesday the Schneider Lectureship. There's actually two people. Merwin Bagan's a past president of this society, and he's also our single largest contributor to NREF. And when he retired, he actually went to Nepal, he and his wife, and helped build neurosurgical infrastructure there. Mike is a faculty member at Duke who does similar work in Uganda. And Reg Haid is our instinctive, natural interviewer. So that should be a great session. And finally, the Van Wagenen Lectureship. Van Wagenen was the first president of AANS, and his family established the Research Foundation. It's a very prestigious competition among residents. And it funds them to go overseas for a year to do research to further their academic careers. And if you look at people who have been Van Wagenen fellows and track their careers subsequently, it's a very impressive list of folks who have gone on to contribute quite a bit in neurosurgical research and be leaders in the field. So that is our lineup. And again, I thank you all for coming to New Orleans. I hope to bump into you at the opening reception and in the hallways of the convention center here. Thanks. Thank you.

Dr. Alex Vlodka

AANS

neurosurgery conference

advanced practice providers

collaboration among physicians