History of the Council of State Neurosurgical Societies

Regional, national and international neurosurgical societies were formed predominantly in the first half of the 20th century to disseminate advances in neurological surgery and to promote research. Socio-economic matters were usually privately managed between neurosurgeons and their patients. However, with the expansion of third party payers and the advent of Medicare in the 1960s, socio-economic issues began to impinge on the practice of neurosurgery and could not be ignored.

In response to Blue Shield initiating relative value scales in various states, the Congress of Neurological Surgeons (CNS) established a Socio-Economics Committee in 1963 under the Chairmanship of the late Dr. William Mosberg. This committee, composed of appointed members representing as many different states as possible, surveyed neurosurgeons and published the first Neurosurgical Fee Survey in 1966 and Neurosurgical Utilization Guidelines in 1969. In 1972, the American Association of Neurological Surgeons (AANS) joined the CNS in forming the Joint Socio-Economics Committee (JSEC). The initial Joint Socio-Economics Committee (JSEC) had co-chairmen with Dr. Russel H. Patterson, Jr. appointed by the AANS and Dr. Edwin Amyes appointed by the CNS. Dr. George Ablin was the first Secretary. JSEC members were appointed by the presidents of the AANS and CNS.

When the Congress of the United States passed the Professional Standards Review Organization (PSRO) law in 1972, which set up review organizations in each state to monitor medical care, the JSEC and the AANS/CNS recognized the need for individual state neurosurgical societies to interact with these PSROs. At the AANS meeting in the spring of 1973, JSEC, with the support of AANS President Meacham and CNS President Patrick, appointed an advisory group of geographically diverse neurosurgeons to meet under the guidance of Drs. Amyes, Patterson and Ablin in order to facilitate the formation of state societies to interact with the PSROs and provide input to the JSEC regarding local and regional economic issues. Thirty seven neurosurgeons representing a majority of the states met at the O'Hare Airport on June 23, 1973. This group chose to name itself the National Advisory Group and elected Dr. Frank Wrenn as chairman. At this first meeting, the attendees divided themselves into four regions; the Northeast, Northwest, Southeast and Southwest in order to facilitate information transfer and regionally assist each other in the formation of state societies.

The National Advisory Group, under the leadership of Dr. Wrenn, promoted the establishment of state neurosurgical societies in those states which did not previously have state societies. There were 21 state neurosurgical societies in existence in September, 1974; now there are 37. Eight additional states are in two regional societies, the Midwest Neurosurgical Society (Nebraska, Iowa, South Dakota & Kansas) and the New England Neurosurgical Society (Connecticut, Maine, Massachusetts & New Hampshire) and all eight have delegate positions in the CSNS.

The National Advisory Group was under the umbrella of the Joint Socio-Economics Committee and reported to this committee. The National Advisory Group would meet during the JSEC meeting twice each year and when JSEC decided to have its meetings just before rather than during the AANS and CNS annual meetings in 1974, it moved to that time slot as well. The National Advisory Group initially had its membership appointed by JSEC but as it evolved, each state society began to send representatives to the National Advisory Group meetings as essentially elected delegates. The National Advisory Group changed its name to the Council of State Neurosurgical Societies (CSNS) in 1976 and formalized the elected state delegate concept. JSEC appointed Edwin Amyes the first Chairman of the CSNS in 1977 and the CSNS held its first formal meeting in 1978.

The Council formalized the four quadrant division of the group and structured many of its procedures upon the activities of the quadrant chairpersons. In 1982 JSEC and the CSNS recommended an AANS by-laws change to create four regional AANS Board Directors, one elected from each CSNS quadrant and in 1983 the AANS by-laws were so amended.

The Council of State Neurosurgical Societies initially functioned as a committee of and reported to the Joint Socio-Economics Committee and met as part of each JSEC meeting. Because the scope of CSNS' socioeconomic interests was so wide, its meetings became a substantial part of the JSEC meetings and the Council developed its own set of officers including a treasurer to oversee the Council's separate budget. It became clear that the Council was functioning as more than a committee of the JSEC.

Responding to recommendations of the AANS Executive and Long Range Planning Committee and the CNS Executive Committee in 1984, based largely on previous recommendations made by the CSNS to consolidate the CSNS and JSEC to avoid duplicative efforts by similar committees in each body, the JSEC/CSNS organizational structure was streamlined in1986 and became the Joint Council of State Neurosurgical Societies (JCSNS) with a single set of officers and a membership composed of delegates elected from each state society plus delegates appointed by the parent bodies. The council subsequently changed its name to simply the Council of State Neurosurgical Societies (CSNS) and to this day functions as a joint committee of the AANS and CNS much as the AANS/CNS Washington Committee and the various subspecialty joint committees.

The early CSNS meetings were marked by adequate information exchange but recommendations by the CSNS to the parent bodies were frequently the result of issues brought up during the meetings and acted upon with limited time for study or refinement. In 1995, at the instigation of CSNS Chairman Stan Pelofsky and Vice-Chairman Jim Bean, the CSNS adopted procedures requiring it to act as a representative assembly with a well defined resolution process that mandated pre-meeting submission of resolutions and their study by appropriate committees prior to consideration at the actual CSNS meeting.

The CSNS is composed of members of the various state neurosurgical societies in the ratio of 1 representative per 50 state society neurosurgeon members. Each state has at least one representative and states without a society may have one neurosurgeon from that state declared a delegate by the CSNS Chairperson. The Presidents of the AANS and CNS appoint members/delegates to the CSNS in addition to the state designated delegates and 12 neurosurgery residents are elected as delegates from the four Quadrants. The Council meets twice a year just before the annual meetings of the AANS and the CNS during which it considers resolutions submitted by delegates or its committees and receives reports from those committees as well as the AANS and CNS. Resolutions that are adopted by assembly vote are sent to the AANS/CNS for consideration and potential implementation.

Throughout its 35 years of existence, the grass roots concept embodied at first by the National Advisory Group and subsequently by the Council of State Neurosurgical Societies has functioned well as egalitarian input into the generally hierarchical leadership of the AANS and CNS. There have been times (more past than present) when the parent bodies may have characterized the grass roots input in terms of the National Advisory Group's acronym used as a verb but there has never been any wavering of support from the AANS and CNS for the concept of a CSNS and the Council's budget which now approaches 150K a year. The Council does not function as a policy setting body like the AMA House of Delegates and that leaves the Executive Committee of the CNS and the Board of Directors of the AANS considerable leeway and greater nimbleness to steer the neurosurgical ship. The Council does cover a lot of socioeconomic ground upon which the parent bodies rely and for which the AANS and CNS have expressed their gratitude. The CSNS continues to have the ear of its parent bodies and will continue to pursue the concerns of the neurosurgeon in the trenches.

Submitted by John M. Thompson, M.D.
Former Secretary of JSEC and JCNS
Edited by Randall Smith, M.D., CSNS Historian
September, 2008