The Value of the Neurosurgeon

The value of the neurosurgeon to our communities across this great nation is without measure.  Neurosurgeons are the protectors of the central nervous system.  As the dedicated guardians of the crown jewel of evolution¹, we selflessly sacrifice a significant portion of our lives in that service.  The emergent craniotomy for an expanding epidural hematoma, the clip ligation of a ruptured aneurysm or the decompression and stabilization of an incomplete spinal cord injury.  All those interventions preserve and restore neurological function.  Those interventions save lives.  Our country, without the neurosurgeon on call and at the ready to act, would be unimaginable. 

However, over the past decade, our commercial payers, our hospitals and even our own government, have diminished the value of the neurosurgeon.  Instead of facilitating an already arduous self-sacrificing practice, the neurosurgeon in 2025 faces the burden of prior authorization, denial of payment even after successful prior authorization and declining reimbursement.  As hospital administrators continue to proliferate at an unsustainable pace and government regulations continue to mount, maintaining the true value of neurosurgeon remains at risk.

Since its inception, the Council of State Neurosurgical Societies (CSNS) has never lost its focus on the value of the neurosurgeon.  As the premier socioeconomic resource in neurosurgery through patient and physician advocacy, education, and leadership training, the CSNS has thoughtfully examined all aspects of the practice of neurosurgery and advocated for those changes to enhance the value of the neurosurgeon for decades.  This coming year will be no exception.

During my tenure as Chair (2025-2026), the CSNS will analyze those current aspects of the socio-economic landscape of neurosurgery that diminish our value.  I will place a particular focus on Section 6001 of the 2010 Affordable Care Act, which limits physician hospital ownership.  The ACA legislation empowered hospitals but hamstrung physicians.  As a result, the ACA’s promise of increased access to affordable care has not been fully realized.  How can such an aspirational goal become reality when the ACA legislation marginalized the most important player administering to a patient: the physician?  Advocacy for repeal of Section 6001 of the ACA offers the promise of increased quality, increased access and decreased cost.

The second focus will be on how commercial payers conduct themselves in the marketplace of healthcare.  Recoupments of payments in a delayed manner by insurance companies after completion of surgical care and denial of payments even after successful prior authorization have become commonplace in neurosurgery. No other industry tolerates such treatment.  Neurosurgeons should be no exception.  Advocacy for placing the burden of proof of surgeries performed not on the neurosurgeon but on the commercial payer places us on the same level as general contractors.  Advocacy for a guarantee of payment when a surgery performed precisely matches the prior authorization again places neurosurgeons at least equivalent with general contractors.  Few can argue that resection of a malignant glioma should not be on par with the construction of a home. 

The next focus will be on the fastest growing practice demographic in neurosurgery: the hospital employed neurosurgeon.  That growing trend may be related to the vertical integration of hospitals empowered by Section 6001 of the ACA.  Regardless of the cause, their voices need to be heard.  As such, the CSNS will serve as a forum for our hospital employed colleagues to gather, unify their voices and identify areas where a coordinated effort will increase their value. 

The CSNS is uniquely positioned to accomplish all these goals.  The bi-directional communication with state societies, the AANS, the CNS and the Washington Committee facilitates the education of these socioeconomic issues to neurosurgeons across this country.  Increased awareness leads to a groundswell of support.  Change becomes an inevitability. 

In the final analysis, we are advocating for the crestfallen patient with a recent diagnosis of a malignant glioma, the patient with a middle cerebral artery occlusion in the middle of the night or the mother of four children with a mobile spondylolisthesis who can no longer make it through the day because of the pain. Our relentless advocacy ensures access to the highest quality of neurosurgery care with the greatest value for these patients today, tomorrow and for the decades to come.

The value of the neurosurgeon is without measure.

Luis Manuel Tumialán, M.D.
Chair of the Council of State Neurosurgical Societies

1. Rhoton, AL, Rhoton Cranial Anatomy and Surgical Approaches, Wolters Kluwer 2023.