National Neurosurgery Update from the CSNS Fall 2018 Meeting

The Council of State Neurosurgical Societies (CSNS) represents the official socioeconomic arm of neurosurgery and is a national organization composed of representatives of state neurosurgical societies, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS). The CSNS sponsors a one-year socioeconomic fellowship for residents representing four quadrants nationwide who are vital to the composition, debate and final vote on resolutions. Within the CSNS, the Young Neurosurgery Section (YNS) runs an active committee tasked with representing young neurosurgeons nationwide in the discussion and debate of important neurosurgical socioeconomic issues.

The Fall 2018 CSNS meeting was both dynamic and prolific, with eighteen resolutions presented and debated – the second greatest number in CSNS history. Resolutions are formal declarations of issues of interest to neurosurgeons that are deliberated and voted upon by the CSNS, and then submitted to the parent AANS/CNS organizations for a final vote and approval. Resolutions have included public statements on important current events, calls for research and formal study and requests to the parent bodies to take a stand on important socioeconomic issues, such as malpractice, reimbursement, contract law and more. Highlights and issues relevant to young neurosurgeons from the 2018 meeting include the following:

  • Sherry Taylor, MD, PhD, FAANS, chair of the Medical Directors Section, provided a useful overview, comparing methods of neurosurgeon employment, including solo, group, hospital and academic employment as well as summarized several tips for young neurosurgeons seeking to negotiate their first contract.
  • A white paper on balanced billing presented by Luis Tumialán, MD, FAANS, of the Medical Practice Committee.
  • Updates on the medical review panel project presented by Bharat Guthikonda, MD, FAANS, of the Medicolegal Committee.

New resolutions during the meeting included expansion of advanced leadership development tracks (Resolution II) within the CSNS, in conjunction with the CNS and the AANS. This aims to be a significant pathway for residents interested in expanding their involvement within organized neurosurgery. Another resolution sought to form a Physician Wellness Committee within CSNS (Resolution III) to evaluate studies, strategies, actions and policies to ameliorate the effects of burnout. A popular resolution that passed was Resolution X, a call to investigate and raise awareness about cybersecurity threats towards implanted neurosurgical devices. Discussion within the YNS committee was particularly animated for this resolution, with many of its young, technically savvy members sharing their institutional experiences in combating hacking.

Other prominent resolutions included those aimed to inform surgeons about gainsharing initiatives and practices used around the country (XI), non-compete clauses within neurosurgical contracts (XIII) and the appropriateness of neurosurgical transfers and integration of telemedicine services (XV). Another resolution aimed to evaluate, along with the CNS, the AANS and the NeuroPoint Alliance, the feasibility for all neurosurgeons to participate in CMS-approved, qualified clinical registries (XVIII).

The Handbook of Neurosurgical Socio-Economics and Leadership, a CSNS-branded publication designed to inform residents transitioning to practice, was also discussed. Introduced as part of a resolution from spring 2018, the handbook is planned to include chapters on coding, reimbursement, practice building and management, credentialing, medicolegal issues, quality and performance improvement, government advocacy and neurosurgical leadership. The handbook is scheduled for completion next year and is set to be available online to all neurosurgical residents.

Gary Steinberg, MD, PhD, FAANS, professor of neurosurgery from Stanford University, headlined the YNS reception. Dr. Steinberg discussed his career in neurosurgery, including his upbringing, passion for research in vascular neurosurgery and eventual rise to chair of his department. Dr. Steinberg spoke about the importance of following your passions within neurosurgery and taking opportunities when they arise, even if they are inconvenient. He also discussed his emphasis on personal character, strategy for program development and the importance of fulfilling the need for newly recruited faculty, rather than fitting them within a specific subspecialty role. He further stressed the importance of spending time with family and getting good exercise to maintain a long, healthy career. He closed by stressing that residents seeking to develop their career must be available, affable and show solid clinical ability.

The CSNS aims to empower residents and increase awareness of socioeconomic issues. For those interested in getting further involved on projects, presenting resolutions to improve neurosurgery on a national level or for other comments/inquiries, visit the CSNS website ( or email Anand Veeravagu, MD ( For those interested in serving as a CSNS socioeconomic fellow, applications are due in March 2019.

Darian Esfahani, MD, MPH
Neurosurgery Resident
University of Illinois at Chicago

Michael Karsy, MD, PhD, MSc
Neurosurgery Resident
University of Utah

Anand Veeravagu, MD
Assistant Professor
Stanford University