I have found this letter very difficult to write, not the least reason being that I can hardly believe that two years have passed since I stepped to the podium in Los Angeles to formally succeed Jim Bale as CNS President. It has been a wonderful two years; an odd thing to say, I suppose, about a time that began, really, with the devastation and dislocation brought on by Hurricane Katrina. I think such events teach us a lot about ourselves, clarifying our sense of what is truly most important in life and reminding us almost daily of the remarkable kindness and generosity that so many others possess and so freely share. I can’t tell you how extraordinary it was to see all of the outpouring of concern and help that seemed to rush in almost as fast as the water. I don’t think a day has passed that I did not hear from fellow child neurologists offering any kind and level of assistance that they had at their disposal, from shelter to job opportunities. I truly believe that this is just one measure of the heart to be found in our profession and Society. Ultimately my family and I were direct beneficiaries of enormous generosity in Houston. My children were able to go to excellent school because of Marvin and Gloria Fishman claiming us, essentially, as family. Gary Clark and his staff at Baylor embraced me as a faculty member. How many times does someone have such an opportunity? Our LSU Child Neurology group found strength and support in one another and with that found our way back to our patients and New Orleans.
As I reflect on the role of the President of the CNS it is clear that one needs to look not only at the immediate present, but five, ten, even twenty years into the future. My hope has always been to both continue down the excellent path that my predecessors have forged and be open to exploring other avenues as they open up in changing times.
The MAIN issues wrestled with during my two-year tenure have included the following:
-Workforce Issues. I do not think there’s a single member of the CNS that doesn’t see the growing shortage of child neurologists as THE dominant issue that needs to be addressed. We’re not alone in this, of course: many pediatric subspecialties are confronting similar challenges, as is neurology in general, if not quite so acutely.
Our initial efforts in addressing workforce issues really began about seven or eight years ago when we drew on the expertise of health economists at the University of Pennsylvania to begin surveying child neurologists to get a clearer sense of the changes they were experiencing “on the ground.” Follow-up surveys of child neurologists and on-line surveys of pediatricians, our primary referral source, have corroborated earlier estimates suggesting a significant (20 per cent) shortfall of child neurologists nationwide.
So now the question is: where do we go from here? As a small subspecialty and a correspondingly small professional organization with relatively limited resources in numbers and dollars, we really need to focus our efforts for maximum effect. We need to address recruitment, reimbursement, and the role of child neurology in the larger medical and public community.
-Recruitment. We are just now seeing the first sizable wave of child neurologists retire—the founding and charter members of the CNS when it started in 1972. Their departure is keenly felt. Thanks to the mentorship they provided and the development of the seventy-plus child neurology training programs we are able to continue successfully with an outstanding “second generation” of neurologists. And we’re drawing some truly impressive young people into the field, including a growing number of combined MD, PhDs. The problem is we’re not drawing enough of them. We have made efforts to address this; signing up with the San Francisco match has made a difference. Additionally, the outreach work done by the Child Neurology Foundation has helped raise awareness about our field among medical students. But we need to do more to convince prospective child neurologists early on, as undergraduates and medical students, that this is a great field to grow in and find real lifelong career satisfaction.
-Reimbursement. This is one of the chief concerns of some medical students and residents as they consider a career in child neurology. There is poor reimbursement nationally for specialties that are not procedurally based but are instead centered on cognitive skills. As one would expect, this has a profound negative impact on our members directly and does not go unnoticed by potential trainees. Trainees often must face a heavy burden of debt from their education and by necessity seek residencies that offer higher earning potential. This is a national issue and needs to be addressed on a national level. The CNS is working with other organizations such as the AAP and AAN to advocate for better reimbursement.
-The Role of child neurology in general, and the Child Neurology Society specifically in the larger medical and public community. Advocacy for children with disorders of their neurological system is a central focus of the CNS mission. This involves teaming up with families and organizations with similar missions, including a wide range of family support and disease specific research associations, as well as professional associations with whom we share both large numbers of members and interests: the AAN, ANA and AAP. The CNS has benefited greatly over the years from the willingness of these larger “sister” organizations to share their numbers and resources to influence policy changes affecting issues related to reimbursement and recruitment.
-CNS and CNF. We are indeed one and the same, with the common goal of advancing the mission of child neurology being the tie that binds. Progress has been made toward clarifying issues pertaining to mission and accountability at two retreats and through joint participation of representatives from each organization at the other’s board meetings. The CNF, under the direction of Mike Painter, its Board of Directors, and new Executive Director, John Stone, have worked diligently with contributors to solicit the funding necessary to support the missions of the CNS and CNF.
• Integration of the Society of Developmental Pediatrics has been accomplished. It is clear that the broadening of this area of interest in our society has been a great addition, especially with training programs now including Neurodevelopmental Disabilities. It is our clear intent that this group of trainees call their professional home the CNS
What is new and on the horizon for the CNS?
-CNS Web site. You may have noticed prior Letters from the President have not all been updated on the Web. We are midway through a transition from our original web developer to a new developer and, as with any repair or renovation (I still don’t have a kitchen!), not everything gets done according to our wishes and timetables. The new site should be completed by mid- November. Although the basic “look” will remain the same, its usefulness (and “ease of use”) should be noticeably enhanced. Two exciting new features developed by the Electronic Communications Committee will debut in November: a Journal club and a Case Studies section, both greatly enhancing the Society’s goal of supporting training efforts nationally. On-line CME capability will be added in January as well as a section designed to enhance prospective trainees’ ability to explore training and career opportunities in child neurology.
– Closer relationships with the AAP and AAN. We recognize that while our small size offers flexibility we do need to team with larger organizations to address more global issues.
—We now have Memorandum of Understanding with the AAP outlining a series of collaborations between the AAP Section of Neurology and the CNS. Through this common effort, the two organizations will seek to improve the health of infants, children, adolescents, and young adults who face the challenges of neurological and developmental disorders.
The two organizations will also work to promote the discipline of pediatric neurology in medical schools and in the pediatric marketplace in ways that will enhance medical care for these children and aid the growth of the subspecialty. It is recognized that combining the expertise and resources of both organizations will reap benefits for patients and their families, for pediatric neurologists, and for general pediatricians.
— The AAN is very receptive as well. I have had the opportunity to meet with AAN President, Dr. Stephen Sergay
(a child neurologist at heart). The organization is very willing to discuss common needs and possible support. For example, we have discussed training and workforce issues, and expansion of Child Neurology related topics at the AAN meetings and in the publications.
I want to close with a special note of gratitude to the many people who have contributed to the CNS the past two years. This society is successful because of the many contributions of the Committee chairs and their members, and the ever-sage and energetic Executive Board, just to name a few. It has been a real pleasure working with the National Office staff, most notably Mary Currey, CNS Executive Director and Roger Larson, our Associate Director; they are the touchstones of this organization and truly take the Society’s mission and the individual needs and concerns of its members to heart.
I am so proud to be a part of this very special group of committed physicians who truly love what they do and I am so grateful to have been given the honor to serve as your president these past two years.
—The QCCC is visible at street level from both
the Hilton and Delta Hotels. It may also be accessed via underground walkways that feature a number of shops and restaurants. Follow signs to the QCCC, then go up one level to CNS Registration Desk.
—The CNS Registration Counter is located on the 4th floor (i.e., Street Level) as you walk in. Registration for those NOT attending the NDC symposium begins at 1:00 pm, Wednesday.
—Wednesday’s Opening Reception will be held in the spacious 4th Floor (Street Level) Foyer.
—Exhibits and Posters will be on display Thursday (11:30 am – 5:30 pm) and Friday (11:30 am – 4:00 pm) in Rm 400A/B of the QCCC (Street Level).
—All symposia and breakfast seminars will be held in Rooms 200A, 200B or 301A/B of the QCCC. The rooms are located on the 2nd or 3rd level of the QCCC, accessed by taking elevators or escalators outside the exhibit/poster hall down to Level 2 or 3.
—Monitors throughout the building will keep you up on the day’s schedule. Updates will be shown on-screen before/between each session.
–CME credit. It’s simple, really: Attend the sessions, fill out the required on-line survey form by November 10, and you’ll have a certificate sent to you by December 10; miss the deadline, and you won’t. On-line CME survey will be available beginning Thursday, October 11.
–Thanks! Special thanks to Ortho-McNeil Neurologics, Inc. (tote bags and continuous beverage service), Ovation Pharmaceuticals (lanyards), and UCB, Inc. (CyberCafe and Thursday Moderated Poster Session on Epilepsy) for their generous support of this meeting and their continuing commitment to the Child Neurology Society Annual Meeting.
-Movement Disorders Special Interest Group Meeting. Although not originally placed on the program due to the high level of interest expected for the “Neurology of Great Musicians” seminar scheduled at the same time (8:00 – 10:00 pm, Wednesday), popular demand put it back on the schedule, albeit too late to appear in the published program. Those interested in presenting cases should bring video clips on standard format storage devices easily loaded onto the computer at the front of the room. Session will be held in Rm 301A/B (QCCC).
-Satellite Symposium: “AED Mandatory Substitution Policy Issues” Thursday, October 11; 6:00 PM – 7:30 PM 200C QCCC. Buffet dinner served.
See highlighted box, page 6.
-Junior Member Seminar: “Life After Residency: Where Do You Want to Be in Five Years?” (3:30 pm, Friday; 301A/B QCCC). This marks the third consecutive year Meredith Golomb, MD has led CNS Junior Members through a guided tour of different key aspects of their future in the field. “Highly informative,” “enormously helpful,” and “most valuable part of the meeting” are among the comments registered by those attending past sessions. Cookies and beverages will be served. Note to trainees: You MUST be a CNS Junior Member to attend—Apply on-line now!
–A Wine and Cheese Reception hosted by the Ring Chromosome 20 Foundation will be held Thursday, October 11, 2007 at 7:30 PM in the Delta Quebec Hotel, Duquesne Ballroom, First Floor.
-Tallie Z. Baram, MD, PhD (Breakfast Seminar 4) hails from UC Irvine, not UCLA.
-One can never say too many good things about Phil Dodge, in whose honor the Young Investigator Award is named. One can, however, use too many “l’s”; the correct spelling is: Philip R. Dodge, MD.