Bringing CNS Members Together to Make Children’s Lives Better


Letter from the CNS President – Fall 2009

By John Bodensteiner, MD | CNS President

John Bodensteiner, MD
John Bodensteiner, MD
CNS President

With the Annual Meeting and the end of my term just around the corner, I have several things I would like to say to the membership of the Child Neurology Society. Before anything else I would like to thank the members of the Society and the nomination committee for giving me the opportunity and the honor of serving as President of the CNS. I also want to thank the staff of the CNS national office, Mary Currey and Roger Larson, who, as most of you know, are the only two who know everything about the Society and thus represent its living archives. We have talked on a weekly basis and they have been instrumental in literally everything that the CNS has accomplished during my time in office. I owe them a debt that I am not able to describe adequately but at least I want to express my heartfelt gratitude for their guidance and help for me personally and for all they have done for the Child Neurology Society over the years. Thanks also to Sue Hussman and LeAnn Lewno, for the key support they provide Mary, Roger and the CNS.

It has been true for a decade al least and continues to be true that there are not enough child neurologists in the country to meet the demand for services. Although I was opposed to child neurology entering the match, it clearly has been beneficial for the specialty. Information is more available to students and prospective residents and apparently, as a result, there has been an increase in the number of prospects choosing to enter child neurology residencies. The number of trainees per year had been about 35 for a decade or so prior to the institution of the match, but the number has jumped to just over 100 since then. This increase in trainees may help to offset the fact that there are a number of child neurologists who are reaching the age when retirement seems like an attractive option; though the economic recession may forestall the retirement of many, it will not last forever and there may be trouble meeting the demand for pediatric neurologist, and the current number of trainees will not erase the gap between the number of child neurology practitioners and the number required to meet the demand for their services.

This brings me to a comment about a disturbing trend that I have seen developing as the budding child neurologists begin looking for jobs. Administrators of hospitals in many medium size to smallish towns have decided that they want to be able to say they have child neurology among the services they offer. Many of them have apparently decided that the way to attract such a specialist is to offer rather large salary guarantees for the first year or so of practice. This practice seems somewhat mendacious to me as the resident certainly is attracted to the offer and often fails to realize that the income after the guarantee period will be strictly dependent on the revenue they are able to generate on their own. This is not to mention the 24/7 call and coverage for consultation that is expected. I submit that it is very difficult for a child neurologist to generate the kind of revenue that would be required to cover their inflated “guaranteed” salary without being compelled to do things that they really should not be doing.

The issue of fair reimbursement for services for non-procedure based specialties, however, is much larger than the questionable practice of making outrageous offers to newly minted practitioners. As long as the mechanism for determining the value of a service delivered is unable to take into account the cognitive work of making an appropriate diagnosis, or translating the diagnosis into meaningful information for the families, there will be a shortage of physicians willing to participate in the cognitive specialties. This is true of Pediatric Neurology (outside of epilepsy) and several other pediatric specialties like endocrinology, nephrology and genetics. The government often decries the shortage of primary care and cognitive physicians, but the shortage will not be remedied until a way is found to reimburse them fairly for what they do.

As long as I am talking about governmental issues I want to say something about the role of the CNS and CNF as advocates for children with neurological disease, which I believe is critical for our mission and even our survival in many ways. Due to our small numbers, however, we must collaborate/cooperate with like-minded, preferably larger organizations when possible, to achieve our shared objectives. At this point in time, the work of our Legislative Affairs Committee is pivotal to our progress. The LAC identifies pending legislation, hearings, position statements and the like that we can affect either by our own efforts or by partnering

with larger groups. In the last year we have been quite successful in working with the AAN, ANA, AES (less so with the AAP) on issues of mutual interest. With profound changes considered for the entire health care delivery system our efforts in these areas and our attention to the ongoing legislative process is very important, indeed critical to the well being of our specialty. Implicit in the advocacy efforts of the CNS is the idea that the Society represents the community of child neurologists in this country. If this is to be the case, then it is critical that the Society embrace the young child neurologists finishing their training. I would encourage all the training directors to have their residents take advantage of the discounted membership dues for junior members and the discounted registration fees for junior members to attend the annual meeting of the CNS. As further inducement to encourage the junior members to participate in the annual meeting, this year’s registration fee is waived for those junior members who are presenting posters or papers at the meeting.

The theme of developing a closer relationship to the AAN has been important for Dr. Sergay, the previous president of the Academy, and the current president, Dr. Berch Griggs has taken this theme further and plans, with the participation of the CNS, to align the efforts of the two organizations much more closely in the future. Accordingly, I will be discussing how best to accomplish these goals with Dr. Rob Rust, chair of the Pediatric Neurology Section of the AAN. For their part, the Academy has plans for an entire one-day session devoted to child neurology at their annual meeting. This is not to be just child neurology for the adult neurologist, but will be advances in child neurology for the child neurologist. Other discussions for joint activities with the AAN include the possibility of jointly sponsored meetings, educational offerings and research prizes. I think we need to recommit to our efforts to work in concert with the AAP to achieve common goals as well, but I also feel strongly that we should initiate and expand our interactions with international organizations related to child neurology such as ICNA, EPNA, AINP and the child neurology societies of other individual countries. We all share a fundamental interest in advocacy for children with neurological conditions or disabilities and exchange of information and parallel or combined efforts in support of these children can be extraordinarily effective compared to the efforts of isolated or single groups. I think we should expand the interactions with our global neighbors by sponsoring directly and otherwise encouraging visiting professorships, observerships and other types of interactions between child neurologists from our neighboring countries.

As you all are aware, the process of certification by the ABPN is changing. The certificates are time-limited; in order to take the recertification examination, the diplomate of the ABPN will have to fulfill a number of continuing education and self-improvement activities. One of the primary vehicles for this process will be the Self Assessment Examination (SAE). The Society is in the process of developing a SAE that is to be part of the recertification process now referred to as “maintenance of certification” (MOC). Since the SAE and other MOC activities leading up to the recertification examination are not under the direct control of the ABPN, the CNS has the opportunity to create and administer its own SAE as part of the preparation for the recertifying examination. The first SAE exams will be available in 2010 and will be administered on line by the AAN for adult neurology and by the CNS for child neurology. By the time this is published, we will have most of the materials for the first iteration of the examination complete and will be in the process of putting the examination on the CNS website so all those wishing to use this as part of their MOC may have access to it. Once the first version of the exam is up, work will begin on building a bank of materials for the examination so that it will be updated and modified each year so as to be always current.

Earlier this year, the Society determined that it would begin the process of developing endowments for the major awards we give each year at the annual meeting. This includes the Hower and Sachs lectures, the Lifetime Achievement awards, the Neuroscience Research Prize for the outstanding paper by a high school science student (given jointly with the AAN), the D’Souza International Travel Award and the Outstanding Junior Member Award and the Child Neurology International Visiting Professor Award. The D’Souza Award has served as the prototype for this process as we have successfully built an endowment to insure that this award is funded each year. One of the cornerstones of the effort to develop these endowments was our plan to develop an endowment for the Philip Dodge Young Investigator Award. This is one of our more important awards as it not only encourages promising young investigators to continue their work, but it provides a modest sum to support their research. We had planned to launch the drive to develop the endowment for the Dodge Young Investigator Award at the annual meeting in Louisville. Now, with the recent passing of Dr. Dodge, the effort to build an endowment for the award in his name assumes an even more important and poignant place in our thoughts. I am convinced that Dr. Dodge would have appreciated our efforts. Drs. DeVivo, Fishman, Johnsen and Volpe, four of our most prominent members associated with Dr. Dodge, have graciously agreed to co-chair the Philip R. Dodge Young Investigator Award Endowment Committee. As part of this process, you will be receiving more information about the endowment effort and will have a chance to contribute both at the meeting, where a booth devoted to the Dodge Young Investigator Award will be prominently featured, and after the meeting, either on-line or by mail.

Finally, if you have visited the CNS web site recently you will have noted that it is constantly moving forward with new features and improvements. The web site will serve as the platform for the administration of the Self Assessment Examination next year and also will continue and expand programs such as the case studies section and a repository of the educational materials from the annual meeting, practice guidelines etc. The ACNN (Association of Child Neurology Nurses) has recently published their Child Neurology Telephone Encounter Guide that will be available for perusal and purchase at the meeting. Take a look at this book as it may be very useful for many practices.

I look forward to the meeting in Louisville. It should be fun with high quality educational and scientific presentations; I believe you will find the city quite charming, as there are many good restaurants and lots to see and do, should you be able to break away from the meeting, that is. I want to close by saying that it has been an honor to serve as the President of the Child Neurology Society. I have been impressed by the good sense, intelligence and willingness to contribute time and effort on the part of the officers, committee chairs and the office staff of the Society. I cannot help but think that we will be in for a couple of great years as Donna Ferriero takes over as your next president. We will be in very capable hands.