New directions for the Academy

Thank you for the opportunity to serve as your president these past 2 years. As my term comes to a close, I want to spend this time talking with you about our Academy, our specialty, and our future.

On September 17, 1955, in rural northern Wisconsin, my future seemed pretty bleak. What had begun one evening as a headache and muscle stiffness, seemingly from freshman football, turned terrifying the next morning when I fell flat on my face unable to walk, and then mortifying a day later when ol' Doc Hirschboeck pronounced it poliomyelitis.

Polio. For a 13-year-old boy with dreams of replacing Bart Starr as the Green Bay Packer's quarterback, it seemed a death sentence. But during my 11 months of treatment and rehabilitation, I became fascinated by medicine and the doctors who treated me-what they could do, how they could help, and the respect in which they were held.

Despite using a wheelchair-37 years before access ramps, handicapped parking spots, and the Americans With Disabilities Act-I determined to become a part of the wonderful world of medicine. What a wonderful world it has opened to me these past 31 years-capped by the privilege of serving as your president, especially at such a critical juncture in our history.

As with many specialties, the past years have been good-even golden-times for neurologists, both in our classrooms and laboratories as well as in our examining rooms. Our prestige, our clinical capabilities, and, yes, even our income have grown better each year. But you know as well as I that those days are over. Medicine has changed markedly this past decade. The forces of managed care, the rise of the muscle of third-party payers, the devaluing of research and education, the spiraling-seemingly out-of-control-costs had us, as my young daughter Kari used to say, "cruisin' for a brusin'." And what a brusin' awaits physicians and physician organizations who failed to foresee this decade of upheaval.

Fortunately, your leadership did spot those changes and many more in the early 1990s and began taking immediate steps to respond to them with the development of a formal long-range plan and thoughtful mission statement. You know that because for the past 2 years you have helped us at each step along the way with membership surveys, focus groups, and committee service. And last spring AAN leadership intensified its planning efforts, culminating today in our new Strategic Plan to serve our Academy, neurologists, and, foremost, our patients.

Thanks to the work of Stephen Sergay and his planning committee, we now know in which new direction we are going and how we are going to get there-together. I am pleased this morning to give you a first glimpse, to outline the new directions our Academy will be taking. I say "outline" because we will be providing each of you with a fully detailed report of our Strategic Plan in an issue of Neurology. It should be in your hands by early summer. Instead of detail, this morning I want to use my time to paint the big picture, the broader perspective. This perspective is of five new directions designed to serve both our specialty and our individual members.

First, the AAN will intensify its support of your continuing efforts to improve the quality of care you strive to give your patients. The Academy is beginning a comprehensive program of outcomes research to demonstrate the value of the neurologist as a principal care provider. This direction will go well beyond the gathering of data; it will include ongoing feedback to members to enable them to continuously improve patient care. It also includes plans for broad dissemination of data and results so that managed care, third parties, AND the government see that neurologic care is cost-effective and has a vital role in medicine in the next century. The Academy is prepared to dedicate both the staff and the resources that outcomes research will require. We will be securing those financial resources necessary to begin and to sustain this important work.

Our second direction is expanding the scope of neurologic practice in traditional and new areas. Establishing the expertise neurologists bring to many subspecialties is a priority. We need not tell other specialties that our work with epilepsy, movement disorders, and Alzheimer's disease is of vital importance in treating our patients, but we must help them understand how our neurologic expertise can help them treat other disorders such as stroke, pain, sleep, and headache, as well as with rehabilitation. The Academy is committed to helping you establish legitimacy and leadership in these areas and to provide the support necessary for coding and reimbursement. We will develop and provide you with the marketing tools necessary to establish a firm foothold in these new areas.

Third is an intensifying of activity to ensure that our specialty attracts and trains the highest-quality professionals in our field. We must advocate for a better balance between the number of clinicians needed in practice and the number of those who are in training. We must hold firm to our commitment to attracting both the best and the brightest.

Fourth, the Academy will be significantly increasing the advocacy and coalition-building activities necessary to influence public and private policymaking. Over the past several years, we have developed our Legislative Affairs Committee into an effective, forceful voice for neurology. Our grass-roots network of volunteer members is organized and structured to influence key legislators and policymakers in the federal arena. We will be building on this foundation of commitment to advocacy and to links with other appropriate organizations and associations. Whoever they are, wherever they are, the AAN is committed to working with them to further neurology's cause and the cause of our member physicians and their patients. Again, we will be adding staff resources to ensure the success of this commitment.

Finally, our fifth new direction is giving neurologists in all settings better tools to succeed in this changing, and challenging, health care environment. Today, we neurologists need even more information and more tools to help us manage our practices in the most cost-efficient ways possible. As you know, in recent years the Academy has expanded its efforts to provide life-long learning programs such as the popular C ONTINUUM and coding manuals. These manuals have served as invaluable tools to the practicing neurologists in helping us understand and adjust to the details of managed care, the capitated reimbursements, the ICD-9 coding manuals.

We are reaffirming our determination to expand on our offerings to provide products and services to members that help meet their need to be efficient and effective. This past year saw the launching of our AAN web site. This, too, expands our interactive capabilities and multiplies the ways in which the Academy can tell you of its newest products and services. It helps assure communication among our sections members, grass-roots participants, and individual members. If you have yet to log on to www.aan.com, I urge you to do so. If offers useful information and is another of many invaluable membership benefits.

I have been talking about the new directions your Academy will take as it improves its service, but those improvements will take money. Last month, when your Executive Board approved this new Strategic Plan, it committed nearly $600,000 to begin immediate implementation. Over the next few years, we anticipate a substantially greater investment of dollars and staff resources to achieve our objectives. Do not fear that these new directions will come at the diminishing of our current activities and offerings. They will not. Our core activities will remain at our core-the business of education, the developing of practice parameters and technology assessments, and our annual meeting. All will continue to enjoy high priority as your Academy continues to do what it does best-meet the needs of neurologists whether in the classroom, in the laboratory, or at the bedside.

So there you have it, the five new directions the Academy will be taking to assure our future: outcomes research, expanded scope of practice, workforce quality, advocacy and representation, and practice enhancement. Consider these five new directions as overlays-templates, if you will-for guiding our educational and member service activities. These wonderful plans and programs come with one caveat. They are going to cost, and at a time when the growth the Academy has seen in recent years cannot and should not be expected to continue. This means your Academy must be more conscious of and selective in its spending and more aggressive in seeking new sources of funds to support our objectives. While your Academy was developing its new Strategic Plan this past 8 months, it also began the process of looking carefully at the structure of our organization-its committees, its daily operations, its staff organization.

We formed an ad hoc committee, under the leadership of past president Jack Whisnant, to lead this organizational study. When it makes its final report to the Executive Committee in June, I expect to see recommendations that will help both the Board and the committees operate more efficiently and with better definition. In short, we will have an internal organization and operation to match an external one.

I began my remarks telling you of a boyhood dream deferred. Polio kept me from replacing Bart Starr and quarterbacking for my beloved Green Bay Packers, but it hasn't hindered me from being a devoted fan and, as I travel for the Academy, beginning all of my speeches-since January 26-with "Hi, I'm Ken Viste. I practice neurology in Wisconsin, home of the Super Bowl Champion Green Bay Packers." When I think about my love for the Packers and my pride in their achievement, I realize that I have a similar pride in my Academy and its achievements. Neither's achievements came about overnight, by accident, or by lack of long-range planning. Just as Green Bay began its Super Bowl climb back in the early 90s with the hiring of a new general manager and coach, Mike Holmgren, the Academy began the groundwork for its firm foundation back in the early 90s, electing leaders with vision and staff working to carry out that vision. Today, like the Packers, we can begin to enjoy the fruits of that vision, planning, and preparation-in our practice, in our profession, and, most importantly, in our work with our patients.