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Should neurosurgeons become interventional neuroradiologists?
Editorial
Should Neurosurgeons Become Interventional Neuroradiologists?
The short answer to this question is “yes.” But not the way it is being done in many institutions in the United States. A few years ago, I wrote an editorial predicting that coiling of aneurysms would become a prominent treatment for intracranial aneurysms [1], which prompted criticism from neurosurgeons at several institutions. Now, aneurysms are being coiled at these very institutions. The problem with neurosurgeons is that they are paralyzed by the fear that they will lose patients (and money) when new methods of treatment become available. But this thinking is archaic. The first craniotomy was performed 100 years ago, and the first aneurysm was clipped more than 60 years ago. Since then, we have seen the microscope, CT, and MRI revolutionize our specialty, while pneumoencephalography and myelography have been slowly disappearing from the armamentarium of tests we use. We have seen the stereotactic treatment of Parkinson’s disease replaced by L-dopa, and now are witnessing a return of surgical treatment for the disease. Within 100 years, surgical procedures as we know them today will be of merely historical interest. What do these changes mean to neurosurgeons? Neurosurgeons must be flexible and adaptable to change, or become dinosaurs. Surgical Neurology has devoted many pages to preparing neurosurgeons for the future. Yet many are still desperately holding onto the past. Neurosurgery of the future will be multi-disciplinary—it may not even be called “neurosurgery.” Teams of neurosurgeons, neurologists, radiologists, computer scientists, molecular biologists, and others will focus on solving medical problems. Magnetic resonance imaging will reveal what is going on in the brain in 500-m-diameter pixels. We will be working with metabolic maps and microenvironments. We will be viewing anatomy, biochemistry, and physiological functions in small pixels. This will be an exciting time, not a threatening one. What neurosurgeons need to do is to get into these fields as fast as they © 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
can, and become leaders in their development. The promise of the future of medicine is phenomenal. So, should a neurosurgeon become an interventional neuroradiologist? Yes. But so should an interventional neuroradiologist. To be in the forefront of this field, you will have to work 24 hours a day, 7 days a week. Entering the field simply to keep others out or to keep all the potential income is futile; however, many physicians are trying this approach. It, too, will fail. When we established the position of interventional neuroradiologist in our department, our intention was to recruit the best people in the world, and for the Neurosurgery and Radiology Departments to share the responsibility and the benefits. Our neuroradiologists’ salaries are divided between the departments; income from interventional procedures goes to Neurosurgery and that from diagnostic procedures to Radiology. Money is not an issue in deciding whether an aneurysm should be clipped or coiled; the patient’s welfare is. This is the way it should be—and this approach can extend to other fields, as well. Get prepared for the future; it is here. But it is not what the past was. The future will be determined by teamwork, not by lone neurosurgeons trying to keep everything for themselves. The field of neurosurgery, and medicine in general, is expanding too rapidly for a single person to be knowledgeable in all areas; this is why specialization will prevail. It is also the reason why neurosurgery is wrong in not recognizing superspecialties. And yes, you will make more money working as part of a world-class team than as a loner—as well as being more satisfied professionally. James I. Ausman, M.D., Ph.D. Editor REFERENCE 1. Ausman JI. The future of neurovascular surgery. Part I: Intracranial aneurysms. Surg Neurol 1997;48:98 –100. 0090-3019//$–see front matter PII S0090-3019(00)00286-X
Should Neurosurgeons Become Interventional Neuroradiologists?
The short answer to this question is “yes.” But not the way it is being done in many institutions in the United States. A few years ago, I wrote an editorial predicting that coiling of aneurysms would become a prominent treatment for intracranial aneurysms [1], which prompted criticism from neurosurgeons at several institutions. Now, aneurysms are being coiled at these very institutions. The problem with neurosurgeons is that they are paralyzed by the fear that they will lose patients (and money) when new methods of treatment become available. But this thinking is archaic. The first craniotomy was performed 100 years ago, and the first aneurysm was clipped more than 60 years ago. Since then, we have seen the microscope, CT, and MRI revolutionize our specialty, while pneumoencephalography and myelography have been slowly disappearing from the armamentarium of tests we use. We have seen the stereotactic treatment of Parkinson’s disease replaced by L-dopa, and now are witnessing a return of surgical treatment for the disease. Within 100 years, surgical procedures as we know them today will be of merely historical interest. What do these changes mean to neurosurgeons? Neurosurgeons must be flexible and adaptable to change, or become dinosaurs. Surgical Neurology has devoted many pages to preparing neurosurgeons for the future. Yet many are still desperately holding onto the past. Neurosurgery of the future will be multi-disciplinary—it may not even be called “neurosurgery.” Teams of neurosurgeons, neurologists, radiologists, computer scientists, molecular biologists, and others will focus on solving medical problems. Magnetic resonance imaging will reveal what is going on in the brain in 500-m-diameter pixels. We will be working with metabolic maps and microenvironments. We will be viewing anatomy, biochemistry, and physiological functions in small pixels. This will be an exciting time, not a threatening one. What neurosurgeons need to do is to get into these fields as fast as they © 2000 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
can, and become leaders in their development. The promise of the future of medicine is phenomenal. So, should a neurosurgeon become an interventional neuroradiologist? Yes. But so should an interventional neuroradiologist. To be in the forefront of this field, you will have to work 24 hours a day, 7 days a week. Entering the field simply to keep others out or to keep all the potential income is futile; however, many physicians are trying this approach. It, too, will fail. When we established the position of interventional neuroradiologist in our department, our intention was to recruit the best people in the world, and for the Neurosurgery and Radiology Departments to share the responsibility and the benefits. Our neuroradiologists’ salaries are divided between the departments; income from interventional procedures goes to Neurosurgery and that from diagnostic procedures to Radiology. Money is not an issue in deciding whether an aneurysm should be clipped or coiled; the patient’s welfare is. This is the way it should be—and this approach can extend to other fields, as well. Get prepared for the future; it is here. But it is not what the past was. The future will be determined by teamwork, not by lone neurosurgeons trying to keep everything for themselves. The field of neurosurgery, and medicine in general, is expanding too rapidly for a single person to be knowledgeable in all areas; this is why specialization will prevail. It is also the reason why neurosurgery is wrong in not recognizing superspecialties. And yes, you will make more money working as part of a world-class team than as a loner—as well as being more satisfied professionally. James I. Ausman, M.D., Ph.D. Editor REFERENCE 1. Ausman JI. The future of neurovascular surgery. Part I: Intracranial aneurysms. Surg Neurol 1997;48:98 –100. 0090-3019//$–see front matter PII S0090-3019(00)00286-X