Interview with Terrence L. Cascino, MD, FAAN: AAN President 2015−2017
Terrence L. Cascino, MD, FAAN
AAN President 2015−2017
Wednesday, April 12, 2017
AAN Headquarters
Minneapolis, MN
Interviewer: Tim Streeter, AAN staff
(c) 2017 by the American Academy of Neurology. All rights reserved. No part of this work may be reproduced or transmitted by any means, electronic or mechanical, including photocopy and recording or by any information storage and retrieval system, without permission in writing from the American Academy of Neurology.
TS: Good morning. My name is Tim Streeter [TS]. I am at the American Academy of Neurology with Dr. Terry Cascino [TC]. He is concluding his term as president of the Academy, and he has been kind enough to stop by this morning and talk about his leadership roles and his tenure as president. Good morning.
TC: Good morning, Tim. Thank you for having me.
TS: Thank you very much for coming. The first question here of course is, when and why did you become a neurologist?
TC: So, actually that’s a very simple answer. I’ve been interested in neurology and neurosciences probably since I was about five years old. And you’d say, why is that? It was quite simple. My dad was a neurosurgeon, and my dad would talk about the brain and neurology and neurosurgery. And in fact we began making rounds on Saturday morning when I was about ten years old, both my brother Greg and I. Those were the days before HIPA and everything else, but I learned a lot about being a doctor and about the interesting nature of neurology and neuroscience. And so that stuck with me, and then I eventually decided on neurology rather than neurosurgery and became a neurologist.
TS: Well, that’s interesting. It’s in the family then.
TC: It is.
TS: Definitely. Now you joined the Academy in 1985. what were your needs then as a young practicing neurologist?
TC: I think the main thing about the Academy, first of all, I was at the Mayo Clinic, and everybody was a member of the Academy. It was a way of networking and meeting some of the big names in neurology that I had studied and heard about and a way of me being able to be more involved with academic neurology. And that’s really what it was back then.
TS: Did you know Joe Brown?
TC: Yes, I did as a matter of fact. Dr. Brown was the head of a section I was in. He wasn’t practicing, but I remember going to dinner with him. I remember him being a very charismatic, interesting person that we all looked up to.
TS: Um-hum, he was very instrumental in the early years of the Academy.
TC: He certainly was. He certainly was.
TS: Yes. How did you get motivated to become involved in Academy leadership activities? Do you recall your first committee assignment?
TC: Yes. Well, I was interested in education. I was an—I am a trained neuro-oncology—or neuro-oncologist. I was doing clinical academic work, but I had an interest in education. I became the program director at Mayo a number of years ago, and my first assignment was in education in the Graduate Education Committee and as a member of the Education Committee, of which Dr. Fahn was the chair.
TS: And what did the Education Committee do back in those days?
TC: Almost exclusively plan the annual meeting. Come up with courses for the annual meeting. In fact, there was so little numbers of people who were applying to do courses, we brought in ideas for courses so we would have enough. Now of course it’s entirely different. We have far more people volunteering to put on courses than we have space. So, we have now triage. But back then we had to come up with a program.
TS: Did you have any mentors during your early years?
TC: Yes, I had great mentors, and too many to make sure I touch on everybody. One is Dr. Jack Whisnant who became president of the American Academy of Neurology. He was my first chair at Mayo. Dr. Burt Sandok, who was also a chair at Mayo, was also chair of the Education Committee of the Academy. That was very impactful. Nearly all the presidents who I’ve dealt with, it goes back to Dr. Whisnant forward, have taught me something that was important. But I did want to note one that I think was especially impactful and that’s Dr. Ken Viste. Dr. Viste, as you know, has passed on, but he was a private practitioner from Wisconsin. Very, very involved with advocacy at the state and national level. Very great leader of the Academy, became president. He had a very important presidency. For one thing, he brought—he helped bring the idea of private practice and advocacy to the Academy. It had been done a lot by Dr. Nelson Richards before him, but I think Ken also made a real impact on that. And personally, he made a big impact on me, and a story that I remember was that unfortunately he got a relatively quick, severe medical illness. And I visited him in the hospital the day before he died. And Ken’s last words to me were—and I think he knew that he was probably not going to make it any longer. He looked at me and he says, “Terry, take good care of the Academy.” And then I left, and then he died the next day. I will never forget that conversation, ever. And it means a lot to me, but what I think about is the incredible love and dedication Ken had for neurology, he had for the Academy of Neurology and the resilience he had to overcome issues. He was paraplegic, in a wheelchair and yet if you watched Ken at board meetings, he was indistinguishable from anybody else who had two working legs. So, Ken brought a lot to the Academy. We owe him a lot, and I personally owe him a lot.
TS: He went to Washington a lot. We’ve got photos of him.
TC: He did. Both Madison, Wisconsin in his state and then Washington a lot and we have awards, Advocate of the Year award I think named after Ken.
TS: Yeah, it was a big loss.
TC: A huge loss.
TS: We felt it here among the staff, yes.
TC: Yes.
TS: Well, let’s turn to an issue that the Academy has had to address, both before and during your presidency and that’s been Continuing Certification (CC). Can you explain this issue, how you see it and what it’s meant to the Academy?
TC: So, Continuing Certification came up through the American Board of Medical Specialties, which oversees all the boards, including the American Board of Psychiatry and Neurology. It is not in any way an invention of the Academy. But the reality is, is that the vast majority of members of the Academy do have certification and are interested in continuing certification. They may or may not agree with the way it has been done, but they don’t want to lose their certification. That’s the vast majority.
So, what we believed at the board was, we weren’t responsible for it, but our members needed and many wanted to continue maintaining it. And so, what we should do is to make it as easy to achieve and as inexpensive as possible. And to that end we put together programs which satisfied some of the parts of maintenance and certification. We put together the self-assessment programs. We put together the practice—performance and practice programs, because these were requirements of those. It’s voluntary. Members who didn’t want to do it, really there’s no problem with that.
But if they wanted to do that, and as I said, thousands of our members have decided to continue, whether they like it or not, they’ve decided to continue. We wanted to make it not only easy, but as I said, as inexpensive as possible. What we decided is to give it away free. As a member benefit, use our resources so that people didn’t have to pay for that, because we were sensitive to the fact that this was not only something they had to do, but it was an expense. So, that’s the tack we took.
We then began to look at different parts of it, and we realized that what they call performance and practice or part four, wasn’t necessarily helping our members deliver high quality care or learn how to deliver higher quality care. Instead it was just going through some motions. We had discussions at the American Board of Psychiatry and Neurology, and I think with some of our influence and influence of others, that has been changed and you can do our great performance and practice modules, which were really well done. Or you can participate in other ways, such as with our registry, or in other ways, such as quality improvement in your institution.
So, it has become I think easier to do what we call part four. What the future of CC is, we’ll have to see as these years ago by. Whether it will evolve a lot. Whether nobody will be doing any, it’s hard to know. I think the public is going to demand that physicians in some way make sure that they’re keeping up with their training, whatever that way is. I’m pretty sure of that. And so, if we don’t police ourselves—“police” is a bad word—but if we don’t regulate ourselves, I’m afraid somebody else is going to and that could be far less appealing. But we’ll see what comes out of it. I think the Academy’s role, again, has to be to support our members. It isn’t to try to influence people to go one way or another way.
TS: What are some of the other challenges that practicing neurologists are facing these days?
TC: Well, the challenges I think are fairly huge. There’s a number of them. But the ones that we really have focused on are this: getting fair reimbursement for the value you produce. Reducing the regulations that are just hassles that don’t produce value. Having adequate time in terms of patient/physician relationship. So, you can sit and talk to patients and understand their problem. Getting increased neuroscience funding so we have the kind of innovations that we need to help our patients. Those are the kinds of things we’re facing.
Now a big issue that sits above all this is the epidemic of physician burnout, which we became concerned about in 2012. Long before it was in the press. Long before most societies were involved. Long before those words were necessarily being used in the Academy. But we began to notice—we began to see reports, primarily from my colleagues at Mayo, that neurology was amongst the most burnt out specialty and amongst the worst work/life balance. We became alarmed about that, and we have worked very hard to understand and to mitigate and try to prevent physician burnout. Because if you have a burned-out workforce, Tim, all these other things don’t mean a lot quite honestly. Because you’re not going to have career satisfaction. You’re not going to have happy, hardworking provider-doctors. You’re not going to fulfill what you want to do. And so this has to be attacked. We’ve taken that on full force at the Academy.
TS: How will we be able to measure the results of our wellness programs and mitigating burnout?
TC: Well, one thing we did is, when we put together our studies and surveys, we spent a lot of time making sure that we were using validated instruments that had been used by others, because we wanted apples to apples comparison. We didn’t want to see, neurology said this, but it wasn’t the same instrument. It wasn’t validated. And so, it wouldn’t be good linearly. We brought on board as a co-investigator and a co-author, the author of a lot of the burnout publications, Dr. Tait Shanafelt, who’s a hematologist from Mayo Clinic and is really a world authority on physician burnout. Tait has served as a co-investigator He’s, as I said, a co-author. That assures us that going forward we could do our surveys and be pretty sure we were looking at apples to apples in a comparison, from other specialties. From potentially other occupations, other countries, which would be of interest, and ourselves going forward.
So, we should get a pretty good idea, are we getting more burnt out or less burnt out? The mitigation piece is to try to decrease that percentage. Right now, it’s 61 percent are burnt out. To decrease that number, to help mitigate the people who are already burnt out and probably more importantly, prevent burnout in the next generation.
TS: Now this is part of a larger workforce issue in that right now we’re looking at a 20 percent shortage in the number of neurologists that we see needed by 2020 as people get older and have more chronic neurologic issues. This has been a concern for the Academy for a number of years. What steps is the Academy taking to address that?
TC: So, that’s a complex question in terms of what that’s about and what can we do. On the surface, we’re going to need more neurologists or some sort of neuro providers to take care of the big bulk of people who are going to come down the road as the baby boomers get neurological diseases, stroke, Alzheimer's, etcetera. We only have so many resident slots. And so that’s something that we’re looking at. Neurology is not a terribly appealing thing for graduates to go into. We have to make it more appealing.
TS: Why isn’t it appealing?
TC: Well, you could see, there’s all sorts of things at play here. Students come out of medical school with high debt. There’s a clear relationship between the subspecialties that students want and the reimbursement that comes with it. So, what are the popular subspecialties? Radiology, dermatology, anaesthesia, ophthalmology. What are the least popular? The ones at the other end of the spectrum, family medicine, general internal medicine, general surgery, neurology. That’s number one.
Then you put together a high burnout population, 61 percent. What do students see? They could potentially see people who are burned out as role models. That doesn’t help.
Now the other issue though that’s at play is, I’m convinced neurologists also spend a lot of time seeing non-neurological patients. If we could figure out a way where we saw neurology and only neurology, which probably really can’t happen, but if we could figure that out, it might not be such a big gap. Because I can tell you, I spend a lot of time and I talk to my colleagues all over the country, spend a lot of time seeing patients who really probably don’t need to see a neurologist. Now we have to help our colleagues in other specialties. We have to do consult. I understand all that. But at some point, you got to say it’s obvious this patient doesn’t need to see a neurologist. Instead we should work in a patient with neurological disease and not have an ALS patient waiting X number of weeks while we’re seeing non-neurology. And I think that’s an issue, and it’s not easy to grapple with. Now what’s the Academy doing? Well, we’re working on the burnout. We’re working with trainees and medical students to make neurology more appealing. We’re trying to fight for fair reimbursement for the value we produce. That’s, again, an important thing. But we got to look for new ways, and I know my successor Dr. Ralph Sacco is really very passionate about that. And I think Ralph is right on, that we need to look at that pipeline and see what we can do to increase it. We have really good people going into neurology. We just probably need more people. And to that end, we’ve gotten a grant from the Hilton Foundation to look at this. Ralph and Dr. Gordon Smith and others will be doing that.
It’s money coming, primarily to figure out how you get more people to go into neurology. And I think that’s just right on.
TS: So, is that primarily a grant for the academy to do research into those issues?
TC: To do something to change it. And I think, and I don’t have that in front of me, that one of the metrics is, you get more people who want to go into neurology. I think it’s not just a study, but it’s an action implementation. And I think that’s exactly where we should be.
TS: You were on the board for our Foundation for a number of years and it—over the past few years it’s gone through some re-branding and restructuring. What were the challenges that the Foundation has been up against in raising money for research?
TC: I think the Foundation is and was a really excellent idea, concept. For example, if the American Heart Association can raise all sorts of funding for research for heart disease, of which there are many types, you would think the American Brain Foundation or before that our foundation—Academy Foundation, could do the same for a variety of brain illnesses. It has been slow going, and it’s one thing to say it’s been slow going for a couple of years. It’s been slow going for almost 20 years. I think the re-branding was very critical. To take it away from a name that nobody could relate to, outside of this office, to the American Brain Foundation that sounds like something that would be pretty important. The only issue there of course is it includes muscle disease and peripheral nerve disease. But that’s just a detail.
The American Brain Foundation tells you it’s something to do with neurology and the brain. The other thing is, is the focus becoming more on getting dollars to cure brain disease. That resonates with people. What resonates a little bit less is things that are just having to do with clinical training grants. Those are important. That’s been the hallmark of what the Academy—the Foundation has done. They’ve done great work. These have gone from fellows to people getting grants, who are making important contributions, leaders of neurology. But it’s got to be more than that. So now the focus includes external dollars to cure brain disease, and I think we have a chance of being successful. And—but we need to get moving, and we have an excellent foundation now with great leadership and great staff and so I’m optimistic about that.
TS: Good. The Academy now has 32,000 members. That’s pretty amazing, isn’t it?
TC: Unbelievable.
TS: But like any membership association, it has to retain the ones it has, attract new ones. What drives the decisions to expand the membership to include business administrators and advance practice providers?
TC: Well, from my perspective, it isn’t a—the driver isn’t, we need more members, we need more finances. It’s who participates in the team of taking care of neurology patients.
Who participates in the research team? And as we go through, that becomes obvious. The team has to expand. The team includes people doing the business side. The team includes advance practice—advance—
TS: Practice providers, yeah.
TC: Practice providers, thank you. The team includes people involved with neuroscience and others. And since that’s part of the team, it’s in our interest to work together, to help neurologists deliver high value of care, to enhance career satisfaction, which is our mission. So that’s what’s driven that. I think that’s very important. That is a big reason our membership has gone up so much. But we’re very good at retaining our members. For one thing, if you look at the market penetration in the US of neurologists, ours is extraordinarily high. When I compare it to other societies, like the American Psychiatric Association, APA, it’s much lower. We have virtually all neurologists in the United States as members of the Academy.
That’s a big advantage because we can work together to do something for the common good, for our patient’s common good. And so that’s a big thing. We’re able to retain members. How do we retain members? You got to deliver. We wrote the vision a few years ago, and it was not simply done as a marketing tool. It was done with the idea, we’re going to use this to make decisions at the highest level. And we went from no vision and a mission nobody could repeat, to a vision nearly everybody can recite, to be indispensable to our members. The only way you can retain members, especially in this day and age, because they have other options, is you got to make yourself indispensable. You got to give them something that they need and they want. And I think we’ve done a really good job of doing that. We have to continue to be vigilant to do that.
TS: We also have 6,000 international members. How do we attract them and provide value to them and their membership?
TC: Let me just talk a little bit about international relations if I could. That’s something that’s been very important to me and something we’ve focused on at the Academy board. Over the years we are the largest and most influential neurological association in the world. That’s important. That draws members. It draws a huge number of manuscripts to the journal. It draws a huge number of abstracts to the meeting. It draws people coming to the meeting. This is critical to our future. Even though we’re the American Academy of Neurology, we have to do something to make sure we maintain that.
What we’ve decided to do is I think the right thing and that is, enhance relationships with different neurological groups throughout the world. Now how do you do that? You got to show up. What you can’t do is, and we’ve decided not to do is, you can’t go to battle and try to steal their members. I’m being very blunt about that. That will be ineffective, and it also would not be well received. What you have to do is you have to show up as a partner and at times a helper, at times a mentor for different neurology societies. And we have worked very hard in forming those relationships with a variety. And I’ll just mention some. It’s not the only ones. We’ve worked hard working with the World Federation of Neurology, the European Academy of Neurology, the Mexican Academy of Neurology, the Canadian Neurological Association and the Japanese Society of Neurology.
We share many of the same values and interests. The relationships have been very productive for us. But I think in the long run it’ll be very important if we want to keep our role as the pre-eminent neurological society, some of the responsibility is, you have to be there and you have to participate in the discussion. So that’s what we’re doing. And I think that also will come down to membership and attendance at the meeting and journal manuscripts and abstract submissions.
TS: You made a point in your first president’s column in AANnews® that you wanted to make sure that all member’s views were heard and leadership would improve communications. Did you find in your travels talking to members that they were tuned in to what the Academy is doing for them? Or did you get some, you know, oh, I didn’t know that.
TC: Every day, sure. You know, so I said that and I said that when I actually was interviewed to be president. I said, I realize I have to be president of all members of the Academy, from a solo practitioner, to a Nobel Laureate and everybody in between. And you have to consciously think about that. Because I think it’s very easy as a leader to assume we’re kind of a homogenous group. But the diversity if tremendous, and I mean diversity in all ways. Diversity in what we do, how we look, male or female, private practice or academic, and diversity in terms of views. I tell people in the travels I’ve had, and I met many neurologists over the last two years, if you have these views, whether they’re political or whatever they are, I can show you a big group that has the exact opposite.
And we’ve got to figure out how do we work together as an academy? Because you look at that and you say, how can that work? It can work because we all have some shared values that drives us. Our love for neurology, our desire to be able to deliver high quality care for our patients, our hope to have an enriched, satisfying career. When you boil right down to it and you put people in the room, people pretty much say, that’s what we want. And so that’s something I’ve worked on, I’ve worked on with the board. I think the board is understanding that, and the way to—one way you got to do that, and there’s no getting around this, you got to spend face-to-face time with people and ask them, what’s up? And I’ve tried to do that, and one person can only do so much. But I think our leaders need to do that, and again, we’ve talked at the board and I know Dr. Sacco feels exactly the same way. And he’ll be very good at that.
TS: You mentioned diversity. The Academy’s made a lot of attempts over the past few years to create leadership programs for our diverse membership and for women, for young members, for mid-career members. What do you see the importance of that?
TC: Well, going forward, hardly anything is more important because it’s clear the membership is looking different and will look very different going forward. For instance, you take the Diversity Leadership Program. We have started that. I didn’t know what to expect. We have uncovered tremendous leaders who will be leaders of the Academy. And they were there as members, but I can tell you, I’m interviewing a lot of them and they said, “Well, I didn’t think the Academy was really for people like me.” Well, the Academy better be for all people and we better make sure that that’s clear and real and we’re trying to do that. Same thing with the gender. You know, we have the gender disparity in pay right now and in promotion. We got to step up to these things. The days of assuming we all look kind of the same is gone. And we’re very passionate about that. And I will tell you, I have not met a leader who I don’t sense has that passion. I think neurologists are particularly good at that. So, I think that is on a good trajectory, but we got to do better and we will.
TS: You mentioned the Axon Registry earlier. That’s one of the biggest projects the Academy has ever taken on. Can you talk about the registry and what the benefit will be for neurology and for our members?
TC: Some of this goes back to the fact that when we go to visit people like the Center for Medicare Services, CMS or insurance companies, and we talk about, for instance, cognitive subspecialties and reimbursement. They no longer accept the fact that we tell them we deliver high quality care or high value care. Instead they want proof. And other societies are more than willing to collect data and bring proof. Now whether it really is proof, I think you could question it. But they’re producing something, the data, and the people or the payers are accepting that.
So, it became obvious, we needed to really do better in demonstrating our value. And so the board took as their number one goal, the most important thing, demonstrate the value of neurology, to Congress, third party peers and Medicare in order to get further reimbursement for the value we produce. Now what we’ve seen work in some other organizations is a clinical registry. We began looking at that. We had lengthy, really good debates at the board. Why? This is a big thing. This is very expensive. This could not work. Maybe it won’t produce the kind of value we hope it would. After a lot of discussion, it became obvious this was something we needed to do.
It’s expensive. We contract out with a group called FIGmd, putting people on costs money. But we decided at the beginning, this would be free to members. The money has to come from us, and we have to figure out ways of raising that money. And we’re doing that.
Now what’s the number one goal of the registry? I talked about going and showing your data, and I will say, I believe to my heart we add value. The problem is, the people who are paying no longer accept that as a given. But what’s the number one reason to have a registry? And we’ve talked about this a lot. It’s to improve patient care. It’s to look at different issues, treatments, situations and try to make it better.
The number one goal is not get paid better or give data to CMS. It’s to improve patient care. Can we get there? I hope so. It’s going to take a lot of work. It’s going to take a lot of smart people who are smarter than I am. But I think that should be the bottom line, not just checking boxes or producing something. Now the individual neurologist, with hopefully no cost to them, in seamless interaction with whatever their electronic medical record is, gets some quality benchmarking of quality metrics the Academy has deemed worthwhile, not some outside agency. And hopefully can improve their practice. We’ll see. But it can’t hurt I don’t think. So, that’s the registry, and I think it’s a huge project and we’re committed to making it work. So far, so good. We have at this point in time about 1.5 million records in there. So, we call it a pilot. Well, that’s well past the pilot stage. But we are accelerating to get more neurologists involved. At the same time, we got to get the funding to be able to do so.
TS: The Academy recently took a neutral stand on the American Healthcare Act. We took a neutral stand on Obamacare back in 2009. However, this time around we created a set of principles by which we would assess any health reform changes that come out of Washington. At what point do you think that it’s necessary for the Academy to take a firm stand on an issue, like it did back in 2003, 2004, on stem cell research funding from the government? You risk alienating some of your membership if you go this way or if you go that way. But at some point, do you think that the Academy has to come out and say, you know, kind of plant its flag and say, this is what we believe?
TC: Well, that’s the reason that we put together these new healthcare policy values, which were debated widely. We got a lot of input from membership, our committees, the board. Because there’s got to be some things we believe in. There’s got to be. Now we did in fact come out with a statement that we were not supportive of the try at the new American Healthcare Act because it didn’t fulfill our values. And our values are well outlined. They include access for our patients, but other things, and I’ll just use my own words, reduce regulatory hassle, medical liability reform, the sanctity of the patient/physician relationship and other things.
Where we get in trouble is where we make a political stand, and I know this is a fine line. And I suspect not everybody agrees with me. But I will tell you, again, the diversity of our membership is very wide. When you start taking a political stand, you’ve got one group who might like that, and you got another big group that might not like that. What you got to find is what do we all agree on? We agree that we need to be able to give high quality care. We need to have reduced regulatory hassles. We need sanctity of the patient/physician relationship. We need to be fairly reimbursed for what the value we produce. I think those are things we can resonate with.
Using those values, I hope going forward we can do that. But again, I would be careful that we aren’t becoming a political organization. We are not. We should not be, and I think that will get us in trouble going forward. And you see other societies, Tim, who have done that and then they got a big loss in their membership. That’s because you’re not doing what their members want. Our members want us to help them to deliver high quality care and enhance their career satisfaction. That has nothing to do with some other things, like who’s going to be the payer? Is it going to be a government run single payer system? Is it going to be get all government out of health care and let us do this ourselves? I can tell you, I can show you people in both those camps who are active members of the Academy of Neurology. But if we can concentrate on what we can all agree on, I think we’ll be okay.
TS: You’ve been to Washington numerous times.
TC: Yes.
TS: You’ve participated in Neurology on the Hill where last winter we had more than 260 members visit members of Congress. What’s that experience like? Is that invigorating for you?
TC: I will tell you, I’ve been now maybe four or five times, and it’s my favorite event for the Academy. It is really invigorating, to see these 200 plus people come in, all ages, all levels, a lot of trainees, a lot of private practice, academics, passionate about neurology and making a difference. Taking time out of their schedule. I mean, this is something out of your own hide. And being passionate about advocating for neurology, spending a day at the training session and then a day on the Hill. I find that incredibly invigorating. I have told everybody I have talked to about this, that’s something everybody should try to do at least once.
TS: It’s not something that everybody can do in other countries too.
TC: No, and this is something that our international members don’t have access to. But I will tell you, some of our international members have had a great desire to mimic our Palatucci advocacy group and have mimicked it and have had some Academy—asked for some Academy help doing that. So, there is the interest everywhere. But Neurology on the Hill is obviously just for US neurologists. But I find that incredibly invigorating.
TS: The 2016 Annual Meeting made some very major changes, risky changes in its structure last year in Vancouver. Can you talk about that?
TC: Yeah, so we decided to blow up the meeting. We could have tinkered around the edges. We had a scheduling change that came up. We knew we had to cut one day off at the end or something. And we made a conscious decision, which was the right decision, let’s re-look at this meeting. And the biggest change for anybody who was there is, you pay one fee and you go to whatever you want. Pretty much, a couple of exceptions. Tremendously popular, unbelievably popular. Because people could now walk with their—vote with their feet. You go into a course, you listen to what you want to hear and then you go to another course. And if the course isn’t good you leave, you go to something else.
We got plenaries more scattered throughout the week, we got education courses more scattered throughout the week. These are profound changes. This is really blowing up a successful meeting, and I believe it became more successful as we looked at the feedback, not less. So, we’re continuing that. We’re making it more of a blow up when we look at the scientific presentations and the Science Committee’s done a fabulous job and we’ll see how that works at this Annual Meeting next week.
TS: It’s a challenge keeping the meetings fresh, isn’t it?
TC: It is a challenge, and we have incredibly innovative staff, unbelievable, because we could have decided we had a great meeting 20 years and made no changes. And I can tell you where we’d be now. We would be a stale meeting where we’re trying to wring our hands and figure out what to do. And instead we have an exciting meeting that changes almost every year, and people are still excited about going. I’m still excited about going, and I’ve been to countless meetings.
TS: We’ve added a number of regional conferences over the past few years. We’ve got a sports concussion conference, breakthroughs in neurology. We’ll be adding a winter conference next year. Is there a point where you hit the law of diminishing returns, where you’re offering too much and it starts to drain your attendance at one thing or another?
TC: We don’t know the answer to that. When I was education chair, is when we first brought up the idea of having regional conference. We had two a year, spring and summer or something. So, spring and winter—
TS: Spring and fall.
TC: Yeah, spring and fall, thank you. And they were successful, but to see what that’s grown into is unbelievable. Just unbelievable, going to the Las Vegas course. There is a space for this because a lot of people that go to that tend to be more of the private practice and tend not to necessarily have the time or interest to go to the annual meeting. We’re doing something good. Same thing with the break groups. We’re doing something good. The question is, if you have ten more of those, are you just simply not siphoning off? And we don’t know the answer to that. So, this will be done slowly, with a lot of thought, rather than just keep adding.
Now the sports concussion is a different thing because it’s a different space we’re going into. We’re not looking for Academy members necessarily. We’re looking for non-Academy, non-neurology, in a way non-medical people to come, trainers, people like that. I think that’s been a good success. But do you want to have ten more of those? Well, I don’t know the answer to that. But certainly, we’re not going to just run out and do that because to some extent these have to be self-financed. We can’t put on a lot of these at a huge cost and simply keep taking it out of member’s dues. So right now, they are or they make money. I don’t know what the future is, but I will tell you, we made an incredibly great decision by starting it back a number of years ago.
TS: You were on the board of directors for the Academy’s for-profit subsidiary, AAN Enterprises, Inc., [AEI] for several years before it closed [in 2013]. What were some of its accomplishments, and why did it close?
TC: The really important thing was, we were able to get the publications really ramped up in the Academy, in addition to our flagship green journal. We were able to look at it from a business point of view. It had tax implications back then, which would save the Academy. We could negotiate a really very good contract, and all those were very important things and I don’t think could have been done without AEI. We tried to get into other businesses in order to raise money so that we could do other things over here or keep dues down. That was less of a success. Things changed. We got the publications ramped up. The tax implications pretty much went away. We realized the business endeavours probably were not going to be a huge winner, and we decided at that point to close it down, and I think that was the right decision. But it played an important role and did very important things, especially in the area of publications.
TS: Our publications have grown exponentially.
TC: Terrific, yeah. A lot of credit goes to my colleague Dr. Steve Ringel who ran that from the beginning. I became the chair near the end. I think we were both very impressed by what it accomplished, and I think we also agreed it was time to shut it down.
TS: Got a few final questions here. Two-year term as president, that’s kind of brief in the scheme of things here with the Academy. What accomplishment has satisfied you the most, and what do you wish you had a few more years to work on?
TC: So, it isn’t brief. [laughs]
TS: It’s a six-year commitment, really, yes.
TC: It’s a six-year commitment, and if you look at a lot of other societies, it’s one year as president. And my fear about that is, is that becomes more honorific. The year goes by and it’s gone. Two years does not go that—it goes fast, but you can get things done. So, I’m pleased with the term and what there was. You know, I think we accomplished a lot, but I intentionally wanted to focus on a few things, because I think the other thing you can do is try to fix everything that’s wrong with medicine or neurology, and that’s not doable. We focused on demonstrating the value of neurology and getting the registry up and running. We focused on physician wellness and the burnout epidemic, and I think we’re doing a really good job on that. We focused on helping our—and understanding the problems of our colleagues in solo and small practice, 25 percent of our Academy. We focused on enhancing neuroscience funding. We focused on getting these international relationships going.
At the same time as continuing to fly the plane and having a great annual meeting and unbelievable education and science and publications and guidelines and all that kind of thing. So, I’m very proud of what we accomplished. You always feel like you would like to be able to finish the story. But I knew going in and I knew from my experience in different administrative roles at Mayo, it isn’t like that. It’s a continuum. It isn’t like the story starts, the book finishes, you got it all done. It’s more, you serve a period of time in a continuum of leadership. And so I was well aware of that and well used to that. But you’d like to see—couldn’t we make a difference with burnout? Couldn’t we get more people excited about neurology? Couldn’t we have the registry prove that it improves patient care? But I had no idea that that could be done in that time and of course it can’t. But I’m hopeful in the years ahead. We have fantastic leaders. I have great confidence in that, and I think it’ll happen.
TS: These initiatives will continue.
TC: I believe so. And they’re not my initiatives. This is so important. They’re initiatives developed through board discussions, experience, discussions with the president elect and the CEO, Cathy Rydell. These aren’t Terry’s and they’re not—Ralph doesn’t have a whole different set. They’re, again, a continuum, and they have to be sequentially done. You have to attack burnout before you get the pipeline increased. You can’t have burnout sitting out there and pretend it doesn’t exist and try to get more people to go into neurology. They are being done sequentially on purpose.
TS: You’ll be stepping into the role of immediate past president in a few weeks. What will you be doing in that role?
TC: So, here’s what I think the role of past president should be, and I’ve thought a lot about this. Because I think it isn’t always clear, and the last thing I want to do is get in the way. And I would never do that, and I think my predecessors have done a great job of not doing that. I took a comment from a person that I think highly of in leadership, Richard Leiter, who’s worked with the Academy staff. And that is, you become a wise elder. Now, to be a wise elder, you have to be shown to be wise. So that’ll be a debate. You have to be elder. You have to have done stuff. If you had, I think that’s the right place for the past presidents. Rather than do nothing or recycle through the same committees.
I’ll be continuing doing—running the Leadership Development Committee for a few more years. I’ll participate at the board, and hopefully I’ll have comments or experiences that will be of use to Dr. Sacco and his successors.
TS: Final question, what advice would you give to AAN members who want to get more involved with the Academy and get into leadership positions, whether on a subcommittee, taskforce committee, the board?
TC: I say this a little tongue in cheek, the number one mitigator to burnout is being involved with the Academy. Why is that? Why do I say that? And it could be true of other activities. You don’t see many burned out people who are involved, and that engagement really helps defeat the isolation that comes with burnout. So, I think it’s very important to be involved.
You got to show up. You got to be willing to do stuff. You have to do a good job. You have to behave appropriately. I mean, I think that’s all stuff we were taught when we grew up. Volunteer. Sometimes it’ll be a committee assignment. Sometimes it’ll be a taskforce. Sometimes you’ll just find something that you say, I’ll help with that. Sometimes it’ll be through our new leadership programs, which I encourage people who want to be leaders. That’s a good place to play. Sometimes you show up at Neurology on the Hill. Sometimes you apply for PALF. There’s all sorts of ways.
And some will like it, some won’t. Some will be really good at it, some maybe not. Hopefully they will be, and you take it from there. I will tell you, I didn’t start joining the Academy to become education chair. And I never dreamed I could possibly be president of the Academy of Neurology. I say that with incredible sincerity. Anybody who’s starting out at that level, I’m not sure they’re going to succeed. I mean, it just happens for circumstances that in a way you can’t control. But from my point of view, it’s been the greatest honor of my professional life, and I couldn’t do it without all the great people I work with. And one question people ask, what are you going to miss? You didn’t ask that, but I’ll—so, it’s similar to what my roles have been at the Mayo. I’m not going to miss the day-to-day meetings or being in the loop. I was in the loop, and my time will be done being in the loop. But what you miss is the people, greatly. I mean, that part you miss, the incredibly great people, staff, Cathy, Christy Phelps, Jason Kopinski, my board members, my friends, my colleagues.
That part I’ll miss greatly and, you know, we’ll continue, but it’s never quite the same relationship.
TS: Well, thank you for your time. We will miss you.
TC: Well, thank you. I appreciate that.
TS: I can tell you that and I appreciate it so much you coming by.
TC: Yeah, thanks for interviewing me, Tim.
TS: You bet.
TC: Okay.