Mitchel Berger, MD, who chairs the Department of Neurological Surgery at UCSF, has just begun his term as president of the American Association of Neurological Surgeons (AANS), a scientific and educational association with more than 8,000 members worldwide.
Mitchel Berger, MD
The AANS is dedicated to advancing the specialty of neurological surgery to provide the highest quality of neurosurgical care to the public. All active members of the AANS are physicians who are certified by the American Board of Neurological Surgery. Berger is the first neurosurgeon in the history of UCSF to be selected as president of the AANS.
Berger is a nationally recognized expert in treating brain tumors and tumor-related epilepsy in adults and children. He also is a specialist in brain mapping techniques used during surgery to identify areas of motor, sensory and language function, and he has used these tools to develop protocols that are more likely to spare crucial brain functions during the removal of cancerous brain tissue.
In this interview, Berger discusses his new term as president of the AANS, the creation of a national outcomes database that will satisfy future federal requirements and guide the development of safer, more cost effective neurosurgical practices, and a new research organization to fund innovative pre-clinical science that otherwise would not be supported.
Q: Congratulations. How does if feel to be president of the AANS?
A: It means a lot to me personally, and it puts a spotlight on UCSF neurosurgery. The AANS is an organization that's been around since 1931. Its founder, Harvey Cushing, was in a way thought of as the father of neurosurgery. I am the 81st president. It's a great honor and privilege for me to have been elected to serve as president and to represent not only my specialty, but also my department at UCSF, the School of Medicine, and the medical center.
Q What’s on the agenda for the AANS for the next year?
A: One of the most important things we're trying to deal with now is to develop a national neurosurgery quality-outcomes database. We realized that in the future reimbursement is going to be linked to our performance as physicians. And one of the things we haven't done a very good job of, throughout the varied practices in the United States, is in systematically collecting our outcomes data.
Q: Is that something that has to be done before you can identify what the challenges are in terms of, for example, reducing readmission rates?
A: Well, the development of the database deals with various aspects of care having to do with quality improvement and patient safety, including medication errors, wrong-site surgeries and other errors in the care delivered in the operating room. Readmission rates are another way to measure adverse outcomes. We're trying to pay attention to all of these in a significant way. The insurers, the payers, CMS, Medicare — they're coming to us now and making it very clear that they must see our outcomes data for a given procedure if they're going to pay us a certain fee to do a procedure. They need to make sure we're doing it cost effectively, that we’re doing it safely, and that we're not having excessive adverse outcomes.
Q: What’s the status of the project?
A: The project has started. We're being proactive in developing this national registry through an effort that we as neurosurgeons are funding. So we have our own group of investigators who are running this. We are offering the registry service to all neurosurgeons at any level of practice, throughout the country. The project is called N2QOD, and it’s housed at the Vanderbilt Institute for Medicine and Public Health. All of our data is entered through their software system, called Red Cap, which is a well known outcomes database-management system. It's processed and analyzed at Vanderbilt, and they will be providing feedback to us on this data so that we can begin to report these outcomes soon.
Q: What else is on the agenda for your term as AANS president?
A: I think the other very important agenda for us is that we want to promote more research among the ranks of neurosurgeons. Traditionally, less than one percent of the entire pool of neurosurgeons is funded through the National Institutes of Health [NIH] to conduct research in any discipline or domain. And that's just not acceptable. So we have to help our own, because a lot of our colleagues in neurosurgery are very talented. They can do the research, but they can't devote 50 to 75 percent of their time to research. So we've established something called the Neurosurgery Research and Education Foundation to promote residents and board-certified neurosurgeons who want to do independent research and compete for funds to help support clinical trials, comparative effectiveness research and industry-based studies.
Q: Will funds for this primarily coming from industry?
A: I envision the funds primarily coming through industry and through endowments that we develop through industry. But it will serve the purpose of allowing seed money to be directed to individuals in neurosurgery who don't have the time or the where-with-all to be competitive at the NIH level, but who still want to do clinical research.
Q: Will these clinical trials be led by neurosurgeons at academic medical centers?
A: Not necessarily. The trials will be led by neurosurgeons. They could be at academic medical centers, or they could be at large, multi-specialty, private practice groups as well. All research proposals are going to be peer reviewed and evaluated. But this is a way of basically protecting our research talent, and not letting them get discouraged by the declining funding levels at the NIH. We will be funding our own, giving them the necessary resources to take on a project, to get preliminary data, and then we hope they compete for a larger-scale grant through government research-funding agencies.
Q: Will this work for all different kinds of clinical trials including, for example, studies of new surgical techniques?
A: Sure, it's not limited to drugs. It also includes devices. And neurosurgeons have been very innovative, for a long time, in developing techniques, instrumentation and methodologies. This will also give them the capability to do that.
Q: Will the emphasis of the Neurological Research in Education Foundation be on research normally not conducted by companies or funded by government agencies?
A: I think so. There are certain kinds of neurosurgery research that will probably never get to the level of NIH funding, for example, very basic spine biomechanical studies by neurosurgeons who develop new spinal constructs for spinal stabilization. It would be very difficult to get the funding to test this in cadavers. Likewise, when you're talking about new device development or new instrumentation, it may take a certain amount of money to be able to craft the tools or the devices and to create several generations of them before they're tested on cadavers or animals and then brought to patients. The NIH is not typically going to fund that kind of work. So I perceive this as a way to fund high-risk but promising procedures or proposals that otherwise would not be supported.
Q: What would you like the broader public beyond the neurosurgery community to appreciate about the role of this organization in advancing the field of neurological surgery for the benefit of the patients who need that care?
A: Well, the reason we exist as neurosurgeons is to serve the public. And so it's our responsibility for us to be current in our understanding of the field, to continue to promote innovation, and to partner with industry so that we can bring new devices and techniques into the clinical milieu to serve our patients well. And I think we're also very interested in having neurosurgeons be well rounded individuals who promote patient health, well being and safety. We need to do more to promote patient safety, and that will continue to be a theme that I speak out about.