Interview with Robert C. Griggs, MD, FAAN: AAN President 2009−2011
Robert C. Griggs, MD, FAAN
AAN President 2009−2011
Saturday, April 22, 2017
Boston Entertainment and Convention Center
Boston, MA
Tim Streeter, AAN staff, Interviewer
(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: Hello. My name is Tim Streeter. I’m with the American Academy of Neurology, and this morning I am with Dr. Robert Griggs, who was president of the AAN from 2009 to 2011, and he has been kind enough to stop by here in Boston at the Annual Meeting to tell us about his leadership experiences with the Academy. Good morning.
RG: Good morning, Tim.
TS: How are you?
RG: Fine. Thank you.
TS: Good. Well, I’m going to start out with the obvious question: when and why did you decide to become a neurologist?
RG: Well, I sort of went back and forth. I actually ended up becoming an internist first and a neurologist second, but there was an era when I started out that you could do a year or two and then go back and forth, so I vacillated between both and ultimately decided to do both. Probably the seminal event in my life was when Milton Shy arrived at the University of Pennsylvania when I was a third-year medical student, and my medical school roommate said, "Why don’t we take an elective that he’s giving in the evenings?" I started going to this elective, and I still remember him telling me, "Griggs, go to the board and draw me a cross-section of the spinal cord." You have to know, we had an absolutely wonderful neuroscience course at Penn taught by world leaders, but because they were talking about the research and not about anything I thought I needed to know, I didn’t go to the course, which was possible at that time. They had us write a paper at the end of the course, on which I did a good job; so that worked out just fine, but I had no idea about the spine. I didn’t even know how to draw an oval. That put a certain amount of fear into me, and I spent the rest of my third-year learning neurology because I never wanted to be as embarrassed again. I actually became pretty good on the nervous system while a medical student. He was a wonderful teacher, Milton Shy. It’s fun now that I’m working with his son, Michael, a great deal. Neurology really captured my attention because of him.
TS: Really? He inspired you?
RG: He did. He inspired me, and then I went back and forth, neurology with King Engel. I went to the NIH. Then, when I came to Rochester, I was planning to go back into medicine, but I met Bob Joynt and that settled it. I knew I then wanted to do both medicine and neurology.
TS: Now, you joined the Academy in 1971. What were your expectations when you joined? What did you need as a young neurologist?
RG: I think what I found at the Academy was good clinical science. I actually went to the first Academy meeting and presented a platform paper in 1970 when I was a medical resident, and I looked to the Academy for science. Then, not long thereafter, when I was still just finishing residency, I was asked to participate in a course at the Academy. I became aware that there were really good educational programs, and I got involved in education and science very early, even while I was just finishing my training. I saw that both of those were academies where you went if you wanted educational courses to expand what you were learning at home. For my field, neuromuscular disease, it was the best scientific meeting for clinical papers in neuromuscular disease. It was and really still is.
TS: How did you become involved in leadership activities?
RG: Various people gave me things to do at the Academy. Bob Joynt, of course, had been president of the Academy, and he sort of pushed my name forward to be involved in things with the Academy. My chair of medicine in Rochester had gotten me involved in what was called the MKSAP (Medical Knowledge Self-Assessment Program). Because of my experience with that, I had done that right out of residency, and had run the neurology section for that. I was tapped by Ted Munsat, another Academy leader who was to be involved in the early efforts to develop a self-assessment program in neurology [Continuum® Lifelong Learning in Neurology]. That put me into a position where I was involved with education and started going to the Education Committee. I was also put on the Science Committee early on, because I’d been involved in presenting and talking at the Academy meeting quite a bit. People who were involved in education, Ted Munsat was particularly important to me, but others got me involved in science.
TS: Munsat was responsible for creating Continuum®.
RG: He was. He ran the education committee and he put me on the education committee, was my impression. I think various presidents got me involved early on. [Former President] Nelson Richards appointed me to run a subcommittee of education, the Non-Neurologist Education Subcommittee. For some reason, I got invited to go to the board meetings almost frequently because we were working on educating internists and educating family practitioners, so I started going to board meetings actually in the late ‘70s.
TS: Really. Were Dr. Joynt, Dr. Richards, were they like mentors to you within the committee?
RG: They were. Nelson was terrific. I’ve been in touch with him just within the past few weeks. He’s still active, bright, and doing well. Bob Joynt was definitely a mentor of how you work with people. People say, "You can’t always be right, but you can always be kind," and that was sort of Bob Joynt’s motto.
TS: He really seemed to be a people person.
RG: He was. I would ask him—when I was putting people on the self-assessment program for medicine, I did neurology—I would ask him about people. The worst he would ever say about someone was that he was "prickly." That was his worst thing he could say. If Bob Joynt said he was prickly, I actually did point out somebody who was prickly, and Bob Joynt was absolutely right.
TS: Before you became president of the Academy, you spent 10 years [1997-2006] as the editor-in-chief of the Neurology® journal. What accomplishments during that period of time are you most proud of?
RG: It wasn’t just me. I had wonderful associate editors. I had wonderful people helping me. There were good people at the Academy helping me, but I was proud, because I came and was appointed editor at just the right time. The things had not gone online, and our publisher at the time, Lippincott, didn’t want to go online, because they were making a lot of money from advertisements. So, they said, "We go online, we’ll lose all that revenue." I thought that was absolutely not true, and so working with an Academy staff person, Tom Cooper, we put the journal online through working with HighWire. I thought that was terrific. Then we started doing electronic reviewing by email, and that was an absolutely wonderful breakthrough in the way you did things. Before that time, we were sending papers out by Federal Express, and this meant to send them overseas was very costly. Neurology had never had international reviewers, and we started sending things out electronically. By the time I finished, the majority of our reviewers were from other countries, much as the majority of our authors of the journal are from other countries. The other thing I realized was that big journals that are important in the field were published more frequently, so we first went from a monthly to eight, twelve issues a year, to eighteen, and I tell you, that was such a success, because it shortened the time to getting the papers published. We were getting so many papers. We went from 1,500 to 5,000 papers a year while I was editor.
TS: That’s quite a backlog, isn’t it?
RG: That was the number we received. We would get a backlog, and so we then needed to expand our number of issues. We wanted to expand the currency of what we did, and it was such a success moving to 18 issues that I said, "Look, Circulation heart journal has gone to weekly.” My editor was a friend. I said, "What are the downsides?" There were no downsides, and so we decided to go to weekly the last couple of years while I was editor, and that was a really good thing to do. One of the things that happens when you sort of dominate the print publishing areas is you dominate the advertising revenue. Although that’s not editors’ main job, the only really vigorous applause I got from the board as editor was when they would announce how many millions of dollars we’d increased our revenue from our various advertising things that we did. I think editors should pay attention to the money. No money, no mission. That was one of the important things.
TS: That revenue helps keep members’ dues down, too.
RG: It does make a difference. It makes it possible for the meeting to be relatively inexpensive, and I think that has contributed a lot. Doing things internationally was so much fun. We developed international editions in Poland, in Japan, in Korea, in Spain. It was a wonderful experience working internationally, and of course I had to go meet with the editor in Italy, the editor in Poland, the editor in Japan, the editor in China, and the editor in Korea. Each time, I would be wined and dined and had a really good time doing that and met so many wonderful people. That was one of the really fun things of being editor. You got to know 2,000 reviewers around the world.
TS: The Academy has successfully tested a prototype of neurology clinical practice while you were president. That helped pave the way for a couple more spokes, journals. Neurology® Genetics and Neurology® Neuroimmunology and Neuroinflammation. How did that come about?
RG: I didn’t really drive that. I was aware that we were receiving so many good papers. When I took over the journal, the acceptance rate was close to 50 percent, and then it dropped while I was editor, down to around 20, 18 percent. You could just see that the number of percentage of papers was going to be too small. I’d always felt that one of our things was, we should be publishing the work of young people that presented papers at the meeting. I didn’t feel that they had to submit it to us, but I thought that to be one of the jobs of the editor and the reviewer: to help young people get their papers into shape and publish them in the journal. Eventually, the journal was only accepting about 10 percent. That’s pretty discouraging statistics. I think it’s a good thing, because unquestionably, 20 to 30 percent of papers are outstanding. They get published someplace, but why not capture those good papers, particularly if they’re of great clinical importance? I think having a clinical journal, that really has everything that clinicians need to see, turned out to be a really important step, and I thought it was a great idea.
TS: You knew [former Neurology editors-in-chief] Bud Rowland and Robert Daroff. Can you talk about their contributions to the journal before you became the editor-in-chief?
RG: Bud Rowland taught me about editing. It was a privilege to get to know Bud and Esther extremely well and they’re just wonderful people. They changed my political views about the world. They did lots of other things for me. We used to go to the opera with them and have dinner with them; they were just wonderful people. While he was editor, I sent him lots of papers and I think he accepted most, if not, all of them. He certainly had a heavy hand in editing. His red pen on my papers was famous for everybody’s papers. It was a good sign if he’d edit your paper, because that meant it was likely to be accepted. He taught me how to write tersely, consistently, and clearly. That was a big thing. The other thing, he knew his authors very well. When I was editor, I wanted to know every reviewer and every author, because I continued to edit every paper that I saw and read every review, and that meant that I got to know people and their work habits and how they thought. Bob Daroff was a brilliant editor. He was very insightful and very ethically superb. He understood the ethics of publishing and doing things right. I learned things from him. He also knew people and could evaluate whether somebody was doing a good job. He taught me how to evaluate reviewers and think about them, and Bob also had wonderful tricks of writing clearly and concisely. He wrote this paper in the journal and I used his advice, and it was excellent advice.
TS: Did you know Dr. DeJong [founding Neurology Editor-in-Chief Russell N. DeJong, MD, FAAN]?
RG: I did. He was a visitor to Rochester very early in my career, and I was just impressed with him as a distinguished clinical neuroscientist, and I think I could have had a paper published while he was editor. I did have papers very early in my career in neurology, but I didn’t have a feeling for him as editor, but I did know him as a person. In fact, I had a signed portrait of him on my wall of my office while I was editor, from all the editors.
TS: He had a remarkable career with the journal.
RG: He did. He started it, and it was his friend, Abe Baker, that got him involved, I think. There was another man. I’m blocking on the name.
TS: Did you know Abe Baker?
RG: Yes. I went to a course he gave early on in the Academy, before I became a member, actually I had been to a course he gave. Then, of course, with Bob Joynt, there was a multi-volume loose-leaf text that [Baker] edited, and Bob Joynt and I became editors together of that after he gave it up, Baker’s textbook of neurology.
TS: Right. Going back to the journal, much of the day-to-day publications were handled by another company, weren’t they in Philadelphia at that time?
RG: Yes. Philadelphia, Lippincott.
TS: You eventually kind of created your own staff there in Rochester?
RG: I did.
TS: That was just kind of to speed communications?
RG: An editor needed—because of the volume of things you received, and the pace of publishing things, you needed your own staff. I’m very proud of the way my staff developed. I took people who didn’t really have much background in science. The only person who is still with the journal was Bob Joynt’s daughter, Kathy Pieper. She was a real talent in the editorial area who worked with Bob on the Archives of Neurology, now JAMA Neurology. I hired my staff and sort of mentored them. One of my things I’m proudest of in my career overall is the fact, when I gave up the editor, the new editor, who was John Noseworthy, and the Academy staff said, "Well, we can’t lose these people in Rochester."
They continued to handle the journal from Rochester, New York, and they’re still in Rochester, New York, because they are so good.
TS: Yeah. I’ve met them. They are wonderful people. I work with them quite often. What sort of leadership skills are required to successfully run these publications? Do you need to have a business sense as well as an editorial skill?
RG: I think an editor should pay attention to the money. Some editors of very big journals say, "It’s not my job." I think it’s extremely important for the editor to sit on the board of the Academy, because I think what is going on in neurology should be uppermost in the mind of the journal editor. I’ve always argued that it’s critical for a journal editor to be involved with the structure of the Academy. At the same time, I think being an editor is less of a business and more about the people. One of the things that the late David Drachmann told me is the key question: Is Neurology a journal for the authors or a journal for the readers? I concluded that it was both. This meant I had to know what readers wanted and talk to people, and I had to know what authors wanted and make sure I knew each one of them.
TS: When you became president in 2009 did you have any ambitions to become Academy president? How did that come about?
RG: I knew the people who’d been president before me, and I was just impressed at their impact. It looked like they were having fun: Bud Rowland, Nelson Richards, Mel Greer, Sandy Olson, and Ken Viste. He was a wonderful person. I still remember Ken Viste. I think it was he who called me and told me I was chosen as editor. Ken was a wonderful person. I just loved him. I was impressed. Ted Munsat, Stan Fahn, and Steve Ringel were all really close friends. I admired the people who had done it, and I thought the Academy was an exceedingly well-run organization and became even better-run in more recent years. But it was big, and it did so much for education in terms of the science. I always thought it was, without any question, the best meeting for the practicing neurologist, as well as for the clinically-focused academic neurologist. I was happy to serve. I didn’t say, "That’s what I want to be when I grow up." I actually had thrown my hat out in the ring while when I was just starting as journal editor. Somebody asked me, "Do you want to be president?" I said, "Oh, that might be fun." I was glad I wasn’t chosen, because I ended up having so much fun being editor, but when I was asked to do it, I was overjoyed to throw my hat in the ring later as well.
TS: It certainly was a benefit to the Academy.
RG: Thank you.
TS: During your presidency, there were a lot of advocacy activities. One of them went back nearly 20 years, even before you were president: the annual Sustained Growth Rate debate in Congress as to whether reimbursements were going to be reduced for neurologists, or all physicians, for that matter. It was finally eliminated by Congress in 2016.
Now, were you involved much with the advocacy activities surrounding that? Did you ever go to Washington?
RG: Yes. I was actually quite involved in advocacy. I preferred to view advocacy as something that we need to do because of the patients with neurological diseases. You have to make sure neurologists are adequately compensated in order to have neurologists to take care of patients with neurological disease, but I always felt it was important for us to argue for the importance of taking care of patients with Alzheimer’s disease, epilepsy, Parkinson’s disease, and all the thousands of rare neurological diseases, that we had to make sure that we were looking after the patients. This involved making sure that neurologists were well-trained, were supported, and were able to spend enough time with patients. Neurology is a cognitive specialty. You were not doing surgery. We have relatively small number of procedures. Then, what patients need is somebody to talk to, somebody to advise them, somebody to talk to their families, and somebody to think in terms of preventing the disease in their children if it’s a hereditary disease. I felt that making sure that the political process operates for patients with neurological diseases was absolutely critical. I went to the [AAN’s Palatucci Advocacy Leadership Forum]; I loved it. It was absolutely wonderful. The people that ran it and the people I met remain close friends. I’m very admiring of the people who have been involved. It’s so much fun to see people like Elaine Jones get recognized as she is this year and to see so many people. I thought that was fun. I did go to Neurology on the Hill. I went there twice. It was just a question of how you spend your time.
I seem to be doing lots of things, and so at the present time, I continue to support the PAC [BrainPAC, the AAN’s political action committee established in 2007], and I was very supportive. Neurology was one of the last specialty groups to start a PAC. I was very impressed and thought that was very important to do that—strongly supportive of that. You asked about the SGR or the growth rate. Congress has not paid attention to the economic issues in terms of health care, as far as I’m concerned. I spent a lot of time in England, and I myself see that the way medical care is delivered in Europe is much better. The outcomes are better, the doctors are happier, the patients are happier. I have felt that the way American medicine has developed and persisted as an outlier should be changed. I think there are lots of people in neurology who don’t necessarily agree with me, so I didn’t feel that it was my job to espouse a specific particular. I felt it was extremely important to be involved, to be supporting members of Congress. That’s the way Congress runs. If you’re not in their office telling them about what you want, then they need to hear from us. I’ve always felt that it’s important for us to be in Washington and to talk to Congress. One of the things I did when I was on Neurology on the Hill was that I went to [New York Senator] Hillary Clinton’s office. We were a little disappointed Hillary wasn’t there, but we talked to a staffer who was a PhD neuroscientist, and that resulted in getting them to champion a bill that got the VA to develop epilepsy programs within the VA. Then I felt I could see firsthand that talking to a senator’s staff person got the ball rolling in terms of doing something that was of immense benefit to patients with epilepsy, and the veterans.
TS: Do you think that the PAC money feeds this political monster where, looking at SGR, where they continued to put off a solution, they just patched it each year. Organizations such as ours were making donations to the campaigns of the politicians who supported our view. At the same time, doesn’t that just kind of let them kick the can down the road a little longer?
RG: Yes. I think lots of people are critical of politicians. My feeling is that it’s a tough job. Being a neurologist in today’s environment is not easy. I think being a political leader is harder, and I can’t really second-guess. The system works by supporting congressmen with political donations. I think there should be a limit to how much people give, and I’m not happy with Supreme Court decisions to allow big money to have a big influence, but I do think that it’s important for us to be involved with our Congress people and educate them about what needs to be done. I felt strongly that it’s important for us to advocate for neurological research.
That is something the Academy has really stepped up to and had an important impact on. I established a group where we were meeting with all the institutes that deal with neurology disease in Washington, not just NINDS, and I found NINDS love this and they continue meeting here with NINDS, making sure that they have input to what we’re doing, and we know what’s going on with the research enterprise is important as well.
TS: The Academy added a couple of staff people to the Washington office while you were president. At one point, I don’t know if you were aware of this, but back in the 1980s there was discussion about moving the headquarters of the Academy to Washington. Do you think in retrospect anything would have been different or better for neurology?
RG: I think it’s possible we wouldn’t have been one of the last organizations to develop a PAC if we’d have been on-site and understood what was going on. I think there was probably a feeling you can’t do everything, so the Academy felt they should focus on education, and on science, and support their practicing neurologist. But I think it only became apparent in the past maybe 10 to 15 years, that if we don’t do more to support our practitioners and to work to make sure that their reimbursement is done fairly, that it’s going to be hard to get people to go into neurology. It didn’t become that critical an issue until more recently. I also feel that the people who are working in the Academy staff—our CEO Cathy Rydell, herself, had political experience. She was an elected official [in] North Dakota, and I think it required having that type of a perspective at the Academy to recognize the importance of being more involved in Washington. Of course, [AAN Senior Legislative Counsel] Mike Amery probably knows every congressman and most of the staffers. He’s the right man at the right time to take things to Washington. I’m not sure we had the people before that that would have been as effective as they have been recently.
TS: [Chief Health Policy Officer] Rod Larson was also a legislator in North Dakota—
RG: He was. Rod helped drive the move to Washington as well, so I think they get the credit. I think it required both good staff and right timing to get people there. I don’t know. I think if we’d gone sooner it might not have worked, just because we might not have had the right amount of people at the staff level in Minneapolis.
TS: Right. Correct. When you were president, the Academy took a neutral stand on Obamacare when there was the debate in Congress. Was there a particular reason for that?
RG: I think that the Academy has done a good job of steering a middle course, because there are lots of people, lots of conservative neurologists and lots of ultra-liberal neurologists, and I think the Academy has been wise not to pick a party and support it. I think that’s probably the right thing to do. My own view is that, as I’ve already mentioned, the United States is an outlier, both in terms of the quality of care, and in terms of the adequacy of medical care for our people. I think it is not right that we don’t have medical care for all people in this country as every other developed country in the world provides for its people. I think physicians would be happier, but there has always been a divide. In Rochester, for example, the institution collectively did not take Medicare or Medicaid funding for years. They didn’t have a VA Hospital. They thought government involvement in anything to do with health care was wrong. I was actually the first person to bill Medicare in Rochester, because a chief resident said, "We’re losing money by not billing. You go around and figure out how to bill the patients." So, I did. That was the first Medicare bill. This was some time after Medicare had been put in place. Doctors have always been divided in their opinions about what you do. I think you can’t take a strong alignment with a party, because we serve our members, and I can argue with anyone that it’s not right not to have good medical care for everyone, but I’m not going to argue that everybody ought to be a Democrat or Republican.
TS: The Academy took a stand back in around 2004 when there was a lot of debate about federal funding for stem cell research. The Academy came out in favor of that, because of its scientific application to finding cures for various diseases. Do you think that there are some issues where it’s necessary for the organization to take a very firm stand, even if it will alienate some members?
RG: Yes. Well, I was willing to publish papers on stem cell. I was willing to publish on where to search, and then the issue of brain death. There is a small number of neurologists I know and respect and think the world of, who feel that you can’t speak of a minimally conscious state, and they think, "My patients are still thinking great thoughts." You fight the fact that they can’t. There are other people who I enjoy as people. I think where the vast majority of people who feel that science can ethically do things, I think it’s not inappropriate for the Academy to take a position in regard to that and recognizing that there may be members that disagree. In this situation, I think for stem cell research you find the vast majority of neurologists, including people who are very conservative, religiously, as I am very much a person of faith. I feel that sometimes I disagree with people in my church over the issues, and I don’t make a big point of it, but if asked, I tell them. I think there are things that we should be doing for patients because I do think it’s ethical. I don’t agree with the stance. My own opinion was that it was an ethical decision, and I was prepared to take it.
TS: In 2011, you established the Workforce Task Force to look at the magnitude of the current and projected neurologist shortage. Can you talk about some of the findings of this?
RG: The big finding is that not enough people are going into neurology. This has never been a problem in Rochester. I have the most wonderful—I appointed him to be head of our program. In Rochester, anywhere from 10 to 15 percent of the medical students go into neurology. The average is someplace between one to three percent. I think you can get people to go into neurology because it’s the most exciting field, but some places they don’t. I think the economics of neurology are one of the factors that weigh into that fact. [Former AAN President] Terry Cascino has pointed out they get burned out, both because of financial problems and their difficult patients.
We set out to see if we are training enough neurologists, because we needed data to argue that we need to change things in neurology. It was a really good thing, because it looks like we were going to be probably 20-percent short of the neurologists we need, and that’s before we have a treatment for Alzheimer’s. Let me tell you, as soon as we have a treatment for one of the Alzheimer’s diseases, and it doesn’t work in others, the pressure is going to be on to figure out who has front or temporal dementia, or dementia with Lewy bodies, or figuring out which patient needs a new treatment. It’s going to become both an economic imperative as well as a clinical imperative. We are going to double the number of neurologists needed. If we start off short by at least 20 percent, the number of pediatric neurologists needed is inexhaustible as far as I’m concerned. There are never enough child neurologists. I actually thought the 20-percent figure didn’t square with my experience, that you just cannot satisfy a need for neurologists to see patients with headaches, kids with developmental problems, or seizures. I think that the report was extremely important to document with very carefully developed numbers. We do not have enough neurologists.
TS: Yeah. Now we’ve got a grant from the [Conrad N.] Hilton Foundation to help research that some more and find ways to bring more medical students into neurology.
RG: Right. I think this is one of the biggest things. We’re really working on getting young people in general, but particularly, a diverse group of young people involved in neuroscience starting at the high school level. I’m thinking ways we can get people from African-American, Hispanic, other under-represented groups involved in clinical neuroscience, both at the research level as well as at the level of taking care of patients.
TS: We need to find the Milton Shys and Robert Joynts to inspire people, don’t we?
RG: Exactly right.
TS: There was more public outreach from the Academy during your term. We produced the first patient video. There was a satellite radio show, “Neural Frontiers.” The very popular Neuro Film Festival was started during that time. What are your thoughts about these types of public outreach and education opportunities?
RG: I think educated patients are much more likely to get the appropriate medical care. Teaching patients about their disease is always something I did. I was always in the department of neurology in Rochester. I was the busiest clinician for many years, even though as I developed my research career, that tapered down a bit. Then I was always focused on educating patients and their families right from the start. I think that having an educated public is going to make the difference. I’m now vice chair of the foundation and chair of the research advisory committee, and we’re developing a program for crowdfunding by the public of neurological disease. This is an area where people who understand neurological diseases can make an incredible impact by helping support the research programs of young investigators. This is the way of the future in terms of developing support for new treatments for neurological diseases, which has always been my mantra in neurology. That’s what we need to do: develop new treatments for patients with neurological diseases. Having an educated public is essential to get them involved in research, to have their support for research, and have them understand the diseases that we’re working on treating and preventing. You need to have educated patients to learn how to prevent disease getting worse in themselves and appearing in their family, so this is highly important.
TS: You also took a stronger interest in reaching out to the wider neurology community with state neurological societies and neurology subspecialties. Can you talk about your—
RG: With regard to subspecialties, people go into subspecialties through neurology, so I think that it’s absolutely critical to be part of the mother ship in terms of thinking of themselves as neurologists. That’s true in general. Most neurologists, be they headache specialists or movement disorder specialists, sort of like to consider themselves as a neurologist first. They may ask their colleague to take care of a tricky Parkinson’s patient, or a tricky myasthenic, but they like to think that they can diagnose anything. I think that’s the way our specialties should be. I felt that specialists needed us to attract people into the field. People don’t just come out of medical school saying, "I want to be a headache specialist." They may decide they want to go into neurology and ultimately go into headaches. It was very important for the subspecialty societies. We were talking before about advocacy. If all of the 20 or 30 subspecialties of neurology are balkanized into little groups of little nests of specialists, they will not be able to argue collectively with the political process, so it’s very important to have us maintain one unified organization. I was very big on making sure we have neurologists. Sometimes they can’t get to the meetings, so it’s important for state societies to have a link to us. To have good, strong state societies, I restarted the New York Neurological Society, and that was a fun thing to do, and it’s actually getting stronger and stronger. It got stronger after I turned it over to somebody else. It’s doing very well.
TS: How did it happen that there was no society there?
RG: There was. There are actually more neurologists in New York state than any other in 2000. I think because there are so many good medical schools, and such an evolved Academy of many of the people, I think that there tended to be work with the academies opposed to developing the state. There are state issues. A lot of reimbursement issues, a lot of issues with patient access, a lot of scope of practice issues are decided at the state level. We looked at the very strong Texas organization, at their neurological society, and said, "We’ve got to do something here like that." We’re slowly but surely getting there.
TS: Is there any reason why the state societies have never been formally chapters of the Academy?
RG: There’s two different models. The AMA and the American College Physicians often have state-related chapter involvement, and particularly American College Physicians. I think there are active decisions against doing that, just because staff like [Chief Executive Officer/CEO] Cathy Rydell looked at these models and reconsidered it. It’s tricky. Some states have a handful of neurologists, whereas some have 2,000 in New York, and close to 2,000 in Texas or California. I think the notion of trying to have 50 societies, or 51 with Puerto Rico, is important to be there, but not necessarily having a representative group from each state. It’s a tricky issue. I’m not sure it’s a right decision, but that’s always been the decision that’s been made.
TS: The Academy has also helped promote state issues and alert members.
RG: Yeah. They haven’t been blind to the state issues. They have, in fact, supported the state initiatives. Any time I asked somebody [from the AAN] to come to the New York State Neurological Society meeting, they came. Presidents after I—always had a president there. Mike Amery is always there. It was easy to get the Academy interested in any state society. They were totally supportive.
TS: One of the things that you mentioned in your final president’s column that you were very proud of was reducing the amount of time that was spent on resolving complaints and disciplinary actions. Why was that meaningful?
RG: When I became president, it would take up to a year and a half, two years, or even longer to deal with a grievance from a member. A member was sued, somebody gave a testimony during his trial that was obviously flawed, and there are a handful of neurologists—I don’t like to refer to them as bad apples, but I think they get put in a position where they’re trying to help a plaintiff or trying to help a lawyer, and get money for the patient, and they sometimes testify inaccurately. It was very important to solve these problems quickly. And so, working with the Academy legal staff, [General Counsel] Murray Sagsveen and more recently, [Deputy General Counsel] John Hutchins, we said, "Look. We have to solve this quickly. You don’t want to have a neurologist worrying about being sued, if there wasn’t really a case for a grievance, and the people who are aggrieved need to have an answer themselves pretty quickly.” So, we ended up publishing our experience about how a grievance should be dealt with, and I thought that instead of tightening up this problem, make sure it worked for both people who were upset about being sued, and for the people who were. It’s not wrong for neurologists to testify [in] malpractice issues. We have to. It’s our responsibility. But it needs to be done, and make sure it comes to a quick conclusion.
TS: When you were president, the Academy made plans to move from its location in a leased building in St. Paul and build a new headquarters in Minneapolis. What went into making that decision?
RG: I think the Academy volunteers, as we were called—even the presidents were viewed as volunteers—were important. I think the staff recognized, and you could see that the Academy, which was very small when I first joined in terms of its staff, was just getting bigger. We were doing more things, and, as we did more things, the importance of what we were doing generated revenues to do that.
Obviously, we were continuing to grow. My one contribution was I proposed a motion that it should be quite a bit bigger than was the initial plan, because it was a big expense. It was a frightening expense for the board and for the staff. Cathy Rydell championed this, worked with [Chief Financial Officer] Tim Engel. She was brilliant in getting us the location and getting it passed through the city of Minneapolis, and she really gets a lot of credit, but Tim Engel, who worked with her very closely, also gets the credit. I was proud because I made the proposal that it should be bigger than they were planning, and actually thought it should be even bigger. I was right; it should have been even bigger. It certainly was a good thing that it proved to be bigger. I think more than one president felt that they had a major responsibility, but I was proud to be involved, because it had been such a beautiful building. It was so well put together. It’s so important to the city of Minneapolis, and it’s very important to all the programs of the Academy.
TS: Just a few more questions here. Since you ended your presidency, you’ve been involved in numerous committees and task forces, including the American Brain Foundation, and you were very instrumental in reshaping the clinical research program. What are the challenges that you’ve seen within the foundation in supporting neurologists?
RG: The clinical research trainees are such an important program. They started off with two trainees a year. While I was on the board, we were able to get this up, and now it’s 20 trainees a year, so at any given time we have at least 40 trainees or more. We’ve trained over 200 young people, and the success rate of the people the Academy picked for these trainees is so extraordinary. Five or 10 years ago, their success rate was close to 100 percent of them ended up getting NIH funding. It’s down to about 85 or 90 percent now. At the present time, we only are able to fund about 15 percent of the applicants, and there’s no question that twice that number are equally talented and just superb people. The NIH does not have enough money to train people. We recognize we need more neurologists. We need three or four times the number of clinical investigators. I’ve been committed to getting other organizations, pharmaceutical companies, and private donors to try to give money to the fellowships. Others have been equally supportive. Fran Kittridge took a lead in this, Austin Sumner was brilliant, and Darryl De Vivo. We’ve had wonderful senior leaders in the Academy who’ve championed this, and I just joined a bunch of people who I thought were doing the right thing. It’s been a pleasure to see the program thrive.
TS: What’s the best part of being the president of the Academy, from your standpoint?
RG: It’s the people. It’s so much fun working with the people at the Academy. I made a commitment before I became president to learn every staff person personally; I did. One hundred twenty of them; it got bigger. I’m so sad when somebody leaves. These are all my friends. They were wonderful to work with, and the senior leadership were just absolutely wonderful. The staff, [Deputy Executive Director] Christy Phelps, and [General Counsel] Bruce Levi, just the number of people—I’d love to mention them all, because I had so much fun working with them. That was good, working with the staff. Then, when I was editor, I got to know so many people. I’m still traveling to countries where I meet a reviewer that I’d never had an opportunity to meet personally, and that was what was fun. As president, one of the things you get to do is appoint hundreds of people to various committees, and I just love it when you call and ask, "Would you be willing to chair a committee?" and they say, "Who, me?" and they’re so excited to be asked to do something for the Academy. What other job are you in where people thank you for giving them work for which they get no pay? That was so much fun, and people who get involved with the Academy have so much fun. It’s one of the cures or preventions of burnout. If you’re involved working on things in the Academy, there’s no way you get burned out. You’re just excited about what you’re doing. You’re helping other people, and you’re ultimately helping patients with neurological disease.
TS: We’ve run out of time. I have more questions, but we have to wrap it up. I want to thank you so much for spending some time here talking about your experiences, and I know that I’ve enjoyed working with you when you were president. It was a great experience for me, and I want to thank you for that.
RG: Thank you very much. I appreciate it.
TS: Thank you.