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Stephen M. Sergay, MB BCh, FAAN
AAN President 2009−2011

Sunday, April 23, 2017
Boston Entertainment and Convention Center
Boston, MA

Interviewer: Tim Streeter, AAN Senior Writer 

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TS: Good morning. My name is Tim Streeter. I’m with the ��ɫ����, and with me today is Dr. Stephen Sergay, who was president of the AAN from 2007 to 2009. Thank you very much for joining me this morning.

SS: That’s such a nice thing that you’re doing to create a history like this. I’m very glad to be part of the process.

TS: Thank you very much. The first question is the most obvious one: When and why did you decide to become a neurologist?

SS: When I was a medical student, I looked at all the different fields of medicine, of course, and I initially thought I would be in one of the surgical fields and felt more akin to people in the internal medicine fields. In that realm, I found neuroscience the most appealing, most exciting, and the people who were doing neurology were more my kind of people. That sealed the deal, so to speak, and I went ahead with it.

TS: You were born in Johannesburg, is that correct?

SS: Yes, I was.

TS: Did you do all of your studying there?

SS: I went to high school and I went to medical school in South Africa. Our medical schools were six-year courses directly out of high school, and so, I actually did things for the two years in between, and then went to a six-year medical school program. After that, we were supposed to do six-month blocks of internships and residencies, and I spent two-and-a-half years of those in search of some residencies in South Africa before I came to Boston, actually, to do my neurology training.

TS: What year was that?

SS: That was in 1973.

TS: Okay. So, I think you were the first, perhaps only, foreign-born president of the Academy.

SS: Yes, and I saw that in your questions and I suddenly stood back and said, “You know, I never thought about that before.” It never really occurred to me. I think what happens in medicine, maybe in particular, people from all walks of life and from every country, are thrown together all the time. It almost doesn’t matter where you come from. I’ve never felt different. I might have some differences, but really, insubstantial differences to other people in medicine. It never occurred to me that I was a foreign-born person who was becoming the president.

TS: You joined the Academy in 1974?

SS: Yes, I did.

TS: What were your needs then, as a young neurologist?

SS: I didn’t really have specific needs as a neurologist; I’d always been involved in monitoring and managing affairs of medical school and of my profession as a medical student at that particular time. I couldn’t see going forward with a career without being part of the group that try to understand the career and manage the career of neurology. This was automatic for me. As soon as I had the opportunity, I joined the Academy, and I’ve been with the Academy ever since. It was a tiny, little organization at that time.

TS: Yes.

SS: There weren’t even, maybe, 2,000 members at that particular time.

TS: How did you get involved in leadership activities? Do you recall what your first committee assignment was?

SS: I recall exactly. It’s going to be a story that is an unusual story. There was a break-away society from academic and practice medicine—the Society of Clinical Neurologists—where we come from both sides of the street and we talk clinical neurology. I was at a meeting, actually, in Tucson, I believe. At that time, Jacuzzis had just come into being, and I was from Boston, which was too proper for Jacuzzis at that particular time. Going out west, there was a Jacuzzi, and I got in the Jacuzzi one night with a person by the name of Joe Bicknell, who was the head of neurology in, I think, in Albuquerque at that particular time. We were talking in the hot tub, and the bubbles were flowing forth and our feet sort of intermingled, which was sort of wrong, I thought, from a proper point of view. And Joe said to me, “Hey, Steve, are you doing anything with the Academy?” I said, “Not really.” He said, “Would you like to?” I said, “I’d love to.” He said, “You know, I’m the chairman of the Membership Committee and I’m kind of sick of it. Do you want it?” I said, “I’d love it.” Low and behold, I went home [and] on Monday the phone rang from the Academy office. They said, “We hear you’re the chairman of the Membership Committee.” I said, “Sure, I am.” And it went from there. That was a lucky break I had.

TS: Things can happen in a hot tub, right?

SS: They can.

TS: Did you have any mentors within the Academy as you were getting involved in committees?

SS: I didn’t really have mentors. I had people who I looked up to. I hadn’t even passed the board exam yet, and I couldn’t believe I was mingling with those kinds of people. I thought it just couldn’t be. I saw how they managed themselves, and there wasn’t really an official mentorship program during those days. It was, just, go along and let’s see how things work.

TS: Um-hum. You chaired the strategic planning committee in 1997—.

SS: Yes, I did.

TS: What was important about that committee and its work?

SS: There were things that were important for me, personally, and there were things that were very important for the Academy. That was in Ken Viste’s term as president, and he asked me to do that. Typically, when you get asked to do something, you first wonder if you’re up to the task, and secondly, very thankful for the opportunity. I didn’t really understand what strategic planning was, and I learned about it through that process. I read a lot about it to help me understand the process. That process had a specific aim in mind, and that was, to look at what the Academy was not doing that it should be doing, which is very different from subsequent strategic planning efforts that I was involved with. We came up with five different objectives for the next president of the Academy to consider. I understood a little bit about participating in the discussion and working through ideas and drawing consensus from that experience, all of which was fundamental for me in my future career with the Academy. I had another opportunity for being involved in strategic planning when, instead of asking that question, we asked, “What is it that we’re doing that we could do better?” That was a whole different slant on strategic planning and strategizing. From that first strategic planning exercise, we came up with all kinds of opportunities for the Academy, including development of AEI, for example, and should we move forward with subspecialty societies. There were five in all, and some of them worked out to be valuable, and some not to be valuable. It started people thinking in a different way. I think that was really probably the primary value of that whole process.

TS: More looking forward rather than just kind of being in the moment, or focused just on the Annual Meeting?

SS: All of us who have worked with the Academy have respected the Academy as an organization of not only excellent staff, but excellent volunteers. Everybody does it because of their love of neurology. One of the issues is when you join the board or any of the committees, it seems well-oiled and everything is going fine. But, every now and then, you should stand back and say, “Well, what could we do better?” I think if you could inculcate that idea in people and in groups, typically, those groups prosper from having that thinking.

TS: Correct. Was it your idea to come up with UCNS?

SS: Yes and no. What happened was that when Fran [Kitteridge] was president, he asked me to further work up the subspecialties, and could we develop an organization for the subspecialties? This had been debated for a while, and Kathy Foley [Kathleen M. Foley MD, FAAN] first stood it in 1991, where there was a strategic planning exercise just on what was the role of subspecialties in the Academy. Then, when Fran was president and he asked me to do that, I thought about it a lot on my own; I knew I wasn’t really completely up to the task. I happened to bump into Kathy Foley at a meeting in Philadelphia. She was going up one escalator and I was going down the other. I knew I needed to talk to her, so I ran around and went up the escalator. She had worked with a guy by the name of Ben Munger, who had all of the credentials to understand organizations that do certification of individuals and accreditation of training programs. I spoke with Ben, and we developed a team, the two of us, together, worked to try to coalesce the thinking to put together the UCNS. It was a two- or three-year—I think, maybe, a two-year job—with multiple meetings with every different group. It was a wonderful exercise, again, for me. Mostly, when one is trying to accomplish something in a big group, the question is, “What’s in it for this guy? What are you trying to take away from us? Who is going to try to seek power after all of this?” You have to be really calm and not defensive when you do that type of thing. We actually had a wonderful partnership, Ben and myself.

Ben was outside of the organization, so there were things he could say that I couldn’t say, because people might think it was for my best interest. We used to have two podiums in front of the meeting—him on the left, me on the right. I’d answer some of the questions that he didn’t know about, and he’d answer those I didn’t know about. We would meet prior to meetings, and we would strategize about what we were trying to accomplish. At our last meeting before we incorporated, we needed to have a name. We had chosen various names over time; nobody was really happy with any. It was a meeting, actually, here in Boston. At lunchtime, I said to myself, “We’re trying to unite everybody; we were looking at pediatric neurologists, a doc neurologist, neurologists across the sphere of interests, as well as people who aren’t neurologists, for example, in sleep medicine.”

After lunch I said, “Listen. Let’s just forget about those debates; let’s just call ourselves “the United Council on Neurologic Subspecialties.” There it was.

TS: If you wear everybody down enough, you come up with the right name at the right time. Did you have ambitions to become president of the Academy?

SS: I had been in leadership positions all my life, in medical school, and I enjoyed it. I particularly enjoyed the challenge to my way of being and behaving. I never once thought that I was ever going to be the president of the Academy; I never aspired to that, because I thought, “Look, who knows. If I even get onto the board, I’ll be excited.” Then I became vice president, and I said, “Well, if it stops here, it’s just wonderful; I’ve had a terrific life.” Low and behold, I was nominated. Typically, you need to be nominated several times before actually passing muster, so, I went through that same course that everybody else did, and I was overjoyed when the opportunity came my way.

TS: How has the practice of neurology changed between the time you joined the Academy and when you became president in 2007?

SS: I could probably sum it up best in a speech that Tim Pedley, who was president sometime after me, as you know, a wonderful person. He had made a speech maybe five or eight years before I became president, when things were really starting to change. His speech started with a Dickens quote, “These are the best of times; these are the worst of times.” And, it’s been like that ever since. The neuroscience has been spectacular and rapidly changing, significantly impacting the practice of neurology. At the same time, the dismay in medicine and the concerns of how we have lived our lives in medicine and charged—charged perhaps excessively, some people have said. All of that has resulted in an evolving discipline ethos that has been brought to bear on the way we do things in practice. That has changed that side of the equation. I would say the difference is night and day; the one thing that is a constant in medical care delivery, if you are actually a practitioner, which is different than if you are a researcher, for example, and I can’t talk about that, as well.

If you are a practitioner, the patient and needs never changes; that’s a constant, and the need to be able to fulfill the needs of the patient while delivering care, often to people who have incurable diseases, is unchanged and, I think, will always be present.

TS: The Academy began to develop more resources for practicing neurologists in the mid-2000, such as EHR vendor reports and quality reporting information. These things were things that practicing neurologists needed to help them deal with health care reform issues, and such. Was it a challenge for the Academy to keep pace with the changes of health care reform?

SS: These are gigantic, broad questions that you’re asking. There are issues, for example, in neurology now of burn-out. That’s been part a consequence of health care reform. Did we keep pace with that? Yesterday, Terry Cascino spoke about we’re seeing this bus, but the headlights are basically on us, already. So, perhaps we didn’t keep up with that as well, and maybe that wasn’t clear yet to everybody. Sometimes one only becomes aware of those things when they stare you directly in the face. I do think the Academy made a major effort to keep up with all of the components of health care reform and the needs experienced by practitioners in regard to those changes. One could never be perfect because, for example, you might need to know about electronic health records, but if you work at an institution, they choose whatever they like, whether you know about it or not. It’s nice and valuable that the data is available through the Academy.

TS: You were involved with advocacy activities. We have a photo in our files of you and Ken Viste, Fran Kittredge, a number of other doctors meeting with some people in Washington. That was important to you?

SS: That was important to me, and it still is important to me. It’s a very difficult street. There are many people looking to Washington for various things. Going to Washington taught me how difficult it is to accomplish anything there. I think we have it even more difficult than most because we are three percent of the doctors in this country, so, how much of a loud voice can we actually have? We are limited in that; we are limited, also, in that we don’t have a clear product. It’s not like you had a bad knee; you walk out with a brand-new knee, and then, you’re perfect. We help people cope with disease, so that isn’t as clear cut a need for people who haven’t had a neurologic disease as those who have had. I don’t think it’s an easy slam-dunk. That doesn’t mean that you shouldn’t do advocacy, so, I think it’s very important that they should carry on.

TS: The Academy started BrainPAC, our political action committee in 2007. It had been discussed for a number of years; I assume there were pros and cons?

SS: Yes. There were pros and cons, and then the vote was taken, I think at one of the very first meetings of Tom Swift’s presidency, if I remember correctly. All of us had some ambivalence because of the fact that we needed to support people whose policies we might not have believed in beyond what they were doing for medicine. We realized that was the game, and it needed to be done.

TS: One ends up, like you say, supporting a politician because they understand neurology or some of the issues you face, but politically, they might be on the different end of the spectrum.

SS: Exactly.

TS: It is also feeding into the “pay for play” sort of politics that a lot of people don’t like. “Lobbyist” is not the most favored profession in this country, right now.

SS: Right. It was always reassuring to me that George Washington used to meet in the lobby of a hotel in DC, and that’s where the word came from, lobbyist. If he could do it, we could do it.

TS: Right. Another big issue during your term was maintenance of certification. The Academy began developing resources such as NeuroSAE. What are your thoughts about maintenance of certification?

SS: I understand the rationale behind it, and I believe that matters have to be determined to ensure on-going competency. And that time, it was very late in my presidency, but I remember the on-going debates with the ABPN [American Board of Psychiatry and Neurology] about how to manage that. There was some sort of partnership developed between the ABPN and the Academy to try to come up with the right methodology. On my own individual point of view, I say to myself, “What would you do if you were a father of three kids and now you are paying a mortgage; you’ve got no time because of all the other stuff in medicine, and all of a sudden, you have to study for an exam on top of that. What happens if you don’t pass the exam?” I realize the anxiety it provokes in people, but I think it’s a really valuable thing for the community to know that doctors keep up with their science and with their art.

TS: Medicine has become more of a consumer-driven profession, hasn’t it, in some ways?

SS: Again, it’s a big question, Tim. It’s always consumer-driven because our patients are consumers, so we always have to work to satisfy our patients’ needs. Who is the consumer that, maybe, you’re talking about? The consumer is, maybe, the health insurance companies, you know, the Medicare and businesses like—I’ve read books about some of the plans who have GE as a customer. Then, they question for themselves, who’s really the customer, the patient or GE, because we control so many of their dollars. I understand about all those customers, but I do think, ultimately, our customer is the patient. We should never veer from this.

TS: Let’s talk about our conferences a little bit. The Academy celebrated its fiftieth anniversary when you were president, in 2008. How does the AAN keep its signature event, such as the Annual Meeting, fresh for attendees?

SS: Well, first of all, the science changes, so, that changes things a lot. Far more than that, it’s the Academy staff that is responsible for this whole meeting, Christy [Phelps] in particular, and of course, Cathy [Rydell] behind Christy. They’ve done a spectacular job through the years. With the committees that underlie the conference, and the Annual Meeting, ideas bubble up and the staff take those ideas and create some of the new things that are rolled out at every single meeting. The ideas are not all from the physicians; many of them are directly from the staff, and I’ve never seen a step backwards. I’ve seen steps forward with every meeting I’ve been to.

TS: Good. You spent several years on the Board of Trustees for the AAN Foundation; what were the challenges that the Foundation faced during those years?

SS: The Foundation, which was really Fran’s [Kittredge] baby—and I think it was Roger [Rosenberg] who recommended the formation of the Foundation—which was a perfectly good idea. It ran into a roadblock very early on in that it was very difficult to define a message. It’s one thing if you have a foundation supporting cancer, but if you say, “brain research,” it just didn’t resonate. There was no real feeling that we could generate with the name, in those days when I was more involved. As a result, our earning capacity was reduced; that threatened the Foundation throughout it’s time when I knew the Foundation. It wasn’t that the aims of the Foundation were bared or misguided—they were excellent. The question was the difficulty in raising funding for the Foundation.

TS: And, there’s a lot of competition, isn’t there, with the other very disease-specific foundations?

SS: Exactly. Yes.

TS: I suppose that many of the sub-specialists will tend to support the Parkinson’s Foundation or the Movement Disorders—.

SS: Exactly.

TS: —so, then, it’s the challenges to try to convey the broader scope of the AAN Foundation.

SS: Or, to liaise with those other groups, because the other opportunity that the Foundation provided was the science committee behind us who could help groups who weren’t in the know. For example, there’s a Friedreich's Ataxia Association—and I don’t think that they—I think they’re an independent association, but if they wanted to award money to somebody, I always thought our science committee would be the people who could direct them who would be the better people to receive that grant in time to come.

TS: Right, so, we have a number of those clinical training fellowships that are co-sponsored by the Academy and another foundation that seems to be working very well.

SS: Yes, it does.

TS: You were also on the board for the AAN Enterprises [the AAN's for-profit subsidiary from 2000 to 2013].

SS: Yes, I was.

TS: Can you share how this benefitted the Academy and its members?

SS: Yes. I think that came out of Ken Viste’s year of strategic planning. The thought was that here we have, almost, a captive audience, so to speak, of people who were in need of reducing their overhead and their expenses. Maybe we could help people from insurance opportunities onwards. We thought that we would be able to do that. It was a major struggle because of many difficulties including, for example, in insurances that to cross state lines with various insurance projects is extremely difficult. It became more complex than we thought. It was thought that this would be an earning arm for the Academy and that, maybe, our publications should be in that vehicle. It was the business side of the Academy, even though a lot of what the Academy does is business. That was, like, pure business, so to speak. It was very difficult to move that forward. By the time I left, it was still functioning, and I’m not sure what’s happened since then. It was very difficult to get that to move forward.

TS: It seemed to pave the way for the Academy to bring the journals inside to the Academy.

SS: Yes, it did.

TS: We’re still working with Wolters Kluwer, the publishers of the journals, but the journals have grown exponentially with the spoke journals.

SS: Yes.

TS: Do you think when AEI closed it was an idea that had run its course?

SS: I have to assume that; I wasn’t there at the time, but I felt like it was tending in that direction.

TS: Prior to becoming the president, you were the first editor-in-chief of AANnews—the member news magazine.

SS: Yes. Right, and so, that was entrusted to me many years before. To develop a newspaper like that, we had a committee called the Professional Publication Committee of the Academy. We sat around and tried to dream up a name over several meetings; we tried to dream up content, and we started to publish that. I thought it was a very good vehicle at that particular time. I still enjoy reading that. There’s many more things that one can read these days than just that. It was a fun undertaking.

TS: Since then, the Academy has relied on emails; we develop podcasts, social media, Facebook, Twitter. All of these things are directed at members. At what point do you think there’s too much? Neurologists are very, very busy people.

SS: Yes, we are.

TS: Do you get a chance to read all of the emails that we send you?

SS: Oh, yes, I read the emails; I do read the emails. So, like too much, again, if one person was going to do all of that, it’s too much; maybe by doing all of that, it’s valuable for various sectors of the membership. Some do this, some do that, and it doesn’t matter if not everybody does everything. I think it was a necessary thing; it was the coming of the electronic era, the new millennium, and all of that. I think it’s very important that that stuff continues.

TS: You were talking about—with the UCNS and strategic planning and your experience with membership—working with other people. You have a reputation within the Academy of being a consensus builder. How does that come to you? How did you develop that skill?

SS: First of all, when I read that in your paper, I said to myself, “That is as flattering a feeling as I could have had that, actually, was recognized.” I very much enjoyed doing that. I think it was for several reasons, if I try to go back—probably, I was just lucky, that I was born with that. I know there were things in my life. For example, in growing up in South Africa, which was an amoral country, I had to, at a very young age, find my own moral compass. That made it easy for me because I always felt like I could see the way forward in what I believed in. I also grew up in a big family; there were four kids, and you couldn’t have everything you wanted. You had to work out who would have what and why. Beyond that, I very much intellectually enjoyed the process of sitting around with people who seemed to differ, and yet, if you really listened carefully, you could really hear the kernel of similarity that everybody had, and then, to try to bring that thinking together. That was never more evident for me than when I was in the role of president elect, as the chair of the Committee on Sections.

The first meeting I went to—and I’d worked with all of these people putting together the UCNS reform. I knew many of them but not all. It was a long table of all these different sections and everybody knew they were right in what they wanted. The question was, could you coalesce that voice into a meaningful voice that, then, could take stage in the Academy voice? Could you, somehow, make that happen without making people become disaffected and yet unifying the voice on some significant issues? The way we achieved it—and Christy was with me at those meetings—when a topic came up, I went around the table and I asked every person, there must have been maybe 30 people at the table, what did they think? Everybody spoke. There were things that were floating around that were uniform, that people actually agreed on, far more than people disagreed. I thought the only way to handle this is to take it further. I went around the table a second time. Slowly, but surely, we came up with something that everybody said they were so glad they thought of. It was “we thought of,” but, everybody felt comfortable enough that it seemed like it was their thinking. The chairman of a meeting couldn’t ask for any more than that, than the members of the committee think it was their voice that came out of the meeting. What grew out of that was the Executive Committee of the Committee on Sections which, then, actually was a real action arm for the Committee on Sections. I’m not sure if that still persists, but it was a very valuable thing at that time.

TS: During your term, the Future of the Profession and the AAN Taskforce [FPAAN] was formed. What was its purpose, and what did it accomplish?

SS: In my two years as president elect, I read a lot and I dreamed what was, maybe, missing from the Academy that could be done better, and what were the threats that the Academy and the profession of neurology faced. I came to realize that the threats to the Academy are of one kind, and the threats to the profession are of a different kind. Both need to be paid attention to. So, I drew up a method of handling that and I wanted that to be a main thing for myself, as president, that would be the platform I’d like to move forward. I called it the “FPAAN” That was the Future of the Profession and the Future of the Academy, and that both needed full attention.

TS: Can you tell me what those threats were that you saw?

SS: The threats were, from the point of view of the profession, it was all the changes that the country and the world is going through because of the scientific revolution, and the cultural things that we’ve been living with, the growing US population, the polyglot nature of the US population, the cost of care—all of those things that could directly impact the profession. And, if they had a negative impact on the profession, it could affect the Academy, but the way it was going to impact the profession needed to be carefully scrutinized and managed.

The Academy—and my major issue with the Academy was not the staff because I was always comfortable with the staff—but my major issue was that the debates in the board wasn’t always based on context, because there are many contexts out there and everybody had different views of what context was. Secondly, there was not really a deeply thought-through question before the debates came about, and so, the board meetings were nice happy places of people giving their opinion, but I felt like the Academy was a mature enough organization that it needed to move forward from an opinion board to a data-informed board. The saying “informed” rather than “driven” because there are emotions and feelings and philosophies that are far beyond data. So, it had to be data-informed, and then I thought the debate would really be meaningful. It would be more exciting to be on the board; the board would keep up with all of the breaking issues in neurology, and I thought it would be a better board and would be better for the organization. I had hopes to plan for both, and, like any change, there’s all kinds of difficulties when one attempts to accomplish that. That was what my focus was.

I actually went into the presidency with two focuses, and the FPAAN was one of them, and the other one was to try to define what the issues were that doctors were facing. In my second year as Academy president, I actually developed that philosophy and tried to get myself invited to many medical schools to talk about it, so I could be criticized, and then I could really see my way clear more easily. That led to my presidential address, ultimately, at the end of my presidency. I had a spectacular two years—a wonderful two years as president—a life-changing two years, two years I’ll never forget.

TS: The Academy developed a leadership development program in 2007. Leaders—are they born? Are they created? How do we develop the future leaders for the Academy?

SS: That was—Burch Griggs was my successor, and I think he might have been more involved in that than I was. I knew that was happening, but I really didn’t play a significant role in that. I do think that some people have a greater tendency to lead than other people; but, I also think that there are aspects of leadership that people can learn and become skilled at. So, I think having a leadership academy is a vital thing for the Academy, and I’m so glad to see that that’s prospering.

TS: In the middle of your term, the great recession hit. That affected everybody; that certainly affected the Academy’s outlook as to revenue, and such. What steps did the Academy take to protect itself?

SS: We had lots of debates, but the debating that we did as the docs in Academy, I suspect, was one-tenth of what was going on in the executive office. That was an expense that could be directly controlled. I think the staff was spectacular in the accomplishments during that time of preventing any significant damage to the programs that we were trying to deliver to the members, and in maintaining the fluidity of the economy of the Academy. I think Cathy could probably take the credit and probably discuss that on a staff level far more meaningfully than I could. From my perspective, when I saw that coming and I understood what was happening also in practice, with the expense ratios and so on, and I knew the Academy’s state of financial health, I always felt it very important to try not to ever increase the cost of the meeting or the cost of the dues to people who wanted to come to the meeting. The life blood of the Academy was keeping people comfortable in their practice and coming to the Annual Meeting. If we could earn other than by dues, it would be a really good thing.

TS: There was a shift in the board, and you alluded to this earlier, to becoming more of a strategic focus body rather than micro-managing the day-to-day tactics. Why did that come about?

SS: Well, during my time of trying to put forward the FPAAN issues, that was the focus, that that should be the outcome of that program—that discussion—that, ultimately, we should have a far more strategic board. I could never have done that on my own; I might have brought up the idea. Terry Cascino, who was a young neurologist in those days and was very helpful for me in bringing that through. Changing legislation takes more than a horse; it takes several horses to be in the race, and he really had done strategic planning, himself, at Mayo, and understood the issues far better than I did. I understood the concept; he understood some of the issues. Collectively, that helped move the board forward. I think that if the board had not wanted that, it would not have gone forward. So, it really required the acceptance by the board and by the Academy staff, that that was a valuable way to move forward.

TS: The Academy adopted a new vision and mission statement at that time. Do you recall the reason for refreshing that?

SS: Well, there’s always a reason to refresh that because things change, and if you can really have a vision and a mission that is unchanging, then you haven’t kept up with the times. That was the time to look at it again, particularly, in light of the process of strategic planning that we had been through. Again, Terry was helpful, and Cathy was helpful with the formulation of that.

TS: I’ve got just a few more questions here before I let you go. Two years is a very brief time to be president. Were there things that you were—what were some of the things that you were the proudest of accomplishing, and what were some of the things—or one thing—that you wish you had had more time to work on?

SS: The way the Academy is now set up will make that never be a problem for people because one goes through the vice presidency, president-elect, presidency, the whole evolution of that person allows that person to define things along the way and move different things forward. That wasn’t the case with us.

I had been vice president and then I actually stepped down from the opportunity to repeat that during Stan Fahn’s time.

I did that to develop the UCNS, and I was very happy for that experience of developing the UCNS. So, I did not go into the Academy presidency expecting more than two years. I didn’t feel like I was unfinished, so to speak. My two major things that I wanted to accomplish, I think I set them both in process. I think that had I had another year, I might have done more, not on the strategy side because that was happening, but in trying to define how we in medicine should interact with the people who are trying to define medicine for us. I don’t think people understand what the issues are in caregiving, and that—in people who try to plan for medical care delivery without understanding those issues—it’s just a matter of time until that falls short. I would have loved to have done more about that at that particular time, but, time was up. As I was told when I was president, the most important thing about being president is to learn how to be past-president, which means biting your tongue, so that’s what it is.

TS: What was the best part, from a personal standpoint, of being the president?

SS: The best part was the people that I met with. I’m talking about the staff, again, but also the neurologists and people around the world in neurology. I was going to meeting after meeting after meeting, and I sat down at a table with meaningful people, having meaningful discussions every day of the week. It was wondrous—it was absolutely spectacular. I thrived on that, and I get some of that from my patients these days, but that experience with the Academy could never be improved upon.

TS: What advice would you give to a young neurologist who wanted to get more involved in the Academy?

SS: I would advise them to do that. I would say, this would be a wonderful opportunity for you. If you feel any frustration in what’s going on in the world, this is a place you can get your frustrations out. I think it could be a career to the side of your other career, and that you would enjoy every moment and be challenged at all times. You’d have to look at your assumptions of life every moment. I think you should do it.

TS: Thank you, very much, for taking the time to come down here, today. I know that you’ve got many things to do here at the Annual Meeting, so I really appreciate you joining me.

SS: Well, I’ve loved it. I thought you ran a good interview and thank you for taking the time to do this.

TS: Thank you, so much.