Implications of subcertification in neurotology. (Editorial).

The American Neurotology Society (ANS) voted with an overwhelming majority at its business meeting on May 3, 2003, to make it "the official position of the ANS that it is opposed to the Certificate of Added Qualifications (CAQ) [subspecialty certification] in Otology and Neurotology" and directed the ANS president to send a letter to the American Board of Otolaryngology stating that position. Three days later, it was announced that the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) no longer would administer Combined Otolaryngological Spring Meetings (COSM) for financial reasons, and that the Council of The Triological Society had decided that The Triological Society would withdraw from COSM because they were dissatisfied with the direction the Society meetings had taken.

Times and conditions of medical practice have changed dramatically since the specialty of neurotologic surgery began in 1963 and fellowships were gradually established. The goal at that time was to improve and provide training. Socialized medicine, third-party payment, and third-party control of medicine as we have today were not issues. In the mid-1970s, I developed an academic program at the University of Southern California that led to a master's degree in Neuro-otology. The program was of interest primarily for the fellow interested in an academic career and was not popular with the majority of fellows because of the additional effort and high cost required.

The concept of and reasons for subcertification have completely changed since many of us initially proposed and supported the proposal. In the present socioeconomic environment, subcertification is ill timed and can only add to the fragmentation of our specialty. The harm to general otolaryngologists is to eventually effectively restrict them from doing otologic surgery, even though they are trained to treat the majority of their patients who need ear surgery.

The Board of Governors has wisely provided you with a way to make your voice heard. They have requested that the AAO-HNS place on the election ballot a referendum of the Academy membership regarding the membership's wishes for or against CAQ in Otology and/or Neurotology. When your ballot arrives in the mail, be informed about what is best for Otolaryngology and make your vote count.