Neurosurgical Spotlight
      Across the country, a shortage of neurosurgeons has left many regions without neurosurgical services. As the leader in advanced surgical programs in the Brazos Valley, St. Joseph Regional Health Center has stepped forward to support the community of Bryan/College Station, by recognizing the importance of providing quality care for complex neurosurgical cases close to home.
      The foundation for an advanced neurosurgery program was actually being laid more than 15 years ago. The arrival of Rudy Briner, MD to the community represented a deepening commitment to fill a gap in specialty services in the area. Dr. Briner, trained in neurosurgery at UT Galveston and Board Certified in Neurological Surgery since 1994, has been performing brain and spine surgery at St. Joseph since 1988.
       "The advances in technology and the development of new procedures has dramatically changed the neurosurgery practice," said Briner. "The foundation of neurosurgical services that we have built here in the Brazos Valley in the last decade has become the launching pad that will make St. Joseph Regional Health Center a regional referral center for leading edge brain and spine surgery."

Building on the Foundation
       In 2005, St. Joseph and Dr. Briner welcomed Jonathan Friedman, MD to Texas. Dr. Friedman’s experience and training, including residency at the Mayo Clinic in Rochester, MN, have made it possible to expand the availability and scope of neurosurgical services in Central Texas.
       "We are focused on creating a top-tier, state of the art neurosurgery program here in the Brazos Valley," Friedman said, "that begins with the strong foundation and reputation that Dr. Briner has already created here."
       In an effort to develop a regional referral center for neurosurgery, Friedman outlined several key components of a quality neurosurgery program that patients need to know when looking for a place for treatment.
       "The cornerstones of our neurosurgery program are the ability to offer the full scope of brain and spine surgeries, including spinal reconstructions, complex brain procedures, and brain and spinal trauma. We have state-of-the-art tools and techniques, such as the computer-guided surgery that is currently being done at St. Joseph, that are supported by specially trained operating room staff. Additionally, our program is multidisciplinary with support from neurology, anesthesia, radiology and rehabilitative medicine. These pieces are all here in our community, and St. Joseph is key in bringing them together for neurosurgical care."
       The multidisciplinary approach to neurosurgery provides the best outcomes for the patient. Collaboration among specialists helps to determine the best treatment options for a particular diagnosis, whether that be surgical intervention or a non-surgical alternative.
       "We are very excited with what is happening in the neurosurgery area at St. Joseph," said Kelly Lobb, MD, physiatrist at St. Joseph Regional Rehabilitation Center, "The rehabilitation model has always been about bringing a variety of disciplines together to work as a team in order to improve outcomes. I look forward to working with the neurosurgeons to develop a model in which spine care is practiced in an inclusive, interdisciplinary and integrated fashion that offers the patient a variety of proven therapies and options."
       Communication, as well as the collaboration that Lobb mentioned, will be the glue that brings together the pieces of the quality neurosurgery program and continuum of care that St. Joseph, the neurosurgeons and representatives of other medical specialties are building.

Competition versus Convenience
       The biggest obstacle to expanding services in the Brazos Valley is the proximity of large metropolitan medical centers. There has always been a strong perception that "big city" means "big medicine" and therefore better quality. However, for many of the patients that travel to these medical centers from the Brazos Valley, there are sacrifices.
       Patients and their caregivers must make frequent trips that can be an hour and a half or more, one way. This is due to the fact that many physicians choose to have diagnostics done close by where they practice, and most procedures require a number of pre-procedure and follow-up visits. When overnight stays are required, the caregivers are often faced with commuting back and forth each day, or taking on the additional expense of hotels.
       "What we have found through research is that the outmigration numbers were very high," said Dr. Mark Montgomery, vice president of medical affairs and quality services at St. Joseph Regional Health Center. "In Brazos County, it has been as high as 47 percent of the patients, and even up to 73 percent of those patients living in the outer part of our market."
       Dr. Briner and the administration of St. Joseph realized that providing excellent care with the convenience of being close to home was essential to better outcomes. Working together, a plan developed to keep patients seeking treatment locally.
       Over time, the level of talent and technology available in the Bryan/College Station medical community has equaled that found in major medical centers, and this is changing how people make choices about their healthcare and where to get it. The increased availability of quality diagnostic tools has made it possible for facilities such as St. Joseph to invest in the type of state-of-the-art resources that attract and retain top-rate physicians.
       Drs. Briner and Friedman are committed to keeping patients close to home. This fall, they began seeing patients in outreach clinics set up in Huntsville and Brenham. Patients are able to have their initial evaluations and all of their follow-up without having to drive out of town, while the treatments are an hour or less away.
       "It’s about the relationships that we build," said Friedman. "As physicians in other communities see what we have to offer here at St. Joseph, and the types of procedures that we are doing here, they are inclined to send their patients this way instead of to Houston or Austin. For this reason, these outreach clinics represent a vital step in solidifying our position as the region’s main neurosurgical referral center."

High Tech, High Touch
       Already there has been substantial momentum generated by St. Joseph’s commitment to building neurosurgery services in the Brazos Valley, and what lies in the future is equally exciting.
       "Our neurosurgeons have really taken the task of building this service to heart," said Montgomery. "They’ve begun to take that firm foundation, build upon it in a way that encourages future growth, and then take that package out to the surrounding communities in order to expand our presence for the patients in the region."
       "We’re treating complex aneurysms and brain tumors, and using state of the art technology," said Friedman. "In addition to the spinal procedures and trauma that we see, the cutting-edge procedures contribute to establishing St. Joseph as a regional referral center for neurosurgery."
       The growth of this program will only be enhanced as the different disciplines are woven more tightly, and this integration begins to fill in the continuum of care. High end diagnostics, complemented with a broad scope of both surgical and non-surgical treatment options set the stage. A highly specialized and trained clinical staff and a comprehensive rehabilitation program improve the opportunity for successful outcomes, even on the most complex problems.
       "Our goal will be to increase the services that we provide and to bring in newer, more advanced technology," said Friedman. "Over time -- and we are already seeing this - patients with brain or spine problems will be coming to our community from farther and farther distances for their complex neurosurgical care."