Department of Neurosurgery
Uses Innovative Strategies for Growth
-Judy Wright, from the February 2005 issue of Academic Physician & Scientist
 

Bill Hamilton takes an active role in promoting the activities in the department as well as overseeing the department’s financial structure. Additionally, Bill provides training for the faculty and staff. “We’re trying to approach the development of an academic neurosurgery department from a different perspective, which includes developing a strong clinical practice using a nontraditional academic-based strategy,” says Bill. He is passionate about providing training in the nonclinical aspects of health care. This led him to develop an online training program in collaboration with resident Dr. Jonathan Tuttle, M.D., complete with a pre-test, a post-test, and seven slide sessions which include audio-visual training presented by Bill. This course teaches residents, faculty, and staff about the business aspects of health care. Dr. Tuttle submitted a paper describing the course and the advantages of using online training to the Congress of Neurological Surgery and received a CNS Resident Award for his efforts.

Like a father looking to improve his child’s future, Dr. Lee is taking a careful look as his Department of Neurosurgery. “We already have strengths in epilepsy and functional neurosurgery. We are one of the top five centers in the country for epilepsy surgery. We have strength in spine surgery and pediatrics. But we have some weaknesses,” says the neurosurgery chair. “One of them was in neurovascular surgery,” says Dr. Lee, who happily made that verb past tense last year when he hired Dr. Cargill H. Alleyne Jr., M.D. Dr. Alleyne completed a cerebrovascular and skull base surgery fellowship at the Barrow Neurological Institute in Phoenix and worked at the University of Rochester Medical Center in New York for about four and a half years before coming to MCG in January of 2004. Dr. Alleyne is also trained in endovascular techniques and he serves as Program Director and Academic Vice-Chairman of the department. “We’re initiating certain changes in our program to place us in a position to become one of the best neurosurgery training programs in the country,” says Dr. Alleyne, who is one of four new faculty members for the department that is making a major effort to expand in a specialty that is shrinking across the country.

Addressing the Shortage of Neurosurgeons
“There is an extreme shortage of neurosurgeons in this country, the worst it’s been since the 1950s,” says Dr. Lee.

He noted that the Augusta community is experiencing that shortage firsthand with the loss of several neurosurgeons in the last few years. In fact, MCG – with seven neurosurgeons on faculty and possibly more on the way – now has more neurosurgeons than the community. “This is indicative of what is happening across the country,” says Dr. Lee, who intends to expand the depth and breadth of his department’s services despite national trends.

To foster needed growth, he’s working innovatively with related departments. As an example, Dr. Alleyne is working closely with Dr. Jeffrey A. Stone, M.D., an interventional neuroradiologist in the Department of Radiology, on endovascular procedures, such as placing tiny coils to occlude aneurysms and cranial surgery. That closeness includes all physician fees for neurovascular procedures going into one pot that is equally divided between the two.
Perhaps even more innovative is the recent recruitment of the first neurologist with a primary appointment in the neurosurgery department, Dr. Alfredo Daniel Voloschin, M.D., a neuro-oncologist who just completed his training at Massachusetts General Hospital/Harvard Medical School. The new subspecialist is a critical piece of the Department of Neurosurgery’s expansion into tumor treatment. “When you think about brain surgery, what do you think about? Brain tumors,” says Dr. Lee. “One of our flagship programs needs to be in cancer.” Dr. Lee works closely with Dr. Voloschin, who takes care of patients before and after surgery. Recently the department initiated recruitment of a surgical neuro-oncologist that will help take tumor treatment to the next level. “By ‘next level’ we mean working with Dr. Voloschin to develop clinical research protocols, becoming involved with national brain tumor organizations and partnering with a basic scientist in neuro-oncology – whom we have yet to recruit – to develop a strong basic research program with a translational focus,” Dr. Lee says.

Recruitment of a second pediatric neurosurgeon in 2004 – Dr. Kimberly Bingaman, M.D., from Children’s National Medical Center in Washington, D.C. as the new chief of the Section of Pediatric Neurosurgery – has enabled not only the department to expand its neurosurgical care of children, but has given Dr. Lee, who worked solo in pediatric neurosurgery for more than a year, the opportunity to focus more on cancer.

The goal is for the brain tumor program to function as flawlessly as the epilepsy program, with adult neurologists Drs. Jeffrey M. Politsky, M.D., and Anthony Murro, M.D., and child neurologists Drs. Yong Park, M.D., and Ki Lee, M.D., working closely with Drs. Joseph Smith, M.D., F.A.C.S., and Lee to treat patients. Recruitment is underway for a neuro-intensivist who will help develop similar programs for patients who need intensive care. Physical medicine rehabilitation specialist Dr. Saima M. Samdani, M.D., who joined the neurosurgery faculty in 2003, already is working with Dr. Haroon Fiaz Choudhri, M.D., director of the Neurosurgery Spine Service, to make this happen in non-operative back pain.

The fourth recruit in 2004 was Dr. Samuel D. Macomson, M.D., who recently completed his neurosurgery residency at MCG and will help meet a broad spectrum of neurosurgical needs, including plans to provide neurosurgical services at two nearby hospitals.

Community-Based Practice Augments Clinical Practice
Dr. Macomson and Dr. Lee have established a community-based practice in Aiken, South Carolina, and provide complete neurosurgical call coverage, and outpatient and inpatient services to Aiken Regional Medical Centers. The intent is to augment the clinical practice in the department to include a patient base outside of MCG. While the less complex surgeries are conducted at the Aiken hospital, the more complex neurosurgical cases are conducted at MCG, which has the advantage of a full range of neurological-intensive based technologies and staffing. A similar arrangement is being made with a local Catholic Hospital, which is in Augusta and is less than two miles away from MCG’s campus. “Our community-based practice makes sense for us and the Augusta/Aiken area,” states Dr. Lee. “The shortage of neurosurgeons in our community coupled with the advantages of affiliation with a large academic medical center, provide an unparalled level of neurosurgical coverage for an area of our size.”

Research Growth
Parallel growth also is occurring in research. Dr. Sergei Kirov, Ph.D., neuroscientist, came to MCG in 2002 from Boston University to establish the Human Brain Lab that has enabled laboratory studies of problems such as epilepsy and tumors to extend from animal models to the human brain. Dr. Lee is working with School of Medicine Dean David M. Stern, M.D., to recruit a vice-chair for research for the department and possibly some additional researchers, including director of a neurovascular research laboratory. MCG’s neurosurgery residency program will be expanded by one year to accommodate a year of research. “The Department of Neurosurgery’s growth is logical, responsible and in concert with growth throughout the School of Medicine, ” says Dr. Stern. “Our goal for this department and every department is to maximize each aspect of our tripartite mission of teaching, discovery, and service.”

To help spread the news about burgeoning clinical, research, and teaching pursuits of the department, Dr. Lee has created an editorial office and started a bi-annual publication that will be made available to neurosurgeons and neurologists across the Southeast. The second edition of the department newsletter Neuroscience Outlook was completed in January of 2005. Dr. Alleyne is Director of the Editorial Department and Editor in Chief of the newsletter.

Its nonmedical staff complements the department’s growth. With 17 years of technical writing experience in Denver, Colorado, Judy Wright has recently joined the editorial team as the technical writer/editor for the department. She co-authors and edits the newsletter, web site content, articles, books, presentations, and grants. MCG alumnus Andy J. Rekito, M.S., has been the department’s medical illustrator for over two years. In addition to providing illustrations and photos for all of the department publications, and videotaping some of the surgical procedures used for teaching, Andy designed the layout for the Neuroscience Outlook and designed and maintains the department web sites. Recently, Andy attended the 2004 AMI (Association of Medical Illustrators) annual meeting at the Cleveland Clinic where he received the distinguished Russell Drake award for traditional pen and ink illustration and received a Certificate of Merit for his instructional color artwork. As the neurosurgery department adds new members, more and more technical writing, editing, illustration, and other media will be needed. The editorial department expects to expand accordingly to keep pace with this growth.

“Our whole growth strategy is based on getting the right faculty member at the right place and at the right time,” says Bill Hamilton. Dr. Lee adds, “We are committed on all fronts. We want to be the best in the country.”

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