At the beginning of his career, when Marshall Cress, MD, was deciding what practice area he wanted to specialize in, it was the potential for technological advancement that drew his interest and imagination to neurosurgery. Today, as a highly respected neurosurgeon at Orlando Health, he is part of a rapidly growing neuro-services practice that is in the process of doubling the number of neurosurgeons.
"For several years we hovered around four neurosurgeons," Cress said in a recent interview. But by this fall, the eighth neurosurgeon will be joining the Orlando Health team.
"Our skillsets are going to run the gamut: Vascular neurosurgery, fellowship trained spine surgeons, surgeons who perform deep brain stimulation and epilepsy surgery, and a surgeon who specializes in tumors of the skull base - and who has specialized training in taking them out with endoscopes, so only a very small incision is needed," said Cress. Treatment doesn't begin and end in the surgical suite, however. "It takes a collaborative, established team to work together. You need neurologists, neuropsychologists, pain management physicians, as well as surgeons. And we have that here.
"Beyond that, all those surgeons are also very well-versed in taking care of tumors. And so, we have a very busy and capable neuro-oncology service for both the brain and the spine, and we work very closely with the cancer center and the surgeons in that arena to give patients access to easy, centralized care for their cancer treatments, which I think is important, because oncology patients have to make a lot of appointments and see a lot of people."
Orlando Health has made a strategic decision to make the neuro-service line a focus point for its growth, said Cress, and that means ensuring patients have access to other specializations such as pain management in addition to neurosurgeons.
"Our goal is to hire people who have specializations that can take care of a number of problems," he said, "and then put them all in a collegial collaborative system that helps get patients to the right people quickly."
Getting people help quickly is a core element of the neuroscience department, which makes them leaders in patient care and experience. Their goal is to have patients seen by the appropriate provider within one week of the referral.
Simple demographics are one factor in making the neuro-services practice a growth area. For example, with an aging population, one would expect to see an increase in age-related ailments, such as back problems, strokes, certain cancers and Parkinson's Disease.
An even bigger factor in this arena, however, is the advances that are being made in treatments.
These advancements, for example, include the ability to do less invasive surgeries through small incisions for problems such as back pain, said Cress. "We also are starting to see the introduction of robots in spine surgery, and we are starting to see the introduction of a lot of imaging modalities in neurosurgery. And so, the technology aspect is exciting from both a surgeon standpoint and from a patient standpoint. The problem is that not all facilities have the ability or interest to get into those areas."
A native of Arkansas, Cress joined Orlando Health Physicians Neurosurgery Group in 2015. He earned his medical degree from the University of Arkansas for Medical Sciences and completed an internship in general surgery at Baylor University Medical Center in Dallas. He then completed a residency in neurological surgery at the University of Missouri, followed by a fellowship in endovascular neurosurgery at University at Buffalo Neurosurgery, New York, one of the leading programs in the world for that specialization.
Drawing him to neurosurgery was the "recognition that there is a lot of advancement of medicine in general, but ... the most opportunity for advancement and some of the most exciting technological applications had yet to really be developed in the neuro-science realm," he said. "And so, in that sense I felt that the world was wide open."
Stroke is one of the pathologies that draws the focus of much of Cress' work. And this is one of the areas in which a lot of progress has been made that Cress finds especially exciting. "Stroke is one area where it was just a hopeless event for a lot of people," he said. "You had a stroke; you were put in the hospital; you were put on aspirin; you went to rehab, and that was your life."
"Now, with our new advances in treatments and technologies and systems care it has really made a lot of difference in a lot of people's lives. It is not easy work, but it is extremely rewarding work."
And that is one of the key pieces of advice that Cress passes along to future doctors. "I still think of myself as young," he said, "but I find myself having conversations with prospective medical students who are trying to decide what to do. And the bottom line, I tell them all, is at the end of the day you don't want to make a decision based just on money. You are going to work hard no matter what you do in medicine, so you need to make sure that the specialty you chose is the specialty you enjoy, because otherwise you won't enjoy your life as you move forward. And I think I got lucky and that I made a really good decision."