Support your people. — Empower those who work for and with you. Great leaders often use the term “we” and not “me,” so let your employees take credit for their successes and encourage them to learn from their mistakes
As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Dr. Daniel R. Gorin.
With over twenty years of experience running his own private practices, Dr. Daniel Gorin, founding partner of The Vascular Care Group and board member of Mangrove Management Partners, is well-versed in what it takes to make a practice successful. For the last eight years, he has been the lead vascular surgeon at The Vascular Care Group’s Hyannis location, one of the first outpatient endovascular care centers in Massachusetts. His center also serves as a key location for The Vascular Care Group, training new staff and serving as a support system for TVCG’s other locations.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?
I have been in practice for over twenty years and have evolved along with vascular surgery as it has grown and changed. I have been lucky to have worked on the forefront of vascular surgery as it transitioned into a minimally invasive specialty that allows us to treat a large portion of our patients in outpatient care facilities. This shift separated me from those I was working with in general surgery whose specialties required them to be hospital employed. As they started to leave, I took over the practice and began wondering why my colleagues in vascular surgery were not taking advantage of the changes in the field and moving into outpatient care facilities like myself. As I built a vein center and an outpatient endovascular suite to accommodate vascular patients outside of the hospital, I did not see others in the New England area follow suit with the same trends that were occurring across the country. Many of these physicians were stuck in their circumstances with too heavy of a lift to make the move. Luckily, I met a group of individuals with similar goals for outpatient vascular care and we formed Mangrove Management Partners. Together, we developed a network of physicians called The Vascular Care Group (TVCG), where I am the executive partner.
With both Mangrove and TVCG, we were ultimately able to build the infrastructure to move talented vascular surgeons into private practice. Not only did this allow us to have more control over the care we were providing to patients but have more control over the way our practices are run. Over the past two years, this change has been successful and has grown TVCG from just me and my practice in Hyannis to a practice of 14 vascular surgeons and multiple other practices across Massachusetts.
I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?
All surgeons are trained through apprenticeships. I did my fellowship under Dr. James Menzoian who was the Chief of Vascular Surgery at Boston University when I was completing my residency. He was a big mentor for how I approach my job from a clinical standpoint.
When most surgeons are learning their craft, they do not get a chance to also learn the business side of surgery. However, I was lucky to have my father as a huge inspiration. He owned one of the largest ophthalmologist practices in Connecticut and as his practice continued to grow, he taught me how to successfully run a business. As I went into private practice, I did not initially open my own, I joined a general surgery practice as a vascular surgeon. My time there gave me the opportunity to observe my senior partners who had far more experience.
What made you want to start your own practice? Can you tell us the story of how you started it?
I was lucky to have built a very successful individual private practice. As that was very rewarding, I wanted to do something bigger in the larger community. I looked at my fellow colleagues in vascular surgery and wondered why they too were not joining or opening their own outpatient clinics. With the goal of building upon my clinic, I joined with a number of talented people to form Mangrove Management Partners and developed The Vascular Care Group into a partnership of respected Massachusetts vascular physicians with four full-service vascular care centers and five satellite offices, from Worcester to Cape Cod. Ever since, TVCG has been expanding and evolving at a rapid pace, providing superior patient care.
Can you share the most interesting story that happened to you since you began your career?
A big change in my career occurred when I switched from being an individual private practice doctor to forming The Vascular Care Group, because it meant shifting from everything in the business revolving around me to a group where many other physicians and staff were involved. Instead of just worrying about myself and my own clinic, I became part of a larger network of specialized physicians as well as business professionals. We have transformed vascular care to be better for patients. We provide patients with easy access to patient centered care in their communities.
Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?
You have to remember that healthcare is a business. Every hospital is a business; it may be a nonprofit, but it has a fiduciary responsibility. Physicians in a large health system are several steps away from the business side of care, so they don’t feel the same fiduciary responsibility as a physician in private practice.
At one of our vascular conferences, a paper was presented that looked at these very expensive stents that we use to fix abdominal aneurisms. These procedures are done in the hospital and the overwhelming majority of the cost of the procedure comes from the stents. The researchers got doctors involved and looked at the cost of all the different devices and worked out a process to negotiate for lower prices. But this made me think that the best way we could achieve lower prices would be to pay the physicians a little more to do the procedure and have them buy the device themselves.
We have found that when physicians have “skin in the game” and have to research the medical devices they use and the financial investment in those devices, it can help them make the most economically responsible and best decisions for their patients. We, as physicians, need to make these important decisions but we also need to be impacted by these decisions. I think if you divorce yourself from the business end, you are doing no one a favor.
Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?
Being a provider and business owner are one in the same when you run your own private practice. If I do not run a successful practice, I cannot take care of my patients. I am responsible not only for myself but for everyone who works with me at my practice. Therefore, everything I do as a physician generates the revenue that pays for all these moving parts. If I do not make responsible decisions to run a profitable practice, then my nurse or my scheduler cannot do their jobs. As a private practice owner, I am responsible not only for my patients but also for my staff who keep the entire place running. This is a huge responsibility that I take very seriously. There is no way to run a successful private practice as a physician when you separate being a provider and a business owner.
From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?
When I originally began practicing vascular surgery, it was not identified as a separate specialty. Most of the surgeons I was working with, including myself, were part of a multi-specialty surgical group. As my specialty matured, my colleagues found that their specialties would have a tough time surviving in the private practice model. Many of these surgeons were forced to join hospitals to accommodate their specialties. As they began leaving the practice, I had to navigate how to take over ownership of the bigger practice. As a business owner, I had to put myself in everyone else’s shoes and really understand their stressors and concerns as the practice was growing and changing.
Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)
1.) Work with great people.
When you work with talented and passionate people who align with your own personal and professional goals, you will achieve great things together.
2.) Support your people.
Empower those who work for and with you. Great leaders often use the term “we” and not “me,” so let your employees take credit for their successes and encourage them to learn from their mistakes.
3.) Always grow.
Never sit still or be content with where you are at. Be relentless in finding ways to improve. Successful businesses and practices foster a culture that encourages growth and celebrates change.
4.) Support your colleagues in your medical community.
Support the physicians in your specialty, work alongside them, and be a resource for others to benefit the greater good for patients.
5.) Be a sponge.
You do not know what you do not know. Be ready to learn, visit other practices, and formulate relationships so you can learn from people in other communities who are solving problems in new ways. Join your societies as well. I am a big supporter of the OEIS (Outpatient Endovascular and Interventional Society), an organization I have been a member and leader of since its early days.
As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?
When I was a general surgery resident, our chief Dr. Peter Deckers, would always tell us when he saw us outside the operating room “it’s time for scholarship.” By this he meant, although you are not in surgery, find something to do to make your time productive. For me, in addition to my patient care, the business end of my practice is not separate. Whenever I have downtime, I am always trying to make use of it and work on my practice whether it be as simple as sending an email or making a call. My staff jokes that it is a really good idea to keep me busy because if I have a little downtime, I will come up with some project for us to do. You have to be engaged all the time and the business elements must be part of your thinking. This also goes both ways; on days I am not seeing patients, I am still a doctor. I either go to the hospital to see patients or talk with my nurse practitioners about another patient.
I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?
It is simply not healthy to center your whole life around your career. Vascular care is my career, so of course I am proud of what I do and am excited by it, but it does not define me as an individual. It is extremely important to have a life outside of my career. For example, singing is a huge passion of mine. For over 25 years, I have been a member of a small acapella group in the Boston area called The Works. We started the group when I was a vascular fellow and it is comprised of phenomenal musicians, all of whom are successful professionals in various fields. None of them are physicians and they do not want to talk about medicine when we are together, so this is truly my time away from my day job. Once a week, I drive to the Boston area, rehearse for a couple of hours with people I consider family, and spend time focusing on music. Unfortunately, the pandemic put a pause on our performances, but we will be at the American Acapella Alliance in Bar Harbor, Maine in May 2022.
It is vital to have hobbies, especially when your job is as demanding as mine is. Music is very important to me, and I make sure to devote time to it as much as possible. Whether your passion lies in music or sports or anything else, I recommend keeping it in your life.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?
I was out to eat with a great friend of mine, fellow vascular surgeon, Dr. Bob Tahara. He practices in rural Pennsylvania and is one of the only vascular surgeons for four hours in any direction. Bob and I met at a course in Grand Rapids, Michigan. It was snowing and below freezing, but we made it with our group to a steakhouse. After ordering some wine, the waiter told us about the specials: ribeye steak and a special filet mignon, and both sounded delicious. I turned to Bob and said, “the special sounds great but I really love ribeye.” Bob replied with a quote from the author Robert Heinlein who said, “when given the choice between being a live jackal and a dead lion, I always choose to be a live lion.” He turned to the waiter and said, “I will have the special but with ribeye.”
The life lesson is don’t let other people define your life choices. Be a live lion, make your own choices, and forge your own path.
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