Find a team you trust, train them completely, granting them autonomy and treating them very well.
Dr. David Anthony Greuner is the managing director and co-founder of NYC Surgical Associates. He is a double board certified surgeon with over 10 years of experience. His post graduate residency training was performed at University of Arizona and Mount Sinai School of Medicine affiliate hospitals (Morristown Memorial Hospital) where he was named chief resident of the year, and won the Hughes Dougan award for dedication to patient care and excellence in surgical technique his chief year.
His fellowship training in Cardiovascular and Thoracic Surgery was performed at Albert Einstein School of Medicine in New York City. Although Dr. Greuner’s surgical training encompassed a broad base of surgical procedures; his area of interest lies specifically in minimally invasive procedures and minimal access/robotic surgery, including procedures involving the Da Vinci robot and percutaneous (no incision) access – allowing his patients the least disruption possible from their busy lives.
He has developed and pioneered advanced surgical techniques such as the No-Knife EVLT, which has been featured in several nationwide television broadcasts.
Where did the idea for NYC Surgical Associates come from?
I was working for a large, reputable hospital, and while their results clinically were superior in every way, I thought that the personal touch that should be there any time you did something as invasive as operating on someone, was lacking. I thought that given the opportunity, I could do a better job, and build a better system. While that may sound like a daydream, and unattainable, I still wanted to try. Being single, without children, not the greatest credit, but a decent amount of liquid cash in the bank at this time, I didn’t have much to lose. Well, except all of my cash, which I did, temporarily. It was pretty rough initially, but Ive never looked back.
What does your typical day look like and how do you make it productive?
I learned a long time ago, that being ahead of everyone else in terms of timing, as well as the ability to make business decisions in a stress-free environment makes a huge difference in terms of your success. This being the case, I get up earlier than most, and typically defer most decisions of the previous day to the time of the day when Im the least stressed and subject to outside influences, which is the early morning. I start my “stress management” regimen at this time, which typically includes a solid workout, which for me is anything from Pilates to martial arts, or anything in between.
I review emails, go through pending decisions, and I typically have most of my initial responses to email saved in my drafts folder so that I can review them for soundness of ideas at that time. You would be surprised how much your mood can affect the soundness of your decisions, especially me. No one makes their best decisions when irritated.
After this groundwork for my day is finished, I’ll typically head to the office, where my clinical day starts. I find my administrative work is best done outside the office, where I have some peace of mind without others interrupting my thought process.
At this point in my career I typically am training at least one fellow per year who is a credentialed surgeon training with us in specific new techniques that are unique to our practice. I hand pick these surgeons from a fairly strenuous interview process we hold each spring, looking for not just clinical talent, but affability, and the ability to relate to others. These fellows have been pretty instrumental in getting my day started, they prep y patients for the operating room, which is typically at least an hour-long process to go through our “pre-flight checklist” so to speak. I reach the office around 930-1030am when surgical patients are ready to head into the operating room, so while we open at 8, I don’t need to be there at that time. Typically I’ll perform anywhere from 4-10 surgeries a day, while seeing other pre and post-operative patients in between my cases, and finish up around 7-9pm.
Organization and streamlining are crucial to being efficient, so every patient, and every surgery has a clearly delineated pathway that they follow, which also helps improve safety measures dramatically. As I get quite busy during the day, having every single patient meet parameters that demonstrate safety prior to any surgery being performed or anyone being discharged is integral to allowing us to function so efficiently. In many ways, it’s similar to protocols learned from the airline industry.
How do you bring ideas to life?
I’m lucky enough to have a very easy going partner, and he’s the only one I need to run decisions by prior to execution, so in general, I have an idea, I execute it. In general, the best business plans involve offering new service lines to your already existing customers, and that is typically how I’ll proceed – with more clinical services germane to the conditions we already treat.
What’s one trend that really excites you?
Patient directed referrals due to the internet. Medicine went through a huge transition in the last 10 years, where corporate takeover of all but the smallest percentage of physicians affected care dramatically, and in a very negative way in my opinion. No longer was patient satisfaction tied to their practices, and many conditions, comprehensive patient care was subjected to a “shift-work” mentality, with doctors exchanging patient care, and not fully aware of all events that transpired. This is a particular problem in surgery, when only one surgeon truly understands what events took place in the operating room, and is thus best equipped to make post-operative decisions, not someone that came in to fill a “shift” as the operating surgeon went home.
Then came internet reviews, and followed by that, patient directed referrals based on impartial reviews that demand not just technical acumen, but that physicians had an appropriate bedside manner, and exhibit compassion. In fact, this is the fastest growing segment of referrals today, and one of the reasons our practice is so successful, especially in a market as competitive as New York City.
While many older physicians do not appreciate this trend, I believe it empowers patients and allows them to make a choice based on their own assessment, not based on what someone else has directed them based on a corporate agreement. And that leads to higher satisfaction and better care.
What is one habit of yours that makes you more productive as an entrepreneur?
Obsession with detail. Nothing irritates me more than redundancy or repetitive imperfect results, when I know that better is possible. In surgery, this is particularly important for safety reasons, and the financial soundness of your organization is absolutely tied to seamless workflows.
What advice would you give your younger self?
It’s never a waste of time if you learned something, and mistakes can either destroy your morale, or can teach you a lesson that will help you avoid similar situations in the future. The key is to reflect upon your mistakes, and use them constructively to improve your future decisions, not allow them to act as an impediment that hinders your progress because of fear. Find the root cause of your mistake, and learn how to prevent it from occurring in the future.
Tell us something that’s true that almost nobody agrees with you on.
That doing good for others, regardless of expectation, typically leads to your own benefit, at some point in your life. It might not be from the person you did something for, but trust me, believe in karma. Whether it manifests as payment in kind, an overall contribution to your reputation in the community at large, or simply to make you feel better internally, it will somehow improve your future self.
As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?
I track objective results on a real-time basis and evaluate them consistently and systematically. I always look back at anything new I did that week at the end of the week, whether it’s a new approach to surgery, decisions on clinical workflow, or an administrative change. I look at the parameters that allow me to judge efficacy, and what I could have done to make it better, safer, or quicker, and implement change accordingly.
What is one strategy that has helped you grow your business?
Find a team you trust, train them completely, granting them autonomy and treating them very well. At some point in time, you will reach a point where it’s simply impossible for you to do everything yourself, and at this point, you must either slow down, or designate others you trust to act on your behalf. This is a very tenuous time mentally for someone like me, who is a little OCD, but Ive learned to trust those that deserve it, and it has helped me grow. When you do find these people, who are very rare to find, treat them with the respect they deserve.
What is one failure you had as an entrepreneur, and how did you overcome it?
Typically, there are two main points in time when businesses fail. The first is during the initiation of business in the first 2 years, when cash flow is low, and accounts for almost all failures. Little known to others, is that second point of failure, when seemingly vibrantly successful business bankrupt themselves due to over expansion, and I feel victim to this, about 2 years ago. It almost bankrupted me, and thankfully, I made some very sound real estate investments that I was able to leverage to augment our cash flow. My crucial mistake, was that I underestimated the training and competency needed to run a business as I do, using remote providers. I recovered, and instituted a longer training program, as well as far more objective staff checkpoints to ensure that I did not repeat this mistake again. Only when I have the staff ready for the new expansion, do I make that decision.
What is one business idea that you’re willing to give away to our readers?
A device that can calculate total power output for multisport activities would be profoundly useful for the majority of athletes and aspiring athletes out there today. Power output is the only objective measure of actual work performed during any athletic activity, and in cycling and running, is used to track actual work for performance athletes, as subjective work, or how hard you “feel” you are working is subject to a huge number of variables, such as weather, overall condition, etc. Power output is not influenced by any other factor than actual work performed, and gives you a true, unwavering measure of you level of fitness. The problem is, measurement of power depends on the angle you are pushing against, or exerting power against, which means that if your position is dynamic, it’s very hard for it to be accurate. Im sure someone out there will figure it out…..or maybe I will….
What is the best $100 you recently spent? What and why?
Honestly, investing in some great underwear. I’ll leave the specific reasons out, but do it. Never underestimate the importance of health and comfort in maintaining a calm demeanor.
What is one piece of software or a web service that helps you be productive? How do you use it?
I recently spent a year building out custom software with a start-up called grow.com that allows me to check the real time financial statistics of our company, which I’d compare to checking vital signs during an operation. Integral to your ability to detect errors early and act accordingly. I use it daily to ensure that all financial ends are in order even in the 7 centers we have that I am not ever personally in, and are run by outside teams.
What is the one book that you recommend our community should read and why?
“The Power of Failure” by NFL hall of fame quarterback Fran Tarkenton. In it he describes how to harness the power of your mistakes as teaching opportunities, which is paramount to progress. Everyone successful has made far more mistakes than successful endeavors in their lives, including me, it’s just that the mistakes are far less publicized. Without the ability to learn from them you are destined for long term failure.
What is your favorite quote?
There are a lot, but “Persistence conquers all.” is probably my favorite, by the late president Calvin Coolidge, and has rung true in my life more times than I can count.
- When embarking on a new task, think of the worst possible situations that may result, and what you would do to resolve it immediately. Then change your mindset to optimism. Think of the worst, and expect the best.
- Persistence is absolutely the most important quality needed in success. Be selective about what you dedicate yourself to, but when you make that decision, don’t let anything get in your way.
- Do good things for others as a habit, and expect nothing in return. It pays dividends in many ways.
- Find key personnel, treat them well, and utilize them to further your expansion when needed. You can’t do it all yourself.
- Know the objective parameters germane to your business, and review them systematically on a regular schedule to assess your progress and/or failures.
- Know that failure is a part of any business, and learn to use them to your improve your future.
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