Becoming Virtuosa

By Susan Crockett, MD
Tuesday, July 30, 2019

“How come you’re still making it when so many around us aren’t?” One of my colleagues asked me at lunch in the doctor’s lounge last week. He, like I, owns a private practice, an endangered species in these times of corporate buyouts and hospital ownership of medical practices.

“I’ve kept my overhead low,” I told him. “I’ve had some GREAT advisors. I use AthenaHealth.” Then as an afterthought, “and no partners.” Not that I wouldn’t ever consider having a physician business partner, but one of the secrets to my success undoubtedly has been the ability to focus the decision-making for moving the business forward (for better or worse) on my shoulders alone, without the messiness of competing partner interests. The outdated process of offering a contract for employment along with an automatic subsequent buy-in to the practice partnership has accounted for a great deal of the demise I’ve seen of the private practice model.

“And luck. I’ve gotten lucky too.” We smiled, nodding in mutual understanding.

The truth is, seven years ago I was stuck.

It turns out that being stuck is a great motivation for envisioning a different way that life could be, being willing to take the necessary risks to get there,and taking the initiative to move.

I was employed by a very large group, which had been great for me when I joined — good pay, good benefits, great physicians, high patient volume — but in which I had reached the limit of who I could become as a doctor. But my voice didn’t matter. I was a cog in the machine.

In-house, overnight call was taking a toll on my health. The overhead was high, making it difficult to take time off for vacations. It was made clear to me that I would never be considered for a leadership position in the business, even if I made partner. Most importantly, I was restricted from being able to grow as a physician and specialize in the field that I was developing massive interest and skills in — robotic surgery.

Two years prior, in 2010, I had been one of the first 24 OB-GYNs in the country to train at the master’s level in benign robotic surgery. I had always known that I was called to be a surgeon, and when robotics came along, it was the perfect blend of the art of surgery and the fine motor skills I had honed as a musician when I was young. Twenty years into my career, I stood at the intersection of what God had created me to do and the technology to do it.

I was smitten.

My life’s passion is making surgery easier for women. It’s what I was born to do. I’ve spent my career building new skills, learning new techniques and developing ERAS protocols for minimizing pain, but robotics was the game changer I had been waiting for. With robotics, I could do everything I used to do through large incisions, only using small laparoscopic ports. I could do finer dissections and easily reach places that were difficult to visualize with open surgery. My open surgical rate plummeted as I replaced laparotomies with robotics. Instead of having to stay in the hospital for several nights to recover from large incisions and take six weeks off work, my patients could be at home with their families the night of surgery and be back to work within two weeks.

As great as this was, I saw other minimally invasive gynecological surgeons around me reaching higher levels of expertise. They had only 1% open surgical rates, minimal blood loss and much higher surgical volumes. Reaching this level of expertise required a lot of practice (just like becoming an excellent musician did), and a high volume of patients. A different model was necessary, based on referral streams — like a general surgery practice — rather than the traditional model of an OB-GYN practice, where most surgeries came from within the physician’s patient panel.

The problem was, I couldn’t get the volume I needed within my existing practice model. My male colleagues who were advancing in minimally invasive gynecology surgery (MIGS) had the ability to quit obstetrics. I did not. My clinic was so full of OB visits that I could not possibly make room for enough gynecology cases to perform at the level of my mentors. Nor was I allowed to make the necessary changes within the constraints of the large practice.

I became stuck.

So, five years ago this month, I left that group and founded my current practice, Virtuosa GYN. Virtuosa is the feminized version of virtuoso, a person who is highly skilled in music or their art. In short, it means “woman of excellence,” and it represents the best version of myself that I can possibly strive for. I saw the development of myself as a robotic surgeon as similar to my development as a musician.

I will forever be grateful for my banker, who took a look at my crazy business plan, said she believed in me and then stuck by me through the turbulent first two years. Within those two years, I opened four different offices, closed three, suffered a break-in and completely switched hospitals. I learned how to hire slowly and fire quickly, how to consolidate my assets and increase efficiency. Still, by September 2016, I had only three more months of reserve capital to make the practice profitable or face bankruptcy.

I remember sitting down with my trusted advisor and accountant in that same doctor’s lounge that I sat in with my friend last week. We were determined to develop an additional revenue stream to pull the business up and out. We worked our tails off, and pulled it out.

Today, I’m within a few months of paying off the business loan. I’ve created a practice in which the providers are free to do the parts of our specialty that they want to do, menu style. Some do only clinic. We utilize laborists and hospitalists. I concentrate on surgery. My health is better. I’ve created a referral stream-based surgical practice that allows me to practice as an advanced minimally invasive gynecological surgeon, specializing in benign complex gynecology. I’m in the operating room three days a week. Now, at around 200 robotic cases a year, I’ve been able to offer minimally invasive surgeries to over 1,000 women.

So what’s next? I have a strong desire to change how women’s surgery is delivered on a larger scale. There are not enough physicians with the skills and surgical experience that my MIGS colleagues and I have. We can each only do so many surgeries one at a time. There is no way to scale.

Again, stuck.

The answer, this time, has come in the form of creating on online style blog to influence the market by directly educating patients about what is available to them. It is called Virtuosa Surgery, and it just launched this April. In serving our patients and the larger community of women, we hope to influence more physicians to learn the skills and utilize the tools we use to provide less invasive options for women. It is my dream to further expand this online platform to mentor and teach more physicians to provide minimally invasive surgical experiences for women.

“I had always known that I was called to be a surgeon, and when robotics came along, it was the perfect blend of the art of surgery and the fine motor skills I had honed as a musician when I was young. Twenty years into my career, I stood at the intersection of what God had created me to do and the technology to do it.”
— Susan Crockett, MD

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