Mike and hi everybody. I hope to lighten the mood a little bit after the contracts talk. I can feel the tension in the air. These will be top ten pearls. How do I advance with this? The pearl is to come up before the session and see which clicker we're using for which thing. I just wanted to pay homage to all the gap tooth people out there. I forgot Brian Cole is also a gap tooth and a great mentor so I should put him up there as well but that's a short list. My disclosures and disclaimers for this talk are to try to do as I say and not necessarily as I do. I think as you'll see my pearls I strive to attain them as well and they are constantly being evaluated and re-evaluated but I hope we all take something from this next 10 minutes or so. I just wanted to provide a little context from my own pathway. I'm now 11 years into practice. I'm from Staten Island, New York. Anyone been there? It's home to the largest garbage dump in the continental United States and the Wu-Tang. My dad took care of them when I was a kid and I'm very East Coast educated. Penn, Cornell, HSS. Then I went to Rush for fellowship with Brian and Bernie and the group and so a lot of city and when it came time to pick my pathway in my job I wound up here, Columbia, Missouri. No family ties and really just took a gamble and took a chance on it and it was a wonderful eight years and tremendous academic opportunity. My wife was from the Midwest but as truth be told she really wanted to be in a city but you know it was something that I think you'll all wrestle with when you make your initial list and you really see is location, location, location the most important early or there are other things and do you have that supportive family and so Missouri is not that bad. I had a great time there but you know I think all good things must come to an end and when it came down to it we had other life goals and priorities and decided to move onward and so I was really lucky as well. Another theme is to have great mentors and Mark Safran was a mentor of mine. I spent a summer with him when he was at UCSF when I was an undergrad. He would take me for an hour at lunch for Chinese food. We'd drive around in his I think it was a Corvette at the time and I made him a mixtape back in the day and so he never forgot any of that. I turned him down for two opportunities along the way, residency and fellowship and he still supported me like the mentor he is and then when it came time to bring me to Stanford all the cards fell in the right places and so you know I just encourage you all to engage with the mentors in this room and really to continue to stay in contact with them. It was almost a decade and a half before you know he was able to kind of you know bring me in and he's still supporting me to this day and so Stanford's been a great opportunity. You know one of my passions is to be a mentor and I now have the opportunity to run our fellowship program and that's been my lifelong dream and I achieved it at 41 and I hope to keep it throughout my career. I don't have huge aspirations for other things that you may want to be a chairman or chief of the department. I wanted to be a you know a teacher and a fellowship director so it's so lucky and also team doctor. This is my grandfather. He was a general surgeon and he was a really one of the original team docs in Brooklyn. That's him clearing that guy for return to play back in the 50s. That's me on the sidelines. So I grew up basically like that with my grandfather and my father. I grew up going to Nathan's and fishing after games and then we'd have Doc's Clinic. So I was kind of hooked from the beginning and that's a different story than some of you who may not have anybody in orthopedics or in medicine and that's wonderful life path as well. What's that? It looks like. That's my dad there. He's a local team doc in New York City and he actually was the one who taught me sideline assessment, taught me the Lachman and Pete Millett told my dad that he taught him the Lachman about 35 years ago as well and so I think at any level we can always teach and learn and give back even if you're not on the presidential line here. You know there's always people who you can influence their lives along your path and so for me at Mizzou is a wonderful ride learning from great mentors how to be a team doc and now taking over Stanford I really understand the immense responsibility that comes along with that and so hopefully with that backdrop I'll just go through what I think are the top 10 things that I've learned along the way and they're in some particular order but you know I think you know this is the way that I approach this and you know number one thing family first period. If we don't have the home front in order and you don't have the support of your loved ones behind you then I don't think that you're going to be able to sustain for the long term and so I think it's important for us in our busy lives just to recognize when it's a little shaky when you need to leave clinic early or leave the OR or take a weekend and make things right with your family make time for your kids there's always you know other papers to write there's always more cases to do but this time goes very quickly and I try to really really appreciate that and family first has to be the number one pearl. Stay healthy I don't always follow this one I'm a yo-yo for those who know me gaining somewhere between you know 10 to 30 40 pounds on occasion over the time of six months or years so I think just try to have a regimen stick to it Peloton may work for some of you some of you may be more inclined and more athletic think about intermittent fasting think about you know keto diets think about just being a regular person eating healthy because you just should we should get sleep and you know this is one where you know do as I say not as I do but I try hard now and we can't help our patients if we can't help ourselves so I think staying healthy is extremely important. Having a hobby I think this is critical I'm a diehard fly fisherman and this is near and dear to my heart and luckily three generations of my family also diehard fishermen I look to pass it on to the fourth generation over time. It doesn't matter what you do or what that hobby is I think what matters is that you're concentrating so hard on something that's outside of work and not necessarily just focused on the family you may not look for hours on your phone check your email do a text you may forget about the stressors or the complication just for a moment just to release your brain and I think that that's critically important if anyone is a fisherman come find me because I love talking about it this one's really important honesty and integrity we build this up each of us throughout our lifetime through med school through residency through interactions with your peers through fellowship and as an attending you lose this in one second one lie it's gone one stretch where you're not really you know telling everyone the absolute truth in the situation and it's gone I fortunately haven't run into this many times in my career but there are a handful of orthopedic surgeons out there that I know crossed me and frankly lied and they're with a grain of salt for the rest of my life and so really upholding honesty and integrity is critically critically important learning every day is extremely important you must be passionate and try to love Mondays and come to work enthusiastic and try to learn every single day I remember Hollis Potter at HSS you know we never ever look at the reports before we look at the images for anything that's just one small example but I still do that so we learn how to read images interpret them our own way we learn how to critically analyze situations that goes for how do we interpret and get information from the literature and thanks to you know my former fellow clay Nully and others who are giving us kind of sound bites of really great information and social media pathways and otherwise we have access to this information at our fingertips like we never did before so you need to engage with that or actually get the paper copies and read them but you have to stay active and we can ask JT Tokish how and when he learns because he's actively reading all the time and it's really incredible and then I think we need to really critically analyze every single surgery that you do we can always be better I leave every case really breaking it down in my own head or I leave the room I think about it I come back when my fellows closing I ask about it I review the images at the end I put together a future plan for the patient I put it in my op report so we can always be better and if you think you've really learned everything just wait a couple of years build a team that doesn't have to be a huge team that's national or international that can be in your or in your community you're the captain of the ship as an orthopedic surgeon I think it's really important to know everybody by name look people in the eye during the day say hello you know you should know the people who clean your OR and turn it over you should know the circulator nurse you should know the pre-op and post-op I mean just make it a point to know these people I try to take them out at least once a year and you'll be amazed at how your efficiency goes up when they're working on your side I also think we need to support them with a common mission and vision and these people sometimes are transients they have their own goals and aspirations and I think we really can help them along their pathway this for example is Justin he started cleaning the ORs at HSS many years ago when I was a resident and now Justin has emerged to the highest level he's got an advanced degrees he's helping to run the simulator lab there and you know we take care of our own people and I think that that's really contagious and really important learning curve try to treat things non-surgically if you can if you get a patient better without touching them they will tell all their friends it will be exponential and you will start building a practice in your community much much quicker than if you do an awesome ACL and get that person back and then an awesome cuff and get that back and so I always ask myself can I solve this particular problem without surgery and if I can't and it's obvious then I ask what's the least invasive thing that I might need to do to get the job done and sometimes those two questions I have to go through quickly and obviously have to get to osteotomy and cartilage and meniscus and and whatnot but at least go through that exercise in your own brain every single time ensure that your skills are within the bell curve for the quote-unquote easier or bread-and-butter cases before taking on the harder problems you have you maybe haven't done you know skin to skin and the full rehab for your own patient for an ACL for a cuff or meniscus repair so make sure that you are within the bell curve of the outcomes that you had in your fellowship that your mentors had before you start doing bigger or crazier things I've just seen that go so awfully wrong and it's so avoidable and so for an example this was my learning curve for osteotomy and you can see the first couple of years I did very very few then I got confidence I knew I could do straightforward things I was seeing these patients I was treating them not operatively they weren't doing well now it's time to ramp up and then you see I ramp up too much because I don't fully understand the indications and fully stratify you know by who really needs these operations so if you look at the next five years it kind of tapers to you know balance that I think is more reasonable and you know more in line with things that we've talked about during this meeting don't take on crazy things like patient-specific osteotomy combined with an ACL or you know entertain but don't necessarily jump into the bandwagon of internal bracing and you know meniscus transplants Dr. Leprod says one of the hardest operations he does and I agree with him and so you know these things come with time and so I would just pace yourself go slow to go fast and I think that that will help you in your learning curve journey this one is great we're paying homage to uncle Bernie tonight as he retires but like your patients and love your complications and this is something I've learned from him and I use all the time our gut knee jerk is to push them away just do the complete opposite get them access give them your information make sure they can contact you bring them back to the clinic as much as they want it'll save you a lot of trouble and possibly save you lawsuits even some very very challenging situations because these things are unfortunately going to happen we need to like our patients but love our complications we've talked about getting involved being a leader Anna has given you wonderful pathways to do that I did a traveling fellowship I would strongly encourage this it changed my life and I showed up early to the OLC courses volunteered to teach you guys do the same we'll embrace you and I think from there you meet the network and then you know it can be exponential growth for your career so you don't have to be in academics to be a leader within Anna this one's really important mentorship and friendship by far this has enriched my life in ways that I couldn't even imagine my heroes became my colleagues who became my closest friends and advisors people like Brian Cole Jack Farr Bill Bugbee and and others here John Fulkerson you see on this list in my space of interest have really been there for me and are critically important to my overall well-being and to my advancing in the field and so I'll leave you with this from Chuck Bliss Joseph it's a marathon and not a sprint I think we want to maintain that fire and that passion for what we do we are the luckiest people in the world we have the best job by far but pace yourself have some awareness that not everyone's going to like you and I think that's something that you know some of us learn the hard way and you know that's okay but try to do the best you can and support each other because I think that that you know you guys will grow up in orthopedics together and see each other at meetings like this and so really support each other throughout the journey ortho famous is not famous and so that's critically important don't get full of yourself you know I think that we need to stay in the trenches keeping our head down and this is Paul Polici where he reminded us at HSS the harder thing to do is usually the right thing and so work hard be humble stay hungry to achieve your goals and most of all please you know make us proud we're here for you and you know best of luck on your journey and I thank you for your attention thank you Seth fantastic points next I'm going to invite Dr.

Dr. Mike

pearls of wisdom

preparedness

supportive mentors

continuous learning