Episode 56: Starting A Pain Practice In A Competitive Metro Area w. Dr. George Hanna

Today’s episode is the second in a two part series about starting your own pain practice. I’m very pleased to have with us, Dr. George Hanna. Dr. Hanna is a Harvard trained interventional pain physician anesthesiologist. He has experience as an academic faculty member working with a bigger private group, being an entrepreneur, and launching a practice in Manhattan.

Justin (01:17)
So check that out. Anesthesia success.com/resources to help you manage these transitions. Also, we’ve got an episode coming up in two weeks that you won’t want to miss. We’ve got eight characteristics of financially successful physicians. So if you’re looking to establish yourself properly during a time of professional transition, or maybe you’re a few years in and wanting to revisit some essential elements of financial success for doctors, you’re definitely gonna want to check that out. Today’s episode is the second in a two part series about starting your own pain practice. Last week, we heard from Dr. Shachi Patel about how she started the solo practice right out of fellowship. If you miss that, you’ll definitely want to go back and hear her story. Anesthesia success.com/ 55. You can hear that this week. My guest is Dr. George Hanna, who took a little bit of a different path to practice ownership with several career stops along the way before co-founding and interventional pain practice right there in Manhattan. There’s different paths to practice ownership. And these are just two recent examples, which I’ve really enjoyed both of these conversations. If you’ve benefited from any of this content, I’d really appreciate it. If you want to pause this episode right now, you can pause and leave a review in iTunes. Go ahead and pause. I’ll wait,

Justin (02:35)
Thank you very much as always. Thanks for tuning into the anesthesia success podcast. Hope you enjoy today’s episode.

Justin (02:43)
Welcome to episode 56 of the anesthesia success podcast. I’m very pleased to have with us today as special guests, Dr. George Hanna, Dr. Hanna is a Harvard trained interventional pain physician anesthesiologist, and he has a really exciting breadth of experience. And as, as an academic faculty member in working with a bigger private group and as an entrepreneur, as an interventional pain physician, launching a practice in a very high cost of living place in Manhattan. And I can’t wait to unpack his career experience here and hear a little bit about some of the important decisions along the way. So Dr. Hanna, thanks a lot for joining us today.

Dr. George Hanna (03:19)
Thanks so much for having me Justin, glad to be here.

Justin (03:22)
So to kick us off, why don’t you just describe give us the 30,000 foot view? Cause you know, obviously you’re very accomplished, you’ve done a lot of different types of things, and I think this conversation is going to be really valuable because you can offer the relative perspective about these different career paths and opportunities in, in interventional pain.

Dr. George Hanna (03:41)
Oh, absolutely. So anesthesiologists and pain management physicians are near and dear to my heart. That’s what I am and who I’ve taught over the years. And I’ll I’m happy to talk more about that. I’m a native of New York. New York is home to me. I grew up in the boroughs of New York and went through New York city public schools for which I’m forever indebted. I think I learned a lot of important things going through New York city public schools, just as much as I did in undergrad college and training, believe it or not. Yeah. So shout out to New York city public schools. I did my undergraduate training at Cornell. I went to med school at Penn, both outstanding institutions, forever indebted to them and went up to Boston for anesthesia training at mass general, interventional pain training at Brigham and women’s.

Dr. George Hanna (04:33)
And I’ll kind of fast forward to my fellowship, your, you know, to one year pain fellowship as I’m sure you know, and your listeners know, and you know, you gotta take in a lot and it’s a 12 month period, you know, you’ve, you’ve finished your anesthesia residency, you’re a board certified or board eligible anesthesiologist. You know what to do in the operating room, in a hospital based setting, but in a one year pain fellowship, you’re trying to get the hang of things in the outpatient setting, put your career hat on and figure out what your next step will be up until that point. Everything is set up for you as a roadmap. You know, you know, you need to finish high school. You know, you need to finish college, finish med school, pass a few tests, get a few good letters of recommendation, go through residency, show up, do well, listen to your attendings.

Dr. George Hanna (05:30)
And then you, you know, in a one year fellowship, you’re trying to amass a huge amount of clinical information patient care information, and also make a decision about the first step out of the gate of training. I, you know, I’ll say that this should be embraced. It’s kind of a combination of things get to this point of, of fellowship. And I, I remember it being October, November of, of my fellowship year and looking at a plethora of options. And I, you know, the point to emphasize here is I think with every step of the way of going through a career in medicine and anesthesia and pain, you see an extraordinary number of doors opening for you and it keeps it very exciting and it should be embraced. And I don’t think there’s a lot of professions like that. So for, for all of the negative statements that we all hear about being a doctor, being in medicine, being in healthcare, you know, I encourage you to embrace the opportunities that come up along the career.

Justin (06:33)
Yeah. And by the way, it’s interesting, you know, like there’s so much clinical information to intake in these 12 months. I know anybody listening to this podcast right now, who’s a fellow is probably thinking, Holy cow, I’ve only had eight and a half months. Cause like we’ve been all hands on deck trying to do, you know, deal with whatever the current buyer situation looks like and helping out in the ICU and not doing the interventional stuff because the RS have been shut down. So I think understanding the way that you manage this transition is going to be a helpful, so what were you thinking about as you’re wrapping up fellowship and what kind of opportunities were you considering?

Dr. George Hanna (07:04)
Yeah, absolutely. And I’ll, you know, just, you said something really important there, undoubtedly we’re in a very challenging time in the world and society in healthcare. And as much as we would want a cookie cutter roadmap, sometimes life doesn’t have that in store for us. Your listeners are all very smart, resilient people. And you know, just a personal note, my mom passed away during October, November of my fellowship. So at a time where I had these opportunities, my mom, who was my rock passed away, you know, thankfully it wasn’t unexpected. You know, w we knew what was happening. We had time to, to talk to each other, to, to have meaningful events together. And this was alongside getting a lot of clinical information cramped into my brain and my hands and, and making a lot of decisions about next steps.

Dr. George Hanna (07:59)
So, you know, the important point here is life’s going to throw curve balls at all of us. And, and I think we’re all equipped with ways to, to overcome these challenges. I am forever grateful to the institutions that, that taught me and trained me, you know, aside from the clinical knowledge and the clinical experience, the networking opportunities, and you hear a lot of, a lot of MBA students and people in the business world talk about networking. And I think that’s an important point. You know, you’re working with world class leaders in the field and leveraging their opinions and perspectives is, is critical to do, especially during a one year fellowship people that trained me at Brigham and women’s hospital and mass general hospital, where we’re an abundance of, of experience and perspective, and really helped guide my decision making process. I, I want to emphasize the word guide.

Dr. George Hanna (09:00)
They didn’t don’t ever let anyone make a decision for you, but hear people’s perspectives. And it’s an amalgamation of, of, of thought and perspective and put that all together as, as, as, as you make these decisions about your career and next steps, you know, as, as you’re concluding fellowship, or even before the time of, of concluding fellowship, mid fellowship here, you’re thinking about and I was thinking about whether or not I should work as an anesthesiologist or a pain management physician, or a combination of the two what my practice setting would be a hospital based or outpatient based or combination of the two, or would I try to start my own thing or join a smaller group or a larger group, or join a hospital medical staff and become predominantly a hospital based physician. And you begin thinking about the, these opportunities in a very interesting way. Again, these aren’t things that you really think about in med school and residency. And, and it was, it was really, really interesting. And I was concluding my time in Boston thinking that I would rush back to New York back to home, but really, really fell in love with the city. I know new Yorkers, never supposed to say that

Justin (10:17)
You might have to keep a low profile for a couple of weeks after this goes live. Yeah, we might have to censor that part out.

Dr. George Hanna (10:23)
Just kidding. I had a really great mentors at mass general. I’m gonna, I’m going to drop their names. One is Dr. James Rathmell the others Dr. Lisa LeFort, who were, were outstanding on so many levels. They offered me a unique opportunity to join pain center at mass general, which was a couple of miles across the road from where I did my fellowship at Brigham and women’s. And I had done my residency at mass general. So it, to me, it was in a way, a very low resistance pathway and in an incredibly prestigious faculty position at one of the country’s best hospitals, there was also this, this feeling that I was a very independent autonomous resident and fellow really, really did things independently, but I, you know, I want to emphasize that my feeling was especially the first few years out of training.

Dr. George Hanna (11:20)
You want good support systems to help you in challenging clinical or administrative or bureaucratic situations. I wanted to spend a few more years in Boston to, to enjoy the city and it made sense to start with, with a faculty position. And, and I would have not done that any differently. I, I was really happy about that position. I did that for a little over three years, had a really, really incredible opportunity to teach residents and fellows and work alongside some very, very prominent researchers and doctors at MGH in various specialties. Some of which are still my closest friends and colleagues today is able to have a few niche projects. One of which was helping develop a telemedicine program to the Island of Martha’s vineyard and Martha’s vineyard hospital. So kudos to my other mentor, Dr.

Dr. George Hanna (12:21)
Chris Gilligan who was at MGH, who’s now at Brigham and women’s for showing me the ropes and, and helping me through that process, that, that that’s an opportunity in my opinion, that you really can’t find in a private practice or in other types of jobs scenarios. And then for that, I, I I’m really grateful. MGH also allowed me to partake in some research projects, work alongside with other researchers and other medical specialties teach me the administrative and bureaucratic ropes of working in a hospital based setting which is a very complex, but very, very interesting. And, and, and, and for that, I thought it was a, it was a great healthy experience for me. Yeah.

Justin (13:11)
At what, so it sounds like you always had this sort of thought in the back of your mind that, you know, maybe a, a journey South, but down, back to New York might be in the cards, but you were gonna hang out in Boston for a little while. What was the catalyst, or was there one to say, like, okay, I’m ready to, I’m ready to change it up and in, so doing, I want to consider a different clinical model as well.

Dr. George Hanna (13:30)
Okay. So, so half, half professional and half personal, probably more than half personal. So I met my, my awesome wife, Jenna in Boston, originally from New Jersey. And she’s always wanted to live closer to home and live live in the New York Metro area. She’s a radiation physicist. She was working at one of the Harvard hospitals,

Justin (13:54)
Radiation physicists. That sounds incredibly smart.

Dr. George Hanna (13:58)
Yeah. She, she she’s, she’s the she’s the gifted one out of the two of us and very, very smart. She knows a lot of technical physics information, so kudos to her. She, she wanted to move back. And so did I we, you know, we, we had gotten close, we got engaged in Boston. We actually got married in New York, but during the time of us still living in Boston, we were kind of honing in on opportunities closer to home for both of us. A really incredible opportunity came up at a very large national anesthesia company for chairman of an anesthesia group in, in the New Jersey area. At this time I’m, I’m about three, three and a half years out of training. I’m director of pain innovations in technology at mass general and medical director of, of pain at Martha’s vineyard hospital.

Dr. George Hanna (14:54)
Really, I mean, I can’t emphasize the incredible opportunities. And I was looking for leadership and professional growth. And this, this was an interesting opportunity. My wife simultaneously found a very, very good opportunity and in the New York area the stars aligned our family and friends were applying perpetual pressure. And yeah, we, we, we made the jump out of Boston and it was very bittersweet. I, you know, cliche term, but you know, w we left a lot of close friends and professional relationships there. I had concluded about eight years in, in the Boston area, and I felt sad, but excited to rejoin my family and friends in the New York area where, where I had grown up. So it was, it was a great time. Great, great kind of process of leaving. Just a point of emphasis hero. I had talked to my mentors and my colleagues at MGH about this for quite some time leading up to it. So it wasn’t an abrupt departure. It was something that I had discussed with them in the setting of both my professional and personal interests. And it, it was by no means a shock and awe abrupt departure. And I think that helps preserve relationships longterm when there’s that cordial understanding. Yeah.

Justin (16:23)
Yeah. It’s a small world in the pain and anesthesia space, so you should always behave,

Dr. George Hanna (16:27)
Always a good idea. Always a good idea.

Justin (16:29)
So I’m curious, you know, talk a little bit about, I’d say like organizational dynamics or whether it’s like a clinical approach or the, you know, how is, how is moving to the place that you just described with the chairman role, original chairman, or however you, whatever it was that I, I didn’t quite catch there. How, how did that transition go for you and what was the new environment like? Did it take some getting used to, was it a lot of similarities?

Dr. George Hanna (16:53)
Absolutely. so I’m, I’m entering a practice of 12 physicians, three to four CRNs half a dozen administrative staff within a hospital setting, which is within a larger overarching health system, a lot of stakeholders, a lot of new team members to get to know the vast majority of these stakeholders and team members have been there for decades. I’m, I’m showing up from Boston very young and very enthusiastic mindful of what their perspective could be for a physician coming out of a big hospital in Boston. Who’s in some instances, half their age. Interesting, interesting experience

Justin (17:42)
And a challenge from a leadership standpoint, right? Cause to get people to, you know, respect to, to able to have mutual respect when you’re kind of coming from you’re just different, right. I’m sure there was some, a bit of a learning curve.

Dr. George Hanna (17:56)
Absolutely. I mean, there, there’s a professional nuances, a generational nuances preexisting relationships issues, and conflicts that I had to better understand and explore before making certain decisions.

Justin (18:14)
Can you maybe as vaguely as you need to describe, give us an example of what one of those might be.

Dr. George Hanna (18:21)
Absolutely. You know, they’re there sometimes when, especially in the hospital based setting, there could be a conflict or pent up aggression between this certain members of the C suite in the hospital and certain physician specialties or nursing groups, or physician nursing tensions or interest physician, specialty tensions. So perhaps the cardiologists don’t like the nephrologist that’s hypothetical, you know, perhaps a certain surgical subspecialty. Doesn’t like a few of the operating room team members. I think, you know, the anesthesia listeners are we’ll, we’ll get my drift there. You know, I want to emphasize, it requires a great deal of reprimand and discipline, not to jump to conclusions, but to kind of circle the wagon and hear everyone’s perspective. Yeah. Some people don’t like giving you their perspective, especially when you’re new on the scene. And some people want to give you all sorts of perspectives.

Dr. George Hanna (19:27)
The second you arrive in, in a incessant fashion. So, so I think circling the wagon and, and making sure that you’re available to, to meet people and to know them both on a professional and personal level, I think goes far in terms of surveying the landscape. And I think the first six to 12 months of, of my role as, as chief and chair of an anesthesia department was, was just a basic survey. See, you know, what everyone was thinking, how they were experiencing their day to day work what was good, what was bad what needed immediate attention? So there was a prior talk, there was a prioritization lists that I had come up with to tackle the, the high yield, critically important topics and issues. And, and it taught me a lot. You know, I think it taught me how to speak to people that have diverse backgrounds that have different opinions that oftentimes have conflicting views and thoughts.

Dr. George Hanna (20:37)
I think at the end of the day, it made me a better doctor and made me a better listener, both professionally and personally. I have to check with my wife to see if that’s actually the case. I’ll ask her later. But I think I think it taught me a dimension, forced me into a dimension that I never really got in, in education and training phases. And perhaps I got a little bit of it at MGH when I was faculty in smaller leadership roles, but this leadership role was a little bit more expansive. It allowed me to work with the high ranks of the anesthesia company that hired and appointed me and with the high ranks of the hospital, but also the health system that managed and oversaw six or seven different hospitals and a lot of, a lot of different stakeholders with lot, a lot of different priorities and requires a very, very political approach and, and measured approach. And for that, you know, I, again, I’m, I’m glad for that opportunity. I did that for about a little over two years and, and really, really enjoyed it.

Justin (21:53)
Did you find that the, your experience in leadership in the the big private group was it required more like political savvy and awareness and ma management of relational and organizational dynamics, then your roles in you know, academic leadership that you described, because from where I’m sitting in my cheap, the cheap seats here, it seems like those both sound like potentially political environments.

Dr. George Hanna (22:16)
Yeah, I agree. I, I, you know, I think it’s, it’s what, what rung you’re on at on the ladder at each. So ha you know, had I spent more years in academia, I think I would have gotten to more complicated political circles. Whereas I by making the career jump I was thrust into a more elaborate apparatus and, and that allowed me to have to navigate more personalities, more stakeholders and leaders. A lot of which taught me very, very, you know, very unique attributes. You know, some, some, some of these stakeholders were excellent leaders some, some were not. And, and you, you kind of pick up these bits and pieces from each of them.

Justin (23:04)
Yeah. And so, as you’re in this position of leadership and the big private group, eventually you’re starting to think, you know, maybe another transition is in your future and go into bat for the cycle. So like, we’ve got the academic check that check that box. We’ve got the big private group, and now maybe like a more entrepreneurial, small, private opportunity could be in the cards. So talk about how that sort of came into your consciousness, or was it something that you had thought about all, all along, like maybe that’s somewhere you want to land eventually. And how did that unfold for you?

Dr. George Hanna (23:38)
That’s a great question, Justin for, for years dating back to my time in Boston. And we, you know, I mentioned the importance of networking, one of my current partners, and I had always been in longitudinal discussions about joining forces and building a practice in the New York, New Jersey Metro area, as you mentioned, a very high cost area, very competitive area. We have physicians especially pain management physicians, every what seems like every 50 feet

Justin (24:14)
We’re the non-competes are written in terms of like a couple city blocks instead of minus.

Dr. George Hanna (24:18)
Exactly, exactly. And, and you know, he, he, he’s a good friend of mine and a very good close colleague. And we, we always stayed, connected, always stayed in touch. And a lot of it had to do with timing. A lot of it had to do with my desire to fulfill contracts that I agreed to and professional obligations and projects that I had agreed to. You know, obviously if I was in a terrible scenario you know, I would’ve made jumps earlier on or at different phases, but I really, you know, found the roles that I, you know, the two roles that I had I’ve described that, that I had the pleasure of, of, of participating in very, very fruitful. And my contract as chief of anesthesia was coming to a close and, and the company that I was working with tried to renew it, and it was really a kind of a flattering situation.

Dr. George Hanna (25:20)
However it would have been more of the same in my opinion. And I felt like I would have easily reached a plateau Schunior rather than later had I stayed on. And at the same time the stars aligned in terms of timing with, with my, my friend and colleague that I had been in touch with. So we kind of racked our brains to make it work. There’s another partner who also had a connection in the Boston area, Brigham and women’s, and she’s absolutely outstanding. I don’t know if either one of them want me to say their names, but so I’ll, you know, if listeners are wondering and feel free to just reach out to me, I’m happy to share, but you know, we, the three of us sat down and, and talk off for a long period of time at various time points.

Dr. George Hanna (26:14)
And the stars aligned the, the, the goals both in the short term and the longterm aligned. I want to emphasize two important factors because when I, when I work closely and intimately with people that they’re very simply, I’m, I’m a very kind of simple thinker in this regard, the, there, there are two factors that mean a lot to me when working with people and, and number one is trust. Number two is competence. And they, they, they had these, these two attributes and that went a long way for me. So everyone takes a chance on each other when they join a partnership work alongside each other difficult decisions, difficult events forced us to make very challenging decisions from time to time. Yeah. And you want to make sure that you trust and, and trust in the people that you work alongside. And also that they’re competent, right? I mean, I think, I think that’s an important thing. Both are Harvard trained Ivy league trained a physician. So from a competence standpoint, I knew that was there. It was evident that that trustworthiness was present right from the gecko.

Justin (27:27)
So this is a very interesting inflection point for you because you’ve spent time in academics. And then in this bigger private group, developing a very certain skillset. A lot of it has to do with like leadership, organizational dynamics and the politics, and like how to get things done in a bureaucracy and like how to make sure a bigger institution functions efficiently and communication and coordinating efforts and all that. And now all of a sudden, there’s this opportunity you just described in the last three minutes where there’s a whole new skill set that needs to be manifest and all of the business elements of what it means to go into practice, as well as like the different clinical model. And there’s just I’m imagining it’s a very steep learning curve and I’m really interested cause there’s, I’m sure a lot of people out there listening who were thinking, this is a transition, which sort of sounds good to me, hypothetically, but there’s, it’s like a bit of a black box.

Justin (28:18)
We don’t know what happens from the time that, you know, Dr. Hanna was the chair of this anesthesia department to the time that he’s, you know, doing his own thing with three or four or five partners in a thriving practice and a big metropolis. So in this box is like getting up to speed on business, practice management, building a team, understanding what experts you need to be working with. And for you talk a little bit about, and I know you mentioned when we spoke prior your father or the engineer who talked about, you’ve got to have a baseline understanding of the way the business works or else if you’re working in an organization, you’re always going to be only a cog and not able to sort of ascend to the strategic level, if you don’t understand the language of the business and the finances and the operation. So talk about how did you either, how had this, how would you acquire this over the years, or how did you at this time say, okay, we need to get up to speed so that this practice is a success instead of us all falling on her face.

Dr. George Hanna (29:14)
Absolutely. That’s a great point. Thanks for reminding me of my dad. So dad happy father’s day, Justin happy father’s day. My dad is a very very pragmatic, almost mathematical type of civil engineer. He, he lays out structure and was always emphasizing the importance of having that structure and understanding that structure both personally and professionally. And he would always remark that, you know, his engineering colleagues, if they didn’t understand the organizational and operational structure of things, then that vacuum would be filled by others who would tell them what to do just simply put and I think it’s critically important for physicians whether they’re hospital-based and especially if they’re in private practice and I’m sure many of my colleagues will, will agree in private practice to have an intimate understanding of, of the backend and operational aspects of things. And I want to talk about that black box, because you, you make these jumps, you’re like, Oh my God, I don’t, I don’t know how to deal with the insurance companies or, Oh my God. I don’t know how to hire someone, or I don’t know how to,

Justin (30:29)
Or find office space or how do you buy a CRM or like, what does an office manager who’s competent look like? How do I hire one? Yeah.

Dr. George Hanna (30:36)
How do you buy medications? I mean, the simplest of things that, you know, you take for granted, I’ll, I’ll tell you when I started in academia, everything was there, laid out on a silver platter. It was amazing if I, if I dropped, you know, 10 medication vials to the floor and they broke, they’re just handing me another one or you know, the cost aspect of things gets lost a little bit to a certain extent in academia. We’re seeing now as I was leaving academia more and more emphasis on making sure that we’re providing high quality care at a reasonable cost, right. Moving to the large national anesthesia company for which I was an anesthesia chief. There, there were certain things I learned and certain opportunities I took advantage of. So there were, there were great leadership opportunities that the, this large apparatus involved me in with Wharton business school and Columbia business school these, these classes and programs and courses taught me basic accounting principles, finance principles, operational approaches, leadership skillsets, how to build effective teams.

Dr. George Hanna (31:49)
And, and these were kind of broad topics that I use every single day now. And I, I was, I was really grateful to have learned those things, but in a very large system, a big, large anesthesia company, very hard to apply some of these principles when there’s a preexisting very complicated and complex structure. And I, I, I found some of these points and topics very interesting and was excited to apply them in a smaller, private setting, my partners in New York and New Jersey, very interesting in that they took it upon themselves to learn specific skill sets as it pertains to getting insurance approvals or buying an X Ray machine or buying an ultrasound machine. And we rely on each other to kind of basically work that out. Now, we live in a very profound, informational age, and a lot of this information can be summoned with, with searches on the internet. Yeah. But I think it’s important to have people close to you that you trust that, you know, are competent to, to get their perspective and to also bounce ideas off of with, with regards to the nuts and bolts of how

Justin (33:08)
Firing

Dr. George Hanna (33:10)
Equipment acquisition office acquisition, the most experienced and the quickest amount of knowledge I’ve ever been able to obtain is by relying on the perspective of people that are close to me in my network, some are doctors, some are not, sometimes the best office space is found through a friend of a friend that I met doing something completely unrelated to medicine. I want to emphasize that, that as you go through life, keep expanding your circles because as, as, as, as your circle and circles, plural in different areas and interests expand you, you’re gonna, you’re going to hear people’s perspectives and insight that you would have otherwise not heard. And so, so again, I used the word amalgam before, you know, I think it’s important to just hear different viewpoints and it makes life more interesting in my opinion, more well rounded. Decision-Making occurs as a result of that. And, you know, that’s basically that jump from the large anesthesia company to a smaller private group in a very competitive area.

Justin (34:17)
So talk about the competition and the transition. So if you’re doing what you just described, did you start from scratch? Were there, did you have sort of like, did some of your partners have some patients that helped you keep the lights on, or were you working two jobs for a while? Or how did you manage that?

Dr. George Hanna (34:33)
It’s a good question. So my partners both outstanding pain physicians had good followings in, in the New York, New Jersey and Metro areas. I also had a strong following from my role as an anesthesia chief. I was still seeing patients in the pain management office at the hospital. So it was a hospital based office in parallel to being anesthesia chief. I was also still seeing outpatient patients and developed a good reputation in that part of, of New Jersey. We kind of combined our reputations, if you will, to basically communicate to patients and to the surrounding communities that Hey, we’re high quality physicians, we’re all together under one roof, we provide X, Y, Z services. And this is who we are. This is what we we’ve done with our careers. And I think that that quickly, when a lot of patients, and I think it really, really helped us with, with the competitors, some of the competitors are some of my closest friends, so nothing against my competitors, but it, it, it helped us get some of the patients from our communities into see us. And I think having that presence nowadays in media on television is important. I think you know, 10, 15, 20 years ago, a lot of word of mouth collaboration with other physicians, and we still do that. So I, I want to emphasize that is, you know, leading up to us joining forces, we had very definitive plans on reaching out to primary care doctors, other physician specialists to let them know who we are and what services we can help with for their patients suffering from pain issues.

Justin (36:25)
When you say reaching out, does that mean like knocking on the door, saying, Hey, Dr. Smith, I’m Dr. Hanna, I’m right down the street, wanted to let you know,

Dr. George Hanna (36:32)
100% and you know, you’ll have a few doors slam on your face and yeah. And you know, it hurts the pride a little bit which is, which is good. I, I you’ll learn from those experiences and you know, who to steer clear up. But you meet a lot of really interesting people. I mean, a lot of, a lot of these people end up becoming my friends or, you know, my, my colleagues that I play tennis with, et cetera. So it, it’s exciting. You get to hear about what they do and what their practices are like, and there’s a good exchange of ideas. So that, that is a kind of a proverbial old school way of getting the word out. I find tremendous value in that. I continue to do that perpetually. So even, even as practices, mature and reach a nice steady state I’m of the opinion.

Dr. George Hanna (37:25)
Why, why ever stop? I mean, I mean, you might meet someone very interesting, and someone ultimately that could help you in your practice, but even more importantly, your patient. Yeah. I’m discovering specialists throughout New York and New Jersey that do very interesting techniques and approaches that I never learned in my residency and my fellowship. Yeah. Some warrant further study and investigation and have to be vetted very closely, but it’s good to see and hear what’s out there. And I think that helps me both professionally and, and also keeps me engaged in, in being a doctor and learning new things and dealing with new people. And we also live, we live in an age where, where people, you know, look up doctors and, you know, care about patient satisfaction reviews. And the, the, this is been a pretty significant transition to that. And it’s

Justin (38:32)
Zoom in on that for a minute. Cause I’m curious, you guys have a website. I noticed this whenever I was, you know, after I had met you and was doing a little research for the show, it’s clear that it’s been an area of, if not your own focus, like you, you had one of your partners or somebody like make sure that this looks really good, professional photography, like great colors, the calls to action, like book appointment button is like a different color than everything else. It’s clear that it was very intentionally constructed by a professional. And it lends a lot of if I’m just Googling you, I’m thinking, wow, this is like a very smooth operation that they put a lot of effort into a professional face. So something, even as simple as that, I’m just curious, how did you come about like this website? How did that process unfold?

Dr. George Hanna (39:13)
Thanks for noticing. We appreciate it.

Justin (39:16)
And for anybody listening, it’s pain treatment specialists.com, which has a great domain name. We’ll link to that in the show notes here. So anesthesia success.com/ 56, we’ll have links to any of the content that we discuss here today, including Dr. Hanna’s website.

Dr. George Hanna (39:30)
Great. Thank you for that. Thank you for that, Justin, that we treat the website almost like signage that we would hang on our shingle. I mean, you want it to look nice. You don’t want to misspelled a deteriorating sign. I think it says a lot about quality of the physicians and the overarching practice where we’re neurotic when it comes to at work. We’re always looking at it, looking to modify it and achieve a better color scheme, better photographs, better videos, a better educational content to engage. Those that are seeking out services. And I think that perpetual look at it. You know, we’ll, we’ll look at it every couple of weeks and come up with ideas. Sometimes we don’t execute the ideas, but at least we’re talking about it and looking at it. And, and that’s, that’s the mantra of, of our practices that, you know, we’re, you know, we might be succeeding, but we need to always make modifications to make things better.

Dr. George Hanna (40:36)
People don’t like going to the doctor, you know, and, and, you know, perhaps as an anesthesiologist, you don’t think about this because your patients oftentimes need or want surgery and you’re providing a very meaningful life protecting service. I, you know, I can’t emphasize that enough anesthesiologists physicians are integral for safety during surgery, but you don’t, you don’t think about the outpatient setting as much where, you know, a patient has severe back pain or severe knee pain. Now they’re limping into a doctor’s office. Now they’re waiting in a waiting room. Maybe one of the lights is out at the front desk and it looks suboptimal. Maybe there’s, you know, a bad encounter with a medical assistant or a nurse. Maybe the doctor appears to be rushed. Maybe the prescription never makes it to the, or the referral never makes it to the physical therapist. They’re there there’s a lot in the processes in all facets of medicine, but the outpatient setting is much different than the inpatient hospital based setting.

Dr. George Hanna (41:47)
And I think you have to put that hat on and think about it in that manner to make sure you do right by the patient. At the end of the day, we want the patients to get better. And we, we want to make this as best an experience for them as possible, which is sometimes very challenging. And sometimes it’s not so challenging. It depends on the person. It depends what they’re dealing with. It depends on so many other factors, but the best we can do is make sure that we stand by what we say we’re going to give them, which is, you know, from a nice sign or website that they see to a nice office with nice staff, receptionists medical assistants that are taught a lot about how to be nice and polite and responsive and solutions oriented to those that come in suffering to see us. I think it’s, it’s that organizational culture that pervades our, our practice. And I think it goes an extremely long way. We oftentimes have to make modifications. I mean, sometimes the staff are having a tough day and sometimes that’s perceived by the patient, but we have ways of addressing that and, and doing it in a very safe environment to help promote that, that culture of, of solutions based thinking and patient experience.

Justin (43:11)
One more question. I want to ask you Dr. Hanna, and then I’ll let you go. Thanks for your time today during this transition to business ownership, practice ownership, as well as maintaining, obviously all of your clinical responsibilities and probably only like augmenting them. Tell me just a short story or reflecting on a time when you saw the fruits of your labor and you saw all the time and effort that went into like, hang in that sign out on, you know, on main street or wherever you are in Manhattan. And, and you were able to see, I think this is going to work. I think we can, the brand is working. The patients are well-served. The partnership is functioning well, like a moment of actualization for you.

Dr. George Hanna (43:50)
So, so I that’s, that’s a great question, Justin. It’s, it’s a hard one to answer, but but I have a few things I just want to comment on my mind is a physician is interesting in that it focuses on things that could be improved upon and potentially suboptimal or problematic scenarios that could be remedied. And oftentimes my mind, my physician mind forgets about all of the hugs and gratitude that we get from patients and their families for helping them. And I think, I think that’s something that’s important for every doctor to reflect on. I, I know it’s easier to remember the, the, the problematic scenarios, but it’s, it’s the patients that really do benefit from the services that we provide. I think we have to reflect on that and, and make, make sure that, you know, we’re humbled by the gratitude, but also that we stood right by people that, that needed help.

Dr. George Hanna (44:50)
So anytime, anytime a patient sends their gratitude or thanks allows me to take a step back from an otherwise pretty hectic schedule and say, you know, I made a difference in this person’s life and all of the skillsets that I learned over the years from public schools in New York to, to college med school training and other jobs and roles that I had over the years has come to fruition to help this person walk better, feel better. You know, that, that, that is you know, reflecting on that puts you in a Zen like state, or puts me in his head like stay rather. I, I, you know, I feel, I feel that when I went being able to take care of patients and also being able to see a practice thrive and having interest from physicians at Harvard wanting to join us in New York and New Jersey really is a Testament to what we’re trying to achieve here.

Dr. George Hanna (45:51)
And, and I think once people started hearing about us and what we were doing in Boston, where all of us were originally from, in terms of training, I think that that really was eye opening and really, really flattering and an important time point. And then one final kind of Bowman, I’m answering this in multiple parts, but, you know, it’s a, it’s a complex question. I’m giving you a complex answer and in the midst of the coronavirus crisis I think you see really the true colors of yourself, your partners, your, your staff, your colleagues that you work alongside, and you’re making hard decisions, and you’re making very hard, complicated decisions to protect your patients and also protect the livelihood of the practice. So we still have an office to walk into once this blows up blows over, and that really was eye opening for me because we had to really shift down into first gear.

Dr. George Hanna (46:59)
And then when the time was right from a public health and safety standpoint, we had to incrementally kind of shift up the gears and watching the practice and the clinical volume kind of move into a suspended animation state for which we quickly pivoted by the way, to telemedicine and myself. And one of my colleagues, Dr. Shane Vallone, who was at mass general, also doing telemedicine, and we were doing this since 2015, 2016. So it proved very, very useful at the time of COVID-19 to quickly move to this format in a very agile and lean way. And it was, it was a beautiful thing to see everyone come together in the practice to make it happen literally overnight. And, and for that, you know, I took a step back and said, this is unbelievable that we were able to do this. And then also many weeks and months later, safely and incrementally open up our offices, it was very smooth and very carefully done with a lot of smart minds and smart opinions. And I think it was at that point that I felt like we know exactly what we’re doing, and we know how to adjust during periods of adversity and that circles back to resilience of physicians, whether it be in clinical practice or business practice. And for me personally, the combination of the two has made this a very fulfilling journey for me so far. Awesome.

Justin (48:36)
Thank you for sharing that. And Dr. George Hanna, it’s been a pleasure having you today on the anesthesia success podcast. Thanks Justin. If you liked what you heard this week, head on over to anesthesia success.com, where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you want it to leave a review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time. Join me today on the anesthesia success podcast.