As a child, Madeline was one of those classic books you read over and over again, laughing at Madeline’s antics and free spirit. However, one of the more serious anecdotes was her medical emergency when she developed appendicitis, and had to be rushed to the hospital (much to the distress of Miss Clavel). After the surgery, her classmates came to visit her, all exclaiming that the “biggest surprise of all—on her stomach was a scar!”
As far as appendicitis, much progress has been made and large incisions are now a thing of the past, replaced by new surgeries called keyhole surgeries (small 3-4 incisions leaving minimal scars). However, aside from appendicitis, there still exist many small surgeries that continue to scar, even if the scars are much smaller than they used to be. Though not as large, these smaller incisions leave a small, but still undeniably visible, reminder of the surgery. For Dr. David Greuner and his NYC Surgical Associates, these kinds of incisions are not only unnecessary, but are entirely avoidable in certain surgical fields. A revolutionary and innovative surgeon, he developed a new procedure for endovascular surgery: using live imaging such as X-rays, ultrasounds and CT scans, he is able to conduct endovascular (disease in blood vessels) surgeries through a catheter. Extraordinarily, the incisions look more like a needle mark than a scar! “Because we don’t make a lot of wounds, we make a tremendous amount of procedures at a very low complication rate.”
Dr. Greuner was an unlikely surgeon. Majoring in Economics in his undergraduate years, his post-university experience was more focused on fitness and health than on a medical career. His interest in anatomy and his overall knowledge of the human body did eventually lead him into the medical sphere, attending St. George’s University School of Medicine before obtaining an important surgical internship. Despite his obvious talent and potential, he lost his position and had to start from scratch, slowly building his way up the ranks with only his ambition and self-determination to push him through. Eventually gaining impressive experience as a resident at numerous medical centers, his residency at the University of Arizona and Mount Sinai School of Medicine affiliate hospitals led to the recognition he had been looking for, and he was named Chief Resident of the year. Just as many patients feel hospitals to be cold and impersonal, Dr. Greuner was not inspired by the relatively sterile and standardized processes of hospital surgery. Looking to find his own path in the medical world, he began to think of opening his own practice. This would not only give him the opportunity to create a more personalized treatment process and atmosphere, but also give him the innovative freedom he had been deprived of. Dr. Greuner, in comparing the patient experience at his own practice and the hospital approach, describes his as a more “conscientious approach to the patients,” in large part due to his commitment to taking care of the patient from beginning to end.
In the beginning, his NYC Surgical Associates practice was only part time as he was living in Boston at the time. Every weekend, he would make a grueling commute to the city to see his patients. The more time passed, the more the excitement and the thrill of endless possibilities rose, reaching a point to where it became impossible for him to remain in Boston. After six months of commuting, he had finally decided to make just one last journey to New York, moving permanently to the city in order to devote himself completely to his practice. Starting off small, New York City Surgical Associates (NYCSA) began to grow exponentially with the addition of highly skilled and impressive doctors: from anesthesia to spine, endovascular to cosmetic and reconstruction, the different specialties of the physicians and surgeons increased patient volume. Graduates from prestigious medical institutions such as Yale University School of Medicine or RUSH University Medical Center, Dr. Greuner recruited the best and the brightest medical minds to create the best possible surgical care for his patients.
What was the added benefit of bringing these minds together? The practice becomes completely in-house, allowing the different fields and specialties to work together in a more synchronous manner. “We have our own anesthesia, our own surgical center. A lot of the problems we treat interrelate, and there are often commonly coexisting conditions between the same patient. The average patient that comes to us ends up getting four to five surgeries for that very reason.” Dr. Greuner goes on to mention another benefit, remarking as he laughs that the extra help gives him a bit of a reprieve: he is now able to focus on just a few major areas, namely endovascular surgery. And yet how can a small practice compete against larger institutions such as Columbia Medical? “The difference is that we do probably a lot more than those people do because we’re just very high volume. We each specialize in a small amount of things or fields, and we each do a huge volume of that.”
The cohesive nature of NYCSA’s setup also helps alleviate one of the major fears of patients in dealing with medical problems: the bill. A large hospital, while having many different departments and varieties of surgeons, also outsources a lot of its resources, especially private surgeons and equipment. This outsourcing means that the bill is more complicated and leaves the patient caught in the realm of the unknown: can I afford this, and when am I going to know? The in-house structure of NYCSA means that the costs are immediately transparent and known. “We track every procedure, so when patients come in with their insurance card, I can tell you what I would get paid per procedure, per insurance provider, per what procedure we’re going to need. I can tell them what their out of pocket cost is going to be. And I can guarantee that, because everything is in-house.”
Since the areas of focus of the practice are not geared towards lifesaving surgeries and procedures, the desired demographic is not your run of the mill New Yorker. Having expanded to nine offices in New York City, the locations themselves are representative of the typical patient: with two offices on 60th and Madison and one in Chelsea, the patients tend to belong to more of the upper middle class. Despite this demographic, Dr. Greuner puts a strong emphasis on his refusal to “cherrypick his cases.” Conducting many pro-bono cases, he asserts that the people who he wants to pick for pro-bono are people with real problems. “We don’t just have the average person off the street, and it’s not because we feel we owe them something. We do it because we want to.” For Dr. Greuner charitable work is a big part of what he does when he’s not working. This May he traveled to the Cannes Film Festival for the Generous People Gala which raises funds for The Heart Fund which saves the lives of children suffering from cardiovascular diseases in third world countries by investing in technological innovations and solutions. This charity was created by Dr. David Luu, one of NYCSA’s associates.
In explaining another of his areas of interest, Dr. Greuner gives us perhaps the best explanation of NYCSA’s goals: “A lot of the stuff we treat is not life threatening, it’s quality of life threatening.” The example given to show how he aims to achieve this goal is based off a representative NYCSA patient narrative: Say you work out a lot. You have a hernia, and a typical treatment of this would have been to implant a mesh, a patch that prevents the bowel from getting stuck. However, while the danger is usually lessened, the hernia, and the corresponding bulge of your abdomen, remains. The NYCSA’s solution is of its own design: through a complex body-wall reconstruction, or a moving around of your musculature to reinstitute your natural physiology, your functional capacity is resolved, and the aesthetic problem gone. With all of these new procedures developed just within the last ten years, it seems we are only skimming the surface of what Dr. Greuner can do. Our only question: What’s next?
For Neurological and Spine surgery Dr Arien Smith is an expert having graduated from the Yale University School of Medicine and having received his B.A. in Biology and Spanish from University of Rochester. Dr Smith has the rare combination of subspecialty training in both orthopedic and neurosurgical spine surgery for chronic, acute, and traumatic issues. He also brings to NYC Surgical Associates his experience in pediatric deformity and scoliosis surgery.
Dr. Jason Hanks specializes in regional anesthesia and acute pain management. Although Dr. Hanks’s anesthesia training encompassed a broad base of surgical procedures (Neuro, Cardiac, Laparoscopic, Thoracic and Obstetrical), his area of interest lies specifically in multi-modal pain management, and using peripheral nerve blocks to manage postoperative pain and make recovery as effortless as possible. Dr. Hanks is active in continuing medical education, is actively involved in community education, including medical volunteer work with NYC Surgical Cares and The Heart Fund.
Dr. Victor Rosenberg, whose specialty is Cosmetic and Complex Reconstructive Surgery of the entire body, has been in private practice since 1970. For twenty years he was the director of Plastic Surgery at NYU Downtown Hospital. During the Viet Nam War, he was a Commander in the United States Navy, serving as Chief of Plastic Surgery at the St. Albans Naval Hospital. Dr. Rosenberg is the inventor of instruments used in Plastic Surgery and other surgical specialties. He has authored papers which were published in medical journals.
With more than 16 years of experience specializing in breast and body procedures, Dr. Fiorillo is recognized as one of the most experienced plastic surgeons in his field. Always looking to improve his technique, he recently traveled to Sweden to be trained by Sientra®, the creators of the popular Gummy Bear breast implants, on advanced procedures and best practices for implementing silicone breast implants. His expertise and thousands of successful surgeries have brought him the honor of being appointed by Sientra, Restylane, Dysport, and Perlane to train other doctors in the United States. Due to his renown, Dr. Fiorillo has performed cosmetic surgery on numerous movie and television stars. He is frequently sought after by mainstream media outlets and programs for his expert opinion, including: Fox News, Good Morning America, The View, The Doctors, and Real Housewives of New Jersey.
Dr. Elie S. Semaan is double board certified in vascular and general surgery, and the Director of the Division of Vascular and Endovascular Surgery at NYC Surgical Associates. His undergraduate training was performed at University of California Los Angeles, and residency training at Maimonides Medical Center in Brooklyn, NY, where his surgical experience spanned from general and minimally invasive surgery to critical care, vascular surgery, and cardiothoracic surgery.
Dr. Maxim Tyorkin is a leading orthopedic specialist dedicated to providing patients in New York City with the most advanced care for musculoskeletal diseases, injuries and disorders. His in-depth understanding of sports injuries helps him develop the most comprehensive treatment plans for all sorts of injuries to joints, ligaments, tendons and other soft tissues so recreational and professional athletes can return to their sports as soon as possible. He also has a wealth of experience treating occupational injuries, age-related diseases such as arthritis, and traumatic injuries sustained in car accidents and slip-and-fall accidents.