“‘Oops’ is not a word we use in the operating room.”
A young Dr. Robert Stanton, now a veteran sports medicine specialist at Orthopedic Specialty Group Specialists of Connecticut, heard these words years ago from a glowering senior surgeon. More on that later.
Dr. Stanton could have been surrounded by terms such as “id” and “constricted affect” from an early age…but his psychiatrist father was healthy. “I grew up in Great Neck, Long Island, where my dad worked as a psychiatrist—probably the only normal psychiatrist I knew. He didn’t bring his practice out of the office. I think he could see that his colleagues who did bring their work home were a bit odd and did their children a disservice. My mom was a housewife who spent much of her time volunteering. She was also a semiprofessional musician with perfect pitch who actually tuned our Steinway grand piano by ear.”
The family zeitgeist was that the firstborn should become the next doctor. Robert Stanton would make a brief detour, however. “While enrolled at Williams College in Massachusetts, I applied to the Woodrow Wilson School of International Affairs. Fancying myself the next Henry Kissinger, I envisioned my life as one of international diplomacy. Yet I had always planned on being a physician. Having had a number of relatively minor sports injuries, and enjoying the orthopedist that my father took me to, ultimately pointed me back to medical school.”
The bright lights of the big city—and of the operating room—then shone on Robert Stanton.
After completing Columbia Medical School in 1972, I did two years of general surgery at Columbia Presbyterian Medical Center. It was here at Presbyterian Hospital that a crusty senior general surgeon made my heart stop briefly. I was doing the stitches, made a mistake, and said ‘oops.’ He paused for a seeming eternity and glared at me, saying, ‘Oops is not a word we use in the OR .’
Dr. Stanton adds, “While in medical school, I was able to keep my interest in international affairs alive. I received an Edward John Noble fellowship from Williams, and spent one year in the School of International Affairs at Columbia.”
On the medical side of things, however, Dr. Stanton found the softer side of surgery in a mentor by the name of Ken Ford. “I have tried to emulate the demeanor of Dr. Ford, a general surgeon at Columbia. He had a superb way of interacting with patients and always encouraged students to ask questions. He seemed to genuinely enjoy helping us find answers and made himself readily available to trainees.”
His preliminary questions answered, Dr. Stanton then headed to Yale to dig deeper into musculoskeletal mysteries. “Dr. Fred Southwick, the son of Yale’s first chair of orthopedics, Dr. Wayne Southwick, was my medical school roommate and teammate on the Old Blue Rugby Club. Dr. Southwick conducted my residency interview at the Southwick fishing camp—when Wayne was cutting Fred’s hair. Dr. Southwick is a true gentleman with great common sense. He was constantly available to help and he made you think on your feet, which challenged me to always be prepared—I still talk with him on rounds at Yale.”
Much of what Dr. Stanton learned at Yale emanated from someone who never held a drill or a reamer.
Bill Dayton was the head athletic trainer at Yale for 30 years; he also worked with Olympic athletes. Bill was so skilled that he was given a formal appointment in the department of orthopedics. He taught me things that you don’t find in textbooks. ‘Just sit with the kids, talk to them, and look at what they’re doing as far as how they are moving. Go to the training rooms and observe them, ’ he would say. ‘If they know you and trust you, they will confide in you, ’ he said. For example, one of my colleagues who works with a girls’ basketball team recently had a situation where a player was having a problem with plantar fasciitis. Her father decided that he didn’t want her to tell the doctor because he would only tell her not to play. The athlete was the one who confided in the doctor.
Bidding Yale farewell in 1977, Dr. Stanton had his skis pointed northward. “I am an avid skier and wanted to settle in northern Vermont. My wife didn’t want to be so far north, however, so we compromised and went to southern Connecticut. I took a job there with someone trained at Yale, had a solo practice for a couple of years, and then got involved with building the practice I manage now.”
Why private practice? Like the vast majority of orthopedists, Dr. Stanton made his decisions in part based on those he came into contact with. “Yale only had a small academic department at the time. This, coupled with the fact that most of those who influenced my career were in private practice, meant that I headed in the same direction.”
In a world where more and more orthopedists are going to work for hospitals, Dr. Stanton has managed to construct an effective practice model. “By the early 1990s we had five physicians and I was managing partner. We could see that things were changing, and that the right strategy was one of growth. My partners and I made a conscious decision to expand the scope of the practice and offer comprehensive musculoskeletal care. There was no grand scientific plan behind this, but it was evident that the only way to succeed—indeed, to survive—was to be large enough to negotiate with insurers. Now we are 17 doctors strong.”
Although their patients may not have to go far for other services, the practice still can’t write its own ticket in one area. “We have a pharmacy, physical therapy department, and an ambulatory surgery center, among other things. The one area that we’re still struggling with is getting an in-house MRI machine…the radiology lobby is a strong player in this state. We still have a couple of options, however.”
He adds:
Some theorize that if a physician owns a piece of equipment, he will overutilize it…I disagree. Ethical physicians order only those tests and procedures that are medically necessary. I spend more time talking people out of tests than ordering them. Ultimately, patients benefit from having all services in one location.
So that private practitioners don’t go the way of the dinosaur, Dr. Stanton recommends, “Orthopedists must think of it as a business, although that can seem at odds with how we are trained to think of taking care of patients. One of our Yale residents, who holds an MBA, gave a talk on this issue recently and said that things having to do with the hand and brain are not financially rewarded as well anymore. What is rewarded is providing comprehensive care and utilizing ancillary services appropriately.”
Innovation good, reinvention of the wheel bad, says Dr. Stanton. “In setting out to add ancillary services private practitioners should do their due diligence. This involves hiring a consultant and then examining what other practices have done. Don’t waste time trying to find your way through the maze when others have already done so. There will be substantial issues, including dealing with government regulators.”
Dr. Stanton, who this year will assume the presidency of the American Orthopaedic Society for Sports Medicine, steers the health of athletes young and old.
I serve as Team Physician for all of Fairfield Universities’ athletic teams, and have learned some important lessons along the way. The key to being a successful sports medicine physician is availability. Some young people out of fellowship come into a new town expecting to be the next Jimmy Andrews (the famed sports medicine specialist). Formulating such a career takes years, however—years of making yourself available at inconvenient hours. You have to go to local high schools, junior highs, etc. and offer your assistance. You can’t have an attitude of, ‘I am superbly trained…bring me your people.’ Instead, you had better get accustomed to standing on freezing race hills.
Fortunately for Dr. Stanton—and his wife—he cultivated that talent years ago. “Nearly forty years ago I met my wife Debby while on ski patrol in Vermont. It was love at first sight. She is a competitive rider and a master gardener. Our son, Jim, is married to Christina; they have a 16-month-old son, Jack, and another child due in early summer. It’s fantastic to be a grandfather, and we’re so pleased that they live nearby.”
“As for my pastimes, although I’m an avid skier, I could not make our national ski team as a competitor. I have been a physician for the U.S. ski team for the past 30 years, however. While working at the 1980 Olympics in Lake Placid I met Richard Steadman, who asked me to join the team’s medical pool. Travelling with the Olympic athletes all over the world has been a unique and very rewarding experience. Many have become lifelong friends.”
“I also play competitive polo, and maintain a string of polo ponies. It sounds crazy for an adult, but it is amazing to play a sport that involves both high level aerobic activity plus hand-eye coordination—and then also to have to ride a horse. The bonus is that I have a group of horses with whom I can have some serious conversations. As long as a carrot is involved, they tend to agree with me.”
Dr. Robert Stanton…private practice for a healthier public.
