Dr. Evan Garfein of Tribeca Institute of Plastic Surgery: 5 Things You Need To Create A Successful Career As A Plastic Surgeon
An Interview With Luke Kervin
Limitless capacity for hard work- I am a firm believer that to be great at anything, one must work very, very hard. Certainly, this is true for being a plastic surgeon. When the demands of a busy clinical practice meet the demands of a family with two young children, if one doesn’t have the capacity for limitless hard work something is going to suffer. I always have been completely committed to my patients and to my family. Therefore, I don’t play golf on the weekends.
As part of my series about healthcare leaders, I had the distinct pleasure of interviewing Evan Garfein, MD.
Evan S. Garfein, MD is Chief of Plastic and Reconstructive Surgery at Montefiore Medical Center and a founding partner of the Tribeca Institute of Plastic Surgery. He is a graduate of Princeton University, Columbia College of Physicians and Surgeons, Harvard Plastic Surgery, NYU microsurgery fellowship, and is currently getting his MBA at Columbia Business School. Dr. Garfein specializes in breast and body aesthetics with a particular focus on liposculpture and holistic aesthetics.
Thank you so much for joining us in this interview series! What is your “backstory”? What led you to this very interesting career?
I grew up in a “medical” family. My father, uncle, and aunt were physicians, my mother a nurse. As I went through college and for no particularly good reason, I made the decision that I was going to be anything but a doctor. I worked for a financial services company in New York City after graduation and had a great time as a young man in Manhattan. One day, however, as I was walking through Grand Central Station into the office, I looked around me at the thousands of business folks heading to their offices and thought that, in thirty years, I really didn’t want to start every day wondering what the Nikkei did the night before. I thought about how happy my dad always seemed when he came home from work and how much satisfaction he got from taking care of people when they were sick. I called him that morning and said, “Dad, I want to go to medical school.”
Fast-forward a few years and I’m at Columbia medical school, about to pick a specialty. My mentors in the first few years wound up being surgeons and I learned that I loved being in the OR. It was beautiful and exciting and fun. I wasn’t sure what kind of surgeon I would be- maybe cardiac or vascular or transplant- but I was sure what kind of surgeon I would never be- a plastic surgeon. From my perspective, plastic surgeons were not doctors who took care of sick people, and I became a doctor to care for sick people. I went to the Brigham and Women’s Hospital as a general surgery resident, and it was there that I met plastic surgeons who were different from any I had previously met or knew about. They did everything. They took care of the sick and the old and the very young and the badly injured and were artists and magicians. In another left turn, I decided that this would be my life’s work.
Moving another few years down the road, I am now Chief of Plastic Surgery at Montefiore Medical Center. I have performed thousands of operations over the past 14 years. Some have been lifesaving operations for patients with massive defects of the head and neck, some have been to reconstruct breasts after breast cancer surgery, and others have been aesthetic operations of the face, breast, or body. Amazingly, these various operations are more similar than they are different. One of my more cherished mentors used to say, “It is impossible to be a great aesthetic surgeon if you don’t understand reconstruction and it is impossible to be a great reconstructive surgeon if you don’t understand aesthetics.”
My partner, Oren Tepper, and I are excited to bring this philosophy to the Tribeca Institute of Plastic Surgery.
Can you share the most interesting story that happened to you since you started your career?
The most interesting thing that happened to me since I started my career was going to business school. My ability to provide better aesthetic surgery solutions to our patients is a direct result of better understanding the patient and the business of delivering world class experience from start to finish.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
When I was a young attending, having just arrived at Montefiore, I was eager to make a splash. I worked feverishly. I took every case, no matter how difficult it was or how busy I was. Pretty soon, I made a name for myself with the corporate leadership and some of the trustees. One day, one of the most senior advisors to the CEO called me and asked if I could see him for a mass on his scalp. I told him that I could be over right away and evaluate him in his office to save him the inconvenience of coming to mine. He thought this was great.
I examined him in his office and made the assessment that this was almost certainly a benign lesion that we could safely remove under local anesthesia. Instead of doing the most intelligent thing (remove this in the OR or ambulatory center) or the second most intelligent thing (remove this in the office under local anesthesia), I thought I would provide super great service and come to his office and remove it there so that he wouldn’t have to interrupt his day.
Fast forward to a shirt collar stained in blood, a waste-basket full of used gauze pads, and finally, the COO of our health system walking in, staring at the scene, and walking out without saying a word. The next day, my patient called to tell me how grateful he was for the care I had given him and the effort I had made to not inconvenience him. Then he told me that the COO told him to kindly request of me that I never, ever do that again. Lesson learned.
Are you working on any new or exciting projects now?
Oren and I are building the Tribeca Institute of Plastic Surgery in New York City. Our vision for this facility is as a place where the greatest aesthetic surgeons in the world can assemble to care for patients, educate young plastic surgeons, and learn from each other. The foundation of this vision is the ability to deliver the finest patient care available anywhere and this is something to which we are committed.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Oren has been the ideal partner. I have learned from him, leaned on him, and grown with him since we started working together 12 years ago. My effort to bring him to Montefiore is still the most important thing I’ve done in Surgery.
Is there a particular book that made an impact on you? Can you share a story?
Thinking Fast and Slow by Daniel Kahneman. Kahneman is a behavioral economist who won the Nobel Prize for his work on how people make decisions and when and where these decisions are predictably wrong. So much of what he wrote about touches Medicine, both as a surgeon and for our patients. The easiest example to grasp is one about the bias we all have when evaluating risk. If an operation has a 1% chance of something terrible happening, I can tell the patient that there is a 99% chance she will be fine or a 1% chance that something terrible will happen. People tend to evaluate that risk differently depending on how it is presented. It is critical to understand this, so patients are as informed as possible about risks and benefits. This is especially true in aesthetic surgery where patients take on this risk electively.
How have you used your success to bring goodness to the world?
The greatest thing about being a plastic surgeon is having the privilege, daily, of caring for all kinds of people. The young and the old, the sick and the healthy, those with enormous problems and those with smaller issues. When I speak with young people who are thinking about Medicine as a career and are worried that “it isn’t what it used to be” or maybe they would rather go into finance or something else, I tell them that I feel that I have the greatest job in the world. Every day when I wake up to go to work, whether to perform aesthetic surgery or reconstructive surgery, I am trying to make someone better. Every day I get the chance to “bring goodness into the world.” That’s a pretty good gig.
Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant to you in your own life?
My favorite quote comes from the Bhagavad-Gita,
“In battle, in forest, at the precipice in the mountains,
On the dark great sea, in the midst of javelins and arrows,
In sleep, in confusion, in the depths of shame,
The good deeds a man has done before defend him.”
Everyone goes through difficult times in life- professionally, personally, medically, financially, etc. These lines remind me that, when these times come, as they will for all of us, the good things we’ve done in the past will help us get through them.
Here is the main question of our interview. What are your “5 Things You Need To Create A Successful Career As A Plastic Surgeon’’ and why? (Please share a story or example for each.)
- Limitless capacity for hard work- I am a firm believer that to be great at anything, one must work very, very hard. Certainly, this is true for being a plastic surgeon. When the demands of a busy clinical practice meet the demands of a family with two young children, if one doesn’t have the capacity for limitless hard work something is going to suffer. I always have been completely committed to my patients and to my family. Therefore, I don’t play golf on the weekends.
- Brutal self-reflection- intellectual honesty is one of the foundations of success, in my opinion everyone likes to market himself or herself as the greatest. Certainly, I have a healthy opinion of my abilities as a plastic surgeon, but I am savagely critical of my results because I think that is the most important ingredient in continuous improvement. I never want to think that I am good enough as a surgeon because tomorrow I want to be better.
- Uncompromising pursuit for excellence- See above. There is only one goal and that is excellence. In whatever we do in life we should try to do it as well as possible. When what we do involves others as in surgery, it is critically important to be unyielding and the pursuit of excellence.
- Compassion- I was raised in a medical family and consider myself a doctor first a surgeon second any plastic surgeon third. My focus is always to care for the patient in whatever capacity I can. Sometimes that is with a scalpel sometimes that is with a word of compassion or understanding or support.
- Humor- lastly, life is simply more fun if one has a sense of humor. There is so much about our daily lives that is serious and tense and sometimes not fun or funny at all. Therefore, when life gives us the opportunity to laugh even if it’s at ourselves, I am convinced that we must take it.
What are the “myths” that you would like to dispel about being a plastic surgeon? Can you explain what you mean?
- It’s all about “art” and “being creative”. Rather, it’s all about reading, studying, and experience.
- Out of the box thinking is required. Rather, if you learn what’s in the box, you can be enormously successful almost all the time.
If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?
The big items, on a global scale, obviously are nutrition, infectious disease, and cardiovascular disease. Plastic Surgery doesn’t deal squarely with any of these. My time in business school has ignited the desire to help solve the economic challenges around healthcare both here, in the United States, and globally. We have to find better solutions to inequitable distribution of healthcare between rich and poor, between wealthy corporations and underpaid providers, and come to an agreement on what we all mean by “healthcare as a right”. This are some of the pressing issues of our time.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them :-)
Daniel Kahneman
Daniel Kahneman (princeton.edu)
Daniel Kahneman won the Nobel prize in economics for his work on how people make decisions and how they are often wrong in their assumptions. I think there is enormous relevance for both surgeons and patients in this regard.
What is the best way our readers can follow you online?
@drevangarfein
Thank you so much for these wonderful insights! We wish you continued success.
About the Interviewer: Luke Kervin is the Co-Founder and Chief Innovation Officer of Tebra, a leader in practice growth technology and cloud-based clinical and financial software for independent practices. With an all-in-one, purpose-built platform to drive practice success and modernize every step of the patient journey, Tebra provides digital tools and support to attract new patients, deliver modern care, get paid quickly, and operate efficiently.
