Thank you, everyone, for being here, and thank you, Steve, for inviting me. Winston, you're going to find a couple pearls that you and I both shared, which maybe will be the nice nuggets. It's nice to be amongst friends. This is an interesting topic, and it's a lot harder to think about this as opposed to fixing a posterior labrum, which you can talk about in your sleep here. You have to ask yourself some questions. So let's see if I can make this advance. I don't have anything specific to disclose with regard to this topic. So what does my competitive landscape look like? The topic is I need to stay competitive. If I look around my world, and what do I see? I've got the hospital for special surgery actually in my front yard and backyard. I've got NYU, Mount Sinai, Yale, and Columbia, and they all surround me as a small little freaking French fry. How on earth can I be competitive in a world where I've got world-class institutions that literally are in the same town, and the surgeons live in the same town, and our kids play in the same teams? Well, how do I do it? Well, I guess I was taught. I was taught about the three A's, the availability, the affability, and third, and in that sequence, your ability. So I thought to myself, look, should I give a talk about the three A's and how I landed on my feet in Greenwich Connecticut with the three A's? And I switched it around. I said, no, you know what? We're going to go with the P's, and not these neurovascular ones, but the P's that I think have gotten me to where I am is it's purpose, it's principle, it's practice, it's persistence, it's people, and it's patience. And I think those are the thoughts, and Steve, this is what you helped me to articulate in my brain. So each one of these, I'll just spend a couple of seconds talking about, but practice. What is my practice? What does it look like? Well, it's pretty mundane. It's the same thing just about week over week. I see about 45 patients in a day, and I see patients on Mondays and Tuesdays. With me, I have a PA, and I have an athletic trainer, and then I have a scheduler. My scheduler is not my own. I share her with her. I share her, right? I have, on Wednesdays, I go to the ASC. I probably do about eight cases at the ASC. On Thursdays, I go to the hospital. I try and get four total shoulders done at the hospital on Thursdays. We have two fellows who work with me. Outside of that daily practice, I help run the National Clinical Board, and I'm on the board of directors of a large PE company. We now have 130 surgeons that we've sort of consolidated, and that could be its own fun discussion in and of itself. And on Fridays, Fridays are my to-be-determined day. Fridays are the days I travel to a meeting. Fridays are the day I try to goof off. Fridays are the days I catch up on extra cases. But it doesn't take a whole lot. This slide that I pulled out, it doesn't take a lot of talent, but if you work hard and you're on time, this is one of my favorite slides that I sort of continue to put up, and I have to remind myself to live by that. Practice. The other thing is I continue to practice. I want to practice at surgery, and I want to practice perfectly. After every single surgical case, whether I think I did it well or poorly, I'm going to sit down and self-assess. I'm going to reflect on that because there's no other way for me to get better at my craft than for me to be critical of myself. So I practice. I practice hard, and I try to practice perfectly. Purpose. Right? That's the next P. I never just show up, right? I set goals constantly, thinking about how many patients I want to see in a week, how many meetings I'm going to be, when I'm going to time to innovate, when I'm going to publish, how many rounds of golf I'm going to play. And this guy in the middle is a friend of mine, and he's carrying a big sword, and he didn't get a big sword just because he showed up, right? He came out with purpose. He came out with a small drafting desk, and he went after it. And then now that I have purpose, now that I'm constantly thinking about my purpose, I constantly reset my goals. So what I may think about being important in a given month, I'm going to change it month over month. I keep a book. I still write things down. I don't keep them on my phone, and I'm always reviewing what my purpose is. Patience. This would be another pun. I engage with my patients. I call them back. I don't have my M.A. or my P.A. call every patient back. I check in on them. I actually want to build that level of trust. And that's it. The post-op call, both. You heard that from Winston, too. We make a post-op call. I'll make that. Dignity. When someone comes in, they're not, hey, Joe, unless they're my friend. They're, hello, Mr. Jones, right? And when Mr. Jones lets me call him by his first name, they call me doctor. Why shouldn't I call you mister, right? When I'm walking to a room a half an hour late or 20 minutes late, I apologize. I say, you know what? I'm sorry I'm late. I know this is your valuable time. I sit down. In my office, I specifically have my seat lower than the patient, right? They're looking down at me. I'm not trying to be empowered by them. And I listen. It took a long time to learn how to listen, but I do. That said, I never let my foot off the gas, right? And finally, with my patience, I am patient. And that took a long time. Principles. Operate when you need to. Case is not a sale. You know, it feels like it is. You feel good when something good comes in. But just, you know, you hold true to what you know. New York City is a funny place. There's a lot of bad mouth. And here's Andre the Giant, a legend. I don't speak badly to people, he said. I've grown up thinking and being told that if you cannot say something nice about someone, this is Andre, you say nothing at all. But I must break that rule, in this case, because I hate Hulk Hogan very much. He's a big ugly goon and I want to smash his face. Don't bad mouth people. It's that simple, right? Persistence. Ray Dalio, who's a hedge fund manager, run the biggest one in the world, he sort of lets you know. The more successful you are, the bigger your problems will be. And instead of sort of looking at those problems as challenges, I look at them as my expectation. I know I'm going to have problems. And my job as a surgeon, as a doctor, as a problem solver, it's the same in my practice in my life. And if I face those problems as part of my normal tasks, it's pretty darn easy. Now, Steve, normally in my talks, I show an embarrassing picture of someone. This time I won't do it to you. I'm a child of an immigrant family. My parents had no idea about sports or sports in the United States. They were both survivors of a genocide. And then I show up, the youngest and only boy, and I'm a competitive guy. I don't give up too easy. So the idea that someone out there is holding their breath, waiting for you to fail, I believe and I still believe it. I'm going to make sure they suffocate. So look, there it is. There's the embarrassing picture. Those are some pipes. Those are some pipes. But however, I turned out a little differently when I took this to the next level and continued to compete at a pretty high level from being that little immigrant kid. Persistence. People. People are so important. You heard it. You heard it from before. I've got, you know, I think out here is my mentor, Jim Tavoni. I saw him sitting down earlier. I don't know if he's still awake. I've got my closest friends. I've got Steve up here, Rafi and Joe. I think you're in there. That's Jay Keener dressed up in case anyone's wondering about that costume. But the people you surround yourself are just, they're going to be what helps you get through. It helps you get through this job and this practice and make it that better. So that's it. Peace. This is where I live. Anyone want to come visit? You're welcome. Come spend a week with us in the OR. We'll go out in the water and enjoy ourselves. But thank you for taking the time to listen to me.

competitive

world-class institutions

three P's

purpose

principle