Urology Blog

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February 02, 2020
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As many of you know, I like to write blogs on major holidays. Groundhog Day is certainly not one of them, but in this case, it is appropriate for what I need to announce: I am closing Greater Austin Urology, and merging with NAU Urology Specialists.

We all know the story and the movie. On this day, Punxsutawney Phil emerges from underground. If he sees his shadow, he goes back into hiding, and we get 6 more weeks of winter. If not, spring arrives early. In the movie, Bill Murray’s character, Phil Connors, is trapped in a time loop, where he is forced to relive the same day, waking up to “I Got You Babe” on the radio every morning. It is only when he changes his ways by embracing the day and continuously seeking to better himself that he is able to escape.

Starting a medical practice and running a business is hard work, but we had momentum. Our patient volumes and revenue more than doubled in 2019, while our expenses stayed relatively stable. We were profitable for the last 6 months, but any volatility in revenue or expense could upset the applecart. And then it happened: we encountered one such jolt, the details of which I cannot mention on advice of counsel. We did not renew our lease when it ended on February 1, so I was forced to make a difficult decision: either continue what I was doing at a different location, or join an existing practice. There is a paucity of high-quality, affordable medical office space near my main office, particularly on short notice, so I would have been forced to operate out of my Round Rock and Lakeway locations. However, I did not want to risk losing those patients who lived or worked near my main office, because given an unexpected rise in expenses, any further drop in revenue could have been catastrophic.

So, like the 2 Phils on Groundhog Day, I made a choice. I did not get scared of my shadow and go back to doing what I was doing. Instead, I took this opportunity to re-evaluate what was important to me and see if I could improve my situation. I will be joining a well-established practice that firmly believes in a holistic approach to their patients’ care. I know it will be different than how I’ve practiced, and I will have to sacrifice a fair amount of autonomy. But in the end, I firmly believe that Dr. Sandeep Mistry and his entire team at NAU Urology Specialists share my vision “to be known and valued for excellence and innovation in patient care, and to be most trusted for personalized, transparent, coordinated care.”

When I wake up on Monday, February 10, I will go to a new office, with mostly new employees. I will surely miss being king of my little office, and most of all working with Stacey and Benny, but I know great things lie ahead. I hope to find a way to continue my blog posts, but I will also have access to even more media outlets, including a radio show that airs on weekends. So, stay tuned, because a new song will soon be playing on the radio. Spring is coming, because this “Phil” is here to stay!

December 31, 2019
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As another year draws to a close, I usually like to pause and reflect on the past. We have endured minor nuisances and major existential threats to the practice, but overall it has been a pretty good year. I was picked as an Austin “Top Doctor” for the 4th consecutive year, patient volume and revenue are at all-time highs, and we opened a 3rd office and are about to open a 4th.

But this year is different, because it is also the end of a decade. A lot has happened in the past 10 years, some good, some bad. Rather than dwell on the past, this time I want to focus on the future, starting with 2020. It is a number that we have all been taught from an early age to associate with perfect vision. However, the future of healthcare is uncertain, especially for us solo practitioners. With healthcare costs skyrocketing, are we really all destined to be hospital employees, under some flawed pay-for-performance model that may exacerbate physician shortages and may raise costs even higher? Or will fee-for-service still be around, where there is still an incentive to see patients while running an efficient cost-conscious practice? The answer is no one really knows, so rather than guess what the future will hold, I turn to the Vision Statement of Greater Austin Urology:

“Our vision is to be known and valued for excellence and innovation in patient care, and to be most trusted for personalized, transparent, coordinated care.”

We want people to know us and value us for how we care for patients. We want to be innovative and to be trusted, but above all, we want the experience to be personalized and fully transparent. I like to think that we try to adhere to those standards every day, and whether I stay solo, hire more providers, go to work with someone else, or join a big hospital system, I intend to keep it that way.

Happy New Year, everybody, and best wishes for continued health and prosperity in the decade to come!

April 21, 2019
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It’s Easter Sunday, at least for most of the world. I’m Greek Orthodox, and our Easter is next week, so today is our Palm Sunday, which means tomorrow is Chocolate Bunnies and Peeps on Sale Day! Whatever your religion or beliefs, it is a time to reflect on life’s journey since last year, and the new lessons learned along the way. I know I haven’t posted a blog since Christmas because (thankfully) I’ve been too busy, so for inspiration, I looked all the way back to one of my first blogs (Reflections after Week One), and made a few modifications:

  1. There are a lot of good people out there who want you to be successful. I already thanked the people who helped me get started, but I would be remiss if I didn’t thank the people who helped me keep it going- besides Stacey and Benny, of course! Special mention to Jessica Browning Schraufnagel from St. David’s, Kristen Largent from Ascension Seton, and Cindy Gall from Austin Cyberknife for introducing me to primary care providers that have been sending me patients, Crystal Lilley Boynton from AthenaHealth for her unwavering support, Zack Ragsdale from Catalyst Consulting for convincing me that (almost) every insurance is worth taking the first year, and finally my accountant Greg Caudell, who was (and still is) the steady voice of calm optimism when I would “occasionally” freak out about how bad I thought things were going.

  2. Sometimes, you have to do this alone. Business startups are all about controlling costs, which means you can’t pay people just to sit around, waiting for the phone to ring. That means everyone has to wear many hats, including you, Doctor, so when all your phone lines are busy, or you give your employees the afternoon off, you have to be willing to occasionally wear the receptionist hat and answer the phone yourself. When I first started doing this, I was worried that patients would find it weird or unsettling. However, I soon realized that it gave me a closer connection to my patients that they never experienced before, and while they are initially caught off-guard when I answer the phone, they appreciate that it is not somehow beneath me to talk to them. Additionally, I have also gained a much deeper appreciation of what my employees have to endure.

  3. Not everyone should do this. Contrary to my original blog, I have to admit that starting your own medical practice is not for everyone. These days, there are serious headwinds, and you have to have serious stomach lining to put up with the ups and downs. You also have to be comfortable with the fact that you will not be able to pay yourself for at least 1.5 to 2 years. I heard this from multiple sources in different industries, and I didn’t want to believe it, but it’s true. Save it up, borrow it, or pay yourself from a previous startup, but plan on being the last one paid. I am glad to say I am well on my way, and it has not changed my opinion of whether or not this was the right decision for me. Hands-down, I would do this again, and I have already started to coach others on how to do the same successfully, but this is one of the first pearls of wisdom I share with them.

And with that, I hope you all enjoyed a joyous Easter with your family, and I look forward to doing the same, while feasting on roasted lamb, next weekend!

December 25, 2018
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As 2018 winds down next week, we will be reminded about what a terrible year this has been. To recap, we witnessed:

  1. Catastrophic hurricanes in North Carolina and Florida, and deadly wildfires in California
  2. Mass shootings in Parkland FL, Santa Fe TX, Pittsburgh PA, and Thousand Oaks CA
  3. A growing refugee crisis on our southern border
  4. Numerous government scandals, indictments, resignations, and now a shutdown
  5. And most recently, a stock market that has fallen nearly 20% (so far)

Tragic events have also hit close to home, as some of my closest friends are dealing with serious illnesses. It is easy to get despondent, but it’s Christmas Day, when we should all look for a glimmer of hope and optimism. Like many of you, I spent this morning enjoying the look on my kids’ faces when they opened their Christmas presents. Not being satisfied, I played old tapes of past Christmases, when they were even more joyful! I can’t say that most of those toys lasted a year before they were broken or forgotten, but the memories of being together at Christmas will last a lifetime!

Like many of you, at Greater Austin Urology, we’ve also seen our ups and downs this year, but I remain focused on True North, and what it will take to get us there. Everything else is just a detractor and a temporary road-bump. I can’t help but think of the words of the late comedian George Carlin, who said it best: “Don’t sweat the petty things…and don’t pet the sweaty things!”

May the blessings of the Holiday Season be with you and your family. Merry Christmas, everybody, and best wishes for a healthy and prosperous 2019!



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