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off work, my patients could be at home with their families the night of surgery and be back to work within two weeks. As great as this was, I saw other minimally invasive gyneco- logical surgeons around me reaching higher levels of expertise. They had only 1% open surgical rates, minimal blood loss and much higher surgical volumes. Reaching this level of expertise required a lot of practice ( just like becoming an excellent musician did), and a high volume of patients. A different model was necessary, based on referral streams — like a general surgery practice — rather than the traditional model of an OB-GYN practice, where most surgeries came from within the physician's patient panel. The problem was, I couldn't get the volume I needed within my existing practice model. My male colleagues who were advancing in minimally invasive gynecology surgery (MIGS) had the ability to quit obstetrics. I did not. My clinic was so full of OB visits that I could not possibly make room for enough gynecology cases to perform at the level of my mentors. Nor was I allowed to make the necessary changes within the constraints of the large practice. I became stuck. So, five years ago this month, I left that group and founded my current practice, Virtuosa GYN. Virtuosa is the feminized version of virtuoso, a person who is highly skilled in music or their art. In short, it means "woman of excellence," and it represents the best version of myself that I can possibly strive for. I saw the development of myself as a robotic surgeon as similar to my development as a musician. I will forever be grateful for my banker, who took a look at my crazy business plan, said she believed in me and then stuck by me through the turbulent first two years. Within those two years, I opened four different offices, closed three, suffered a break-in and completely switched hospitals. I learned how to hire slowly and fire quickly, how to consolidate my assets and increase efficiency. Still, by September 2016, I had only three more months of reserve capital to make the practice profitable or face bankruptcy. I remember sitting down with my trusted advisor and accoun- tant in that same doctor's lounge that I sat in with my friend last week. We were determined to develop an additional revenue stream to pull the business up and out. We worked our tails off, and pulled it out. Today, I'm within a few months of paying off the business loan. I've created a practice in which the providers are free to do the parts of our specialty that they want to do, menu style. Some do only clinic. We utilize laborists and hospitalists. I concentrate on surgery. My health is better. I've created a referral stream-based surgical practice that allows me to practice as an advanced minimally invasive gynecological surgeon, specializing in benign complex gynecology. I'm in the operating room three days a week. Now, at around 200 robotic cases a year, I've been able to offer minimally invasive surgeries to over 1,000 women. So what's next? I have a strong desire to change how women's surgery is delivered on a larger scale. There are not enough physicians with the skills and surgical experience that my MIGS colleagues and I have. We can each only do so many surgeries one at a time. There is no way to scale. Again, stuck. The answer, this time, has come in the form of creating on on line st yle blog to inf luence the ma rket by directly educating patients about what is available to them. It is called Virtuosa Surgery, and it just launched this April. In serving our patients and the larger community of women, we hope to influence more physicians to learn the skills and utilize the tools we use to provide less invasive options for women. It is my dream to further expand this online platform to mentor and teach more physicians to provide minima lly invasive surgica l experiences for women. Visit us and find the encouragement to become your own version of a virtuosa at virtuosagyn.com. n " I had always known that I was called to be a surgeon, and when robotics came along, it was the perfect blend of the art of surgery and the fine motor skills I had honed as a musician when I was young. Twenty years into my career, I stood at the intersection of what God had created me to do and the technology to do it." — SUSAN CROCKETT, MD M D N E W S . C O M /// M D N E W S S A N A N T O N i O ■ 2 019 1 3