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Q: How did you get into surgery?
Dr. Richard Mackessy: I didn’t break a bone, get a disease or have some other sudden conversion. My mom was an operating room nurse. I went to St. Benedict’s in Newark (N.J.), a working-class prep school, and was pre-med at Holy Cross in Worcester, Mass.
Q: You fast-tracked your way into medicine?
RM: Not exactly. I went to medical school in Italy. While I was there, I played basketball in Bologna in a city league with a bunch of guys I’d played with in college.
Q: What was it like to play basketball in Italy?
RM: It was the ’70s. Bologna was the biggest Communist city in Italy. When our team played, the place was packed. It was intense because they were playing against Americans. The Italians would bring the U.S. flag, throw it on the ground and scream “capitalist pig!”
We said you can say anything you want, you’re going to lose. They had some pretty big kids there. But except for the big leagues over there, they didn’t really have an understanding of the game that you get by playing it all your life. So they would lose.
Q: Did you do anything else unusual in med school?
RM: I got married. I transferred back to the [United] States to the University of Medicine and Dentistry of New Jersey (UMDNJ) in Newark and went into orthopedics. For residency, I did two years in general surgery at St. Vincent’s Hospital in New York, orthopedic surgery at St. Luke’s and microsurgery at Thomas Jefferson in Philadelphia.
I joined a group of surgeons in Linden in 1984. I ran a hand center at UMDNJ for 15 years, but I still kept my private practice.
Q: Any particular reason you did that?
RM: It’s hard when you work at a university. When the chief changes, he wants to fire everyone. So I stayed in private practice and got no ulcer. I could always look the new guy in the eye and say, “We can terminate this arrangement anytime you want. I can use the time. And it’s not going to make much difference to my compensation.”
Q: Did this kind of bureaucratic theater make you want to be an owner, rather than a worker bee?
RM: Sure. Look at a hospital. It’s just a very complicated place. Certain cases you have to do there, like a hip replacement or [treating] a car accident [patient], because of equipment and specialties you might need — even a carpal tunnel case, if the patient has heart disease, because you need a cardiologist on premises.
But there are tons of sick people at hospitals. Patients can get infections. The emergency before you can delay you — instead of 10:00, your surgery is at 1:00. There’s a subculture there, there’s fear, for the patient. You could be lying in a bed and the person next to you could have a schizophrenic attack, or be dying.
You read all these things about complications in hospitals, or wrong-sided surgery. You see how it might happen: You’re setting up for one surgery. The hospital is calling to ask about your last case and your next case, plus you get a call from emergency.
Q: Where do surgery centers come in?
RM: Uncomplicated cases: your shoulder, your hand. At a one-room center, you’ll be the star. Come in at 9:30, home by lunchtime. At our center, I can do five cases and be home for dinner at 5:30. At a hospital, I’d be there till 8:30 or 10:00.
The nurses at surgery centers tend to be better. They know they could be home at 5:30 if everyone pulls together. At the hospital, it’s one shift after another and overcrowded. Sometimes, the harder you work, the more work you get. Everything is less cooperative and efficient.
Q: Do hospitals resent surgery centers?
RM: Hospitals and doctors have a love-hate relationship. The CEO of a hospital is a businessman, he’d as soon run 24/7. Before surgery centers, they’d have you doing surgery at 11:00 p.m., 1:00 a.m. But physicians don’t necessarily do their best work after 8:00.
I’m taking money from the hospital by doing it here. Some people say we can get along, other places will try to stop surgery centers. I’m fine in a blue-collar environment, but if I were to go to the ritzy areas and the fancy hospitals, it’s almost like war. The hospitals are pushing special zoning laws to keep centers out.
Q: How did you hear about surgery centers?
RM: From a couple of friends who were trained in California, where they invent everything. Around 1998, they introduced us to Murphy HealthCare, who had been building centers for ophthalmology, and were glad to branch out into orthopedics.
Q: What was the big selling point for you?
RM: It was going to be better for my patients and for me. I have four kids. Since we built our center, it’s been the difference between eating dinner with my family or coming home when everyone’s asleep, with a cold plate waiting for me. It’s not as if I was doing anything better by working late at the hospital. It just takes less of my time to get the same amount done.
The surgery center lets me offer nice things for the patient, such as one-stop shopping: Besides the OR, we have MRI, and upstairs there’s physical therapy to get them functioning.
Q: What’s the most important thing a good management company does for a center?
[For us,] the Murphys knew how to help us get credentialing. In New Jersey, a one-room surgery center couldn’t have a license. It was considered part of your office. The Murphys had us go to Medicare and a national licensing association to meet their standards: Were the halls wide enough for a stretcher? Did we have a hospital arrangement for emergencies? Were our anesthesia machines up to date? Once we met the federal guidelines, the state and local approvals followed.
Q: What has been the most surprising thing about ASCs for you?
RM: We can now make operations more of a positive experience for the patient. Take something like rotator cuff repair. In the old days, we had to open up all the muscles and put stitches in. You might stay in the hospital a couple of days, the pain was so bad.
Now I do those with an arthroscope. The patient is home the same day. I’ve had patients say things like, “Jeez, I only took one pain pill.”
Q: Have these innovations changed what patients expect from surgery?
RM: Yes. People [used to] come to the surgeon and say, “Tell me what I need to do. Whatever you do, don’t operate on me.”
The change was the result of the runners. They said to the surgeon, “Don’t tell me not to run. I’m going back to running. Just do whatever you have to do, to make that easier.” Now, more and more patients have that attitude.
I think if I weren’t getting paid more, I would still do it this way. My life is so much better, and the patients do so much better.
Learn more about Murphy Healthcare Group.
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