By Dean Celia
Matthew Marano, MD, is a board-certified ophthalmologist and a national leader in laser vision eye care. He is also Chief of Ophthalmology at Saint Barnabas Medical Center and Saint Michael’s Medical Center in New Jersey. Dr. Marano was among the first to perform bladeless laser cataract surgery. His willingness to innovate and adapt has led to a number of accolades and awards. He has been recognized by New Jersey Monthly magazine as one of the state’s top doctors, and is also the recipient of the American Academy of Hospitality Services’ prestigious 5-Star Diamond Award.
We recently sat down with Dr. Marano to discuss why he chose the eye care field; how the profession has changed and what he has done to adapt; how he markets his business (hint: quality patient care serve at the core of his marketing plan); and why he does not plan to sell to private equity anytime soon.
How long have you been practicing ophthalmology?
I finished my residency in 1982 and was looking at opportunities in major urban areas: San Francisco, Los Angeles, New York, etc. But I was approached by an infectious disease director of internal medicine at a major teaching hospital in Newark, NJ.
He told me they had no ophthalmologists—no one wanted to practice in Newark. The population there was underserved. It was made up of mostly elderly, indigent individuals with severe pathology. This was also at the beginning of what would become the AIDS epidemic. I jumped at the opportunity to serve in the community.
You got to practice in a larger urban setting and it happened to be close to home.
That’s right. And right off the bat I had my hands full with cataracts, glaucoma, diabetes—the full gamut. And I’ve not looked back. Some 37 years later I am still at it in Newark, and I love the challenge of working with underserved individuals. My staff and I get a lot of satisfaction around helping educate patients about the need for quality care, and how to achieve and maintain it. I believe I am among the group of physicians who have been serving in Newark the longest. And probably the ophthalmologist with the longest tenure there.
Why have you stayed in Newark all this time?
It’s all about the patients. I enjoy the mix of patients that I see and they are among the most grateful you can take care of. And while I love doing surgery, in many ways educating patients and helping them get other quality care in addition to great eye care—that is just as satisfying. In fact, the experience of working with patients in this way has made me a better surgeon.
What drew you to ophthalmology?
Initially I wanted to practice internal medicine, but eventually my interests shifted to neurology and neurosurgery. I spent 4 months at the Neurological Institute at Columbia with a neuro-ophthalmologist who was brilliant and energizing. I decided to do an ophthalmology rotation. The Chief of Ophthalmology there, Charles Campbell, took me under his wing. I watched corneal transplants when that procedure was in its infancy. I was fascinated with what took place under the microscope. So that aspect drew me in. But it was also about the people. The ophthalmologists I met were among the finest, most generous people I met in medicine. They were also brave individuals. That impressed me as a student. The lightbulb went off and I thought this is where I need to be.
That’s great. What are some of the biggest changes that you’ve witnessed over the years that have impacted your practice?
When I started out, we were doing intracapsular cataracts. We were freezing the lens, making a large, 180-degree incision in the eye. Eventually the extracapsular approach was developed.
I spent some time watching Charles Kelman, who pioneered phacoemulsification. In the last 4 months of my residency, I performed a number of extracapsular procedures. To me one of the most dramatic developments in the 1980s was the transition to inserting the lens into the posterior chamber rather than the anterior chamber. The patients healed much more quickly. The evolution was mind-boggling when I think that, at the start of my residency, we were using contact lenses or iris-fixated lenses after intracapsular cataracts.
What is the key to adapting to change in ophthalmology?
It’s important to fully embrace the new technology. That is critical. But it goes beyond that. You have to be good—actually even better than just good. When you fast forward to today, you see that a lot of surgeons have been weeded out be- cause they haven’t been able to keep up with the advances, even if they embraced the technology. The outcomes have gotten better because of that.
What about adapting on the business side— how has your practice evolved in that regard?
Let me start out by acknowledging that I could be a much better businessperson. With that said, the key to running a good business to me, first and foremost, is enjoying what you do. I like going to work. In fact, it doesn’t feel like work to me. I try to hire individuals who have the same mindset. That approach alone is the best marketing tool you possess. If you can develop a culture where the prevailing mindset is “I want to be here and I want to give patients the best I have to offer,” patients will benefit and there will be a ripple effect. It will translate into word-of- mouth advertising, which I think is better than anything you do on social media.
You let your work speak for itself by having patients speak about their experience with your practice. What else is key?
It’s very organic. If you have the right culture, that tends to happen. As mentioned, I think you have to embrace technology. However, from a business perspective, timing is key. I have found that you do not necessarily need to be the first in your area to invest in a new technology just because it’s available. I ask my staff about it. I also ask patients. It gives me a good feel for when to buy something. Providing the right technology at the right time is key. And once you do invest, go for it! You can’t be afraid to adopt it fully. Dive right in. Practice!
It’s also important to build a staff you can trust. That happens first through the hiring process and then by continuing to educate staff members. As my practice had gotten bigger, I have learned to trust my staff—including the optometrists and other ophthalmologists I’ve brought on. It allows me to take a step back and leave the postoperative follow-up to them.
On the marketing side, I don’t pay attention day to day to our website. I have entrusted certain staff members to do that and they keep it going.
A lot of this sounds intuitive. Just good common sense.
It is. But I don’t want to minimize the need for business acumen and sense. I didn’t receive formal business training, but I know how to analyze things. Sometimes I’ll look at things from a high level. What’s working well? What isn’t? Why isn’t a particular approach working? I’ll talk to col- leagues to find out what’s working well for them. Then I’ll work with my team to improve things.
Have you seen success using this approach?
It depends on how you define success. I think the best analogy is that of a vineyard owner. He decides one day to grow grapes. Of course, the payoff is not immediate. It takes time. But he keeps his head down and does things the right way and 5 years later he starts to see the fruit of his labor. It’s no different with a surgical practice like mine. You have to be patient.
You have been recognized many years running by New Jersey Monthly magazine as one of the state’s top doctors. You’ve been named to the publication’s Honor Roll of superior clinicians every year since 2005. You are also a recipient of the American Academy of Hospitality Services’ Star Diamond Award. Those are notable accomplishments.
Thank you. Being recognized by those organizations is an honor. It’s about offering superior service and quality. And that results from all the things I touched on earlier in our conversation. It would not happen without passion, a superior team, and an ability to adapt with the times.
I recently watched a video featuring a patient of yours, Bishop Manuel Cruz, the Rector of Sacred Heart Cathedral in Newark, and was struck by his story. In particular, the way you helped change the course of his life when you performed cataract surgery on him. His situation had gotten to the point where he could not read and do important aspects of his job. This is a prime example of the word-of- mouth marketing you referred to earlier. The so-called soft marketing approach. Letting the work and the fact that you change the course of patients’ lives speak for itself.
Yes, stories like that are very gratifying. First of all, I want to be clear it’s not just me, obviously. I think many eye surgeons have these stories be- cause the fact is, we can and do change things for the better for patients—often in a dramatic way (see below).
Of course. In your experience, what is the best way for ophthalmologists to tell their success story?
There is no secret formula. It happens organically. If you really help a patient, they will send you every person they know—family members, friends, and other acquaintances. You’ll also get referrals from primary care clinicians, optometrists, and others. It is important in those situations to keep the referrer in the loop about how their patient is progressing under your care. Open lines of communication will help as care is transitioned back to the primary care provider. And the primary care doctor will remember that. It keeps the referrals coming.
I understand it needs to happen organically, but is there anything systematic about it?
Sure. You know that millennial patients, as well as the children of an 85-year-old, are going to look you up online and read the reviews. So, it’s important to make sure these stories are told on your website. Allow satisfied patients to speak for you. Our website is important. Patient reviews on other websites is also important. If you’re making patients happy—like we did with Bishop Cruz— that will all bubble to the top. But it doesn’t just happen—it takes effort. We have someone in our office speak with patients about writing a review or telling of their positive experience in another way. Bishop Cruz’s story was unsolicited—he came to us and told us how happy he was with how things turned out. That is a golden opportunity for that soft marketing approach.
I am sure there are also other examples.
Sure. Recently a woman in her 40s came to us who was complaining of floaters and was worried about her retina. She had sustained an injury to her left eye 25 years ago that caused it to be blind. She had 20/400 vision in the injured left eye and 20/100 in the right. Both eyes had cataracts; the left had residual traumatic cataracts that caused significant scarring to the anterior segment and cornea from the injury. She told us that she’s been told nothing could be done to help her, and she’s been sent on her way. I like challenges like that—where others say something can’t be done. I want to figure out a way to help if I can.
So, I handed her a near card and asked her to read it. She held it about 3 inches away from her face and you could see her hunting around. She got to 20/400. This is a perfect example of some- one who’s been told her vision could never be improved. Her driving was awful, but only because she couldn’t see out of her left eye and her right eye had a general cataract that needed attention. Instead of telling her nothing could be done, I told her I could remove the cataracts. You should have seen how excited she was! And her eventual result was great. It shows you what can happen when you think outside the box. She got to 20/40 in the injured eye after a very complicated surgery. The other was eye was eventually corrected to 20/20.
Speaking of thinking outside the box, many ophthalmologists—especially those who have been practicing as long as you have—are taking advantage of private equity’s interest in the eye surgery business. I am sure you have been approached by these firms.
I have, but I’d rather be in the operating room than on the golf course at this point in my life. My goal is to maintain my surgical acumen for as long as I can. For now, I want to maintain control of the business I have built. I’ve enjoyed running my own little practice, which is not so little anymore. I’ve built my staff the way I want. If I sense during a job interview that a surgeon I am thinking of hiring is not capable, I don’t make the hire. I like maintaining that quality control.
Of course, there are benefits to going the private equity route.
Sure, there are. I would be able to focus on the clinical and surgical aspects that I love. I could continue interacting with patients the way I like and not have the headaches of running a business. I get that.
But that is not enough to tempt you?
Not at this point. It is certainly a viable option, but you really have to think it through. Whenever I spend 15 minutes on hold with United Airlines, it gets me thinking about how losing control of quality might look for my practice. I realize that not all private equity firms operate that way. Many are very good. I worry about how the private equity firm is going to run my practice. I don’t want to change my reception area. I want patients to walk in, see a familiar face, and have a sense that they are in a place that cares about them.
I take what I do very seriously. Everybody needs their eyes. I operate on artists, surgeons, pilots, and others who depend on seeing. Really, all of us de- pend on seeing. People who work at a desk spend the majority of their time looking at a computer screen, a tablet, or a phone. Then they spend a lot of their down time looking at screens too.
I don’t want a big organization telling me how to invest in those people. I don’t want to have to force my business to fit that organization’s model.
What would you tell a colleague who asks for advice about selling?
It can be a worthwhile option. If you know you want to retire in 3 years, go for it. Get the best deal you can and then work with your new owners to make sure your business thrives.
What about selling to a smaller independent organization that would allow you to run your practice pretty much on your own?
Yeah, that’s an option. But even then, you have to worry about that organization eventually being acquired. Before you know it, you are part of a conglomerate you were trying to avoid in the first place.
Of course, Father Time has a big say in all of our plans. You can’t perform surgery forever.
That’s very true. I totally accept it. But I can be a consultant, and I can teach. And my business will still have my stamp on it. My brand will still be there. The opportunities in this profession are expanding. There are more virgin eyes to treat, more enhancements that need to be made in aging baby boomers. And millennials are prime candidates because they want their vision to be at peak level.
I heard at a recent conference that, according to a poll of refractive patients, the number one driver of their decision to get surgery is the promise of vision better than 20/20.
Absolutely. Younger individuals drive that and demand premium lenses. As patients age, more and more cataract surgeries will need to be done. Moreover, the way I see it, there are fewer great surgeons being trained because there are fewer individuals going into medicine. And when they do go into medicine they don’t want to work as hard.
My father was a pediatrician who worked 7 days a week. He’s my role model and I embrace his philosophy. Frankly I don’t think that mind- set exists much anymore.
All of these things reassure me that my decision to keep practicing and stay actively involved in the business side of my practice is the right one.
Making A Difference One Eye at a Time
When you ask Dr. Marano to speak about himself he typically deflects such praise. This doesn’t surprise his longtime friend, Bishop Manuel Cruz, of the Archdiocese of Newark, NJ. “I am from Cuba, and we have a saying there,” he said. “’Tell me what you are bragging about, and I will tell you what is missing in your life.’”
Bishop Cruz, a neuropathologist by vocation, and Dr. Marano crossed paths at St. Barnabas Medical Center in Livingston, NJ. “Because of my medical background, priests would approach me when they had a medical issue,” the Bishop explained. “Many of them had problems with their sight and I never hesitated to refer them to Dr. Marano.”
Several years ago while visiting his native Cuba, Bishop Cruz visited with Sister Milgros Quesada, who he remembered from his youth. “These sisters were my teachers—they were the best. When Sister Milgros told me she was losing sight in one eye, I knew I had to do something. I called Dr. Marano. Without hesitating, he told me to bring her to him.”
Dr. Marano not only operated successfully on Sister Milgros, but saw her regularly after that to manage her diabetic retinopathy. “We never received a bill for any of this,” noted Bishop Cruz. “That is the kind of man Dr. Marano is.”
When the Bishop himself needed cataract surgery, he knew where to turn. “Dr. Marano told me not to be afraid, and that he would take care of me. I am forever grateful to him, for his work is enabling me to continue in my ministry.”
Dr. Marano’s expertise touched the lives of Sister Milgros and Bishop Cruz but his work also impacted the lives of others; namely the individuals these two servants of God were able to minister to when they returned to work after surgery. “I am in awe of the power of medicine, particularly when it is in the hands of a giving person like my friend, Dr. Matt.”