Interview with G. Quayle Neslen, M.D. Founder of Sylva Orthopedics
- Q: Tell us a little about yourself. Where did you study medicine? A: I was born in Dallas, Texas, and I was raised in Whittier, CA. I graduated from the same high school Richard Nixon did. I went to college at Stanford University for my undergraduate, and then I attended graduate school for one year, worked for a year, and then decided to pursue medical school. I graduated medical school at George Washington University in Washington D.C.
2. Q: What factors led you to the decision to open a practice in Sylva, NC? A: The hospital was looking an orthopedic surgeon, and my wife and I were looking for a smaller community as opposed to a larger city. I did my internship after medical school at LA county hospital, and my residency at Grady Hospital in Atlanta, GA. My wife and I had decided we wanted a town smaller than Atlanta and did not want to go back to California. I also liked the idea of being in a place that truly needed my services. Sylva had no orthopedic program at all before the foundation of Sylva Orthopedics.
3. Q: Could you give me some examples to illustrate the challenge you faced in starting Sylva Orthopedics and Associates? A: The hospital wanted to guarantee my income for the first year. After some small negotiations we agreed on a figure, and provided me a location next to their facility for my practice. My next step was to go to the bank for a loan to start my practice. It was easy to get money from the banks in 1980; after I had my capital was when the challenges began.
I had to hire employees; which I had never done. I hired a secretary, and my wife was an RN so the three of us were the entire company to start. Other challenges were my slow learning curve with the book keeping process. All of my training was technical training for medicine. I was not taught the first thing about running a business in medical school.
4. Q: How was the structure of the company determined when the new partners joined the firm? A: My first partner came to Sylva six months after I opened the practice. Our partnership was an equal 50/50 split on expenses, and splitting proceeds based on what revenues you produced. After one year we incorporated instead of remaining a partnership.
As new surgeons joined throughout the years, were brought in as an employee for their first year. If they were satisfactory employees we would offer them a partnership with a monetary buy in after that first year.
5. Q: How did you motivate and reward people?
A: Well the promise of potential partnership was good motivator and then once you were a partner it was production based. You eat what you kill, is the term used by other physicians.
For non-partner employees we offered a pension plan and health benefits to help retain our valued employees. However, we would only paid 75% of health care costs. My initial partner and I felt employees would use their health insurance policies more responsible if they had some skin in the game. The 25% help keep our benefits packages from being abused.
6. Q: How did you decide whom to let join your practice when a new surgeon was needed? A: Usually we would have an initial meet and greet with a potential new recruit; this is usually a dinner to get a feel if you like the person. Some legwork was then required to make sure the person is who they represented themselves to be in the interview or dinner. If all his credentials checked out we would give it a shot. It is not an exact science, and mistakes were certainly made.
7. Q: How have the experiences that you have had during your entire career influenced the way you now run your own company? A: I sold the company to the hospital three years ago because of changes in the medical field. My partners left and as time goes by I feel like I am looking from the outside in. I don’t particularly like what I see, but that’s why I am retiring.
If I had it to do over again, I would place more focus on running my organization as a business. For me life was always about practicing medicine. Over the last thirty-two years the firm has become more about being a business. I think this is part of what is wrong with medicine, but I would certainly have a different perspective if I was to do it again.