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Interview: Juan C. Suarez, MD · AHF Podcast

0:05
Joseph M Schwab: Hello and welcome to the AHF podcast.
0:08
Joseph M Schwab: I'm your host, Joe Schwab.
0:10
Joseph M Schwab: Our guest today is Juan Suarez, an orthopedic surgeon at the Baptist Health Orthopedic Institute in South Florida.
0:18
Joseph M Schwab: I've known Juan for a number of years, but this past year at the 2024 Anterior Hip Foundation Annual Meeting, he received the Joel Matta Award for Excellence and Innovation in Anterior Approach.
0:33
Joseph M Schwab: So it's my pleasure to be sitting down with Juan today to have a conversation.
0:38
Joseph M Schwab: Juan, welcome to the podcast.
0:40
Joseph M Schwab: Thank you for having me, Joe.
0:42
Joseph M Schwab: So tell me a little bit about your uh about yourself and your background.
0:47
Juan Suarez: So, you know, I currently practice in um in Miami at Baptist Hill, South Florida.
0:53
Juan Suarez: My career has kind of been pretty interesting.
0:59
Juan Suarez: I I grew up in Puerto Rico and I did medical school there, and then I did my residency at the University of Miami.
1:05
Juan Suarez: Then I did my fellowship at um Carolina and then worked at the Cleveland Clinic for some time in in Florida, and then I was commuting like an hour to work every day, and then got this offer basically in a hospital that's a mile from my house.
1:24
Juan Suarez: Oh wow.
1:25
Juan Suarez: I took it, and obviously there was some hesitation there because I was doing very well where I was, but it's you know, I've been there for the last five years, it's been a game changer for me and my family.
1:37
Joseph M Schwab: So, and you ended up in medicine.
1:39
Joseph M Schwab: Am I right in remembering that um your father was a surgeon, right?
1:44
Joseph M Schwab: Yeah, my father's a general surgeon.
1:46
Joseph M Schwab: Yeah, was that influential on you and your decision to go into medicine?
1:50
Juan Suarez: I don't think it was influential in the sense that I saw him and I'm like, I want to do that because you know he works, he's still he's 75 and still works.
1:57
Juan Suarez: Oh wow, so he's still around on the weekends, and I, you know, and and I looked at that and I'm like, I don't want to do what he's doing, but he was influential and he still is influential in the sense that I knew what it took to be a doctor, like I saw that in him like the discipline, the dedication.
2:18
Juan Suarez: Like I like when I got into medicine, I knew that that was the standard.
2:23
Juan Suarez: And if I was able, if I wasn't willing to do it that way, I was probably not gonna be able to do it.
2:29
Juan Suarez: So that's the influence that he kind of put on me.
2:33
Joseph M Schwab: So, what if it wasn't a direct influence from him necessarily, what led you to medicine?
2:40
Juan Suarez: You know, I I'm not a risk taker in life, and I and medicine is a career that I think, at least the way I see it, and I educate my daughter that's a pre-med student right now.
2:53
Juan Suarez: If you work hard, you see the fruits of your work.
2:56
Juan Suarez: It's not like going into a business that there's a lot of uncertainty.
3:00
Juan Suarez: Yeah, like you're like taking risks with money or time or or commitments.
3:06
Juan Suarez: You know, medicine it's a very rewarding career.
3:10
Juan Suarez: You're helping people, and for the most part, it's pretty predictable to a certain degree in terms of the fruits of your labor.
3:20
Juan Suarez: And that's kind of how I saw it at that point.
3:23
Juan Suarez: Initially, I wanted to go to vet school, to be honest, it's veterinary school.
3:26
Juan Suarez: I like I love animals, and I and I and that was but then as I started my undergrad training.
3:34
Juan Suarez: I'm kind of like, if I'm gonna, I I kind of like drifted away from that after working uh with some vets in the beginning.
3:42
Juan Suarez: Uh, but that's kind of how I saw it.
3:45
Joseph M Schwab: That's interesting that you mention uh, you know, business and the uncertainty with business, because you I mean you've definitely shown some uh entrepreneurial spirit, you know.
3:54
Joseph M Schwab: You you've you've done some development in uh in the orthopedics world with things like Cuptimize.
4:00
Joseph M Schwab: And uh are you at a point in your life where you feel like um even if you were to enter into an uh enterprise like that, you could um weather those storms?
4:11
Juan Suarez: Well, you know, it's you know, I I like the academia, you know, we have a fellowship and I like teaching, and I like some of the research that we do that's clinically relevant, but I think the most the thing that I'm most drawn to in what we do is innovation.
4:29
Juan Suarez: I love that part of it.
4:31
Juan Suarez: I love to work with smarter people than myself and how they think and how they push the envelope, and that to me is that to me is fascinating.
4:40
Juan Suarez: I wish I had more time because I'm so busy clinically that it's sometimes I mean something's gotta give.
4:45
Juan Suarez: The day has 24 hours.
4:47
Juan Suarez: So either it's family, it's business, it's practice, something's gotta give.
4:52
Juan Suarez: But you know, there's risk on that, but I think once you understand what you're getting into from the medicine side, in terms of once you understand what you're trying to do, I think the risk is a little bit mitigated.
5:03
Joseph M Schwab: Hmm.
5:04
Juan Suarez: I take more risk investing with my brother in real estate than because I have no idea what they're doing.
5:11
Juan Suarez: I just give up money, and I don't know what they do with the money, but that's more of a risk in my opinion.
5:16
Joseph M Schwab: Yeah.
5:17
Joseph M Schwab: So so was it that interest in innovation that led you to, or how did you end up um uh gravitating towards anterior approach hip replacement?
5:27
Joseph M Schwab: What was that story?
5:29
Juan Suarez: You know, it's funny.
5:30
Juan Suarez: I you know, I remember it like yesterday, it was 2007, and I was presenting my the paper that I wrote in my fellowship at ACAS, and it used to be at the Gaylor, and Akha's wasn't a huge meeting back then, it was uh maybe maybe a thousand people, maybe 700 people.
5:49
Juan Suarez: Okay, and and in one of the breakout sessions, the Pew had this thing with Mata about anti-approach.
5:57
Juan Suarez: It was a small room where we're literally like maybe 20 surgeons in that room, and then there's this guy talking about the anti approach, and I'm like, dude, that makes sense.
6:07
Juan Suarez: Like that guy kind of makes sense to me.
6:09
Juan Suarez: I just don't know if I have the gonads to go for it, but that makes sense to me, yeah.
6:14
Juan Suarez: And that's kind of what Spark did in my brain.
6:17
Juan Suarez: You know, I never trained with anybody on tier approach, or though Carolina wasn't doing it at that point, because Masonis was not part of the fellowship, and he was doing so nobody else did it, it was all poster approach, so but I'm like, man, that guy makes sense, and that started me going to courses, cadaver labs, and and that kind of triggered the whole thing.
6:39
Juan Suarez: No, something that I've always thought about, man, and this is something that I'm very I always tell my fellows, you know, the education of joint replacement in this country has been dominated by a few institutions, and we take it as dogma, right?
6:56
Juan Suarez: We take it that this is the only way you do things, yeah.
6:59
Juan Suarez: And and then comes along a guy like Joel Mara and like you know disrupts the situation, and I saw the whole process of people like bashing him in the podium, criticizing him, and and it's very cool to see that happening because that it needed to happen, right?
7:24
Juan Suarez: We were just comfortable.
7:26
Juan Suarez: It's like I I I went to a uh right before COVID, I went to a partial knee meeting in Belgium, and it's eye-opening when you go outside of your comfort zone and you see what people do, yeah, and the results they get, to me, it's fascinating.
7:43
Juan Suarez: I'm like, you know, I'm I'm still doing gap balancing knees, posterior approach, what am I doing?
7:49
Juan Suarez: And you know, I've that has sparked in me to learn from people that think outside the box.
7:57
Joseph M Schwab: So from that from that small meeting at AKIS with 20 people, um how did you decide?
8:05
Joseph M Schwab: I mean, you were in practice at that point, right?
8:07
Joseph M Schwab: Yeah, yeah.
8:08
Joseph M Schwab: So how did you decide?
8:09
Joseph M Schwab: I w what was your journey there to go from this makes sense to this is now my practice?
8:16
Juan Suarez: I went to Smith and Nephew courses that Keggy was the guy in my table.
8:21
Joseph M Schwab: Yeah.
8:22
Juan Suarez: I went to see Masonis back.
8:25
Juan Suarez: I went and saw him.
8:26
Juan Suarez: I I went to a lab that was Laud, Frederick Laud from France.
8:34
Juan Suarez: Yep, and I was in his table.
8:35
Juan Suarez: And then my partner and I at the Cleveland Clinic said, you know, we're gonna do the first like 40 together.
8:42
Juan Suarez: Well, basically, I remember like today, the night before, we're writing every we have four cases on the schedule.
8:49
Juan Suarez: We're writing every step, like one by one, and we pasted it in the wall of the operating room, and you know, this retractor here, this retractor there, and we did like the first 40 together.
9:01
Juan Suarez: We did a table less.
9:02
Juan Suarez: Then we bought the table, and and you know, and then after that, it was it was cruise control.
9:09
Joseph M Schwab: So uh those first few didn't uh dissuade you from uh continuing, or to be honest with you, man.
9:15
Juan Suarez: Honestly, I I always tell people like that that would be in my situation, yeah, that operating with a partner or something is really helpful, yeah, because it decreases the anxiety level, and then you don't have to be worrying about so many things at the same time because there's two competent surgeons there, and I think to me that was a blessing and something that I I think helped me tremendously.
9:38
Joseph M Schwab: So the beginning part of that process, having a partner involved, that was uh that was a huge uh bonus for you since that time.
9:46
Joseph M Schwab: What in your opinion, or what in your experience has been sort of the single biggest uh game changer to how you do anterior approach?
9:56
Juan Suarez: So, you know, I think that number one, it's interesting how the releases of the femur, you don't understand them that well in the beginning.
10:08
Juan Suarez: Yeah, once you get through, I don't know how many cases you have to do, but once you get through, then they you understand the releases, then it's like an aha moment.
10:17
Juan Suarez: It's like wow, that's now I'm feel more comfortable.
10:20
Juan Suarez: I do the socket, and probably the the the the case is pretty much done with.
10:25
Juan Suarez: The other thing that I realized also is like I didn't understand how to interpret philosophy.
10:32
Juan Suarez: I thought I did, and then it wasn't okay.
10:35
Juan Suarez: We started doing research and looking at our extra, we're like, oh, that that's why that happens.
10:40
Juan Suarez: Yeah.
10:41
Juan Suarez: So I think that the the new group of people in surges understand fluoroscopy a lot better than I did when I started DA.
10:48
Juan Suarez: Yeah, so I think those two those are the two of the things that that that helped me and kind of propelled my comfort doing hip anterior hip replacement.
11:00
Joseph M Schwab: So I I think I think you're right that people are coming out being better educated now about fluoroscopy, but I think that's because of you know work that you've done in this area.
11:10
Joseph M Schwab: And I mean your research has always focused on accuracy and precision in um in in hip replacement surgery and in the placement of the components.
11:21
Joseph M Schwab: And I I I'm curious why why do you find that topic to be so important?
11:28
Juan Suarez: Because, you know, that's one of the things that drew me to it.
11:33
Juan Suarez: Like when when when I saw Joel talking about you can use plugoscopy, and then you don't have to guess.
11:39
Juan Suarez: I'm like, oh, I mean, because when at North of Carolina, you would do the operation, they would get an X-ray in the recovery room, and then I remember vividly they had a view box kind of next to the surgeon's lounge and the radiologist that would put the x-ray there, yeah.
11:52
Juan Suarez: So it was there for everybody to see, yeah.
11:55
Juan Suarez: Then you would pass by, and if it looked terrible, you just pulled it down and be like, okay, that wasn't that didn't happen.
12:03
Juan Suarez: So I'm like, why are we doing this?
12:06
Juan Suarez: If there's a way of doing this and not having to like have the anxiety of what I did, yeah.
12:12
Juan Suarez: Like now when I do a posterior approach for any reason, I have no idea what I'm putting in my car.
12:18
Juan Suarez: I'm like, I have no idea where this is going.
12:21
Joseph M Schwab: I mean, I think I am, but I don't.
12:23
Joseph M Schwab: How frequently are you doing posterior approaches these days?
12:27
Juan Suarez: You know, I do maybe one every couple months, you know, and it's typically I I still have an issue with the anterior part when there's like fungal, like the like the skin doesn't look right.
12:40
Juan Suarez: Oh, sure.
12:40
Juan Suarez: I I worry about that.
12:43
Juan Suarez: Uh I you know, I still, you know, a bad crow for dysplastic hip that needs a shorting osteotomy.
12:52
Juan Suarez: I think I I'll prefer to do that through the back.
12:55
Joseph M Schwab: Yeah.
12:56
Juan Suarez: Uh those are the kind of scenarios that I still probably go through the back.
13:01
Joseph M Schwab: And so tell me a little bit about your development of um uh of cupmise and and your development of these technologies that that sort of enable your precision in the operating room.
13:13
Juan Suarez: So one of the subjects that I've always been attracted to is the whole spinal pelvic thing and how that affects composition, functional composition.
13:22
Juan Suarez: You know, I did some early work with Corinne, and I kind of was on the kind of on the first ones to use OPS.
13:31
Juan Suarez: And then when Cooper, Andrew Cooper, uh a good friend of mine and co-resident, you know, he developed Vellus or joint point back at that time.
13:41
Juan Suarez: And I told him, Listen, I think we should develop something on the to kind of with the spinal pelvic thing.
13:47
Juan Suarez: And uh when COVID hit and we didn't have anything to do, we got together him, the cook and myself, and and kind of figure this out.
13:57
Juan Suarez: And and and that's what sparked it.
14:00
Juan Suarez: We had time, and uh, you know, we put some seed money in it, you know.
14:05
Juan Suarez: We have Dr.
14:06
Juan Suarez: Cooper has access to a very good coder.
14:08
Juan Suarez: Uh, and uh, and then we worked through it with uh during COVID.
14:14
Joseph M Schwab: How many cases are you into using it at this point?
14:18
Juan Suarez: Oh man, I mean, I do every case with it, so probably more than a thousand.
14:22
Juan Suarez: Wow, you that use it on every case.
14:24
Juan Suarez: You know, I think I'm learning more and more about the subject, and you know, it's interesting because I think at the end of the day, I think that the best you can do no matter what, is to put your cup of 4025 in the standing position, right?
14:42
Juan Suarez: There's not much more you can do.
14:44
Juan Suarez: The more you study, the more you come back to the first answer.
14:47
Juan Suarez: Because honestly, there's a limit to how you can manipulate the cup.
14:53
Juan Suarez: Yeah, you can change the implant that you use, right?
14:56
Juan Suarez: The information is valuable in the sense that you can say, well, this is a risky patient, and maybe there's really no safe zone, and maybe I should alter the the bearing surface that I use, maybe a dual mobility or something like that.
15:10
Juan Suarez: Yeah, but at the end of the day, there's so much you can do, you know, and it's interesting because I don't know how you do the hip, but I was talking to a guy at AHF, and he was arguing that I should put my cup in the supine pelvic tilt.
15:26
Juan Suarez: And and I'm like, Well, I've never had a patient dislocate supine, so I don't know why I would use that, right?
15:34
Juan Suarez: And so there's still it's I would I would think that most people say use the standing pelvic tilt.
15:42
Joseph M Schwab: So you adjust the position of your pelvis fluoroscopically to mimic the standing pelvis.
15:47
Juan Suarez: Yeah, but with cuptomite, you don't have to because you draw the SFP angle, it automatically knows, right?
15:52
Juan Suarez: But some people they just look at the supine and they go from there, and yeah, and I'm I probably you do the same, and but what but we have we just looked at over like 500 x rays.
16:04
Juan Suarez: We want to uh submit this to ACUS, and basically there's a lot of change from supine to stand, it's a lot, yeah.
16:11
Juan Suarez: It's very patient specific, it's very rare, so it's interesting how this still is a topic of the debate, you know.
16:21
Joseph M Schwab: So speaking of the AHF, now you uh this year were the recipient of the Joel Matta Award uh from the Anterior Hip Foundation, and I'm curious what your thoughts are on being sort of recognized by your peers as being a leader in not just anterior approach, but in the uh in excellence and in in innovation in that area.
16:46
Juan Suarez: You know, it's I've never I never do what I do to get recognized, but it's actually pretty cool to get recognized by people like yourself, Joel Mata, Jonathan Gerasimidi, and because you know you guys are the thought leaders in this area, and and to be recognized is you know it's humbling and it's it's pretty cool.
17:09
Juan Suarez: I I value the forum of AHF because I think again it disrupts a little, you know, it's a disruptive forum.
17:21
Juan Suarez: Yeah, and and and I think it's uh it's needed.
17:25
Juan Suarez: It's it's something that I think uh serves a purpose, and I think it's something that people value, and I think it's something that helps our patients at the end of the day.
17:35
Juan Suarez: Uh so getting recognized in a forum like that is I think it's pretty cool and and and a humbling experience.
17:42
Joseph M Schwab: I do you have the award with you?
17:44
Joseph M Schwab: I'm curious.
17:44
Joseph M Schwab: I've never actually seen what it looks like.
17:46
Joseph M Schwab: You've got it.
17:47
Joseph M Schwab: I do have it.
17:49
Joseph M Schwab: Here, let's see.
17:50
Joseph M Schwab: Oh, look at that.
17:51
Joseph M Schwab: Let me see that you go.
17:53
Joseph M Schwab: Oh, very, is it glass, huh?
17:56
Joseph M Schwab: It looks like it's glass.
17:57
Juan Suarez: Oh, that's see.
17:59
Juan Suarez: My daughter's asking, but that what does that mean?
18:02
Juan Suarez: And I'm like, I'm the best surgeon in the world.
18:07
Juan Suarez: And they ask me, hey dad, does that come with money?
18:12
Juan Suarez: And I'm like, no.
18:13
Juan Suarez: Yeah.
18:20
Juan Suarez: But I just think it's it's interesting in the perspective of, you know, it's it's it's interesting now that I'm almost 50 and I look back a little bit, like I think I've gone a long, I've come a long way in my career.
18:33
Juan Suarez: And I if I look back, I would have never guessed that I would be in the place that I am.
18:36
Juan Suarez: But it's interesting the perspective of your sons or daughters about it.
18:43
Juan Suarez: Like it's they talk about a place of innocence, and it's that's so nice.
18:48
Joseph M Schwab: Well, and they grow up with a different experience than you did, but uh yeah, yeah.
18:53
Joseph M Schwab: So had you ever thought, did you expect to be back in Puerto Rico, or was the plan always to come to sort of mainland US?
19:01
Juan Suarez: You know, once you train in the US, going back there is hard because you don't have the same support, you don't have the same facilities.
19:12
Juan Suarez: Yeah, so you I always tell people you have to get you have to accept some level of mediocrity to be able to not you know completely burn out.
19:24
Juan Suarez: Yeah, so you know, and I and I wouldn't be able to do all every uh all that I've done if I was there.
19:31
Juan Suarez: I mean, there's excellent surgeons in Puerto Rico, and they do great job, and you know, I I know some of them that have done tremendous things, but yeah, but I I think I think that where I where I am where I am, and in part because of the of the places that I worked and the support that I've gotten there and the networking.
19:55
Joseph M Schwab: I had um I had the opportunity to uh to operate in Puerto Rico once with a uh a former resident of mine uh who practices there.
20:03
Joseph M Schwab: And what I found interesting was that the the reps who provide the materials scrub into the case and act as surgical text, and I was just blown away by this.
20:15
Juan Suarez: Yeah, and actually there's they some of the surgeons, if their rep doesn't show up, they'll cancel the case.
20:22
Joseph M Schwab: Oh my gosh.
20:23
Joseph M Schwab: Is that the same?
20:24
Joseph M Schwab: And is it the same in general surgery too with your father?
20:27
Juan Suarez: No, general surgery.
20:28
Juan Suarez: No, because you know the thing is that the those reps are the ones that know the trays, the instrumentation, so they rely heavily on that.
20:36
Joseph M Schwab: Yeah.
20:37
Joseph M Schwab: It was such an interesting um and unusual for me experience because you know, coming from I don't know what it's like in your hospital, but I I've been in hospitals where heaven forbid if the rep touches anything, you know, it's an incident report.
20:53
Juan Suarez: They even they even dress them differently, so instantly recognizable.
20:58
Juan Suarez: No, but it's yeah, it's true.
21:02
Joseph M Schwab: So if you, I mean, obviously you've got plenty of career left, but you have a lot of perspective now on where you came from and and uh how you got to the place that you are.
21:12
Joseph M Schwab: Um, you know, looking back and at your experience and if you were to give advice, you know, whether it's to your daughter or whether it's to other med students or orthopedic residents or fellows, um what could you share?
21:27
Juan Suarez: So, you know, my daughter's a pre-med now.
21:29
Juan Suarez: And um, you know, one of the things that I tell her is like, listen, try to understand what you're gonna get into ahead of ahead of time, right?
21:39
Juan Suarez: Because in medicine and in they don't teach you what it's like to be a general surgeon, they don't teach you what it's that you get caught up in the hype of what you want to do, but you know the quality of life that you're gonna have matters a lot for burnout, longevity.
22:00
Juan Suarez: So I think it's important that the young people understand that before they get into it, because once you're in it, it's too late, right?
22:08
Juan Suarez: I always use the example of the trauma surgeons in my hospital, they all want to be joint replacement surgeons at the end of the day because they're tired of taking call, having an unpredictable uh schedule.
22:21
Juan Suarez: Yeah, so I think that's very important, and um you know, my dad always says that you know, uh medicine is like a priesthood in the sense that you know you're like committed to your patients, and and if you're not willing to do that and put that at the forefront of things, I think I don't think you'll be able to practice medicine the right way.
22:44
Juan Suarez: Yeah, I think you know it's interesting.
22:46
Juan Suarez: Like I will have my phone, I'm available for my patients, whether I'm on call or not.
22:52
Juan Suarez: And it's interesting how now, like the hospitalist or the hospital in the hospital or with other doctors, you call them on a weekend.
22:59
Juan Suarez: Oh, I'm not on call, like uh, you know, like you don't bother me.
23:02
Juan Suarez: Yeah, and it's I I think you know, it's you gotta be committed to your patients in order to provide good service.
23:10
Joseph M Schwab: Yeah, no, it's very true.
23:11
Joseph M Schwab: It's hard to to go through all of that training and to go through all of the the long days and the long nights, and um and then decide you're not gonna be available for the people that you put in all this effort for, you know.
23:25
Joseph M Schwab: Yeah.
23:26
Joseph M Schwab: Um, well, that's great.
23:28
Joseph M Schwab: Hey, are we gonna see you at the next AHF?
23:31
Juan Suarez: Absolutely.
23:32
Juan Suarez: I mean, I think Nashville was a great choice.
23:35
Juan Suarez: Uh yeah, I like I liked it better than Vegas.
23:38
Juan Suarez: Yeah.
23:39
Juan Suarez: You know, and it's a smaller town.
23:40
Juan Suarez: It's I I yeah, for sure.
23:43
Juan Suarez: That's one of the meetings that I always do every year.
23:45
Juan Suarez: And uh, and it was good to see this year.
23:48
Juan Suarez: I saw a lot of younger guys that are really solid surgeons.
23:52
Juan Suarez: I mean, that revision session at the end was fantastic, phenomenal, yeah.
23:56
Juan Suarez: That was impressive stuff, and uh so yeah, you know, and I'm happy to collaborate and and try to help grow it, and for sure.
24:05
Joseph M Schwab: That's awesome.
24:06
Joseph M Schwab: Well, we look forward to seeing you.
24:07
Joseph M Schwab: We're gonna be in Nashville for 25 and 26, so um, so that'll be good.
24:13
Joseph M Schwab: And um yeah, well, uh as always, love having you involved with the AHF and um and love the opportunity to talk with you.
24:21
Joseph M Schwab: This has been great.
24:22
Joseph M Schwab: Thanks for having me, Joe.
24:24
Joseph M Schwab: Appreciate it.
24:25
Joseph M Schwab: Thank you for joining me for another episode of the AHF podcast.
24:30
Joseph M Schwab: If you want more information, you can check us out on Facebook, LinkedIn, or X.
24:35
Joseph M Schwab: Or you can visit us at our website, AnteriorHip Foundation.com.