Where are you from and what brought you to Rome?
I was born and raised in Rome. My parents, back in the day, had the vision that having an international education would be a key to success and personal fulfillment with the collapsing of so many boundaries, geographical and political. They thought that it would be a great opportunity for us children to start exploring at a young age different cultures, religions, different scenarios, and that’s how my sisters and I were enrolled in international schools. I don’t know what it’s like nowadays but when I graduated from Ambrit, if you went to Ambrit you usually went on to St. Stephens.
What are some of your fondest memories of that time? Can you describe your experience at St. Stephen’s?
Of the four years there, the most exciting and life-changing was my freshman year, believe it or not. Which I know might scare a lot of the young freshmen but hopefully by reading this they may change their mind. The ninth grade was fantastic, because not only did I continue my friendship with the people I met in middle school, but I met new people, some of whom are amongst my dearest friends today. It was nice because during that time St. Stephen’s had fewer than one hundred and eighty students total. Everyone knew each other. Across the entire four years, I was pretty luck to have nice upperclassmen, my classmates, so that helped with the transition to high school.
After that, really a lot of focus was on studying and prepping for your university career. Senior year was also very exciting because you can see the light at the end of the tunnel. I wouldn’t put primary- or secondary-school years at the top of my happiest years. I would say my happiest was when I started university, because you’re finally approaching life as an adult. You don’t have all those emotions and psychological problems that any adolescent has that can affect the way you live and your experiences, especially in high school. High school can be a very difficult time in a kid’s life. You feel like you’re neither fish nor fowl. You are expected to act like an adult, but you are not an adult. So that’s a lot of complex contradictions.
The nice thing about St. Stephens is that, being a smaller school, it really allowed more personal interaction at every level, not just with your peers but also with teachers. I cannot stress enough the enormous impact the teachers had on your life, on your career decisions. I’m always fond of Dr. Cecilia Negroni and Dr. Pope. I always knew I wanted to be a doctor. My first science teacher there was Dr. Locilento. He taught biology and his passion for the subject was definitely inspiring to me. Having a teacher who cares so much about a topic that you’re passionate about, I think that’s important. High school is a mosaic or a puzzle of experiences. When even just a small piece is out of place, it can impact the overall end result. I definitely do believe that St. Stephens allowed me to keep the pieces of the puzzle together.
After you graduated from St. Stephens, what came next? How long have you lived in America?
After St. Stephens I went on to medical school in Rome for six years. Then I took a year for research on bone regeneration in Varese, at the University of Insubria. Then followed my residency in orthopedics and trauma surgery, also at the University of Insubria. During that time, I was able to do a year and a half of research at the main orthopedic hospital in the United States, the Hospital for Special Surgery in New York. On my return to Italy to finish my residency, I applied for fellowships that specialized in certain aspects of reconstructive surgery. I was actually the first Italian to be admitted to a foot and ankle reconstruction fellowship in the States. Then I specialized in limb lengthening and limb deformity reconstruction in New York at the Hospital of Special Surgery, where I had done research a few years prior. The combination of the training and reconstruction work is what really appealed to the chair of orthopedics here at Mt. Sinai, who asked me to join their team.
How long have you been at Mt. Sinai?
A year and a half.
You are a leading surgeon in the area of corrective foot and ankle surgery. In August 2017, the FDA approved your percutaneous foot surgery. Can you tell us why this is a breakthrough for your patients? I know it has something to do with recovery time.
This procedure is quite popular in Europe and Asia but it was not in the United States. The company that distributes the machine finally received clearance from the FDA, and because I had trained in Italy and was familiar with the technique, I was actually the first surgeon to perform this type of procedure in the United States. I’m currently the only faculty member in America who can train doctors from all over the world to perform this surgery.
What it is, is doing the same kind of bone cuts that you need to perform through a big open incision, but through the tiniest of holes. In general, people think of knee arthroscopies, making two little holes in the knee to fix the knee instead of a one big incision over the knee. This translates similarly to the foot. It’s not arthroscopic, because that involves using a little camera but the concept is the same. You’re basically eliminating the need for a big incision and instead doing your work through a very small incision. Now, because the incision is so small you’re unable to look directly at the bone, that’s where technical skills and experience become crucial. That’s why I’m involved in teaching this to other surgeons so they can practice this safely.
What are the most common injuries you see in your practice? What causes them and how can they be avoided?
I see everything from knocked knees to bow legs, which can lead to premature arthritis of the knees. Ankle arthritis, ankle fractures, foot fractures, foot arthritis, severe deformity of the bones of the foot in diabetic people. It’s very common and this results in about a fifty-percent amputation rate when not treated appropriately. I do a lot of limb salvaging procedures. Patients who were recommended amputations, in many cases I’m able to save their leg with some quite complex techniques. Flat foot. I treat sports injuries of the foot and ankle. Bunions. Unfortunately, there isn’t much you can do really to prevent these types of things.
A good general rule is to wear appropriate footwear. Flats are usually not the best shoes. High heels are not really good for you. Moderate heels are the way to go. Anything high puts a lot of pressure on the toes and the balls of the feet, which could lead to developing common problems. Flip-flops don’t give any support to the foot or to the ankle. They have very little shock absorption. Therefore, every step you take transmits a tremendous amount of stress back to the foot and ankle. You can develop foot fractures, tendonitis, you can sprain more easily.
Pointy shoes are not good, for bunions especially, and pointy shoes with a heel are worse. However, these alone are not the only cause for bunions.
There is much debate in America regarding replacing the ACA (aka Obamacare). How does this uncertainty impact your work?
It’s going to leave twenty to thirty million people without insurance. I take care of people who have Obamacare. I guarantee that if they didn’t have it they absolutely wouldn’t have any other means to access medical care. I think that’s disgraceful. This is not about being a Republican or a Democrat or left-wing or right-wing; it has nothing to do with that. It’s just horrible that a country as rich as the United States does not have the funds to guarantee basic care to its citizens. I’m not sure, honestly, what’s going to happen.
Unfortunately, this is a problem also for doctors. For example, Medicaid reimburses doctors and hospitals a ridiculously small amount of money. Nothing. For instance, I did a limb-salvaging procedure. I probably spent six hours in the O.R. and Medicaid reimbursed me 140th of what the actual fee would’ve been. My housekeeper would probably make more by the hour, but without the stress of having to be in the O.R. for so long and having to follow up with the patient for six months at least. When you’re performing surgery it’s not over once the surgery is done. Many people think it is. There’s a tremendous amount of follow-up care, back and forth between doctor and patient. I cannot tell you how many sleepless nights I’ve had thinking about patients or patients who were not doing well, patients who were developing complications. I was trying to think of alternative solutions for them or the patients who call constantly because they’re OCD about everything. For the surgeon’s fee, all this should really be included. When you receive 140th of what you’re entitled to, not only is it insulting, but unless you’re salaried, which I am, it can really jeopardize your practice. If you decide to go into private practice, you decide how much to charge patients and if the patient can’t afford it, you don’t do it. If you’re salaried you’re covered, but you’re still operating on a poor patient, the emotional aspect remains unchanged. With Obamacare the reimbursements went down and many doctors decided to opt out of accepting Medicaid. So more and more people who had Medicaid were still unable to see any doctor, because no doctor would take their insurance.
We need not only to give Medicaid to the people who deserve it, but also adjust the reimbursement rates to a decent amount for doctors. Being a doctor is surely a mission but it’s also a job. If you spend half your day working on a case that reimburses you such a low amount, you won’t survive.
As an American living in Rome and having parents who are in the French healthcare system, I’m struck by the general misinformation back in the States regarding how healthcare systems function in other Western countries. America’s R & D and access to cutting-edge technologies are reasons why many people from all over the world come to America to study medicine or for medical treatment. If there was one positive thing America could take from Europe’s healthcare system, what would that be?
Access. Access to healthcare.
America has the best technology for healthcare but the worst access to it. Unless you can afford it, you will not have access to it
Fortunately, when I was growing up both my parents had excellent health insurance through their jobs. I thought it was normal to go to the pediatrician and the dentist every year for a check-up. All my friends had family doctors. It wasn’t until I went to college that I met many people who never saw a doctor when they were growing up. There was no preventative care. By the time they went to the emergency room, their medical condition was critical.
Prevention is the key to being healthy, and that has to start at a very young age. Many kids in the States don’t go to a pediatrician who can tell them about healthy eating and the importance of sports (physical activity). Healthcare in the United States is very financially driven.
Yes, it’s a business.
Exactly. If you watch any American TV, half of the commercials here are about drugs. Strong drugs; a lot of them have to do with depression or anxiety. Basically creating this illusion of yes, just pop a pill and you’ll be fine. There appears to be little interest from bigger corporations (as opposed to medical professionals) to invest in prevention. Prevention does save a lot of money. In the States they don’t care about this because the system is not really public. In Italy or in France, if you’re able to prevent one diabetic, oh my god how much money you can save over the course of a life! You’ll save on diabetic medicine, heart medicine, orthopedic issues, eye issues, and kidney issues. It’s really a small investment if you think about the gain. In the United States, a private company is never going to invest in prevention; they’re making money.
There’s an illusion that the U.S. is the best place in the world for healthcare. I don’t necessarily agree. I know both the Italian and the American environments. I’ve worked with top-notch professionals in Italy as well as with really bad doctors here in the U.S. I think the U.S. has the technology; it’s not the best system. For me in my particular situation, being here is a dream come true: to be a professor at one of the major medical schools in the country and work with medical students. I have forty-five residents. I’m able to share my passion and knowledge with them and help train future leaders. This was one thing that was lacking in Italy, this willingness to teach the younger doctors. That’s because they almost fear that once the students learn, they’ll start their practices and “take patients away from me”. Which is very typically Italian.
What do you say to young people who have a gift and talent for medicine but are concerned about entering the field, because of the rising malpractice insurance premiums and cuts to Medicare and Medicaid? This might be more relevant to the American system.
That’s definitely an issue. The cost of education is going up and the salaries, even though they’re still among the highest, are not increasing substantially, not in line with the increases we’re seeing with tuition fees. Regarding malpractice, if you’re an employee, you’re covered. You don’t have to worry about it. If you’re in private practice, then you’re looking at big, big, big money, depending on your specialty. You’re looking at 50k a year and up. Most surgical specialties pay over one hundred thousand dollars a year. The most penalized are OB-GYNs. It’s an enormous problem. Patients don’t understand that patients lead to this.
So what’s happening, and will continue to happen, because insurance premiums are so high, is that many doctors are refusing to treat high-risk patients or more complex conditions. Ultimately, who’s losing is the patient. I’ve had patients tell me after the first surgery, they have pain, so they’re going to sue me. Well, you’ve just had surgery. They expect to be drugged until there’s no more pain. What they don’t realize is if you give them too many drugs they can become addicted or die from an overdose. This is the situation here and it’s very, very scary. It’s not the same in Europe or other parts of the world, though it’s slowly approaching that. When people ask me whether or not they should go into medicine, I tell them it’s simply passion.
Do you picture yourself doing anything else other than medicine? If the answer is no, then the goal is medicine. If you feel like yeah, I could be a lawyer or a doctor, then pick law school. You need to be one hundred percent committed. The journey is long. It’s tedious. It’s nerve-racking. It’s sometimes depressing and you need that thing, that commitment to medicine to make it through. Once you make it through, no offense to other professions, this is the single most beautiful profession in the world.
It’s never boring, because every single day is different. I’ve never experienced a day, which is like the previous one. Every patient has a story to tell. Every patient is a different human being. When you see a patient and you’re able to treat their pain or their problems, they are so grateful. I’ve had patients who cry and thought they would never be able to walk again tell me, “You saved my life.” The gratitude in their eyes is really the biggest prize. It’s more than money; it’s more than the sweat that you gave to get to this point. It (helping patients) makes it all worth it.
I’ve wanted to be a doctor since I was two years old. People ask me what was my Plan B if I didn’t get into medical school. I thought, “hmmm, maybe I should’ve had a Plan B.” I’m lucky I got into med school. If I hadn’t that first year, I would’ve tried again the next year. I wouldn’t have given up. I wouldn’t have studied architecture because I didn’t get into medicine. I’m one hundred percent convinced that if someone wants to do medicine they will get to medical school. Maybe not the first try but they will.
They must love the profession. As with any profession, if you don’t love it, A, you will not do a good job; B, you will get bored. If you consider that our generation is probably going to work past our 70s, that’s a long time to be bored. Definitely don’t pick a career based on money. I see people who work in finance, who believe it or not lose everything overnight. Then I see extremely successful artists who were told, “You’re going to live under a bridge.” Do what you love to do and what you think you’re good at. You will find a spot. Don’t let money be that thing that drives your choices. You’re going to be unhappy.
Did you have mentors? Do you mentor?
Yes and yes. I mentor students. Also, every year I have a scholarship student from a disadvantaged background who’s interested in a career in medicine and they work with me in the office on a daily basis. I help guide them and try to help them find their way. Many people like medicine, but they’re not sure if they’re right for it, so that’s something that I do.
I teach medical students at the school of medicine as well as the residents in orthopedics. Once a year I do volunteer work in China, where I train local surgeons to perform specific types of surgeries on local patients. I think it’s one thing to give someone a fish and another to teach them how to fish. I prefer to give them a fishing pole and teach them how to use it.
What do you consider your greatest achievement so far?
Being where I am geographically and academically. I’ve always dreamed of New York City. It had a special place in my heart. I’m not sure why, but ever since I was child looking at TV shows and movies where NYC was the background it always made my heart beat. To be a resident of NYC now just feels right.
Career-wise, it’s extraordinarily rare for someone my age, especially being non-American, to hold the position that I hold at one of the largest medical institutions and medical schools in the world. I feel incredibly lucky to not only be doing what I do at one of the best in the world, but doing it in this specific location and this specific institution.
I was going to ask you what you enjoy most about what you do but you answered that question earlier. It sounds to me it’s how every day is different and every patient is different, and when a patient tells you they can walk again and/or you saved their lives, that gives you great joy.
What are some of your other passions?
I love to cook and I love to travel. Those are really my greatest passions. I try to travel as much as I can, whether in the U.S. or abroad. I like to try new foods, new restaurants, and New York is perfect for that. I enjoy cooking for my girlfriend and my friends.
You are an alumnus who has been faithful and loyal with your “time, talent and treasure” throughout the years. What keeps you involved with the school?
At this point, mostly the memories, especially Cecilia Negroni. She’s one of the Italian teachers there. I’m very fond of her because back in high school I was shy and insecure. There were very few, but some people had hinted that I would never become a doctor, and when you’re an adolescent and you’re shy and insecure and you don’t know if you’re fish or fowl, these things can really hurt. If you don’t have good support you’ll think, okay, maybe I shouldn’t do medicine. I remember Cecilia Negroni saying, “You know I think you’ll be the best doctor. Who cares what they say. In your heart you know what you want to do, just do it.” It turned out to be true. I’m glad that she was there at difficult moments for me. Of course, my family was supportive and there for me, but when it comes from your family, you think they’re biased. When it comes from a neutral spectator, like a teacher, then you think, well maybe it’s true.
What are some of the most important lessons from your professional experience you would like to share with the next generation of St. Stephen’s graduates?
To be compassionate. To try to empathize. To try to really feel someone else’s feelings, whether it’s joy or pain or suffering. We’re all, especially the younger generations, so focused on things, on money, the new cell phone, the new car, the new shoes, that we forget that we’re living in a world made of people. People are made of emotions. If you’re unable to understand, perceive, or comprehend those emotions, then you’ll just be an alien. An alien with a cool phone and cool shoes. You won’t fit anymore.