1.  Limit the number of patients you see
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​  2.  See only patients with the diagnoses you choose
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​  3.  Limit the number of surgeries you do
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​  4.  Choose to only do the surgeries you love
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​  5.  Spend as much time as the patient needs
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​  6.  Know that you can walk away when you choose 

  1.  Never miss kid's activities again
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​  2.  Be a more involved parent
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​  3.  Spend quantity and quality time with spouse
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​  4.  Be actively involved in charitable organizations
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​  5.  Enjoy hobbies without guilt
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​  6.  Take more family vacations

Dr. Charles, as he was usually called, was one of two mentors in my Total Joint Fellowship program. 

Historically, total hip replacements were fixed to the bone with cement.  Unfortunately, cemented hip replacements in the 1970's and 1980's were only lasting 10-12 years at most.  The failure mechanism was that the implant came loose from the bone because of failure of the cement fixation.

Dr. Charles was frustrated with the lack of longevity of these cemented total hip replacements, because they made a major difference in the quality of the patient's life. 

He then searched for a better means of fixation.  Ultimately, he invented "bone ingrowth" fixation.  The implant had a porous coated surface.  The bone would grow into this porous coated surface creating a bond with the implant.  He then designed a total hip replacement implant in partnership with the DePuy corporation.
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​He received royalties from the sale of these implants. At the time I was training under him in 1993-1994, he had become financially independent primarily from these royalties.

By the time I was training with Dr. Charles in 1993-1994, his practice had changed.

1.  He saw only the patients he wanted to see.  He saw patients in clinic only twice per week.  He only saw patients who had arthritic hips or those with had a failed total hip replacement performed elsewhere.  He usually saw only 12-14 patients in a single clinic.  That was 8 patients in the morning and 4 or 6 in the afternoon. 

2.  He spent a significant amount of time with each patient.  Because of the small number of patients, he was able to spend a significant amount of time with each one of them.  He got to know them and their families well.  He loved the time with the patients. 

3.  He did only the surgeries he wanted to do.  He only did primary or revision total hip replacements. Nothing else.  And he was very good at them.  And he trained us, the fellows, to do them well, too. 

4.  He did relatively few surgeries.  He did surgery three days per week - Mondays, Wednesdays, and Fridays. He would typically do only three surgeries each of those days. 

5.  He was passionate about teaching.  He loved teaching fellows how to do total hip replacements better. He also taught them the best techniques for performing bone ingrowth hip replacements.  
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​6.  He had monthly fly-in trainings for other surgeons.  These events usually included about 20 visiting surgeons who wanted to learn about bone ingrowth total hip replacements.  The visitors would be in a conference room.  Dr. Charles would do one or two live surgeries with a video and audio feed from the OR back to the conference room.  He would also have a guest moderator present in the conference room who was well versed in bone ingrowth total hip replacements.  The moderator would facilitate discussing the surgery in real time and answer visiting surgeon's questions on the spot.  
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​7.  He was devoted to research.  The porous coated implant Dr. Charles designed was not originally approved by the FDA for use without cement. So, every total hip replacement he performed without cement was an off-label use.  He made it his mission to prove that the bone actually did grow to the implant and that bone ingrowth fixation was superior to cemented fixation.  From the beginning of using this implant, Dr. Charles had patients and families who were willing to sign a consent form giving Dr. Charles permission to retrieve their hip replacements once they passed away.  He would retrieve the femur and acetabulum with the implant in place.  He then had a lab in which these specimens were cut in small sections such that they could be visualized under the microscope with appropriate stains.  Over time, the evidence was overwhelming that the bone ingrowth fixation worked and worked well.  Many such hip replacements now last 25-30 years. 

8.   He spoke at Orthopaedic Surgeon conferences frequently.  His career became proving that bone ingrowth hip replacements worked and were better than cemented hip replacements.  So, he took advantage of opportunities to spread the "gospel" of bone ingrowth success.  At these meetings, he enjoyed discussing his techniques and research with 'skeptics" and loved the challenge of making "converts." He also enjoyed private discussions with friends who were also advocates of bone ingrowth hips.  
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​9.  He indulged in his hobbies.  He loved sailing. He had a second home on the Chesapeake Bay and loved to go sailing there frequently.  He also loved antiques and history.  He owned an old historic home in Old Town Alexandria, VA. There were numerous stories about the home's history. And it was full of antiques, each with a unique story. 
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​10.  He had no fears of malpractice.  Dr. Charles was sued several times. Most of the lawsuits were dismissed because he was in the right.  However, in one patient, the fellow, who was doing the revision surgery, apparently cut part of the sciatic nerve.  That lawsuit settled.  However, because he was financially independent, he was unconcerned and lost no sleep worrying about malpractice lawsuits.  He was insured. And he had enough savings to cover any judgements beyond his policy limits.

​1.  Accumulate enough savings and investments that you can live off of the yields.
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​2.  Create and/or acquire enough income producing assets such that, after all expenses, you can live on that recurring income.
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​3.  A combination of #1 and #2. 

1.  Stocks
2. Govt bonds
3.  Municipal bonds
4.  Cryptocurrencies
5. Mutual funds
6. ETFs 
7. REITs
​8.  Money market funds
​9.  Commodities
​10.  Gold
11. Et al.
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 (The best way to reach financial independence)
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​1.  Practice income
​2.  Retirement accounts
​3.  Ancillary businesses
​4.  Stocks/bonds
​5. Cryptocurrencies
​6.  Your book sales
​7.  Rental properties
​8.  Paid membership programs
​9.  Royalties
​10.  Equity funds
11.  Precious metals
12.  Collectibles
13.  Et al.
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