May 2, 2025 • 24 mins
What happens when a dedicated clinician decides to build a pain management practice that breaks all the rules? Dr. Mila Mogilevski joins us to share the compelling story behind Unique Pain Medicine, her thriving New York-based practice that's challenging conventional approaches to treating chronic and acute pain.
From day one, Dr. Mogilevski set out to create something different. While traditional pain medicine often defaulted to opioid prescriptions, she established a practice focused on comprehensive, multidisciplinary care. "Primary care doctors would call me saying 'I'm sending you so-and-so, he needs Percocet,'" she recalls. "I'd say 'slow down, that's not what's happening here.'" This revolutionary stance has evolved into a holistic approach combining interventional techniques, regenerative medicine options like PRP and stem cells, and wellness services—all designed to treat the whole person rather than just managing symptoms.
At the heart of Unique Pain Medicine's success is an unwavering commitment to personalized care. With locations in Manhattan and Brooklyn (and a third on the horizon), Dr. Mogilevski's team guarantees patients will see physicians—not mid-level providers—and strives to accommodate same-day appointments. This dedication creates a stark contrast to the corporate healthcare trend sweeping through the industry, where small practices are being "gobbled up" by private equity firms and large organizations like Amazon. "The moment clinics get bought by private equity, it becomes all about the numbers...and patients get sidelined," she explains.
Despite substantial challenges—including 75% overhead costs in expensive New York City and the pandemic's disruption to office worker patterns—Dr. Mogilevski remains optimistic about the future of boutique healthcare. She believes there will always be demand for alternatives to impersonal corporate medicine, especially when built around a team that prioritizes cooperation over competition. "That's sort of the secret sauce," she shares. "Be happy while you work and try to work together."
Ready to discover how small, patient-focused clinics are reshaping healthcare delivery? Subscribe now to hear more conversations with innovative leaders who are putting care back at the center of healthcare.
🔗 Guest Contact & Socials
Dr. Mila Mogilevsky, DO
Medical Director, Unique Pain Medicine, PLLC
📍 Manhattan Location
369 Lexington Ave, 19th Floor
New York, NY 10017
📍 Brooklyn Location
626 Sheepshead Bay Rd, Suite 520
Brooklyn, NY 11224
📞 Phone: 929-363-0303
📠 Fax: (347) 252-6731
🌐 Website: https://uniquepainmedicine.com
✉️ Email: milam@uniquemed.com
🔗 Follow Unique Pain Medicine:
- Instagram: @uniquepainmedicine
- Facebook: Unique Pain Medicine NYC
- LinkedIn: Unique Pain Medicine
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:05):
So welcome back to Voices in Health and
Wellness.
This is where we speak withleaders and innovators and
passionate advocates reshapingthe future of healthcare.
I'm Andrew Greenland, I'm thehost of this podcast, and
today's guest brings a powerfulmix of clinical expertise and
entrepreneurial grit to theconversation.
We're joined by Dr MilaMogilevski, medical Director of
Unique Pain Medicine, a thrivingNew York-based practice that's
(00:28):
redefining how chronic and acutepain are treated, with a focus
on real outcomes and deeppatient care.
With two locations in Manhattanand Brooklyn, mila and her team
serve a wide range of patients,using evidence-based medicine
and multidisciplinary approachesto restore function and dignity
, to heavily help people livingwith pain.
(00:49):
We're going to really talktoday about a number of things,
but one thing I really want totalk about is the disturbing
trends that are threatening thefuture of small health clinics,
because we're all working in ourspaces sometimes quite small
operations and I really want toget Mela's perspective on that.
But without further ado, I'dlike to welcome you and
introduce you, mela, to the show.
Dr Mila Mogilevsky (01:08):
Thank you so much, Andrew.
Thank you for having me.
Dr Andrew Greenland (01:11):
Well, you're very welcome and perhaps
you could tell us a little aboutyour role in unique pain
medicine and actually how yougot into this space, because
it's obviously chosen aparticular path, so always
interested to hear how peopleend up doing the things that
they do sure?
Dr Mila Mogilevsky (01:25):
um, you know , I think, um, you know, I would
just start by saying that, um,I guess my, my whole entrance
into medicine was a little bitdifferent than others.
Uh, before I became a doctor, Iwas a physical therapist and so
I understood a little bit moreabout how to manage patients
from the standpoint of, uh, youknow, a provider who takes care
(01:45):
of the patient not justmedically but also rehab wise
and a little bit moreholistically.
So the idea and this passion ofhaving a rehab clinic,
potentially working withpatients that have chronic pain,
was brooding for a long periodof time, not just when I started
medical school, brooding for along period of time, not just
(02:05):
when I started medical school.
So medical school was just anatural progression to step it
up from providing physicaltherapy care to providing full
medical care for the patient.
But when I was working as aphysical therapist, I sort of
noticed that it's this sort ofpersonalized approach that
physical therapists do, almostlike hands-on approach, that a
(02:26):
physical therapist use would bevery helpful as a physician as
well.
And the idea of having my ownprivate practice where I would
really treat patients the way Ithink would benefit them best,
is what brought me to opening myown clinic.
I opened a unique pain medicinealmost straight out of residency
(02:48):
.
I didn't really wait, I reallyjust wanted to, kind of, you
know, take it to that level.
And it was a slow but verysteady growth.
It started with just me andthen I started adding more
providers and more staff to theclinic and so it wasn't like a
(03:09):
fast dive in, but it was verysteady and organic growth.
We started with one practice,which was in Brooklyn just one
location and then pretty quicklyadded the second location and,
as of right now, we're actuallythinking of potentially doing a
third as well, um to sort ofencompass, you know, more of new
york city area and meet demandsof um more patients, if you
(03:32):
will amazing long answer to ashort question, but yeah, what's
I mean?
Dr Andrew Greenland (03:39):
and your role in the clinic.
You're very much hands-on, I'mI'm figuring in the business
okay so what does a typical daylook like for you?
Across your two sites, andobviously you're thinking about
expanding into a third how isthat going?
Dr Mila Mogilevsky (03:50):
to shift yeah, so you know, I, I, I have
um.
Besides myself, of course, Ihave three other uh doctors, and
so there are two of us on eachside.
So two people are in brooklyn,two people are in manh, and also
we have an anesthesiologistpresent in both locations for
complicated cases or for casesthat do require sedations.
(04:11):
We do procedures involvinginjections, and some of them are
painful and those are spinalinjections.
So, to be able to providepatients best experience, we
always have an anesthesiologiston staff.
It's also very helpful becausethey have a little bit more
intense training should there bea problem or an emergency, and
(04:31):
so these guys are alwaysavailable not just available,
but they're active players inour treatment team.
So that's usually what we do.
Because of, I think, of slightlydifferent expertise that all of
us bring to the table.
We have anesthesiologists, wehave rehab doctors with
interventional pain training,like myself.
We also have an internalmedicine physician who is a
(04:53):
sports medicine guy.
Because of all those differentassets that we all have, we are
able to attract slightlydifferent patients.
So I would say that myself,personally, I see more female
patients.
Some of them are a little bitolder, some are younger, but
it's just naturally fit for meto see more women than men.
And then other people see, likemy internal medicine physician
(05:18):
tends to attract more patientsthat are older, medically
complex, and the other twophysicians are attracting a
little bit younger.
One of our guys really likesmarathon runners and he's very
good with sportsmedicine-oriented people, so
that type of clientele naturallygravitates to him.
So it's really more likeorganically people and following
(05:42):
develops as we go.
Dr Andrew Greenland (05:46):
Really interesting and obviously you're
called Unique Pain Medicine.
Yeah, so what are the thingsthat make you unique from the
more traditional pain managementmodels?
Obviously, you mentioned youperhaps get a slightly different
patient mix.
What are the other?
Kind of ingredients for yourclinic that make you unique.
Dr Mila Mogilevsky (06:01):
Right.
So I think you know when Ifirst started this whole
enterprise.
I call it unique because backin 2010, the idea of doing pain
medicine was the idea ofprescribing opioids and from the
(06:21):
outset, I made it so that thiswas not going to be about
chronic opioid management, thatwe would try to really treat
patients from every angle and indoing so, the idea was to try
to actually avoid putting peopleon opioids unless absolutely
necessary.
So that was the first thingthat, in my opinion, was unique,
because no one else did that.
You know like I would haveprimary care doctors call me and
(06:44):
say, hey, I'm sending youso-and-so, he needs Percocet,
and I'm like whoa, slow down,this is not what's happening.
What do you mean?
You're a pain medicine doctor,of course-so he needs Percocet
and I'm like whoa, slow down,this is not what's happening.
They're like what do you mean?
You're a pain medicine doctor,of course you're going to
prescribe Percocet.
Isn't that what you all do?
So that was the first reasonwhy I called myself not myself
(07:04):
my practice unique.
And then, slowly and gradually,we started introducing not just
steroid injections that aresomething that every
interventional pain medicinedoctor, of course, does but we
started doing more regenerativemedicine, introducing PRP and
adipose and also bone marrowstem cells that are now becoming
a little bit more mainstream.
(07:26):
Also collaborating with otherspecialists like physical
therapists and chiropractors,really trying to get patients to
be managed from every angleinstead of just saying, well,
here's your shot and go home andgood luck to you.
So really trying to make it alittle bit more holistic for the
patients.
We're slowly moving into doingother wellness things like Myers
(07:52):
cocktails, nad drips and NADpatches that will provide a
little bit more energy to thepatients.
Could, if we could supplementjust your general, you know, uh,
straightforward interventionalpain to to, to supplement that
(08:14):
with with something else, withother things that will help
patients to live better and stayhealthier amazing.
Dr Andrew Greenland (08:22):
I mean, sounds like a very, very
comprehensive holistic approach.
I mean, have you got muchcompetition that are able to
deliver the kind of variousthings that you're able to offer
your patients?
Dr Mila Mogilevsky (08:32):
You know, I'm sure we do, and I'll tell
you, even in our building alonewe have three other specialists
that sort of you know work inthe same with the same
population and providingprobably similar care and
providing probably similar care.
I don't know.
I try not to look at others andI do this on purpose because I
(08:53):
feel like you know, even ifyou're sort of doing the same
thing, you're still doing it inyour own way.
I think what stands us apartfrom others, apart from
everything else I've mentioned,is that we really try to provide
boutique level of care.
So if the patient calls in themorning, they're going to be
seen the same day.
24 hours is really somethingthat we push for, but ideally
(09:17):
same day.
And that's the first thing.
And the second thing is thatnothing against middle level
providers.
But we are not the kind ofclinic that puts PAs first.
And you know, a lot of timespatients go to see a doctor, the
doctor is not there.
There's a nurse, practitioneror PA and again, not to diss
them, some of them are great,but if you're a patient who is
(09:40):
going to see a doctor, youshould be able to see the doctor
and not another provider intheir place.
So that, I think, is anotherthing that distinguishes us from
others.
We really try not to cutcorners and if we stand for our
brand if you're coming to see me, you're going to see me, you're
(10:01):
not going to see somebody elseTo the point that we try to
accommodate patients to makesure that they're seeing the
provider they wanted.
So, for instance, if somebodyis sick, of course another
person will cover, but that's anexception rather than a rule.
Dr Andrew Greenland (10:16):
Amazing.
So one of the things we'reexploring on this podcast is how
smaller, patient-focusedclinics are being challenged in
today's environment.
I just wondered, from yourperspective, what are some of
the big trends that you'reseeing, or even some of the
threats that you're seeing, inthis field?
Dr Mila Mogilevsky (10:37):
Oh yeah, what are some of the big trends
that you're seeing, or even someof the threats that you're
seeing in this field?
Oh yeah, I mean not to soundnegative but, um, I think when I
, when I first started out, um,in my, in my space, there were
quite a few clinics, uh, justjust around in our radius.
Um, then, after covid, a lot ofthem dropped out.
I just assumed that it'sbecause, you know, covid killed
like new guys.
But now I see that it's becauseCOVID killed new guys.
But now I see that it's notjust COVID which was horrific
for us, but also people arebeing gobbled up by large
(10:59):
organizations.
I'll give you an example.
We worked with a quite famousmedical organization called One
Medical.
You've probably heard of them.
This medical organizationcalled One Medical, you've
probably heard of them.
It's a primary care doctorsexcellent organization.
We used to send patients backand forth and then suddenly they
disappeared and I was like whathappened?
(11:21):
And I found out they got boughtby Amazon, and this is not
uncommon.
People get gobbled up.
Clinics get gobbled up byprivate equity hospitals and
large, huge financialorganizations.
And this is happeningeverywhere and not just our
(11:41):
clinics, not just painmanagement clinics or doctor's
clinics, lots of physicaltherapists, small boutique
clinics disappeared in thematter of the last couple of
years, again got bought by hugeorganizations.
So this is a big threat to asmall guy like us, and the only
thing that I think we have forus that's always going to be
(12:03):
present is that we are not goingto treat patients like just
another number.
I feel the moment that peopleget bought or clinics get bought
by private equity, it becomesall about the numbers.
The idea is, we'll buy you for3 million and we'll sell you for
9 million in like two years,and so the numbers, the outcomes
(12:23):
, get pushed, financial outcomesget pushed and, as a result,
patients get sort of sidelined.
Um, and and I think that that'ssomething that that small
private practices still have anadvantage in you know, we can't
afford, uh, to sideline apatient, simply not first of all
because it's not right, butalso because if we lose one
(12:44):
patient, we lose the following.
So we fight for every singlepatient outcome and for quality
of care.
That cannot be compromised.
Dr Andrew Greenland (12:55):
Amazing.
I like your ethos.
I just wonder these smallclinics that are being gobbled
up, is it because the numbersare attractive to them for the
proposition or they just can'tmake their business work because
of rising costs orreimbursement issues or staffing
?
Dr Mila Mogilevsky (13:07):
Absolutely not.
I don't think it's a numbergame because of rising costs or
reimbursement issues or staffingor kind of thing.
Absolutely no.
I don't think it's a numbergame.
I don't think.
You know, looking from likewhere I stand and other you know
doctors that I talk to that arein private space, there is
really no number that would beworth the freedom of seeing your
patients, of running your ownshow, that thrill that you have
(13:32):
when you're doing something youreally believe in on your own
terms it's invaluable.
So it's not the money, it'smore that you know they just
can't stay in competition.
Just in our area, where we arein Grand Central, we have HSS,
we have NYU, we have hugeorganizations right around,
(13:52):
medical organizations rightaround us that offer the same
thing sort of the same thing youknow allegedly and have
incredible amount of budget thatthey can throw at ads and
everything else.
So it's rough, but again, Idon't want to sound negative
(14:13):
because I think at the end ofthe day, a good guy wins.
Not that they're bad guys, butI think they're better guys for
our patients.
And, as you alluded before,it's all about, you know,
staying on top of thedevelopments, going to
conferences, reading, you know,trying to improve every single
day, really try to push for goodoutcomes so that patients
(14:36):
benefit.
You know, that's really whatit's all about.
Dr Andrew Greenland (14:39):
So this is obviously you talk about this as
something you observe in theindustry, but I'm guessing your
operation.
Do you feel relativelyprotected, in the sense that you
have something which willsurvive and you won't feel that
you're going to be gobbled up inthe future because of the way
that you do things?
Dr Mila Mogilevsky (14:55):
I, I do, I, I, I'm, I'm optimistic, you know
.
I think that there's alwaysgoing to be, you know, a room
for an alternative, right likeif, if you go to the hospital
and you get a horrible care andnot all hospitals do provide
horrible care but generallyspeaking, just from what I see,
people get swamped in thatbureaucracy where nobody
(15:17):
actually takes the time to spendtime with them because
everybody is busy and they'rebig and they don't care.
There's always going to be thatalternative and I think that
you know we may go through badyears or good years, but at the
end of the day, I think what wehave to offer will always be
sought after.
It's just a matter of sometimes, you know, pushing harder,
(15:40):
being more creative, being more,you know, looking at things
from a different angle.
But overall, I think I'moptimistic.
I have to be yeah, no,absolutely.
Dr Andrew Greenland (15:52):
I'm guessing the this threat is not
unique to pain clinics.
I'm guessing this reallyextends to much broader across
outpatient health care.
100 yeah okay, interesting.
So um, sounds like things aregoing well.
You've got two clinics.
You're thinking about a third.
What are you?
What is going well for youright now in the business?
What are you most proud of interms of how you do things?
Dr Mila Mogilevsky (16:13):
You know, I think every clinic is based on.
You know the team that you haveand I think that we finally got
to the place where, you know,after many years of trying
different people and havingdifferent providers, we are in a
place right now where everybodythat works in the clinic works
(16:35):
together and overall it's a veryfriendly bunch of people.
The doctors are young anddriven and they are not as much
in competition as they are incooperation and that definitely
shines through.
We are friends not just insidethe clinic but also outside.
You know we go out, we dothings together and that
(16:57):
definitely helps the staff, Ithink, is overall amazing and
everybody has that samementality, Like we need to.
You know we need to take it tothe next level.
We need to try to help patients.
We need to call them.
We need to take it to the nextlevel.
We need to try to help patients.
We need to call them back, um,if they have a problem.
So you know it's, it's.
I think that's.
That's sort of the secret sauce, right?
You know, be happy while youwork and try to work together.
(17:19):
It is your clinic, is what iswhat is what your staff is so
much of.
It depends on how people feelwhen they come to work, and what
they do, totally agreed.
Dr Andrew Greenland (17:31):
So is there anything that's particularly
frustrating lately in thebusiness, anything that's
keeping you up at night as apractice owner?
Dr Mila Mogilevsky (17:38):
yeah, well, I think, as you said, as you
alluded to before, you knowthere's a huge competition and
you don't always know why people, you know, you always know.
You look at the numbers, youknow month per month, per month
and, um, sometimes you have gooddays, sometimes you have bad
days.
And I think the the thepatience to sort of just say,
okay, you know, it's not aday-to-day situation, it's more
(18:01):
like a period to periodsituation.
Let's compare december thisyear to december last year,
instead of saying, oh my god,this Thursday was horrible, what
about Friday?
Is it going to be worse?
So you always have thosethoughts that you kind of have
to put in a back burner and belike listen, there are good days
, there are bad days.
What matters is that everybodyis doing well, patients are
(18:22):
healthy, no bad outcomes.
That's really what it's allabout Numbers.
At the end of the day, we'llscore them.
You know, we want to make surethe patients do well.
Dr Andrew Greenland (18:33):
Brilliant.
So I was actually going to cometo that very thing about the
metrics that you pay particularattention to.
I mean, is it patient volume,outcomes, operational efficiency
, all of the above, or do youhave anything?
That you particularly look atto kind of really get a gauge of
how your business is doing itreally is all of the above.
Dr Mila Mogilevsky (18:50):
I mean, you mentioned all of it.
The efficiency, I think, issomething that we need to work
better on.
It's always challenging, youknow it doesn't take much to get
thrown off course and you knowsmall perturbations are always
there.
Patience outcomes is somethingwe always drive for and it's not
(19:10):
negotiable.
The outcome has to be good or,you know, we will lose patience
and, frankly, we'll lose ourreputation.
But the efficiency sometimescan be improved.
For sure.
You know the overhead,especially working in a place
like New York City, can reallydrive you down If you overspend
(19:31):
and it's hard not to, this willresult in, you know, in quite a
bad I shouldn't say bad, but itwould be a challenging month if
the overhead is pushed too highup, and as it is, I would say
it's at least 75% on a good day75%.
Dr Andrew Greenland (19:50):
Sorry, what's 75%?
Dr Mila Mogilevsky (19:53):
So your overhead, you know if you grow,
say if you grow, I don't know,$100, you take home 25.
Dr Andrew Greenland (19:59):
Got it.
Okay, that's interesting.
Obviously, this is a globalpodcast.
I'm actually in the UK, so wehave a slightly different model
over here.
I obviously do some of the workI do in functional medicine is
private based, but I still workin the health system, so one of
the values of doing this podcastis getting a real global
perspective.
So we're just beingpractitioners doing different
things in terms of differentdisciplines, but also in
(20:21):
different countries.
So this makes it all veryinteresting to hear about and,
especially with you being in avery central location in the
states, it's just really that'san interesting perspective.
So, um, looking ahead to thenext six to twelve months, what
does success look like forunique pain medicine?
Dr Mila Mogilevsky (20:37):
six to twelve months.
I think it's pretty short,still pretty short period of
time.
I think that right now, um, Iwant to push a little bit harder
on getting a little bit biggerfollowing in the city, in
Manhattan.
Brooklyn seems to havestabilized.
Manhattan is still struggling Iwouldn't call it struggling but
(20:59):
still not as solid as I wouldlike it to be, as it was before
the pandemic.
The pandemic.
I don't know what's going onwith you guys, but in our case,
lots of patients, lots ofemployees of large financial
organizations have not returnedto work full-time.
They're still like in a hybridmodel, and our location,
(21:25):
specifically to us, our location, is in Midtown, where most of
most of it's not a residentiallocation, it's where people work
.
So we lost a third of thepatients that we usually had
just because of the hybrid model, and so the challenge is to
bring those people back or toget other sources of, to get to
know other providers that couldpotentially send patients from
their clinics on to us, thatcould potentially send patients
(21:45):
from their clinics on to us.
So it's about making morecontacts with, you know, outside
disciplines, as I alludedbefore.
You know, we work with physicaltherapists, we work with spinal
surgeons, neurologists, etcetera.
But now I'm thinking, you knowwe should probably also work
with psychologists.
You know there are people thatyou know take care of patients,
(22:07):
like acupuncturists, likebiofeedback specialists.
You know behavioral healthpeople.
That's sort of one of thoseuntapped resources we didn't
look into.
And you mentioned wellness.
I mean, that's all aboutwellness and I think that will
tie in nicely with us.
So sort of trying to do more ofthat.
Uh, outreach, you know doingthis podcast, as I think is also
(22:30):
a little bit.
It's not something I usually dovery frequently, but I think it
also will sort of drive maybe alot of some another, you know,
population of interestedpatients and clients really well
.
Dr Andrew Greenland (22:43):
Hopefully that'll be the case.
That's one of the reasons we'redoing it just to get some
visibility.
So hopefully this will givesome visibility to what you do
and your approach and your ethos, which I really admire.
And finally, if you had a magicwand and you could fix one
major issue in your businesstoday, what would that be?
There may be nothing, but I'mjust curious to know if there's
(23:05):
anything that's like a big one.
Dr Mila Mogilevsky (23:06):
I would get rid of all the insurances and
and the regulations andobstacles that they put in our
um, in our path.
Um, but that never, thatprobably won't happen.
Um, but yeah, that would.
That would be ideal, you know,have that freedom away from
third-party peers and, just youknow, have that direct
interaction with patients.
That would be amazing.
(23:27):
But other than that, it's justcontinue pushing quality and
continue pushing high standardsof care so that patients respond
well.
Dr Andrew Greenland (23:42):
Amazing.
Milica, thank you so much forgiving us the time to speak
today.
Really interesting hearing yourconversation talking about what
you do, your, the passion youhave for what you do and the way
that you've made it a reallyunique offering to patients.
And this is completely my ethos.
You know, I have very muchabout holistic and um holistic
care complete, giving patients agood service and I'm really
(24:04):
impressed with what you do.
So thanks for your conversation.
What we'll do if anybody wantsto contact miller, who's
listening, we'll put yourdetails on the bio page.
So if anybody wants to reach outor look at your socials, we'll
put it on the final page, butyeah, thank you very much again
and thank you and really goodafternoon and all of our
listeners, thank you very much.
I appreciate.
Dr Mila Mogilevsky (24:24):
Thank you, thanks, guys, okay.
So welcome back to Voices in Health and
Wellness.
This is where we speak withleaders and innovators and
passionate advocates reshapingthe future of healthcare.
I'm Andrew Greenland, I'm thehost of this podcast, and
today's guest brings a powerfulmix of clinical expertise and
entrepreneurial grit to theconversation.
We're joined by Dr MilaMogilevski, medical Director of
Unique Pain Medicine, a thrivingNew York-based practice that's
(00:28):
redefining how chronic and acutepain are treated, with a focus
on real outcomes and deeppatient care.
With two locations in Manhattanand Brooklyn, mila and her team
serve a wide range of patients,using evidence-based medicine
and multidisciplinary approachesto restore function and dignity
, to heavily help people livingwith pain.
(00:49):
We're going to really talktoday about a number of things,
but one thing I really want totalk about is the disturbing
trends that are threatening thefuture of small health clinics,
because we're all working in ourspaces sometimes quite small
operations and I really want toget Mela's perspective on that.
But without further ado, I'dlike to welcome you and
introduce you, mela, to the show.
Dr Mila Mogilevsky (01:08):
Thank you so much, Andrew.
Thank you for having me.
Dr Andrew Greenland (01:11):
Well, you're very welcome and perhaps
you could tell us a little aboutyour role in unique pain
medicine and actually how yougot into this space, because
it's obviously chosen aparticular path, so always
interested to hear how peopleend up doing the things that
they do sure?
Dr Mila Mogilevsky (01:25):
um, you know , I think, um, you know, I would
just start by saying that, um,I guess my, my whole entrance
into medicine was a little bitdifferent than others.
Uh, before I became a doctor, Iwas a physical therapist and so
I understood a little bit moreabout how to manage patients
from the standpoint of, uh, youknow, a provider who takes care
(01:45):
of the patient not justmedically but also rehab wise
and a little bit moreholistically.
So the idea and this passion ofhaving a rehab clinic,
potentially working withpatients that have chronic pain,
was brooding for a long periodof time, not just when I started
medical school, brooding for along period of time, not just
(02:05):
when I started medical school.
So medical school was just anatural progression to step it
up from providing physicaltherapy care to providing full
medical care for the patient.
But when I was working as aphysical therapist, I sort of
noticed that it's this sort ofpersonalized approach that
physical therapists do, almostlike hands-on approach, that a
(02:26):
physical therapist use would bevery helpful as a physician as
well.
And the idea of having my ownprivate practice where I would
really treat patients the way Ithink would benefit them best,
is what brought me to opening myown clinic.
I opened a unique pain medicinealmost straight out of residency
(02:48):
.
I didn't really wait, I reallyjust wanted to, kind of, you
know, take it to that level.
And it was a slow but verysteady growth.
It started with just me andthen I started adding more
providers and more staff to theclinic and so it wasn't like a
(03:09):
fast dive in, but it was verysteady and organic growth.
We started with one practice,which was in Brooklyn just one
location and then pretty quicklyadded the second location and,
as of right now, we're actuallythinking of potentially doing a
third as well, um to sort ofencompass, you know, more of new
york city area and meet demandsof um more patients, if you
(03:32):
will amazing long answer to ashort question, but yeah, what's
I mean?
Dr Andrew Greenland (03:39):
and your role in the clinic.
You're very much hands-on, I'mI'm figuring in the business
okay so what does a typical daylook like for you?
Across your two sites, andobviously you're thinking about
expanding into a third how isthat going?
Dr Mila Mogilevsky (03:50):
to shift yeah, so you know, I, I, I have
um.
Besides myself, of course, Ihave three other uh doctors, and
so there are two of us on eachside.
So two people are in brooklyn,two people are in manh, and also
we have an anesthesiologistpresent in both locations for
complicated cases or for casesthat do require sedations.
(04:11):
We do procedures involvinginjections, and some of them are
painful and those are spinalinjections.
So, to be able to providepatients best experience, we
always have an anesthesiologiston staff.
It's also very helpful becausethey have a little bit more
intense training should there bea problem or an emergency, and
(04:31):
so these guys are alwaysavailable not just available,
but they're active players inour treatment team.
So that's usually what we do.
Because of, I think, of slightlydifferent expertise that all of
us bring to the table.
We have anesthesiologists, wehave rehab doctors with
interventional pain training,like myself.
We also have an internalmedicine physician who is a
(04:53):
sports medicine guy.
Because of all those differentassets that we all have, we are
able to attract slightlydifferent patients.
So I would say that myself,personally, I see more female
patients.
Some of them are a little bitolder, some are younger, but
it's just naturally fit for meto see more women than men.
And then other people see, likemy internal medicine physician
(05:18):
tends to attract more patientsthat are older, medically
complex, and the other twophysicians are attracting a
little bit younger.
One of our guys really likesmarathon runners and he's very
good with sportsmedicine-oriented people, so
that type of clientele naturallygravitates to him.
So it's really more likeorganically people and following
(05:42):
develops as we go.
Dr Andrew Greenland (05:46):
Really interesting and obviously you're
called Unique Pain Medicine.
Yeah, so what are the thingsthat make you unique from the
more traditional pain managementmodels?
Obviously, you mentioned youperhaps get a slightly different
patient mix.
What are the other?
Kind of ingredients for yourclinic that make you unique.
Dr Mila Mogilevsky (06:01):
Right.
So I think you know when Ifirst started this whole
enterprise.
I call it unique because backin 2010, the idea of doing pain
medicine was the idea ofprescribing opioids and from the
(06:21):
outset, I made it so that thiswas not going to be about
chronic opioid management, thatwe would try to really treat
patients from every angle and indoing so, the idea was to try
to actually avoid putting peopleon opioids unless absolutely
necessary.
So that was the first thingthat, in my opinion, was unique,
because no one else did that.
You know like I would haveprimary care doctors call me and
(06:44):
say, hey, I'm sending youso-and-so, he needs Percocet,
and I'm like whoa, slow down,this is not what's happening.
What do you mean?
You're a pain medicine doctor,of course-so he needs Percocet
and I'm like whoa, slow down,this is not what's happening.
They're like what do you mean?
You're a pain medicine doctor,of course you're going to
prescribe Percocet.
Isn't that what you all do?
So that was the first reasonwhy I called myself not myself
(07:04):
my practice unique.
And then, slowly and gradually,we started introducing not just
steroid injections that aresomething that every
interventional pain medicinedoctor, of course, does but we
started doing more regenerativemedicine, introducing PRP and
adipose and also bone marrowstem cells that are now becoming
a little bit more mainstream.
(07:26):
Also collaborating with otherspecialists like physical
therapists and chiropractors,really trying to get patients to
be managed from every angleinstead of just saying, well,
here's your shot and go home andgood luck to you.
So really trying to make it alittle bit more holistic for the
patients.
We're slowly moving into doingother wellness things like Myers
(07:52):
cocktails, nad drips and NADpatches that will provide a
little bit more energy to thepatients.
Could, if we could supplementjust your general, you know, uh,
straightforward interventionalpain to to, to supplement that
(08:14):
with with something else, withother things that will help
patients to live better and stayhealthier amazing.
Dr Andrew Greenland (08:22):
I mean, sounds like a very, very
comprehensive holistic approach.
I mean, have you got muchcompetition that are able to
deliver the kind of variousthings that you're able to offer
your patients?
Dr Mila Mogilevsky (08:32):
You know, I'm sure we do, and I'll tell
you, even in our building alonewe have three other specialists
that sort of you know work inthe same with the same
population and providingprobably similar care and
providing probably similar care.
I don't know.
I try not to look at others andI do this on purpose because I
(08:53):
feel like you know, even ifyou're sort of doing the same
thing, you're still doing it inyour own way.
I think what stands us apartfrom others, apart from
everything else I've mentioned,is that we really try to provide
boutique level of care.
So if the patient calls in themorning, they're going to be
seen the same day.
24 hours is really somethingthat we push for, but ideally
(09:17):
same day.
And that's the first thing.
And the second thing is thatnothing against middle level
providers.
But we are not the kind ofclinic that puts PAs first.
And you know, a lot of timespatients go to see a doctor, the
doctor is not there.
There's a nurse, practitioneror PA and again, not to diss
them, some of them are great,but if you're a patient who is
(09:40):
going to see a doctor, youshould be able to see the doctor
and not another provider intheir place.
So that, I think, is anotherthing that distinguishes us from
others.
We really try not to cutcorners and if we stand for our
brand if you're coming to see me, you're going to see me, you're
(10:01):
not going to see somebody elseTo the point that we try to
accommodate patients to makesure that they're seeing the
provider they wanted.
So, for instance, if somebodyis sick, of course another
person will cover, but that's anexception rather than a rule.
Dr Andrew Greenland (10:16):
Amazing.
So one of the things we'reexploring on this podcast is how
smaller, patient-focusedclinics are being challenged in
today's environment.
I just wondered, from yourperspective, what are some of
the big trends that you'reseeing, or even some of the
threats that you're seeing, inthis field?
Dr Mila Mogilevsky (10:37):
Oh yeah, what are some of the big trends
that you're seeing, or even someof the threats that you're
seeing in this field?
Oh yeah, I mean not to soundnegative but, um, I think when I
, when I first started out, um,in my, in my space, there were
quite a few clinics, uh, justjust around in our radius.
Um, then, after covid, a lot ofthem dropped out.
I just assumed that it'sbecause, you know, covid killed
like new guys.
But now I see that it's becauseCOVID killed new guys.
But now I see that it's notjust COVID which was horrific
for us, but also people arebeing gobbled up by large
(10:59):
organizations.
I'll give you an example.
We worked with a quite famousmedical organization called One
Medical.
You've probably heard of them.
This medical organizationcalled One Medical, you've
probably heard of them.
It's a primary care doctorsexcellent organization.
We used to send patients backand forth and then suddenly they
disappeared and I was like whathappened?
(11:21):
And I found out they got boughtby Amazon, and this is not
uncommon.
People get gobbled up.
Clinics get gobbled up byprivate equity hospitals and
large, huge financialorganizations.
And this is happeningeverywhere and not just our
(11:41):
clinics, not just painmanagement clinics or doctor's
clinics, lots of physicaltherapists, small boutique
clinics disappeared in thematter of the last couple of
years, again got bought by hugeorganizations.
So this is a big threat to asmall guy like us, and the only
thing that I think we have forus that's always going to be
(12:03):
present is that we are not goingto treat patients like just
another number.
I feel the moment that peopleget bought or clinics get bought
by private equity, it becomesall about the numbers.
The idea is, we'll buy you for3 million and we'll sell you for
9 million in like two years,and so the numbers, the outcomes
(12:23):
, get pushed, financial outcomesget pushed and, as a result,
patients get sort of sidelined.
Um, and and I think that that'ssomething that that small
private practices still have anadvantage in you know, we can't
afford, uh, to sideline apatient, simply not first of all
because it's not right, butalso because if we lose one
(12:44):
patient, we lose the following.
So we fight for every singlepatient outcome and for quality
of care.
That cannot be compromised.
Dr Andrew Greenland (12:55):
Amazing.
I like your ethos.
I just wonder these smallclinics that are being gobbled
up, is it because the numbersare attractive to them for the
proposition or they just can'tmake their business work because
of rising costs orreimbursement issues or staffing
?
Dr Mila Mogilevsky (13:07):
Absolutely not.
I don't think it's a numbergame because of rising costs or
reimbursement issues or staffingor kind of thing.
Absolutely no.
I don't think it's a numbergame.
I don't think.
You know, looking from likewhere I stand and other you know
doctors that I talk to that arein private space, there is
really no number that would beworth the freedom of seeing your
patients, of running your ownshow, that thrill that you have
(13:32):
when you're doing something youreally believe in on your own
terms it's invaluable.
So it's not the money, it'smore that you know they just
can't stay in competition.
Just in our area, where we arein Grand Central, we have HSS,
we have NYU, we have hugeorganizations right around,
(13:52):
medical organizations rightaround us that offer the same
thing sort of the same thing youknow allegedly and have
incredible amount of budget thatthey can throw at ads and
everything else.
So it's rough, but again, Idon't want to sound negative
(14:13):
because I think at the end ofthe day, a good guy wins.
Not that they're bad guys, butI think they're better guys for
our patients.
And, as you alluded before,it's all about, you know,
staying on top of thedevelopments, going to
conferences, reading, you know,trying to improve every single
day, really try to push for goodoutcomes so that patients
(14:36):
benefit.
You know, that's really whatit's all about.
Dr Andrew Greenland (14:39):
So this is obviously you talk about this as
something you observe in theindustry, but I'm guessing your
operation.
Do you feel relativelyprotected, in the sense that you
have something which willsurvive and you won't feel that
you're going to be gobbled up inthe future because of the way
that you do things?
Dr Mila Mogilevsky (14:55):
I, I do, I, I, I'm, I'm optimistic, you know
.
I think that there's alwaysgoing to be, you know, a room
for an alternative, right likeif, if you go to the hospital
and you get a horrible care andnot all hospitals do provide
horrible care but generallyspeaking, just from what I see,
people get swamped in thatbureaucracy where nobody
(15:17):
actually takes the time to spendtime with them because
everybody is busy and they'rebig and they don't care.
There's always going to be thatalternative and I think that
you know we may go through badyears or good years, but at the
end of the day, I think what wehave to offer will always be
sought after.
It's just a matter of sometimes, you know, pushing harder,
(15:40):
being more creative, being more,you know, looking at things
from a different angle.
But overall, I think I'moptimistic.
I have to be yeah, no,absolutely.
Dr Andrew Greenland (15:52):
I'm guessing the this threat is not
unique to pain clinics.
I'm guessing this reallyextends to much broader across
outpatient health care.
100 yeah okay, interesting.
So um, sounds like things aregoing well.
You've got two clinics.
You're thinking about a third.
What are you?
What is going well for youright now in the business?
What are you most proud of interms of how you do things?
Dr Mila Mogilevsky (16:13):
You know, I think every clinic is based on.
You know the team that you haveand I think that we finally got
to the place where, you know,after many years of trying
different people and havingdifferent providers, we are in a
place right now where everybodythat works in the clinic works
(16:35):
together and overall it's a veryfriendly bunch of people.
The doctors are young anddriven and they are not as much
in competition as they are incooperation and that definitely
shines through.
We are friends not just insidethe clinic but also outside.
You know we go out, we dothings together and that
(16:57):
definitely helps the staff, Ithink, is overall amazing and
everybody has that samementality, Like we need to.
You know we need to take it tothe next level.
We need to try to help patients.
We need to call them.
We need to take it to the nextlevel.
We need to try to help patients.
We need to call them back, um,if they have a problem.
So you know it's, it's.
I think that's.
That's sort of the secret sauce, right?
You know, be happy while youwork and try to work together.
(17:19):
It is your clinic, is what iswhat is what your staff is so
much of.
It depends on how people feelwhen they come to work, and what
they do, totally agreed.
Dr Andrew Greenland (17:31):
So is there anything that's particularly
frustrating lately in thebusiness, anything that's
keeping you up at night as apractice owner?
Dr Mila Mogilevsky (17:38):
yeah, well, I think, as you said, as you
alluded to before, you knowthere's a huge competition and
you don't always know why people, you know, you always know.
You look at the numbers, youknow month per month, per month
and, um, sometimes you have gooddays, sometimes you have bad
days.
And I think the the thepatience to sort of just say,
okay, you know, it's not aday-to-day situation, it's more
(18:01):
like a period to periodsituation.
Let's compare december thisyear to december last year,
instead of saying, oh my god,this Thursday was horrible, what
about Friday?
Is it going to be worse?
So you always have thosethoughts that you kind of have
to put in a back burner and belike listen, there are good days
, there are bad days.
What matters is that everybodyis doing well, patients are
(18:22):
healthy, no bad outcomes.
That's really what it's allabout Numbers.
At the end of the day, we'llscore them.
You know, we want to make surethe patients do well.
Dr Andrew Greenland (18:33):
Brilliant.
So I was actually going to cometo that very thing about the
metrics that you pay particularattention to.
I mean, is it patient volume,outcomes, operational efficiency
, all of the above, or do youhave anything?
That you particularly look atto kind of really get a gauge of
how your business is doing itreally is all of the above.
Dr Mila Mogilevsky (18:50):
I mean, you mentioned all of it.
The efficiency, I think, issomething that we need to work
better on.
It's always challenging, youknow it doesn't take much to get
thrown off course and you knowsmall perturbations are always
there.
Patience outcomes is somethingwe always drive for and it's not
(19:10):
negotiable.
The outcome has to be good or,you know, we will lose patience
and, frankly, we'll lose ourreputation.
But the efficiency sometimescan be improved.
For sure.
You know the overhead,especially working in a place
like New York City, can reallydrive you down If you overspend
(19:31):
and it's hard not to, this willresult in, you know, in quite a
bad I shouldn't say bad, but itwould be a challenging month if
the overhead is pushed too highup, and as it is, I would say
it's at least 75% on a good day75%.
Dr Andrew Greenland (19:50):
Sorry, what's 75%?
Dr Mila Mogilevsky (19:53):
So your overhead, you know if you grow,
say if you grow, I don't know,$100, you take home 25.
Dr Andrew Greenland (19:59):
Got it.
Okay, that's interesting.
Obviously, this is a globalpodcast.
I'm actually in the UK, so wehave a slightly different model
over here.
I obviously do some of the workI do in functional medicine is
private based, but I still workin the health system, so one of
the values of doing this podcastis getting a real global
perspective.
So we're just beingpractitioners doing different
things in terms of differentdisciplines, but also in
(20:21):
different countries.
So this makes it all veryinteresting to hear about and,
especially with you being in avery central location in the
states, it's just really that'san interesting perspective.
So, um, looking ahead to thenext six to twelve months, what
does success look like forunique pain medicine?
Dr Mila Mogilevsky (20:37):
six to twelve months.
I think it's pretty short,still pretty short period of
time.
I think that right now, um, Iwant to push a little bit harder
on getting a little bit biggerfollowing in the city, in
Manhattan.
Brooklyn seems to havestabilized.
Manhattan is still struggling Iwouldn't call it struggling but
(20:59):
still not as solid as I wouldlike it to be, as it was before
the pandemic.
The pandemic.
I don't know what's going onwith you guys, but in our case,
lots of patients, lots ofemployees of large financial
organizations have not returnedto work full-time.
They're still like in a hybridmodel, and our location,
(21:25):
specifically to us, our location, is in Midtown, where most of
most of it's not a residentiallocation, it's where people work
.
So we lost a third of thepatients that we usually had
just because of the hybrid model, and so the challenge is to
bring those people back or toget other sources of, to get to
know other providers that couldpotentially send patients from
their clinics on to us, thatcould potentially send patients
(21:45):
from their clinics on to us.
So it's about making morecontacts with, you know, outside
disciplines, as I alludedbefore.
You know, we work with physicaltherapists, we work with spinal
surgeons, neurologists, etcetera.
But now I'm thinking, you knowwe should probably also work
with psychologists.
You know there are people thatyou know take care of patients,
(22:07):
like acupuncturists, likebiofeedback specialists.
You know behavioral healthpeople.
That's sort of one of thoseuntapped resources we didn't
look into.
And you mentioned wellness.
I mean, that's all aboutwellness and I think that will
tie in nicely with us.
So sort of trying to do more ofthat.
Uh, outreach, you know doingthis podcast, as I think is also
(22:30):
a little bit.
It's not something I usually dovery frequently, but I think it
also will sort of drive maybe alot of some another, you know,
population of interestedpatients and clients really well
.
Dr Andrew Greenland (22:43):
Hopefully that'll be the case.
That's one of the reasons we'redoing it just to get some
visibility.
So hopefully this will givesome visibility to what you do
and your approach and your ethos, which I really admire.
And finally, if you had a magicwand and you could fix one
major issue in your businesstoday, what would that be?
There may be nothing, but I'mjust curious to know if there's
(23:05):
anything that's like a big one.
Dr Mila Mogilevsky (23:06):
I would get rid of all the insurances and
and the regulations andobstacles that they put in our
um, in our path.
Um, but that never, thatprobably won't happen.
Um, but yeah, that would.
That would be ideal, you know,have that freedom away from
third-party peers and, just youknow, have that direct
interaction with patients.
That would be amazing.
(23:27):
But other than that, it's justcontinue pushing quality and
continue pushing high standardsof care so that patients respond
well.
Dr Andrew Greenland (23:42):
Amazing.
Milica, thank you so much forgiving us the time to speak
today.
Really interesting hearing yourconversation talking about what
you do, your, the passion youhave for what you do and the way
that you've made it a reallyunique offering to patients.
And this is completely my ethos.
You know, I have very muchabout holistic and um holistic
care complete, giving patients agood service and I'm really
(24:04):
impressed with what you do.
So thanks for your conversation.
What we'll do if anybody wantsto contact miller, who's
listening, we'll put yourdetails on the bio page.
So if anybody wants to reach outor look at your socials, we'll
put it on the final page, butyeah, thank you very much again
and thank you and really goodafternoon and all of our
listeners, thank you very much.
I appreciate.
Dr Mila Mogilevsky (24:24):
Thank you, thanks, guys, okay.
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