There’s the glamorous side of medical tourism—a quick jaunt to South Korea for a rhinoplasty or winter break in Bali for a new set of veneers and a butt-life chaser in Rio. Then there’s medical tourism, where patients search the world to receive specialized, necessary care that isn’t widely available. And while the Mayo Clinic and Johns Hopkins are familiar brands, something interesting is happening in a corner of South Florida. There, on an unassuming street in West Palm Beach, orthopedic surgeon Dror Paley, M.D., is using groundbreaking surgical procedures to reconstruct and lengthen limbs which otherwise would be amputated. Accordingly, his Paley Institute has become one of the world’s most vital medical tourism destinations, attracting patients from 50 states and over 100 countries. In the process, by reinventing the model of a medical practice, Paley has created a new model for how one surgeon can successfully, ethically corner the market.
Born in Israel, Paley earned his medical degree from the University of Toronto in 1979 and completed his orthopedic surgical residency in 1985. By the time he took over as Chief of Pediatric Orthopedics at the University of Maryland in 1987, he had already established a reputation as a formidable medical mind, traveling back and forth to the Soviet Union in order to train under physician Gavriil Ilizarov (the legendary Russian doctor who revolutionized the field of limb lengthening, despite having no formal orthopedic training). That same year, Paley would become the first doctor in North America to use the Ilizarov Method in performing limb saving procedures with rare bone diseases and birth defects.
For those unfamiliar with Soviet medical breakthroughs, the Ilizarov Method involves surgically breaking a bone and using an external metal device to pull the broken ends apart, a millimeter each day. Eventually, bone tissue grows to fill the gap and once fully healed, the limb is longer. If the procedure sounds grisly, that’s because it is. Since learning from Ilizarov in the 1980s, Paley has developed over 100 new procedures and devices to advance the discipline of limb lengthening beyond its Cronenberg-esque, body horror origins. His patients, many of them children, often have already suffered through a prior treatment that failed and are facing amputation as their only solution. They come to him seeking a miracle.
Now, 14 years after he opened the original Paley Institute in West Palm Beach, Dr. Paley has steadily broadened his organization’s wingspan, establishing clinics in Warsaw and Abu Dhabi, with a fourth clinic on deck in Medellin. Although he speaks six languages fluently, he has become conversant in four more, so he can better communicate with his patients. What began as a solo practice in 2009 has now burgeoned to a staff that’s 23 strong.
“Some people collect baseball cards,” Paley says. “I collect all-star surgeons, surgeons who are already names in the world of medical tourism.” In doing so, Paley has pioneered a method of providing high-quality care outside of the sclerotic, institutional medical model. If hospitals and universities suffer from bureaucratic bloat, Paley has developed a shinier, more efficient system, one that eliminates creaky administrative speed bumps and allows surgeons to parlay their cache into cash.
“Hospitals and universities haven’t kept up with the times,” Paley says. “The die-hard academics, they work for universities and have no idea how to monetize their reputations, because they have no business skills. Private practice is the gold standard, because it can offer a level of compensation and flexibility that hospitals and universities can’t.”
“At a certain point,” Paley continues, “these doctors don’t need the university for their reputation. They’re coming from big-name institutions with strong track records and accomplishments—but institutions don’t treat patients, doctors do.” He pauses. “The doctors should be allowed to profit from what they do.”
Subsequently, Paley has become something of an accidental medical magnate: due to his surgical achievements, his institute has reaped considerable financial success. Like evaporation or the biosphere, it’s a self-sustaining cycle—the Paley Institute offers unmatched standards of care, which makes it a global destination for patients, which then generates revenue that enables Paley surgeons to offer even better care, which then puts them in even higher demand.
“The internet has really empowered patients,” says David Biro, M.D., a dermatologist and skin cancer surgeon in New York. “Whereas patients were once constrained by geography and lack of information, they can now research and find the best treatment around the world. As a result, medical tourism is booming because people have the ability to identify the exact clinics and doctors that they need.”
Of course, that sort of empowerment comes at a price. Limb lengthening is a painful, protracted and expensive endeavor. The families of Paley’s young patients face daunting medical fees, as well as relocation costs to South Florida, while their children recover from surgery. With this in mind, Paley runs two non-profits (the Paley Foundation and the unLIMBited Foundation) which provides financial aid; he also performs a number of pro bono surgeries every year. Still, the surgery is undeniably costly.
Nevertheless, Paley says, money was never his endgame. After all, he happily spent 22 years in underpaid academia and, let’s face it, there are easier ways to make cash than inventing new ways to break bones and regenerate them. He doesn’t do this job for remuneration, although he receives it. Nor does he even necessarily pursue it in the name of Doing Good, although much good is, indeed, done. He does it because he’s driven—whether in the science of saving limbs or the art of streamlining a medical practice—to innovate.
Paley had a different philosophical approach to the field than the “paint by the numbers approach common to orthopedic surgery at the time,” Kevin Tetsworth, M.D., a pediatric orthopedic surgeon who trained with Paley, told me in an interview last year. Tetsworth completed a one-year limb lengthening Ilizarov surgery fellowship with Paley from 1990-1991.
“This,” Paley emphasizes, “is not a business story. My story has simply grown to include a successful business.”
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