This past August, a surgical fellow told me his goal for the year was to complete a hip replacement skin-to-skin in under 45 minutes.

Ambitious. Competitive. Focused.

But as I drove home that night, I kept thinking about the signal we send when we elevate time as the benchmark. Are we teaching that speed is the clearest marker of mastery?

Later that evening, one of my favorite bands came on the radio — Rush. I’ve listened to them for decades. What always stood out was the precision of their legendary drummer, Neil Peart.

What many don’t realize is that at the height of his career, Peart went back to study fundamentals. Grip. Motion. Posture. Flow. He rebuilt his technique to protect longevity and eliminate inefficiency.

Identity is hard to change. Especially when it’s working.

But familiarity is not refinement. And familiarity does not promote growth over time.

The uncomfortable places do.

Using Neil as a quiet mentor, I began leaning more deliberately into discomfort. One habit I developed was returning to fundamentals — not in the operating room, but at a whiteboard in my living room. It stands awkwardly in the corner. It is not aesthetic. My wife tolerates it at best.

But it has become one of my most valuable tools.

I learned this discipline from my mentor, the late master surgeon Jeff Mast, MD. Draw your cases. Deconstruct them. Re-sequence them. When you force yourself to sketch each step, inefficiencies reveal themselves. Movements that felt intuitive suddenly look redundant. Steps that seemed essential can be combined. Corrections can be anticipated rather than repaired.

You begin to see how much of what you do is inherited rather than engineered.

Over time, I began scripting cases more deliberately — simplifying transitions, tightening sequencing, removing unnecessary motion. Structure sharpened. Efficiency followed. Speed emerged without being chased.

Structure builds efficiency.

Efficiency produces rhythm.

Speed becomes the byproduct.

What we call “flow” in surgery is invisible to the patient. It appears as shorter operative times with maintained safety. Less tissue trauma. Smoother recovery. Fewer surprises. Reproducibility with minimal variance.

That is the real benchmark.

One of the most powerful lessons in my career has been to study masters outside my discipline. Musicians. Athletes. Artists. Architects. Elite performers in any field confront the same challenge — how to refine mechanics without losing identity. How to rebuild fundamentals without ego.

Cognitive plasticity is a career-saving trait. The know-it-all mindset calcifies. The learn-it-all mindset evolves.

Structural flaws calcify unless you dismantle them intentionally.

The moment you believe you have arrived is the moment the craft stops teaching you.

Surgery, like drumming, has rhythm.

There is cadence in exposure.
Tempo in preparation.
A build through reconstruction.
Resolution in closure.

When the structure is sound, the rhythm emerges naturally.

Neil Peart did not chase speed.
He rebuilt mechanics.

He studied grip, posture, motion, sequencing — not to play faster, but to play cleaner. The speed came because nothing was wasted. Every movement had intention. Every transition had structure.

The same is true in the operating room.

When your case is sequenced deliberately, when every instrument handoff is anticipated, when exposure flows into execution without hesitation — time compresses on its own. Not because you rushed. Because you removed friction.

Speed is not something you pursue.

It is something that appears when structure eliminates inefficiency.

The drummer does not count faster to play better.

He builds structure so the rhythm can breathe.

And when the rhythm is right, the tempo takes care of itself.

Michael M. Karch, M.D., | Mammoth Orthopedic Institute | Chief Medical Officer Brava Health