When Dr. Miguel Montero-Baker announced he was leaving his prestigious role as Chief of Vascular Surgery at Houston Methodist to start an outpatient clinic, everyone told him it was “professional suicide.”
"That probably made me realize that it was the right thing to do," he says. "Sometimes, when everyone calls your idea stupid, that’s the strongest sign it might be smart."
Three years later, Miguel couldn’t be more satisfied with his decision.
He's built a thriving network of outpatient vascular centers, is developing cutting-edge patient management software, and has established a clinical research accelerator spanning Latin America.
His journey from Costa Rican medical student to innovative physician-entrepreneur offers lessons for anyone committed to forging their own path.
From Costa Rica to Houston: Defining His Own Mission
Miguel's mission crystallized during his early training in Costa Rica. Working within the country's social security system, he watched surgeons perform multiple limb amputations in a single week. The sight hit him hard — families suddenly facing rehabilitation, financial strain, complete life disruption. "This can't be the way, I have to figure something out."
Back then, up-and-coming vascular surgeons typically focused on aortic aneurysms or carotid disease. Specializing in limb salvage was seen as "low-class vascular surgery." But Miguel saw something others missed: while aneurysm repair work — often seen as “high-brow” — could eventually be managed with medication, peripheral artery disease would only get worse. Someone had to care about patients losing their limbs.
That moment led him from medical school in Costa Rica to advanced endovascular training in Leipzig, Germany, and eventually to the University of Arizona. There, under the mentorship of Dr. Joseph Mills and Dr. David Armstrong, he discovered the power of multidisciplinary care through the Southern Arizona Limb Salvage Alliance program. The "toe and flow" approach — combining podiatric care with vascular intervention — became his template for comprehensive patient management.
The Arizona experience was both transformative and eye-opening. One day he was playing the director role, overseeing endovascular therapy at his hospital; the next, he was back to intern work. "It was very humbling. But it was very good. I became a good doctor there," he recalls.
Years later, after becoming Chief of Vascular Surgery at Houston Methodist, Miguel had achieved everything a vascular surgeon could want. Yet something nagged at him: Despite pioneering best practices in multidisciplinary care, the traditional hospital model wasn't built for sustained patient relationships. Fewer than one-third of his patients would return for follow-up visits after life-saving procedures. Geographic barriers, transportation challenges, and system fragmentation meant patients would disappear into the healthcare ecosystem, often never to be seen again.
Meanwhile, becoming a father had Miguel questioning his work-life balance and professional priorities.
Building Excellence Outside the Ivory Tower
Miguel's decision to leave Houston Methodist in August 2022 wasn't just about escaping institutional constraints — it was about reimagining how vascular care could be delivered.
When people ask Miguel if he runs an office-based lab (OBL), his response is immediate: "No, absolutely not. I have a chronic limb threatening ischemia (CLTI) outpatient center of excellence."
The distinction matters. While critics point to profit-driven OBLs that prioritize volume over outcomes, Miguel imagined something different when he started HOPE Vascular & Podiatry Institute: a comprehensive care model that follows patients from "their shoes to their nail trimming to their complex vascular needs." His clinics integrate podiatry, wound care, vascular intervention, and even hyperbaric oxygen therapy under one roof.
The results speak for themselves. Patient satisfaction soared, and follow-up rates jumped to more than 90%, he says. More tellingly, academic training programs began reaching out, asking to send fellows and residents to learn from his model. "I was very surprised that there were two programs reaching out to say, 'Could you take our fellows and our residents? Can they come to you?'" he notes.
Three years in, Miguel operates three clinics in Texas, employing multiple podiatrists and over 25 people. He's turned down "maybe five different chief positions" at major health systems, some with generous salary packages attached.
"This is about creating something that is really going to change the life of the patients that we work with," he explains.
When Software Meets Surgery: The HOPE Flight Plan Innovation
Managing hundreds of complex wound patients across multiple locations created an unexpected challenge: How do you track longitudinal outcomes when generic EMR notes could describe 30 different patients? "The frail guy that's got one leg" is not sufficient.
His solution was to build HOPE Flight Plan, a clinical coordination platform that tracks patients like air traffic control tracks planes. The software leverages the WIfI staging system — a clinical framework scoring wound severity, ischemia level, and foot infection. Every visit generates a new score, creating a timeline that shows whether patients are healing or heading toward amputation.
"We took it from the aeronautic industry," Miguel explains. "Every time you get on a plane, every flight gets tracked by the second." When planes deviate from their flight path — wrong altitude, unexpected course changes — controllers investigate. Weather? Mechanical issues? Pilot error?
The same principle applies to wound healing. When a patient's WIfI score worsens unexpectedly, the software flags the deviation. Maybe they need different treatment. Maybe insurance will cover hyperbaric therapy now. Maybe it's time for a vascular intervention.
With a minimum viable product developed and seed funding secured, Miguel envisions Flight Plan as a tool to help scale personalized care.
Opening Doors in Latin America
For Miguel, every business venture ultimately serves one purpose: creating a path back to Costa Rica. Through Hendosyn, which offers clinical research services, he's building the infrastructure that will eventually allow him to spend more time in his home country while continuing to do meaningful work.
Hendosyn operates as more than a traditional contract research organization, or CRO. Since 2018, the entity has positioned itself as a comprehensive accelerator, offering everything from study design and regulatory support to animation and grant writing services. The timing couldn't be better for medical device companies seeking cost-effective early feasibility studies.
A few years ago, when European regulations tightened research requirements, making studies more expensive and bureaucratic, FDA simultaneously streamlined processes to keep innovation onshore. This regulatory arbitrage created an opportunity for Latin American countries with FDA-aligned regulations and high-quality medical infrastructure.
Costa Rica emerged as the ideal location. Private hospitals rival those in the USA, physicians trained in American and European programs provide clinical expertise, and 15-16 daily flights from U.S. cities ensure connectivity. Perhaps most importantly, studies conducted in Costa Rica can often roll directly into FDA trials, eliminating the need for separate preliminary studies.
"Everything that I'm doing at this stage of my life is to get back to Costa Rica," Miguel says. The business case aligns with personal motivation: Hendosyn offers companies a pathway to high-quality, cost-effective research while building the foundation for his eventual return home.
Speaking Up: Podcasting and Personal Branding
Leaving Houston Methodist led Miguel to a realization about the value of personal branding. Like many physician departures, the transition created communication challenges with his patient base. While Texas law required the hospital to disclose his new location, the regulatory notification process meant patients struggled to find clear information about where he'd gone.
"It made me realize that I needed to have a channel, a voice," Miguel recalls. His response was Life of Flow, a podcast he co-hosts with fellow vascular surgeon Lucas Ferrer Cardona.
With almost 100 episodes under their belt, the show deliberately breaks medical podcasting conventions. While some programs focus exclusively on clinical topics, Life of Flow mirrors real physician conversations. "When we’re having a beer, we're not talking about medicine all the time," Miguel says of his conversations with other doctors. Life of Flow doesn’t shy away from topics discussed outside the operating room — like investment strategies, travel, and even wine preferences.
The intimacy of podcasting creates unique relationships. Strangers approach Miguel at conferences like old friends because they've listened to 50 hours of his conversations. "Someone will come up to me and say, 'I know you love cheese sticks,'" Miguel laughs. "So then you start realizing that you're creating a social construct."
For physician-entrepreneurs, authentic personal brands open new pathways for connecting with patients and peers. When Miguel launches a new HOPE clinic, social media and podcast announcements immediately reach thousands. The message bypasses traditional gatekeepers and gets "picked up by search engines" and "picked up by AI."
His advice for colleagues considering similar ventures: Embrace the work involved. Editing, content creation, social media management — "It's a lot of work, but I think it's worth it" for physicians wanting brand recognition independent of hospital affiliations or industry sponsorships.
The Art of Starting Over
The most important lesson Miguel has learned through his career pivots has nothing to do with medicine or business strategy. It's about resilience.
"How to get back up, how to restart," he explains. "We are so focused on our own lives. Sometimes we just don't realize that we can just reset it whenever we want and start from zero."
He's lived this philosophy. He’s relocated across continents, weathered financial highs and lows, and continually reinvented his career. Each transition required letting go of previous identities and embracing uncertainty.
"If you have the right attitude, if you're very laser-focused when you decide to succeed, you can get up again and rewrite your story as many times as you want." Divorce, professional setbacks, geographic relocations — Miguel believes none of it matters if you maintain the right perspective.
Betting Against the Crowd
Miguel now runs multiple clinics, has developed patient management software attracting pilot partners, and operates a research company bridging American innovation with Latin American capabilities. His model delivers the sustained patient relationships that he felt were lacking in traditional hospital settings.
His unconventional professional path is paying off.
The lesson isn't universal — not every physician should abandon hospital practice. But meaningful change often requires ignoring the crowd and following a path that is aligned with your personal mission.
Miguel's betting on something bigger than career safety: the idea that exceptional patient care, entrepreneurial freedom, and personal fulfillment don't have to be mutually exclusive. When everyone calls your move professional suicide, maybe you're just onto something they can't see yet.
