With years of aches and two prior knee surgeries it was time for a replacement that previously was denied by another physician due to a blot clot issue. Dr. Bircher and I had an open discussion about the clot issue and after careful testing and consultations it was agreed that the surgery could be done with minimal concern. I felt Dr. Bircher and Kari Gabrielse, PA-C were serious and straight forward of the pros and cons of having the surgery as well the physical therapy necessary after the surgery which wasn't easy. I felt so positive of the overall process they took me through, the support staff in the OR, and the after-surgery care from the hospital staff that I could only rate them as 5 STAR practitioners.