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Published by Amy Vertrees, MD
Welcome to BOSS Business of Surgery Series! This program was specifically designed to help surgeons learn concepts not taught in residency but necessary for a successful surgery career. We were not told that most of our job would be interacting with others. We thought it was about the technical success of surgery or the knowledge that we learn. But it is so much more. Difficult partners and colleagues. Dealing with complications. Negotiating with administration. Running a successful and efficient clinic that doesn’t take bleed into our home life. How to have a life outside of surgery But if we don’t learn these concepts, we will end up in a negative spiral that will lead us into misery. And all of the time we spent training for the job we love, that could be so rewarding, is lost. You know there has to be a solution out there. That you can’t be the only one unhappy or wondering if it is just you. It’s time for a program that addresses your specific problems run by someone who knows what you are going through. You need a fellow surgeon who knows the way. You need a surgeon who has been where you are and found her way out to the other side: -Loving surgery again -Not taking work home -finishing notes immediately after clinic and heading home on time -Not letting complications set you back -Interacting with others with confidence -Finally seeing that you can control the results you get at work and home You can find out more about Dr. Vertrees and her work at www.BOSSsurgery.com.
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What do you do when someone has a negative opinion of you—and you know they’re wrong? For high-achieving people, especially surgeons and leaders, it can be incredibly uncomfortable to be misunderstood. We want to explain. We want to correct the record. We want people to understand our intentions. But spending your time trying to change someone’s opinion can pull you into a cycle of defending, explaining, convincing, and people-pleasing. In this episode, Amy Vertrees, MD, explores what it really means to let people be wrong about you without ignoring useful feedback or abandoning your responsibility to yourself. You’ll learn how to: • Decide whose opinions actually deserve your attention • Separate useful feedback from someone else’s story about you • Stop defending yourself and shifting into “convincing energy” • Use criticism as an opportunity to become more effective and authentic • Know when to speak up and defend yourself • Recognize when it’s time to leave a relationship, job, or environment • Avoid becoming consumed by workplace conflict and other people’s opinions • Build greater self-trust and stop making someone else’s opinion your identity The goal isn't to become someone who never cares what other people think. The goal is to become better at deciding whose opinions deserve your attention—and what you want to do with them. Sometimes you learn from the criticism. Sometimes you stand up for yourself. Sometimes you leave. And sometimes the most powerful thing you can do is stop trying to win a game you no longer want to play. For women surgeons navigating difficult colleagues, leadership challenges, workplace conflict, and the pressure to be liked, this is a reminder that you don't have to spend your life convincing everyone to understand you. You can let them be wrong about you—and keep becoming more of yourself.
The late surgical case is one of the fastest ways for a surgeon to go from having a perfectly planned day to feeling completely trapped, frustrated, and angry. Cases get delayed. Emergencies happen. Staffing changes. Patients aren't ready. Equipment isn't available. And sometimes, despite everyone's best efforts, the OR schedule simply doesn't work. But what happens next is where the real coaching work begins. In this episode, Amy talks about her own experience with a very late case and explores why these situations can trigger so much anger and resentment. Beneath the anger, she argues, is often something deeper: powerlessness. You'll learn how to: • Handle the emotional frustration of a late surgical case • Use waiting time intentionally instead of allowing resentment to build • Recognize the difference between advocating for change and emotionally discharging • Avoid taking frustration out on the people around you • Think differently about the thought, “This shouldn't be happening” • Decide what you're willing—and no longer willing—to sacrifice for your patients • Set boundaries without abandoning your commitment to patient care • Prevent one late case from consuming your evening, weekend, relationships, and peace of mind There will always be late cases. There will always be things in surgery that are outside your control. The goal isn't to become the surgeon who never gets frustrated. It's to become the surgeon who can experience frustration without allowing it to consume the rest of the day—or the people around you.
What does Dolly Parton's career teach surgeons about authenticity, ownership, and building a legacy? Listen to hear the 9 lessons I took away from her life and her career. FULL DESCRIPTION: In the days following Dolly Parton's passing, Dr. Amy Vertrees reflects on the business lessons behind one of the most beloved careers in American entertainment, and why they matter so much for surgeons, especially women surgeons. From refusing to change her signature look to fit anyone else's idea of "professional," to keeping the publishing rights to "I Will Always Love You" even when it meant walking away from a deal with Elvis Presley, Dolly Parton built decades of durable, compounding assets rather than trading her time for a paycheck. Amy walks through nine lessons from Dolly's life and career: authenticity as a business strategy, owning your intellectual property, building teams that compound your strengths, scaling your impact through systems instead of personal bandwidth, and leading from values without becoming divisive. This episode is a call to shift from the traditional physician question — how much am I being paid — to the boss question: what am I building? Whether it's expertise, reputation, relationships, intellectual property, or a team, Amy makes the case that surgeons, like Dolly, can build something that continues creating value long after they leave the room. Topics covered: personal branding for physicians, owning your intellectual property, visionary leadership, scaling impact and mentorship, values-based leadership, financial confidence for women in medicine, and building a legacy beyond clinical work. KEYWORDS Primary: personal branding for physicians, women in surgery, physician entrepreneur, Dolly Parton business lessons, surgeon leadership, Boss Surgeons, Business of Surgery podcast Secondary: authenticity in leadership, owning intellectual property, legacy building, scaling impact, values-based leadership, financial confidence for women physicians CHAPTER MARKERS 00:00 Introduction 01:00 Authenticity as a business strategy 04:00 "Coat of Many Colors" 08:00 Building a brand bigger than your product 10:00 The Elvis Presley story and owning your IP 12:00 Nice is not the opposite of powerful 13:00 Visionary leadership and Dollywood 15:30 Scaling impact: the Imagination Library 19:00 Thinking long term 20:00 Don't be afraid to make money 21:00 Values without division 23:00 Make people feel good 24:00 Closing thoughts EPISODE TAGS Dolly Parton, personal branding, women in surgery, physician entrepreneur, intellectual property, visionary leadership, legacy building, values-based leadership, financial confidence, surgeon coaching
Narrative Summary Amy shares the origin story behind Columbia Surgical Partners — the practice she now runs with three additional partners across three locations. After 17 years in the Army and a stint as an employed surgeon in a Tennessee community hospital, Amy hit a breaking point: she wanted to make decisions, choose her team, and build the patient experience she believed in, and the employed model wouldn't let her. She walks through the exact moment she quit without a backup plan, how she bought and renovated a building in six weeks right as the pandemic hit, and the financial formula and mindset shifts that took her from a paper planner and a phone app to a thriving four-surgeon group six years later. Episode Notes The Setup: Military Discipline, Employed Frustration Amy's 17 years in the Army gave her early exposure to leadership and committee work, plus a broad-based general surgery skill set (thoracotomies, neck explorations, abdominal cases) and strong breast cancer training from Walter Reed. When she got out, she took the path 'everyone said you're supposed to do' — an employed job at a Tennessee community hospital that seemed to check every box on paper. But the fit wasn't right: decisions felt illogical (the clinic famously had no voicemail because leadership 'didn't want to give them the impression that we'd be checking messages'), and Amy felt she couldn't shape the environment or the patient experience the way she wanted to. The Breaking Point Around 2019–2020, at the end of her three-year contract, Amy started working with coaching for the first time and began asking for changes at the practice. When she hit a wall with administration, she found herself in a meeting with the medical group's CEO. He told her, 'that's just the way it is.' She responded, 'I don't think that I want to do this anymore' — and when he asked if she was quitting, she said yes, on the spot, without a plan. She describes the moment not as fear but as relief: 'it felt like someone was clipping the tethers... I felt free.' The Leap — Built On Her Own Safety Net Amy didn't have a financial safety net waiting for her — she built one herself. No student debt from her military years, strong financial habits, and the confidence that she could always find another job if the practice failed. That self-trust, more than any external backup plan, was what let her take the risk. Building Fast, During a Pandemic After quitting, Amy drove around her neighborhood the same day, found available buildings through a patient who happened to be a real estate agent, and closed on one within weeks. She gave her contractor six weeks to renovate — right as COVID-19 began. A fortunate decision to buy all renovation materials and supplies upfront (funded partly by the sale of her mother's house) meant she avoided the supply shortages that hit shortly after. She ran the entire early operation on a paper planner and the Spruce app, personally booking the first appointments before the doors even opened. Negotiating the Transition Amy's former group initially wanted her to stop seeing new patients six weeks before her departure. Using a negotiation lesson from Chris Voss — treating a 'no' as the start of a negotiation, not the end — she asked the hospital CEO, 'What would make it a yes?' The answer: proof she could follow up with new patients after the move. She provided it, and the restriction was lifted. The Overwhelm — and Monday Hour One Amy is candid that the early days were consumed by decision fatigue — design decisions, financial decisions, hiring decisions, all at once. What helped was a technique she credits to Brooke Castillo of The Life Coach School: Monday Hour One. Instead of an endless task list, Amy took an hour each week to convert her list into things that would actually get done — put on the calendar, not just written down. 'If it's on the list, good luck. If it's on the calendar, you have a chance.' The Formula: Income Minus Expenses Minus Tax Burden Amy built her practice around a simple formula: income minus expenses minus tax burden. Owning her building (rather than renting) helped control both expenses and tax exposure. She deliberately kept a 'micro clinic' model to minimize overhead, was profitable from month one, and has watched reimbursement percentages shrink industry-wide since — which is part of why she now teaches that physicians who only get paid for clinical work are, in effect, capped hourly workers. Diversifying income and thinking like an entrepreneur, not just a clinician, is what changes the math. Where It Is Now Six years later, what started as a 'cute little solo practice' has grown into Columbia Surgical Partners: four surgeons, two nurse practitioners, and three locations. Amy never set out with that scale in mind — she credits following instinct, building systems as she needed them, and getting better at delegation (an area she admits she still struggles with) for the growth. The Bigger Lesson Amy closes with a reminder that private practice isn't the only path to autonomy — many of the mindset and business lessons she describes can be applied inside an employed job too. Her core message: you don't need someone else to be your safety net. Everything you've built up to this point already is one. Key Takeaways A 'no' from leadership is often the start of a negotiation, not the end of one — ask what would make it a yes. Financial safety nets can be self-built through skills, work ethic, and low personal debt, not just savings. Buying supplies and materials upfront ahead of a tight renovation timeline protected Amy from pandemic-era shortages. Task lists create overwhelm; calendars create progress. Converting 'to-do' into 'when' is what makes work actually happen. The core private-practice formula is income minus expenses minus tax burden — and real estate ownership can help control two of the three. Being paid only for clinical work caps your income; thinking like an entrepreneur is what changes the ceiling. Growth doesn't require a five-year plan — Amy scaled from solo practice to four surgeons and three sites by following instinct and building systems as she needed them. The lessons of autonomy, delegation, and boundary-setting apply whether or not you ever start your own practice. Pull Quotes It felt like someone was clipping the tethers that I had, and I felt free. You don't need someone else to be your safety net. Everything you've done for yourself to this day is what has created your safety net. If it's on the list, good luck. If it's on the calendar, you have a chance. It's not how much money you make, it's who you become in your career.
Here's a question most surgeons have never asked themselves: how many patients do you need to see in clinic to get the number of operations you want each month? In Episode 239 of BOSS: Business of Surgery, host Dr. Amy Vertrees walks through the full patient-to-OR pipeline — from referral to completed case — and shows you how to calculate your own conversion rate so you can predict your operative volume, identify where patients are dropping off, and have a data-driven answer ready when an administrator asks why your case numbers are low. This is the clinic math framework. It covers every step in the funnel: referral source and referral volume, appointment scheduling drop-off, no-show rate, clinic-to-OR conversion rate, OR no-shows and cancellations, and how to calculate how many clinic patients you actually need per booked case. Dr. Vertrees also walks through how subspecialty mix affects your ratio — why a breast or colorectal surgeon with a high proportion of non-operative visits will always need to see more patients per case than a hernia-focused surgeon — and what to do about it. Real numbers included: 100 referrals → 90 appointments → 80 shows → 30 booked cases → 27 completed operations. If you're seeing that kind of attrition and didn't know it, this episode will change how you think about your clinic. Whether you're a new attending trying to build volume, an established surgeon whose numbers have quietly slipped, or a surgeon preparing for a difficult conversation with hospital leadership, this is the episode to hear first. 🎙️ Coaching: bosssurgery.com | Join the BOSS Surgeon Coaching Group ⭐ If this episode helped you, please leave a review on Apple Podcasts — it helps other surgeons find the show. surgeon clinic math | operative volume surgery | clinic to OR conversion rate | surgical practice management | surgeon KPIs | physician revenue RVU | surgical referral pipeline | new attending surgeon | private practice surgery | BOSS Business of Surgery | Dr. Amy Vertrees | surgeon coaching | surgical case volume | physician business skills | surgeon administrator communication
Episode Summary Can video review make better surgeons? Will artificial intelligence change the way surgeons are trained and certified? In this episode of the BOSS Business of Surgery Series , Dr. Amy Vertrees sits down with Dr. Matt Ritter , a 30-year Air Force surgeon, former Program Director at Walter Reed National Military Medical Center, current Program Director at Indiana University, and national leader in surgical education through SAGES . Together, they explore the future of surgical training , video-based surgical assessment , and the growing role of AI in surgery . Topics include: Why surgical competency may need more than a program director's final evaluation How video review can improve surgical performance and resident education The difference between formative feedback and high-stakes competency assessment Why video recording has been available for decades but remains underutilized The practical barriers to implementing video review in surgical practice How artificial intelligence may streamline surgical assessment while preserving expert judgment Whether robotic surgery and AI will eventually replace surgeons Lessons surgeons can learn from elite athletes who routinely review game film Whether you're a medical student, surgery resident, practicing surgeon, residency program director, or surgical educator, this conversation offers an inside look at where general surgery education is headed—and what it means for the future of our profession. If you've ever wondered how we should measure surgical skill, improve technical performance, or prepare the next generation of surgeons, this episode is for you. About Dr. Matt Ritter Dr. Matt Ritter is a general surgeon, former United States Air Force surgeon, former Program Director at Walter Reed National Military Medical Center, and current Program Director of the Indiana University General Surgery Residency Program. Through his leadership with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), he is helping develop psychometrically rigorous video-based surgical assessment tools that may shape the future of competency-based surgical education. In This Episode Surgical education General surgery residency Video review in surgery Surgical competency AI in surgery Robotic surgery Surgical coaching Residency training SAGES Competency-based medical education Technical skill assessment Deliberate practice Surgical performance improvement Want to build a career that's as intentional as your surgical practice? Join the BOSS Surgeons coaching community, where we teach the leadership, negotiation, communication, and business skills that aren't taught in residency. Learn more at www.bosssurgery.com .
Narrative Summary Surgeons are trained to endure, perform, and prove — but nobody ever teaches them to negotiate. In this episode, Amy pulls back the curtain on a live Boss Surgeons coaching call to teach the framework she calls “lion taming”: a way to hold your ground with the difficult partner, the dismissive colleague, or the patient who’s testing you, without becoming someone you’re not. The core insight is a reframe. The people who intimidate you — the “lions” — aren’t attacking out of strength. Their “roar” is their own stress response. Amy uses the classic tale of Androcles and the Lion to show what happens when you address someone’s pain instead of their behavior, then breaks the shift down into a three-step method: Anchor (get grounded in yourself), Align (understand where they’re headed and get in step with it), and Ask (make a clear, direct request from a place of safety, not apology). She backs it up with Heather’s story — a surgeon who used this approach to resolve a toxic work relationship in her own head before she ever left the job, then walked into her next role as a different, more grounded version of herself. The episode closes with an invitation into Boss Surgeons, the year-long group where this framework gets practiced live, and a lower-commitment first step for anyone who isn’t ready to decide yet. Detailed Episode Notes The Skill Gap, Not a Personal Failure Amy opens by naming the real problem: surgeons were trained to be employees — to suppress what they want, do what they’re told, and win through overworking or proving themselves. Negotiation was never part of the curriculum. What feels like a confidence problem is actually a skills gap, and skills can be learned. Who Are the “Lions”? A “lion” is anyone in front of you who could cause harm — a more experienced colleague, a competitor, a patient, someone with a differing opinion. Amy makes the point that this is functionally everyone, which is exactly why the skill matters. The goal isn’t to eliminate lions. It’s to learn to move through a room full of them without losing yourself. The Roar Is Their Stress Response — Not Yours to Absorb When someone interrupts, dismisses, or threatens, that’s a fight-flight-freeze-fawn response — theirs. Responding to the roar itself (arguing back, reporting, quitting) only addresses the symptom. Amy’s reframe: speak to the stressor behind the roar, not the roar itself, and the entire interaction changes. Androcles and the Lion Amy retells the classic fable: a runaway slave finds an injured, intimidating lion and, instead of fleeing, notices the thorn in its paw and removes it. Later, when the two are thrown together in an arena, the lion refuses to harm him. The lesson: when you address someone’s underlying pain instead of reacting to their bad behavior, you don’t just neutralize a threat — you can turn it into an ally. Dominance vs. Submission — Reframed Amy untangles two words most people confuse. Dominance isn’t hostility — it’s understanding your own power and using it to move a situation forward. Submission isn’t weakness — it’s knowing exactly what you want and asking for it without apology. Negotiation, in her framing, runs on strategy and emotional intelligence, not logic or force. The Framework: Anchor, Align, Ask Anchor — get present and grounded in yourself before the interaction. “I’m safe. You’re safe. This is important.” Align — observe carefully, understand where the other person is headed, and get in step with it. “I know what I want, and I know what you want too.” Ask — once trust and safety are established, make a direct, clear request — firm, kind, and specific. Amy is explicit that this only works in order: you can’t ask well from a place of fear, and you can’t align if you’re not anchored first. Heather’s Story Amy shares (with permission) the story of Heather, a surgeon who came to coaching while struggling with a difficult colleague. Rather than waiting for the other person to change, Heather worked through the relationship in her own head first — and by the time she left that job, she’d already resolved it internally. She carried that groundedness into her next role, where she described herself as “Switzerland”: same category of problems, completely different result, because she showed up differently. The Invitation Amy closes by naming the real objections surgeons carry into this decision — the price, the time, “I don’t think it’ll work for my situation,” and the high-achiever reflex of “I should be able to do this myself.” Rather than arguing each one down, she reframes the cost of staying stuck: lost time, lost respect, and the compounding toll of walking into the same rooms with the same lions, year after year. Key Takeaways Negotiation is a skill gap, not a character flaw — no one ever taught it to you. The “roar” you’re reacting to is someone else’s stress response, not a verdict on you. Dominance is not hostility. Submission is not weakness. Both are tools. You can’t align or ask well until you’re anchored in yourself first. Addressing someone’s underlying pain — not just their bad behavior — can turn a threat into an ally. Confidence isn’t the absence of fear; it’s the ability to feel any emotion and act anyway. You change your relationships by changing yourself first — not by waiting for the other person to change. Pull Quotes “No one can take your joy. You have to give it to them.” “Dominance is not hostility, and submission is not weakness.” “It’s not logic, it’s strategy. It’s not strength, it’s trust and authority. It’s not a fight, it’s dominance and submission.” “The roar is their stress response. Your response is your stress response.” “Power is a tool, not a threat.” “I used to walk into a room wondering what people thought about me. Now I wonder what I think about them.”
Dr. Amy Vertrees reflects on the weekend screening of the documentary A Thousand and One Cuts and the coaching call that followed it, unpacking why women surgeons' careers are rarely derailed by one dramatic event but by an accumulation of small, repeated moments. She backs this up with hard data: female physicians and surgeons consistently produce lower mortality and complication rates than their male counterparts across multiple large studies, including a JAMA Internal Medicine analysis of 1.5 million Medicare hospitalizations and a 2025 meta-analysis spanning 13.4 million patients — yet women retire from medicine at 49 versus 62 for men. Amy then teaches the core coaching framework from that call: the difference between a fact (something everyone would agree happened) and a thought (your interpretation of it) — including why "microaggression" is a thought, not a fact, and why that distinction actually gives you more power, not less. She closes with tactical empathy, the "mythical white male" trap, and the idea that forcing yourself to be falsely polite is its own kind of self-inflicted harm. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206–213. doi:10.1001/jamainternmed.2016.7875 Heybati K, Chang A, Mohamud H, Satkunasivam R, Coburn N, Salles A, Tsugawa Y, Ikesu R, Saka N, Detsky AS, Ko DT, Ross H, Mamas MA, Jerath A, Wallis CJD. The association between physician sex and patient outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2025 Jan 17;25(1):93. doi: 10.1186/s12913-025-12247-1. PMID: 39819673; PMCID: PMC11740500. Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024 Dec 1;280(6):945-953. doi: 10.1097/SLA.0000000000006339. Epub 2024 May 10. PMID: 38726676; PMCID: PMC11542977. Wallis CJD, Jerath A, Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. 2023;158(11):1185–1194. doi:10.1001/jamasurg.2023.3744 Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 2019 Feb 9;393(10171):560-569. doi: 10.1016/S0140-6736(18)33135-0. PMID: 30739691. Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J Gen Intern Med. 2022 Oct;37(13):3295-3301. doi: 10.1007/s11606-021-07298-z. Epub 2022 Jan 6. PMID: 34993875; PMCID: PMC9550938. Branford GL, Bucala MD, Hepper A, Hadeed NM, Northway RM, Brenner MJ. The Gender Gap in EHR Workload: A Comparative Analysis of Primary Care Physician In Basket Usage. J Gen Intern Med. 2025 Jul;40(10):2255-2264. doi: 10.1007/s11606-025-09629-w. Epub 2025 May 29. PMID: 40439865; PMCID: PMC12344033. Rotenstein LS, He Z, Dziura J, Tsugawa Y, Venkatesh AK, Melnick ER, Gettel CJ. Sex Differences in Physician Attrition from Clinical Practice Across Specialties: A Nationwide, Longitudinal Analysis. J Gen Intern Med. 2026 Apr 2. doi: 10.1007/s11606-026-10362-1. Epub ahead of print. PMID: 41927984.
Turning Pain Points Into Innovation | Dr. Prakash Gatta FULL DESCRIPTION Dr. Prakash Gatta is a foregut and esophageal surgeon who built his hospital's surgical program from zero — and then built two healthcare technology companies from the pain points he kept running into in the OR. In this episode of BOSS: Business of Surgery, host Dr. Amy Vertrees talks with Dr. Gatta about what happens when surgeons stop waiting for someone else to solve the problems they see every day. Company #1: Uncover — Dr. Gatta serves as VP of Clinical Affairs for this AI-powered surgical documentation platform. Uncover analyzes intraoperative video in real time and generates detailed, accurate operative notes automatically. Poor operative notes correlate with worse patient outcomes and cause 15-20% undercoding on procedures — a financial gap that affects both surgeon compensation and hospital facility fees. Uncover closes that gap by turning video into documentation, identifying missed CPT codes, modifier 22s, and APC codes that surgeons never capture. Company #2: EmpowerMedical.ai — Dr. Gatta founded this physician financial transparency platform to answer a question most surgeons have never been able to ask: how much money do I actually generate for my hospital? Using publicly available CMS data and hospital-disclosed pricing, the platform converts a surgeon's case list into a complete financial picture — professional fees, facility revenue, payer mix, DRGs, APCs, and contribution margin. A surgeon performing 124 high-level hernia repairs generates $464,000 in professional fees and $12 million in total system revenue. Most surgeons have no idea. Dr. Gatta wants to make this tool free for all trainees entering practice. The conversation also covers Dr. Gatta's remarkable personal story: born in India, raised in Kuwait during the Gulf War, self-evacuating as a 13-year-old refugee, medical school in Bombay, and arriving in the US in 2000 for surgical training under pioneer Lee Swanstrom in Portland. 🎙️ Website: prakashgatta.com | EmpowerMedical.ai (free blog on coding & billing) 💼 LinkedIn: Dr. Prakash Gatta | Host: Dr. Amy Vertrees | bosssurgery.com ⭐ If this episode helped you, please leave a review on Apple Podcasts.
Dr. Erin King Mullins is a double board-certified general and colorectal surgeon with 12 years in practice and founder of Colorectal Wellness Center in Metro Atlanta. In this episode, she shares the hard-won business lessons from a difficult exit from her fellowship practice, how she navigated a non-compete clause that left her unable to stay or relocate, and the step-by-step path to launching solo private practice — while pregnant with her second child. Dr. Mullins and host Dr. Amy Vertrees cover what every surgeon must know about physician employment contracts: why you should read your exit clause before your salary, the critical difference between radius-based and entity-based non-competes, and what at-will employment actually means for physicians. They also discuss the human side of running a medical practice — from firing employees the right way to separating friendship from business decisions. In the second half of the episode, Dr. Mullins pulls back the curtain on her experience as a volunteer director with the American Board of Surgery (ABS) — including how complaint reviews actually work, what due process looks like for a surgeon facing a board action, and how the new Entrustable Professional Activities (EPA) framework is transforming resident training and surgical education. Whether you’re considering private practice, navigating a contract negotiation, or just want to understand what the ABS actually does for surgeons, this episode is required listening. 🎙️ Find Dr. King Mullins: @DrTushyTouchUp (IG/TikTok/FB) | colowellness.com 🎙️ Host: Dr. Amy Vertrees | bosssurgery.com ⭐ Timestamps: 0:00 Intro: Meet Dr. Erin King Mullins 1:00 12 Years in Colorectal Surgery 1:30 COVID, Maternity Leave & a Difficult Exit 3:30 Locums as a Bridge 4:00 Business Is the Third Person in the Room 5:00 Firing Employees: The Human vs. Business Side 7:00 Read Your Exit Clause First 7:30 At-Will Employment Law for Physicians 8:00 Non-Competes: Radius vs. Entity-Based 10:30 Why Locums Works for Some Physicians Permanently 11:00 Going Solo: One Person, Infrastructure for Two 12:00 Setting Culture from the Top Down 14:00 Biggest Challenges in Solo Practice 16:00 Business Resources That Helped 18:30 Joining the American Board of Surgery 19:30 The ABS Mission Statement 21:00 Who’s in the Room: Board Diversity 22:00 How the ABS Views Locums Physicians 23:30 What Happens When a Complaint Is Filed 26:00 The Standardized Complaint Review Process 28:30 EPAs: Entrustable Professional Activities 31:00 Get Involved with the ABS 33:30 How to Pivot When You’re Stuck 37:00 Going All In — With a Safety Net 38:00 Women’s Colorectal Health & New Focus 38:30 Where to Find Dr. King Mullins If this episode helped you, please leave a review on Apple Podcasts — it helps other surgeons find the show.
Episode Summary What do you do when you discover something that could harm patients—and the system doesn't want to hear it? In this powerful episode, Dr. Amy Vertrees sits down with renowned breast surgeon Dr. Beth Dupree to discuss her extraordinary journey after identifying multiple missed breast cancer diagnoses within a healthcare system. After discovering what initially appeared to be a single missed cancer, Dr. Dupree followed established quality and reporting pathways only to uncover a much larger pattern. What followed was years of advocacy, resistance, investigation, personal sacrifice, and ultimately transformation. The conversation explores not only healthcare accountability but also physician resilience, moral injury, leadership, healing, and the courage required to continue speaking up when the personal cost becomes significant. About Dr. Beth Dupree Beth Dupree is a nationally recognized breast surgeon, educator, author, and pioneer in integrative breast cancer care. Over her career she: Built nationally recognized breast programs Trained breast surgical oncology fellows Led quality and safety initiatives Developed innovative survivorship programs Authored multiple books on healing and survivorship Became a national voice for patient-centered cancer care Key Topics Discussed Following the Evidence Dr. Dupree shares how a routine consultation led her to discover a missed breast cancer diagnosis that had been visible on imaging for years. Rather than dismissing concerns, she followed the data and pursued further investigation. Key lesson: Sometimes the first problem you find is only the beginning. When the System Pushes Back The episode explores what happens when: quality concerns are raised physicians challenge established processes institutional interests conflict with transparency Dr. Dupree discusses navigating: internal quality reviews hospital administration external reviewers medical boards media investigations The Emotional Cost of Advocacy One of the most powerful sections of the conversation centers on the personal impact of advocacy. Topics include: moral injury professional isolation burnout PTSD physician identity Dr. Dupree describes what it feels like to know something is wrong while feeling unable to protect patients in the way she believed they deserved. Courage Versus Comfort A central theme emerges throughout the discussion: Doing the right thing does not guarantee an easy outcome. The conversation explores: professional courage integrity under pressure speaking up despite consequences choosing values over comfort Healing the Healer The latter part of the episode shifts toward recovery and transformation. Dr. Dupree shares her journey through: trauma recovery integrative medicine survivorship care psychedelic-assisted therapy education vagal nerve regulation innovative approaches to healing The discussion examines how physicians can learn to care for themselves while continuing to care deeply for patients. The Future of Medicine Dr. Dupree challenges surgeons to think beyond traditional treatment models and remain open to innovation. Topics include: survivorship care whole-person healing bioelectric medicine mental health support quality of life after treatment Memorable Quotes "Being right about something in a health system is not always the easy path." "You cannot work in a system where you are not respected, heard, and valued." "The truth sets people free." "Bless the thing that breaks you down and cracks you wide open." "Personal courage is what changes medicine." "Sometimes the greatest gift comes from the hardest experience." Key Takeaways ✅ Patient advocacy sometimes requires personal courage ✅ Following proper channels does not always guarantee action ✅ Moral injury can have profound effects on physicians ✅ Healing matters for doctors as much as patients ✅ Innovation often begins by listening deeply ✅ Integrity is often tested when the stakes are highest ✅ The experiences that challenge us most can transform our careers Who Should Listen Surgeons Physicians in leadership Residents and fellows Quality and safety leaders Healthcare administrators Physicians experiencing moral injury Anyone interested in healthcare culture and patient advocacy Connect with Dr. Beth Dupree Social Media: @drbethdupree Author of The Healing Consciousness Contributing author in Women in Surgery Speaker, educator, and advocate for integrative cancer care
🔹 Episode Overview This episode explores intimate partner violence (IPV) in the orthopedic/surgical patient population — an issue surgeons encounter frequently but often fail to recognize or feel unprepared to address . The discussion focuses on: Awareness Identification Surgeon responsibility Practical next steps Key message: 👉 Surgeons see IPV regularly — whether they realize it or not. 👩⚕️ Guest Introductions Dr. Lisa Canada Orthopedic trauma surgeon University of North Carolina School of Medicine – Charlotte Campus 25 years in practice Professional pillars: Education Mentorship Clinical excellence Co-author of paper on IPV in orthopedic patients Motivation: Bridging clinical care and education to help surgeons recognize hidden violence affecting patients. Dr. Marissa Ullrich Third-year orthopedic surgery resident Mayo Clinic, Rochester Medical school: Ohio State University Passionate about whole-patient care Key realization: Medical training teaches mandatory reporting for: Children Elderly Vulnerable adults ➡️ But no standardized system exists for adult IPV screening. 🔹 What Is Intimate Partner Violence? IPV is broader than many physicians assume. Common Misconceptions ❌ Only married couples ❌ Only male-on-female violence ❌ Only long-term relationships Reality IPV can involve: Spouses Boyfriends/girlfriends Dating partners Roommates Caregivers Any gender combination Any age group 🔹 Why Surgeons Must Care Surgeons often encounter IPV first because injuries bring patients to medical attention. Examples include: Fractures Recurrent injuries Injuries inconsistent with reported mechanism Multiple prior visits Orthopedic and trauma surgeons are uniquely positioned to identify abuse patterns. 🔹 The Hidden Gap in Medicine Training emphasizes: Child abuse reporting Elder abuse reporting But lacks: Standardized adult IPV detection Education on resources Clear clinical pathways Result: ➡️ Physicians suspect abuse but don’t know what to do next. 🔹 Clinical Red Flags Surgeons should consider IPV when they notice: Multiple injuries over time Vague or inconsistent injury history Injuries inconsistent with mechanism described Frequent “falls” Delayed presentation for care Partner answering questions for patient Patient reluctance or anxiety Especially important in: Fragility fracture patients Elderly individuals with caregivers Repeat trauma presentations 🔹 Core Takeaways for Surgeons 1. You Are Already Seeing IPV Statistically, surgeons encounter affected patients weekly . 2. Recognition Is the First Step You don’t need to solve everything — awareness matters. 3. Think Beyond the Injury Treat the whole patient , not just the fracture or operation. 4. Pattern Recognition Saves Lives Connecting repeated injuries can reveal abuse. 🔹 Cultural Shift Needed in Surgery The episode highlights a broader shift: Moving from purely technical care → holistic patient care Expanding surgeon identity beyond operator Embracing advocacy and safety as part of surgical responsibility
Episode Summary What happens when a surgeon decides she's done being underpaid and undervalued — and refuses to sell her practice to private equity? She goes out of network. That's exactly what Dr. Sarah Bryczkowski did, and in this episode she walks us through every step of how she made it work. Dr. Bryczkowski is a robotic general surgeon in Somerset County, New Jersey and a partner at Somerset Surgical Specialists. After making partner in a private practice and realizing she was barely covering overhead as an in-network surgeon, she convinced her partners to take the leap out of network. Since September of last year, they've been operating entirely out-of-network — and they've never looked back. This episode breaks down a model that most physicians have heard about but don't fully understand. Sarah demystifies the billing process, explains what the No Surprises Act actually means for surgeons and patients, and talks honestly about the financial risks, the leap of faith, and what it finally feels like to get paid what you're worth. What You'll Learn in This Episode What "out of network" actually means — and why insurance companies don't want you to understand it How the No Surprises Act changed the game (for better and for worse) What balanced billing really is — and how it's used to scare patients away from out-of-network doctors How Independent Dispute Resolution (IDR) works and why surgeons are winning The billing workflow: from consult to arbitration (and why you won't see money for 3–6 months) How Dr. Bryczkowski convinced her skeptical partners to make the switch The partnership track reality — why making partner isn't always what you expect What the first year in an out-of-network practice actually looks like financially The metrics to watch so you're not flying blind on income Who this model is and isn't right for How to find a billing company and legal team you can trust Key Quotes "I'm doing quality surgery. I wanted to find a way to get paid what I'm worth for what I do — and the employed model didn't fit." "Balanced billing is a term insurance companies use to scare people away." "Even if I wasn't making money, I wouldn't want to be told what to do. It's worth it." "I don't have people problems, I have checklist problems." "You're sucking wind now, but as long as you've got the metrics, you know you're gonna be okay." "It's a journey of faith and challenge and courage — but it's so worth it." Resources Mentioned Somerset Surgical Specialists — somersetsurgical.com The No Surprises Act (2021) Independent Dispute Resolution (IDR) process Online directories for in-network/out-of-network physician lookup About Dr. Sarah Bryczkowski Dr. Sarah Bryczkowski is a robotic general surgeon and partner at Somerset Surgical Specialists in Somerset County, New Jersey. She trained at Hackensack University Medical Center, where she was first exposed to the out-of-network practice model. After several years in both employed and in-network private practice settings, she led her practice group to transition out of network — without selling to private equity. She specializes in complex robotic surgery including component separations, hiatal hernia repairs, and fundoplications.
What happens when the job you moved your family for turns out to be the wrong fit? In this episode, Dr. Amy Vertrees sits down with urologist and entrepreneur Dr. Joe Pazona , founder and CEO of VirtuCare, to discuss the unexpected path from being fired to building a new model of healthcare delivery. After experiencing broken promises, loss of autonomy, and ethical conflicts inside traditional employment models, Dr. Pazona realized something many physicians quietly suspect: 👉 The problem isn’t always the doctor. 👉 Sometimes the system itself is broken. This powerful conversation explores how physicians can reclaim leadership, redesign their careers, and create healthcare systems that work for both doctors and patients. 🔥 In This Episode, You’ll Learn: Why great surgeons often struggle as employees The hidden cause of physician burnout (and why it’s not workload) How being fired became the turning point of a career The mindset shift required to move into entrepreneurship Why saying no is essential for career alignment How rural healthcare innovation is reshaping specialty practice What it means to truly work at the top of your license 💡 Key Takeaway When physicians stop trying to fit into broken systems, they can begin building better ones. 👤 About the Guest Dr. Joe Pazona is a urologist and CEO of VirtuCare, a healthcare company focused on supporting physicians while expanding specialty access in underserved communities through innovative team-based care models. Find him on LinkedIn here. 🎧 About the Podcast The BOSS Business of Surgery Podcast , hosted by Dr. Amy Vertrees , teaches the lessons surgeons were never taught in residency — including leadership, negotiation, career design, communication, and professional fulfillment. ⭐ If You Enjoyed This Episode Follow the show, leave a review, and share with a colleague who’s questioning what comes next in their surgical career.
In this powerful and deeply human episode of the BOSS Podcast, Amy sits down with physician advocate Kim Downey — a three-time cancer survivor whose life changed after the tragic loss of her radiologist to suicide. What began as personal grief became a national mission to support physician wellbeing. Together, they explore the hidden emotional cost of practicing medicine, the culture of emotional suppression doctors are trained into, and why physicians must be seen — and supported — as human beings, not superheroes. Kim shares how her advocacy work, including the Stand Up for Doctors and her book White Coats Human Hearts , helps physicians feel less alone while educating patients and communities about the realities of medical practice. This episode is a moving conversation about grief, gratitude, complications, physician families, and the healing power of connection. If you’ve ever wondered who takes care of the doctors — this conversation is for you. 🎧 Topics include: Physician mental health and suicide awareness Emotional suppression in medical training Patient–physician relationships and trust The power of gratitude in medicine Rehumanizing doctors and healthcare culture Perfect for physicians, healthcare professionals, and anyone who wants to better understand the people behind the white coat. https://standupfordoctors.org/
Episode Overview Dr. Jessica Hott shares her journey from hospital-employed surgeon and medical director to private practice founder after uncovering systemic billing and coding failures that prevented physicians from receiving credit for the care they were already providing. Her investigation revealed a critical truth: physician burnout is often not caused by workload alone — but by invisible, uncompensated work embedded within healthcare systems. Key Topics Discussed The Productivity Paradox Physicians working harder while appearing less productive EMR reports failing to capture real clinical work Administrative decisions driven by flawed data The Billing Education Gap Minimal training in billing and coding during residency Generational transfer of incorrect practices Why physicians must understand the business of medicine Global OB Care Misconceptions What global care actually includes Common services physicians unknowingly provide for free How small documentation changes dramatically affect reimbursement Post-Operative Visit Pitfalls How EMR labeling influences coder behavior When post-op visits become separately billable care New diagnoses vs. surgical global periods Coding Strategy That Changed Everything Diagnosis alignment with procedures Real-world ureteral lysis coding example Working effectively with coders and billing teams Modifier 22 & Surgical Complexity Documenting increased time, risk, and technical difficulty When complex cases justify additional RVUs Why many systems fail to recognize complexity Why Health Systems Don’t Fix This Surgical departments already subsidize hospitals Administrative focus on loss centers instead of optimization Misaligned incentives inside healthcare finance The Hidden Cost of Physician Turnover Recruitment and onboarding expenses Budget silos masking true institutional losses The financial impact of losing experienced surgeons The Turning Point: Leaving Employment Moral injury vs burnout Stress vs passion: control as the defining difference Choosing private practice ownership Building a Physician-Designed Practice Renovating a new surgical facility Creating efficiency systems and patient education workflows Attracting mission-aligned team members Key Takeaways Physicians often underbill because they were never taught otherwise. Productivity data may not reflect true clinical value. Knowledge of coding is a form of physician empowerment. Administrative systems rarely reward initiative without structural change. Ownership restores agency, control, and professional fulfillment. Actionable Insights for Physicians Audit what services fall outside global billing. Review how visits are labeled in your EMR. Learn modifier usage and complexity documentation. Partner actively with coders instead of delegating blindly. Understand the financial model of your practice environment. Memorable Quote Themes “You’re not underproducing — your work isn’t being counted.” “Burnout often starts when value and recognition disconnect.” “Stress is when you can’t fix the problem. Passion is when you can.” Ideal Audience Employed physicians questioning productivity metrics Surgeons considering private practice Physician leaders and medical directors Doctors interested in financial literacy and practice ownership
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