BOSS Business of Surgery Series

Summary This podcast episode from the Boss Surgery Series features Dr. Amy Vertries interviewing Dr. Sarah Rasmussen, a pediatric transplant surgeon, about her experience of being in the wrong job and navigating a career transition. Dr. Rasmussen shares her journey from working at the University of Virginia (UVA) to Seattle Children's Hospital and then to a new position that better aligned with her career goals and values. Dr. Rasmussen begins by describing her background as a Gen-Xer born in West Virginia who initially planned to practice medicine with her father. She pursued an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her medical training, she discovered her passion for surgery during rotations and completed her residency at Virginia Commonwealth University followed by a pediatric surgery fellowship at Johns Hopkins. She then worked at UVA from 2011 to 2020, where she established a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction in surgical volume prompted her to accept a position at Seattle Children's Hospital as the surgical director of pediatric liver transplant, which she accepted just before the COVID-19 pandemic began in early 2020. At Seattle Children's, Dr. Rasmussen encountered challenges that made her realize she was in the wrong job. Despite the hospital performing more transplants (13-15 liver transplants and 30 kidney transplants annually), she faced issues with case allocation, micromanagement of her decisions, and resistance to her suggestions for improving processes. After 18 months, she compiled data showing her limited involvement in transplant cases and presented it to leadership, hoping for change. Instead, this led to increased scrutiny of her abilities. Dr. Rasmussen describes how the job stress affected her health, causing panic attacks, chest pain, and dangerously high blood pressure. With support from her family and through Dr. Vertries' coaching program, she decided to explore other opportunities. She interviewed at four institutions and found a position with a partner who shared her vision and valued her contributions. In her new role, Dr. Rasmussen found a supportive environment where her partner encourages her growth, helps her through complications, and values her strengths. She shares how her new partner supported her through a surgical complication by not letting her isolate herself and helping her move past self-doubt. He also encourages her to take on challenging cases, such as performing laparoscopic procedures on very small infants. The conversation concludes with reflections on the importance of finding the right job fit, the impact of career decisions on family, and how having the right partner can make a significant difference in professional growth and satisfaction. Chapters Dr. Rasmussen's Background and Early Career Path ‎ 00:02:12 Dr. Sarah Rasmussen introduces herself as a Gen-Xer born in West Virginia. She initially planned to practice medicine with her father but became interested in research during medical school. She joined an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her clinical rotations, she discovered her passion for surgery, which engaged "all parts of her brain." She completed her residency at Virginia Commonwealth University and a pediatric surgery fellowship at Johns Hopkins. From 2011 to 2020, she worked at the University of Virginia (UVA) as an assistant professor, where she also completed an additional fellowship in abdominal transplant surgery. At UVA, she was active in research, clinical work, teaching, and helped establish a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Transition to Seattle Children's Hospital During the Pandemic ‎ 00:05:21 Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction prompted her to accept a position as surgical director of pediatric liver transplant at Seattle Children's Hospital. She signed her offer letter just before the COVID-19 pandemic began, making the transition particularly challenging as it occurred during social distancing measures. Dr. Rasmussen was attracted to Seattle Children's because they performed more transplants (13-15 liver transplants and 30 kidney transplants annually), and she believed she would have a good working relationship with the program head who had similar training. Challenges at Seattle Children's Hospital ‎ 00:09:27 Dr. Rasmussen describes her initial positive reception at Seattle Children's but quickly noticed concerning dynamics between surgeons during her observation of a liver-kidney transplant on her second day. Despite her efforts to integrate into the team, she faced significant challenges: her clinical decisions were micromanaged, her requests for time off were complicated by "unwritten rules," and she was often excluded from transplant cases because "fellows needed the experience." After 12 months, she realized that her situation wasn't improving despite her efforts to be helpful and engaged. After 18 months, she compiled data showing her limited involvement in transplant cases (only 20% of livers and 15% of kidneys despite being on call 33% of the time) and presented it to leadership, hoping for change. Instead of addressing her concerns, this led to increased scrutiny of her abilities. Recognizing the Need for Change ‎ 00:16:45 Dr. Rasmussen sought advice from colleagues but was consistently told that the situation "would never change." She realized that her vision of being a pediatric liver transplant surgeon required meaningful involvement in cases, which wasn't happening at Seattle. In January 2021, she learned of four potential job openings in her field. Initially resistant to moving her family again so soon after relocating during the pandemic, she joined Dr. Vertries' "difficult partner course" hoping to learn how to succeed in her current position. Through the course, she gave herself permission to explore other opportunities and interviewed at all four institutions. Two positions seemed promising, with one standing out immediately because of her connection with the potential new boss. Health Impact and Decision to Leave ‎ 00:25:56 Dr. Rasmussen describes how the job stress severely affected her health, causing panic attacks manifesting as chest pain and dangerously high blood pressure (190/110 with a heart rate of 197). One night after seeing the clinic and call schedule, she couldn't calm down despite trying mindfulness techniques. Her husband witnessed this and declared, "We are done here." Additional factors influencing her decision included the death of a mentor and her mother's illness. Dr. Rasmussen realized that despite her efforts, the team at Seattle Children's was unwilling to accommodate her career needs, which she viewed as a "breach of contract" - not from the institution but from the team that should invest in its members. Family Considerations in Career Decisions ‎ 00:28:55 Dr. Rasmussen discusses the challenge of considering another move so soon after relocating her family during the pandemic. She worried about uprooting her children who had just established connections in Seattle. A turning point came when her oldest child told her, "Mom, I think it's time for you to worry about yourself. I'm going to be okay." For her job interviews, she took the unusual step of requesting that both potential employers bring her entire family for second visits, not just her spouse. She received advice that "how happy do you think your family can be if mom is not happy?" and realized that many children move multiple times during childhood without negative consequences. She also learned that her oldest child had been bullied at their previous school, reinforcing that staying in Virginia might not have been better for her family. Finding the Right Partner and Environment ‎ 00:47:08 Dr. Rasmussen describes how she connected with her new boss by cold-calling him about a position at his former institution and inquiring if he needed a partner in his new program. Their initial conversation revealed shared vision and energy for building a program. Unlike her experience in Seattle, her new boss explicitly stated, "You tell me what you need out of a case, and that's what will happen," emphasizing team function over hierarchy. She contrasts this with her previous experience, noting the difference between a hierarchical environment and one with a shared vision. When she experienced a serious complication in her first liver transplant at the new institution, her partner provided support without judgment, wouldn't let her isolate herself, and eventually told her "it's time to stop" ruminating, while acknowledging that such complications happen to everyone. Growth and Support in the New Position ‎ 00:54:01 Dr. Rasmussen shares how her new environment supports her growth through challenging cases. During her first on-call experience, she consulted on a 1.6-kilogram baby with duodenal atresia. Though initially planning an open procedure, she researched laparoscopic approaches and found evidence supporting minimally invasive surgery for this condition. When she proposed this to her boss, he gave no pushback and even came to observe the successful procedure. Three months later, when she hesitated about performing a laparoscopic cholecystectomy on an eight-week-old baby, her boss reminded her, "Three months ago, you did a lap duodenal atresia repair on a 1.6 kilo baby - get over it," encouraging her to trust her abilities. Dr. Rasmussen appreciates how her partner recognizes when her tendency to overthink is a strength (when writing policies or justifications) and when it's holding her back. Reflections on Career Transitions and Lessons Learned ‎ 01:00:00 Dr. Rasmussen and Dr. Vertries reflect on the lessons learned through this career journey. Dr. Rasmussen acknowledges how she overcame limiting beliefs such as "I can't move because it will hurt my family" and "I can't have an ideal partner." Dr. Vertries notes that Dr. Rasmussen has experienced a "hero's journey" and that her lessons will have an "exponential effect on other people." Dr. Rasmussen expresses gratitude for the opportunity to reflect on how far she's come in a relatively short time, demonstrating that "you can make some pretty life-altering things in a short period of time with a little bit of help." Action Items Dr. Vertries mentioned reaching out to her at bosssurgery.com for help with toxic job situations. ‎ 00:00:35 Dr. Rasmussen suggested asking detailed questions about job expectations and case allocation when interviewing for new positions. ‎ 00:13:54 Dr. Rasmussen recommended bringing family members on second job interviews when considering relocation. ‎ 00:29:58 Dr. Rasmussen advised seeking coaching before leaving a job to process the situation properly. ‎ 00:42:17 Dr. Rasmussen suggested researching evidence-based approaches to surgical techniques when considering new procedures. ‎ 00:55:57

Summary This episode of the Boss podcast features Dr. Jennifer Whittington sharing her experience with toxic work environments and how she navigated leaving such situations. The host, Dr. Amy Vertries, introduces the podcast as focusing on lessons not taught in residency for surgeons. Dr. Whittington discusses her first job search after residency, where she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues. Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time. The conversation then shifts to Dr. Whittington's experience leaving her toxic job. She explains how she carefully planned her exit, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She maintained professionalism throughout the difficult two-month notice period, despite facing verbal abuse and humiliation. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval. Dr. Whittington then discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle, which ultimately made her a better surgeon while helping her become debt-free. Throughout her journey, Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries. Dr. Whittington concludes by discussing her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges. The episode ends with Dr. Whittington advocating for subsidized childcare for surgical trainees at a national level, noting that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally. Chapters Introduction to the Boss Podcast and Topic of Toxic Jobs ‎ 00:00:00 Dr. Amy Vertries introduces the podcast, explaining that it focuses on lessons not taught in residency for surgeons. She mentions that two of their most downloaded episodes deal with leaving toxic jobs, and introduces Dr. Jennifer Whittington who will share her experience with toxic work environments and how she navigated leaving such situations. Dr. Whittington's First Job Search and Contract Mistakes ‎ 00:01:13 Dr. Whittington discusses her first job search after residency, explaining she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. A lawyer who reviewed it years later told her "no one reasonable would have allowed you to sign this." She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues. Red Flags in Job Interviews and Importance of Due Diligence ‎ 00:02:36 Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time to avoid being "used and abused." Identifying Toxic Workplace Environments ‎ 00:09:22 Dr. Whittington describes signs of a toxic workplace, including lack of respect, being condescended to in front of team members, and feeling uncomfortable with the standard of care provided. She shares her father's advice about being able to "look at yourself in the mirror at night" and feel good about what you did that day, noting that in her toxic job, she couldn't say that about the care being provided. Transitioning Out of a Toxic Job ‎ 00:12:33 Dr. Whittington explains how she carefully planned her exit from her toxic job, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She discusses the documentation needed when changing jobs, including licensure verification, risk management documentation, case logs, and letters of recommendation. She emphasizes the importance of having allies who can help navigate this process. Maintaining Professionalism During Resignation ‎ 00:15:21 Dr. Whittington shares how she maintained professionalism during her difficult two-month notice period, despite facing verbal abuse and humiliation. Her mantra was "I am the consummate professional," which helped her not react negatively to poor treatment. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval. Second Job Experience and Family Emergency ‎ 00:18:03 Dr. Whittington discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how the administration was supportive and even held her position as long as possible. She helped interview her replacement and assured them it was a good practice to join. Financial Challenges and Overcoming Debt ‎ 00:24:56 Dr. Whittington reveals how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle. This experience not only helped her become debt-free but also made her a better surgeon by improving her efficiency and thoughtfulness. She explains her fear of debt stemming from her lower-middle-class upbringing as a coal miner's daughter. Building a Support Network or "Village" ‎ 00:33:10 Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries. Current Position and Future Goals ‎ 00:35:26 Dr. Whittington discusses her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges. Advocacy for Childcare Support in Medical Training ‎ 00:44:10 Dr. Whittington concludes by advocating for subsidized childcare for surgical trainees at a national level. She notes that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally, and expresses her passion for finding ways to address this issue through medical organizations. Action Items Dr. Whittington advised hiring a contract lawyer to review job offers, even if it costs around $500, as it's worth the investment to identify potential issues. ‎ 00:02:52 Dr. Whittington recommended always speaking to the person who previously held the position before accepting a job offer. ‎ 00:04:07 Dr. Whittington suggested going through offer letters point by point with the hiring person, discussing call distribution, reimbursement, block time, and expectations. ‎ 00:03:28 Dr. Whittington advised securing credentials at another hospital before resigning from a toxic job if retaliation is anticipated. ‎ 00:07:14 Dr. Whittington recommended preparing a resignation letter in advance when leaving a difficult workplace situation. ‎ 00:15:36 Dr. Whittington suggested maintaining professionalism when facing verbal abuse or humiliation in the workplace by using a personal mantra like "I am the consummate professional." ‎ 00:16:15 Dr. Whittington advised personally calling patients when transitioning from one practice to another to maintain the relationship and reduce guilt. ‎ 00:21:02 Dr. Whittington advocated for exploring ways to provide subsidized childcare for surgical trainees at a national level through medical organizations. ‎ 00:44:10

Summary This meeting record transcript is a conversation between a host and Dr. Michael Sutherland, the membership director of the American College of Surgeons (ACS). The discussion covers various aspects of the ACS, including its mission, membership benefits, educational resources, advocacy efforts, international outreach programs, and the annual Clinical Congress event. Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident and highlights the opportunities for surgeons at different career stages to participate and contribute to the organization. He emphasizes the value proposition of ACS membership, which includes access to discounted insurance programs, practice management resources, coding and reimbursement support, and personal financial management services. The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization also plays a crucial role in advocacy and health policy, engaging with government agencies and insurance companies to shape policies that impact surgical practice. Internationally, the ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The annual Clinical Congress event is highlighted as a premier educational and networking opportunity, offering cutting-edge education, vendor exhibits, surgical simulations, and social networking events. Overall, the conversation aims to raise awareness about the extensive resources and benefits available to ACS members, encouraging surgeons, particularly younger ones, to get involved and take advantage of the organization's offerings. Chapters Dr. Sutherland's Journey with the ACS 00:01:10 Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident when the 80-hour work week was implemented. He started participating in discussions and committees, eventually becoming the chair of the Resident Associate Society and the Young Fellows Association. He emphasizes that the ACS offers opportunities for passionate individuals to engage and contribute to improving patient care and surgical quality. The Value Proposition of ACS Membership 00:18:22 Dr. Sutherland highlights various benefits and resources available to ACS members, including discounted insurance programs (life, disability, accidental death), practice management materials, contract negotiation services, personal financial management resources, coding and reimbursement support, and access to data-driven initiatives like surgical risk calculators. The goal is to provide value-added benefits that make ACS membership a worthwhile investment for surgeons. The ACS as the House of Surgery 00:08:33 The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization has a strong voice in advocacy and health policy discussions, shaping policies that impact surgical practice. International Outreach and Education 00:11:29 The ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The program has training hubs in countries like Ethiopia, Rwanda, and Zambia, where attending physicians and residents from the U.S. help educate local surgeons and build self-sustaining surgical capabilities. The Annual Clinical Congress 00:29:07 The Clinical Congress is highlighted as the premier event for the ACS, offering cutting-edge education from subject matter experts, vendor exhibits, surgical simulations, and social networking opportunities. Dr. Sutherland emphasizes the importance of networking and building lasting connections with peers at the event. The Congress also features named lectures, convocation ceremonies, and cultural experiences like the "Taste of the City" event. Engaging Younger Surgeons 00:41:12 Dr. Sutherland acknowledges the challenge of communicating the value proposition of ACS membership to younger surgeons, particularly residents and fellows. The organization aims to eliminate cost barriers by offering free membership during residency and highlighting the various resources and opportunities available to engage and contribute to the ACS at different career stages. Action Items Explore the ACS website (facs.org) and update your member dashboard to ensure your profile information is accurate and tailored to your surgical specialty and interests. 00:37:04 Bookmark and utilize the Surgical Risk Health Calculator available on the ACS website to facilitate informed discussions with patients about potential surgical outcomes based on real data. 00:39:09 Attend the annual Clinical Congress event to access cutting-edge education, vendor exhibits, surgical simulations, and networking opportunities with peers from around the world. 00:31:26 Investigate the various ACS podcasts, including 'House of Surgery,' 'Surgical Readings from SRGS,' and 'The Operative Word,' to stay updated on surgical topics and research. 00:46:01 Reach out to the ACS Member Services team (ms@facs.org) for assistance in finding resources or exploring opportunities to get involved with the organization. 00:43:42 Encourage medical students, residents, and younger surgeons to join the ACS and take advantage of the free membership during residency to experience the value proposition and resources available. 00:41:46

In this episode, Amanda Hill, JD joins Amy to talk about why they relaunched the 90 Day Notice program—and why it's more important than ever. Drawing from real stories of doctors facing workplace struggles, they highlight the common scenarios physicians are navigating: complications clustered together, staff complaints escalating into formal reviews, sudden RVU changes, and the fear of being “pushed out” without warning. Amy shares her perspective as a surgeon and coach, while Amanda brings decades of experience as a healthcare attorney. Together, they break down why so many doctors feel powerless, what warning signs to watch for, and how to respond with strategy instead of panic. They stress that leaving a job isn't always the answer—sometimes the solution is learning how to influence opinions, repair professional relationships, and walk through challenges with strength and dignity. Listeners will also hear how the 90 Day Notice program creates real change by blending legal insight, coaching tools, and community support. From navigating workplace conflicts, to avoiding costly missteps, to rebuilding confidence, Amy and Amanda share the process they've refined to help physicians reclaim their leverage and peace of mind. If you've ever wondered, “Am I the problem? Do I need to quit? Or is there another way?”—this episode shows you that there is a path forward.

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees sits down with Dr. Courtney McKeown, who shares her remarkable journey from navigating an operative gap to becoming chief of surgery at a rural hospital. Dr. McKeown opens up about the challenges she faced after being laid off from her first job, her prior recovery from substance use disorder, and the difficulties of securing a new position with a gap in her surgical practice. Together, Dr. Vertrees and Dr. McKeown dive deep into what it takes to return to surgery after time away, from licensing hurdles to credentialing committees, malpractice insurance, and professional references. The conversation also highlights the American Board of Surgery's reentry guidelines, state-specific policies on operative gaps, and the importance of supportive partners and mentorship during the reentry process. Now serving as chief of surgery, Dr. McKeown reflects on how her experience not only rebuilt her career but also brought life-changing surgical services to underserved communities. Her story is both a candid look at the obstacles surgeons face and an inspiring example of resilience, mentorship, and community impact. What You'll Learn in This Episode: The challenges of returning to surgery after an operative gap How state licensing boards and disciplinary history affect reentry The step-by-step process of hospital credentialing Why references and case logs are crucial for reentry Insights into the American Board of Surgery's reentry guidelines The role of mentorship and supportive partners in regaining confidence How Dr. McKeown expanded surgical services in rural Tennessee hospitals Resources & Action Items: 90-Day Notice Program for doctors seeking new positions – launching Sept 28 at 4 p.m. CT Click HERE Keep case logs organized (last 12 months, last 2 years, etc.) for credentialing American Board of Surgery Reentry Guidelines HERE Joint Commission FPPE Guidelines HERE Chapters: 00:00 – Introduction to Dr. McKeown's journey 01:14 – Background and initial challenges 04:01 – Finding a new position 05:44 – Licensing challenges 07:09 – State requirements for operative gaps 09:13 – Impact on board certification 10:36 – Reciprocal disciplinary actions 16:13 – Malpractice insurance considerations 17:22 – Reference challenges 19:43 – Finding the right practice environment 22:00 – Qualities to look for in partners 24:47 – Mutual benefits of mentorship 36:49 – Hospital credentialing process 42:08 – ABS reentry guidelines 46:58 – Gradual return to independent practice 56:42 – Current success as chief of surgery 59:57 – Expanding services and rural community impact 1:02:25 – Conclusion and future impact

Summary The meeting was day three of a launch week focused on complications in surgery, presented by a surgeon who is also an author, podcast host, and certified coach. The presenter emphasized that complications are inevitable in surgical practice and provided guidance on how to manage them effectively. The presenter began by outlining the main topics to be covered: understanding what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment. The presenter defined a complication as a failure to achieve a stated outcome, specifically a perfect procedure where nothing goes wrong. They addressed perfectionist thinking as a double-edged sword - while striving for perfection is admirable, it can lead to fear, overwork, and burnout. The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. The prolonged stress cycle was discussed as a significant issue for surgeons, where continuous stress without recovery leads to cognitive impairment, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter offered strategies to interrupt this cycle, including deep breathing, music, exercise, mindset work, and community support. For managing complications during surgery, the presenter advised checking one's pulse, taking deep breaths, stepping back to think, asking for help, and considering the next best step. They emphasized the importance of clear communication with partners about expectations when asking for help. After a complication, the presenter stressed the importance of naming emotions, practicing self-compassion, and using shame resilience strategies: reaching out to trusted sources, talking kindly to oneself, and owning the story to control the narrative. They highlighted that patients primarily want to know what happened, that the surgeon did their best, that they won't be abandoned, and that learning occurred from the experience. The presenter also discussed peer review processes, advising surgeons to control the narrative in medical charts, respond non-defensively to inquiries, and seek legal counsel if necessary. They emphasized the importance of measuring outcomes and knowing one's numbers to build confidence. The session concluded with advice on debriefing with teams and communicating with patients' families after complications, emphasizing the need to address emotional concerns before providing technical details. Chapters Introduction to Complications in Surgery ‎ 00:00:00 The presenter welcomed attendees to day three of launch week, focusing on complications in surgery. They acknowledged that while complications may seem like a heavy topic, it's important because all surgeons will experience them. The presenter introduced themselves as a surgeon, author, podcast host, and certified coach, emphasizing that complications are "near and dear to their heart." They outlined the main topics to be covered: what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment. Understanding Complications and Perfectionist Thinking ‎ 00:01:46 The presenter began by addressing two common statements about surgical complications: "The only surgeon who doesn't have complications is the one who doesn't operate" and "Every surgeon carries within himself a small cemetery where from time to time he goes to pray." They defined a complication as a failure to achieve a stated outcome - specifically, a perfect procedure. The presenter discussed perfectionist thinking as a double-edged sword, explaining that while striving for perfection seems admirable, it can lead to fear, overwork, and burnout. They recommended shifting perspective from focusing on the gap between achievement and perfection (e.g., achieving 95% vs. 100%) to celebrating the best effort given with available knowledge and resources. The Prolonged Stress Cycle ‎ 00:07:17 The presenter explained how surgeons often experience prolonged stress cycles without recovery, especially when dealing with complications, hostile work environments, or difficult patients. They emphasized that surgical jobs are inherently difficult, stating "Our jobs are hard. Not everyone can do it." When stress continues without relief, it can lead to rumination, hypervigilance, isolation, impaired cognitive function, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter recommended strategies to interrupt this cycle, including deep breathing (especially exhaling), music, exercise, mindset work through neuroplasticity, and community support. Managing Complications During Surgery ‎ 00:11:25 For handling complications during surgery, the presenter advised: checking one's pulse first, taking deep breaths to interrupt the stress cycle, stepping back to think about what you know, asking for help, and considering the next best step. They used the analogy of viewing a maze from above versus being inside it to illustrate the importance of perspective. The presenter emphasized that how a surgeon responds during a complication influences everyone in the operating room, as they are all experiencing stress and looking to the surgeon for leadership. Asking for Help and Managing Expectations ‎ 00:13:51 The presenter discussed the importance of clear communication when asking for help, emphasizing understanding both your expectations and your partner's expectations. They shared examples of misunderstandings, such as a junior surgeon expecting a senior partner to scrub in during a complication while the senior partner was hesitant to appear to be taking over. The presenter advised explicitly stating what you need: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" They also addressed "want mismatches" where partners have different expectations and recommended finding alternative sources of help if necessary. After the Complication: Managing Emotions ‎ 00:18:51 The presenter emphasized the importance of naming emotions after a complication occurs, describing it as learning a new language of emotional intelligence. They discussed "emotional alchemy" - the ability to transform one emotion into another, particularly distinguishing between guilt ("I feel bad that this event happened") and shame ("I feel bad because there's something wrong with me"). The presenter introduced Brené Brown's shame resilience framework: reaching out to trusted sources, talking kindly to oneself (self-compassion), and owning the story to control the ending. They explained self-compassion as "feeling a negative emotion and wrapping it up in love and respect for yourself." Communicating with Patients After Complications ‎ 00:24:51 The presenter shared insights about what patients want after complications: to know what happened while they were asleep, to know the surgeon did their best, to feel they won't be abandoned, and to know the surgeon learned from the experience. They emphasized the importance of giving complications purpose and using them as learning opportunities. The presenter advised being present with patients, acknowledging the reality of what happened, and providing certainty and stability during a confusing time. Peer Review and Professional Consequences ‎ 00:27:12 The presenter discussed peer review processes, acknowledging that surgeons have reason to be concerned but emphasizing that the goal should be quality improvement and patient safety. They advised controlling the narrative in medical charts by clearly documenting decision-making processes. The presenter outlined possible peer review outcomes: no action (sometimes even congratulations for handling difficult situations well), education/questioning, remediation requirements, or more serious consequences like privilege restrictions or National Data Bank reporting. They advised not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise. Building Confidence Despite Complications ‎ 00:33:48 The presenter distinguished between confidence ("I know I can do it because I've already done it") and self-confidence (the ability to take chances, stretch oneself, and manage failure). They recommended breaking down complex procedures into components, recognizing that surgeons typically know 95% of what they need to do, with only 5% requiring special focus. The presenter emphasized the importance of measuring outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence and counter drama with facts: "Information is the best solution when you have drama. Math always settles down drama." Debriefing with Teams and Families ‎ 00:41:54 In response to audience questions, the presenter discussed the importance of debriefing with both teams and patients' families after complications. For families, they advised leading with emotional reassurance before providing technical details: "First, I know things took a little longer, but everything is okay." For team debriefs, they recommended acknowledging everyone's efforts, discussing what went well and what could have gone better, and identifying next steps. The presenter also endorsed proactively reporting complications to administrators rather than waiting to be discovered: "Don't give into that kind of suffering... You're going to decrease the amount of suffering that you're going to have by doing that." Action Items The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. ‎ 00:05:54 The presenter advised interrupting the stress cycle through deep breathing (especially exhaling), music, exercise, mindset work, and community support. ‎ 00:09:51 The presenter suggested discussing expectations with partners before complications occur to establish when and how to call for help. ‎ 00:14:47 The presenter recommended explicitly stating needs when asking for help: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" ‎ 00:15:59 The presenter advised practicing shame resilience by reaching out to trusted sources, talking kindly to oneself, and owning the story to control the ending. ‎ 00:21:54 The presenter suggested controlling the narrative in medical charts by clearly documenting decision-making processes. ‎ 00:28:01 The presenter recommended not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise during peer review. ‎ 00:32:14 The presenter advised measuring personal outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence. ‎ 00:36:37 The presenter suggested debriefing with teams after complications using a simple assessment: three things that went well, three things that could have gone better, and next steps. ‎ 00:45:24 The presenter recommended proactively reporting complications to administrators rather than waiting to be discovered. ‎ 00:48:38

n this episode, Dr. Amy Vertrees sits down with her longtime office manager, Carrie Glass, to unpack one of the most overlooked yet critical dynamics in a physician's career: the relationship between doctor and office manager. With decades of experience running medical offices, Carrie shares insider knowledge that every new attending needs to hear—from credentialing pitfalls and the revenue cycle to handling disruptive patients, managing staff, and mastering delegation. Together, Dr. Vertrees and Carrie explore how communication, boundaries, and trust between physicians and office managers can quite literally “make or break your life in the clinic.” Carrie also introduces her new venture, Medical Office Mastery, designed to equip both physicians and office managers with the tools they need for smoother, more effective practice management.

How do surgery residents find their first job—and keep it? In this episode, Dr. Amy Vertrees sits down with Dr. Sharon Stein, a colorectal surgeon turned professional development coach, to talk about her new program designed to help residents land jobs that truly fit their goals and values. Dr. Stein shares eye-opening statistics: 15% of surgeons leave their first job within 2 years. 50% leave within 5 years. The problem? Training programs teach standardized skills but don't help surgeons identify their unique strengths—or what they really want in a job. Together, Dr. Vertrees and Dr. Stein discuss: ✅ Why comparison (not competition) derails job searches ✅ The mid-career slump and how to prevent it ✅ A 4-step framework for assessing, interviewing, evaluating, and negotiating job offers ✅ How institutions (and surgeons) can avoid the high cost of misaligned job placements Dr. Stein's new six-month program includes on-demand modules, group coaching, and one-on-one sessions—limited to 30 graduates across all surgical specialties.

What happens when a “good job” no longer feels good enough? In this episode of the BOSS Business of Surgery Series Podcast, Dr. Amy Vertrees sits down with Dr. Yemi Lamikanra, orthopedic hand surgeon and founder of Cura Hand Surgery and Orthopedics in Atlanta, to discuss her bold decision to leave a large multi-specialty group and start her own solo practice. Dr. Lamikanra opens up about the pivotal moments that led her to seek change, including the pressures of balancing motherhood with her surgical career. She shares the strategies, resources, and mindset shifts that helped her build a practice that fits her life—and why trusting yourself is often the hardest, but most important, step. You'll learn: How motherhood reshaped her priorities and pushed her toward autonomy Why “10X is easier than 2X” when making major life changes Lessons from setbacks that became invaluable in leadership, coding, and patient acquisition How to evaluate consultants and ensure a return on investment The power of community, self-education, and intentional decision-making in private practice Dr. Lamikanra's journey is an inspiring reminder that your purpose is always bigger than your fear—and that redefining success is not only possible, but necessary. Resources & Links: Connect with Dr. Yemi Lamikandra: Website: atlantahandsurgeon.com Instagram: @atlhandsurgeon LinkedIn: Opeyemi Lamikanra, MD

Summary Dr. Amy Vertrees, a surgeon, author, podcast host, and certified coach, delivered the first session of a launch week series aimed at new attending physicians. The presentation focused on common mistakes new attendings make and strategies to avoid them. Dr.Vertrees emphasized that the information shared was based on her own experiences and lessons learned throughout her career. Dr.Vertrees began by outlining the week-long series of presentations, which would cover topics including office manager insights, money management for physicians, handling complications, legal risks, time management, and efficient note-taking. She emphasized that these sessions were designed to be interactive, encouraging participants to ask questions through chat or Q&A features. A central theme of Dr.Vertrees' presentation was the importance of mastery and recognition for job satisfaction. She explained that mastery means being good at one's job, while recognition involves being acknowledged for one's skills and contributions. Dr.Vertrees noted that this formula applies not only to physicians but to everyone in the workplace, highlighting the importance of recognizing others' contributions and allowing them to develop mastery in their roles. Dr.Vertrees discussed the significance of understanding organizational culture, including the mission, beliefs, and values of one's workplace. She advised new attendings to consider whether their personal values align with their organization's culture, as misalignment can lead to dissatisfaction. She also emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices. The presentation covered strategies for dealing with difficult colleagues, emphasizing that communication breakdowns can make any colleague difficult. Dr.Vertrees offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well. Dr.Vertrees addressed the topic of being reported or receiving negative feedback, advising attendees to view such situations as opportunities for growth rather than threats. She emphasized the importance of participating in leadership positions and committees to have influence in one's organization, noting that "you're either at the table or you're on the menu." The presentation also covered personal development topics such as overcoming imposter syndrome, which Dr.Vertrees defined as feeling inadequate despite demonstrated success. She offered strategies for challenging negative thoughts by turning statements into questions and comparing oneself to past versions rather than to others. Dr.Vertrees distinguished between confidence (which comes from repeated experience) and self-confidence (the courage to act despite fear). Dr.Vertrees discussed the importance of marketing oneself effectively, emphasizing that marketing involves knowing one's values and being authentic. She encouraged attendees to embrace their unique qualities rather than conforming to stereotypical surgeon personas. She also addressed the topic of getting paid appropriately, emphasizing the importance of timely documentation, proper coding, and understanding the revenue cycle. The presentation concluded with advice on tracking various aspects of one's practice, including finances, cases, clinic metrics, and complications. Dr.Vertrees stressed the importance of adapting to life changes and having contingency plans, including knowing one's contract details and having an exit strategy. She offered strategies for dealing with negative emotions, particularly shame, and emphasized the importance of seeking help when needed. Throughout the presentation, Dr.Vertrees maintained that physicians should give themselves permission to quit if necessary, while also finding purpose in their work. She concluded by emphasizing treatments that address root problems, including therapy, coaching, journaling, community support, and sometimes medications. Chapter Introduction to Launch Week for New Attendings ‎ 00:00:02 Dr. AmyVertrees welcomed participants to the first day of launch week, designed specifically for new attending physicians. She explained that the purpose of these sessions was to share information she wished she had known when starting as a new attending. Dr.Vertrees encouraged interaction through chat or Q&A features and introduced herself as a surgeon, author, podcast host, and certified coach. She outlined the week's topics, including office manager insights, money management, handling complications, legal risks, time management, and efficient note-taking. Mastery and Recognition: The Key to Job Satisfaction ‎ 00:03:20 Dr.Vertrees identified mastery and recognition as the fundamental elements of job satisfaction. She defined mastery as being good at one's job and recognition as being acknowledged for one's skills and contributions. She emphasized that this formula applies to everyone in the workplace and highlighted the importance of recognizing others' contributions. Dr.Vertrees cautioned against the mistake of doing everything oneself, as this robs others of the opportunity to develop mastery and receive recognition. Understanding Organizational Culture ‎ 00:05:28 Dr.Vertrees discussed the importance of understanding the culture of one's organization, including its mission, beliefs, and values. She advised attendees to consider whether their personal values align with their organization's culture, noting that misalignment becomes evident over time. Dr.Vertrees emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices. Navigating Difficult Colleagues and Communication ‎ 00:07:46 Dr.Vertrees addressed the challenge of difficult colleagues, noting that communication breakdowns can make any colleague difficult. She offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well. Handling Reports and Feedback ‎ 00:11:52 Dr.Vertrees discussed how to handle situations where one is reported or receives negative feedback. She advised viewing such situations as opportunities for feedback rather than threats, noting that a report simply generates paperwork that someone needs to address. She emphasized the importance of maintaining a good headspace to respond appropriately, whether the feedback indicates an area for personal improvement or a situation to be cautious about. Participating in Organizational Leadership ‎ 00:13:31 Dr.Vertrees emphasized the importance of participating in leadership positions and committees to have influence in one's organization, stating "you're either at the table or you're on the menu." She encouraged attendees to get involved at hospital, state, or national levels, while being selective about which positions to take on. Dr.Vertrees advised being clear about one's motivations for taking on leadership roles and understanding that such roles are often what one makes of them. Creating Personal Safety and Understanding Values ‎ 00:15:18 Dr.Vertrees discussed the importance of understanding one's personal culture and values, especially when working in a difficult organizational culture. She emphasized that clarity about one's values helps in making decisions and recommended values exercises to gain self-awareness. Dr.Vertrees addressed the concept of scarcity, noting that feelings of not having enough can trigger unhelpful "hustle" behaviors and that new physicians may trigger scarcity feelings in established colleagues. Establishing Boundaries ‎ 00:18:32 Dr.Vertrees outlined five steps for establishing effective boundaries: defining the boundary, communicating it to relevant parties, outlining consequences for boundary violations, enforcing those consequences, and allowing oneself to make exceptions when appropriate. She used the example of after-hours patient calls to illustrate these steps, emphasizing that a boundary isn't truly established unless all five steps are followed. Addressing Imposter Syndrome ‎ 00:21:09 Dr.Vertrees defined imposter syndrome as feeling inadequate despite demonstrated success, a phenomenon first identified in high-achieving women in academia in 1978. She explained that people with imposter syndrome have negative thoughts despite outward success, making it difficult for others to understand or help. Dr.Vertrees suggested turning negative statements into questions to challenge these thoughts, such as changing "I'm not doing this right" to "Am I okay?" Challenging Common Negative Thoughts ‎ 00:24:50 Dr.Vertrees identified common negative thoughts that high-achieving people experience, including fears of being perceived as lazy, doubts about one's abilities, and comparisons to others. She emphasized that these thoughts can be challenged and reframed, noting that the job itself is genuinely difficult and that comparing oneself to others can be useful if done constructively rather than destructively. Understanding Confidence and Self-Confidence ‎ 00:32:18 Dr.Vertrees distinguished between confidence, which comes from repeated experience, and self-confidence, which is the courage to act despite fear. She explained that confidence develops through muscle memory and repetition, while self-confidence involves trusting oneself to handle negative emotions and potential failures. Dr.Vertrees emphasized that these feelings are generated by one's own thoughts and actions. Marketing Yourself Effectively ‎ 00:34:09 Dr.Vertrees discussed the importance of marketing oneself effectively, framing it as shifting from an employee mindset to a CEO mindset. She defined business as an exchange of value for money and emphasized the importance of understanding one's own value. Dr.Vertrees encouraged attendees to be authentic rather than conforming to stereotypical surgeon personas, noting that authenticity often receives positive feedback. She emphasized that marketing happens in every interaction, not just through formal channels. Getting Paid Appropriately ‎ 00:39:16 Dr.Vertrees addressed the topic of getting paid appropriately, emphasizing that it's acceptable to expect payment for providing value. She described notes as invoices for one's work, highlighting their importance for patient care, mental health, pre-authorization, and communication with primary care. Dr. Vertries explained the revenue cycle (work → invoice → coding → billing → collections) and stressed the importance of understanding this process to ensure business sustainability and avoid fraud. Tracking Practice Metrics ‎ 00:44:01 Dr.Vertrees emphasized the importance of tracking various aspects of one's practice, including finances, cases, clinic metrics, and complications. She recommended evaluating each clinic session by identifying three things that worked well, three areas for improvement, and one next step. Dr.Vertrees explained the concept of "clinic math" (the ratio of patients seen to operations booked) and how understanding this ratio can help in planning and potentially modifying one's practice. Adapting to Life Changes ‎ 00:50:17 Dr.Vertrees discussed the importance of adapting to life changes, noting that jobs and personal circumstances evolve over time. She emphasized that tracking helps one see these changes while planning helps one adjust to them. Dr.Vertrees pointed out that people often fail to modify their work approach when major life events occur, such as having children, leading to frustration when previous patterns no longer work. Important Documents and Contingency Planning ‎ 00:51:52 Dr.Vertrees highlighted important documents that physicians should be familiar with, including their contracts, hospital bylaws, and credentialing information. She emphasized the importance of having an exit plan, even when starting a new job, as this provides confidence and prevents feeling trapped. Dr. Vertries also mentioned the importance of tracking deadlines for licenses, DEA credentials, contract renewals, and continuing medical education requirements. Managing Negative Emotions and Shame ‎ 00:54:24 Dr.Vertrees addressed the management of negative emotions, particularly shame, which she defined as the feeling that "there's something wrong with me." She credited Brené Brown for three steps of shame resilience: reaching out to a trusted source, talking kindly to oneself, and owning one's story to control the ending. Dr.Vertrees warned that shame leads to isolation and harmful coping mechanisms, emphasizing the importance of addressing it directly. Permission to Quit and Finding Purpose ‎ 00:55:38 Dr.Vertrees shared her personal strategy of giving herself permission to quit every day, which paradoxically helps her remember why she continues in her profession. She acknowledged that eventually, one might take that permission and actually quit, which is acceptable because "this is your one and only life." Dr.Vertrees emphasized that this approach has allowed her to work harder while maintaining perspective on her purpose. Helpful Approaches and Conclusion ‎ 00:57:17 Dr.Vertrees concluded by discussing approaches that help address the root causes of problems, including therapy, coaching, journaling, community support, and sometimes medications. She emphasized the importance of recognizing one's thought patterns, developing new patterns, and having accountability. Dr.Vertrees reminded attendees about the next session on office manager insights and encouraged questions from participants.

Episode Summary: In this deeply moving and practical episode, palliative care nurse Tammy Stokes shares how a personal health crisis at age 36—nearly 100% blockage in three arteries—transformed her career and mission in healthcare. Now an advocate and leader in palliative care in Tennessee, she brings firsthand experience and clinical insight to the often-avoided conversations about serious illness, family dynamics, and end-of-life care. Tammy discusses: The difference between palliative and hospice care The emotional and spiritual impact of critical illness on patients and families Why advanced care planning is essential—at any age How her personal experiences with her father and brother shaped her philosophy of care Tools from her book, including scripts to start hard conversations The power of patient autonomy and how to honor it in clinical practice Whether you're a surgeon, nurse, or family caregiver, this episode equips you to lead hard conversations with courage, compassion, and clarity.

Summary Amy introduces Dr. Adam Rosen, an orthopedic surgeon and author of "OR Confidential: Confessions of a Gen X Surgeon," highlighting the book's exploration of the challenges and mental health struggles faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery . 00:00:02 Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time . 00:01:38 The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff . 00:04:47 Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID . 00:08:57 Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health . 00:11:17 Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation . 00:14:34 Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare . 00:18:43 Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma . 00:26:26 Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession . 00:35:06 Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress . 00:36:50 Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative . 00:41:16 Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller . 00:50:24 Amy commends Dr. Rosen for his openness and advocacy, highlighting the value of his resources for patients and healthcare professionals. She also acknowledges the unique challenges faced by female surgeons and expresses appreciation for initiatives supporting them . 00:54:51 Chapter Introduction to Dr. Adam Rosen and His Book 00:00:02 Amy introduces Dr. Adam Rosen, highlighting his book "OR Confidential: Confessions of a Gen X Surgeon," which explores the mental health challenges faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery. Dr. Rosen's Journey to Becoming a Surgeon 00:01:38 Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time. The Impact of COVID-19 on Surgical Teams 00:04:47 The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff. He notes that travelers were often paid two to three times what the home market paid. The Emotional Toll of Striving for Perfection 00:08:57 Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID. Red Flags and the Feeling of Being Trapped 00:11:17 Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health. The Breaking Point 00:14:34 Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation. Panic Attack and the Importance of Support Systems 00:18:43 Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare. Psychiatric Treatment and the Stigma of Mental Health 00:26:26 Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma. The Importance of Continuous Self-Assessment 00:35:06 Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession. Tools and Strategies for Managing Mental Health 00:36:50 Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress. Cognitive Behavioral Therapy (CBT) and Challenging Negative Beliefs 00:41:16 Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative. Current Activities and Future Plans 00:50:24 Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller. Commendations and Acknowledgements 00:54:51 Amy commends Dr. Rosen for his openness and advocacy, highlighting the value of his resources for patients and healthcare professionals. She also acknowledges the unique challenges faced by female surgeons and expresses appreciation for initiatives supporting them.Find Dr. Rosen at:His Youtube channel here His podcast hereHis book here

Episode Highlights ✅ Introduction to Lion Taming (00:00:00) Dr. Amy Vertrees introduces the “Lion Taming” master class on power and negotiation. Highlights her coaching program for women surgeons, helping them handle difficult colleagues, power dynamics, and negotiations. Defines BOSS as a suite of coaching and courses teaching crucial career skills often missing from surgical training. ✅ Who (or What) is the Lion? (00:02:08) “Lions” = Anyone who can harm your career, reputation, or confidence—senior colleagues, competitors, even patients. The most dangerous lions are sometimes the most powerless or wounded. Lion taming means: Finding your own power Managing those with power over you Acting despite fear Leading without formal authority ✅ Stress Responses in Conflict (00:05:52) Workplace conflicts trigger strong emotions like anger, fear, shame, or sadness. These emotions often stem from being dismissed, interrupted, or undermined. Four stress responses: Fight, Flight, Freeze, Fawn. Lion taming often involves recognizing and managing the “fight” response. Lesson from Androcles & the Lion: understanding and soothing the “lion's pain” can transform conflict into cooperation. ✅ New Approaches to Negotiation (00:12:15) Avoid using: The “Hammer” (intimidation) The “Armor” (withholding vulnerability) Instead, aim for: Honesty Genuine curiosity Emotional intelligence Insights from Kasia Urbaniak's “Woman's Guide to Power Unbound”: Dominance: Knowing and using your power Submission: Knowing what you want and influencing others to give it to you ✅ Self-Discovery & Managing Lions (00:16:35) Crucial steps for effective negotiation: Know your strengths and weaknesses Understand what you truly want Believe in your capacity to achieve it Reduce the lion's perceived threat by envisioning the best version of them. Negotiation isn't purely logical—it's driven by emotion and the sense of safety. ✅ Three Steps to Tame a Lion (00:25:20) Anchor: Create safety and stability within yourself. Align: Shift attention outward to engage strategically. Ask: Make a clear, powerful request. Recognize where your attention is: Inward focus = Submission Outward focus = Dominance ✅ Power is Not a Threat—It's a Tool (00:35:55) Power exists to influence, not intimidate. Dr. Vertrees encourages listeners to use their power for positive change. Power Negotiations course topics include: Identifying your needs Reading others' needs Practical negotiation techniques Surviving high-stakes conversations The “CEO Self-Concept”: Think of yourself as your own business, making choices aligned with your mission and values. ✅ Coaching Program Details (00:41:33) Weekly live sessions Private podcast + Facebook group Email support Discounted 1:1 coaching calls Dr. Vertrees encourages potential clients to discuss fit before joining. Action Items

Summary Dr. Amy Vertrees, the host, introduces the episode focusing on the prolonged stress cycle, a topic relevant to many, especially female surgeons, given the various stressors in medicine and the world . She notes that this topic arose from discussions within the female boss surgeons group, emphasizing its importance and broad applicability . The group, which meets weekly and twice monthly on Sundays, covers topics not typically addressed in residency but crucial for career and mental health . Dr. Vertrees shares her background as a general surgeon and certified coach, highlighting her experiences in military and civilian settings, as well as private practice, which led her to create the Boss Business and Surgery series . She details the program's structure, including three-month modules on dealing with difficult colleagues and managing the impact of complications . The discussion emphasizes the pervasive nature of stress, exacerbated by global events and the demands of being a surgeon . The prolonged stress cycle often begins in training, with experiences that may have been hostile or malignant, impacting future stress responses . Dr. Vertrees references the book "What Happened to You?" by Bruce Perry and Oprah Winfrey, explaining how prolonged stress can dysregulate the nervous system, hindering rational thinking . She differentiates between regulated stress, which builds resilience, and dysregulated stress, which results from extreme, prolonged, and unpredictable situations . Dr. Vertrees explains the stress cycle, involving a trigger, a stress response (fight, flight, freeze, or fawn), and a physiological reaction . Recognizing one's physiological stress response is crucial, as it serves as a red flag indicating excessive stress . She provides an example of a stressful surgical scenario, emphasizing that recognizing a stress response is a sign of awareness, not a personal failing . Finding a colleague in such situations can provide stability and prevent potentially harmful actions . The discussion covers the importance of emotional regulation, especially for new attendings, and the impact of decision fatigue . Impaired coping mechanisms, such as doom scrolling or overeating, can worsen the stress cycle . Confidence is defined as the ability to manage any emotion, including fear and uncertainty, while still acting effectively . Practical techniques to interrupt the stress cycle include deep breathing exercises, focusing on the next best step, and box breathing . Dr.Vertrees stresses that emotional and physiological regulation is crucial for surgeons, who are leaders of their teams and responsible for their patients . She advises on communicating with families during stressful events, emphasizing the importance of reassuring them that their loved one is okay . The value of having a second set of skilled eyes, such as residents, is highlighted, as they can prevent potentially devastating mistakes . Strategies to manage the stress cycle include awareness and tracking, physiological regulation, emotional processing, cognitive reframing, and setting boundaries . Purpose and value alignment, along with gratitude, are also important . Dr. Vertings recommends finding a challenge network, a group of supportive individuals who can be relied upon during difficult times . She concludes by promoting the Boss Female Surgeons Group Coaching Program and other resources available at bosssurgery.com . Chapter Introduction to Prolonged Stress Cycle Dr. AmyVertrees introduces the episode's focus on the prolonged stress cycle, a topic of significant relevance, particularly for female surgeons, given the multitude of stressors present in both medicine and the broader world. She highlights that this subject emerged from discussions within the female boss surgeons group, underscoring its importance and widespread applicability. The Female Boss Surgeons Group Dr. V describes the group of female surgeons who meet weekly, Wednesdays at 6 p.m. Central, and twice a month on Sundays, to discuss topics often overlooked in residency but essential for career advancement and mental well-being. Dr. Vertings' Background and the Boss Business and Surgery Series Dr. V shares her background as a general surgeon and certified coach, emphasizing her experiences in military and civilian settings, as well as in private practice, which inspired her to create the Boss Business and Surgery series. She notes that the business was reinvigorated in 2020 to address new challenges faced by surgeons. Program Structure: Difficult Colleagues and Complications Dr. V details the program's structure, which includes three-month modules dedicated to addressing difficult colleagues and managing the impact of complications. She emphasizes that the program teaches strategies to improve relationships and positively influence workplace dynamics. Pervasive Nature of Stress The discussion emphasizes the pervasive nature of stress, which is exacerbated by global events and the inherent demands of being a surgeon. Dr. V mentions theories suggesting that the high level of stress in the world may be intentional, designed to keep people off balance and disengaged. Stress Cycle in Training and Early Career The prolonged stress cycle often begins during training, with experiences that may have been hostile or malignant, significantly impacting future stress responses. Dr. V reflects on her own training, initially downplaying its hostility but later recognizing its challenging aspects. "What Happened to You?" and Dysregulated Nervous System Dr. V references the book "What Happened to You?" by Bruce Perry and Oprah Winfrey, explaining how prolonged stress can dysregulate the nervous system, hindering rational thinking. She explains that stress can overwhelm the primitive brain, preventing signals from reaching the smart part of the brain. Regulated vs. Dysregulated Stress Dr. V differentiates between regulated stress, which builds tolerance and resilience, and dysregulated stress, which results from extreme, prolonged, and unpredictable situations. She notes that predictable, moderate, and controllable stress can lead to productive stress responses. The Stress Cycle: Trigger, Response, and Physiological Reaction Dr. V explains the stress cycle, which involves a trigger, a stress response (fight, flight, freeze, or fawn), and a physiological reaction. She emphasizes that recognizing these responses is crucial for managing stress effectively. Recognizing Physiological Stress Response Recognizing one's physiological stress response is crucial, as it serves as a red flag indicating excessive stress. Dr. V provides examples such as increased heart rate, muscle tension, and poor sleep. Surgical Scenario and Stress Response Dr. V provides an example of a stressful surgical scenario, emphasizing that recognizing a stress response is a sign of awareness, not a personal failing. She notes that in high-stress situations, the primitive brain can take over, hindering clear thinking. Finding a Colleague for Stability Finding a colleague in stressful situations can provide stability and prevent potentially harmful actions. Dr. V likens this to grabbing onto a stable object during a tornado. Emotional Regulation and Decision Fatigue The discussion covers the importance of emotional regulation, especially for new attendings, and the impact of decision fatigue. Dr. Vertings notes that making numerous decisions can impair one's ability to make further decisions effectively. Impaired Coping Mechanisms Impaired coping mechanisms, such as doom scrolling or overeating, can worsen the stress cycle. Dr. V explains that these behaviors are often attempts to avoid negative feelings but ultimately lead to increased vulnerability. Confidence as Emotional Regulation Confidence is defined as the ability to manage any emotion, including fear and uncertainty, while still acting effectively. Dr. V emphasizes that courage is acting despite feeling fear. Techniques to Interrupt the Stress Cycle Practical techniques to interrupt the stress cycle include deep breathing exercises, focusing on the next best step, and box breathing. Dr. V mentions Dr. Robin Tiger's advice on using deep breathing for both surgeons and patients. Importance of Emotional and Physiological Regulation Dr. V stresses that emotional and physiological regulation is crucial for surgeons, who are leaders of their teams and responsible for their patients. She notes that a calm leader can help the team remain calm and effective. Communicating with Families During Stressful Events Dr. V advises on communicating with families during stressful events, emphasizing the importance of reassuring them that their loved one is okay. She suggests leading with the assurance that the patient is fine before explaining the details. Value of a Second Set of Skilled Eyes The value of having a second set of skilled eyes, such as residents, is highlighted, as they can prevent potentially devastating mistakes. Dr. Vertings shares a personal experience where a resident prevented her from making a significant error. Strategies to Manage the Stress Cycle Strategies to manage the stress cycle include awareness and tracking, physiological regulation, emotional processing, cognitive reframing, and setting boundaries. Dr. V emphasizes the importance of naming and owning feelings. Purpose, Value Alignment, and Gratitude Purpose and value alignment, along with gratitude, are also important. Dr. V suggests reflecting on past experiences to identify one's values and aligning actions with those values. Finding a Challenge Network Dr. V recommends finding a challenge network, a group of supportive individuals who can be relied upon during difficult times. She credits Dr. Jill Clark for this concept. Promotion of Boss Female Surgeons Group Coaching Program Dr. V concludes by promoting the Boss Female Surgeons Group Coaching Program and other resources available at bosssurgery.com. She mentions upcoming topics such as power and negotiating, as well as strategies for managing clinic and developing a CEO self-concept.

The latest BOSS podcast episode features Dr. Jill Clark, with a truly inspiring story. She had her dream job as a colorectal surgeon in a beautiful city, respected by her peers. But under the surface, she felt a growing discontent—one that she tried to ignore until life forced her to listen. Between the pandemic, a breast cancer diagnosis, and an unraveling work environment, Jill felt like a hurricane leveled her life. What happened next wasn't just a recovery—it was a reinvention. In this episode, you'll learn: How to recognize red flags that your job may not be the right fit Why “quitting” can be a sign of strength, not failure The value of a "challenge network" and coaching when navigating change How to get clear on what you want—and ensure a “want match” before accepting your next position Dr. Clark's honesty is refreshing, her insight is hard-won, and her story is exactly what so many surgeons need to hear right now.Find me at: https://www.centeredsurgeon.com/Linked In: https://www.linkedin.com/in/jillclarkmd/

Summary Dr. Elisa Chiang discussed strategies for creating predictability in unpredictable economic times, emphasizing that the fundamentals of the economy are generally sound, with current uncertainty stemming from external factors. She highlighted the importance of understanding economic interrelations and the potential impact of challenging international relationships. Dr. Chiang suggested that individuals and businesses should evaluate their dependencies and explore ways to become more self-reliant. For physicians, this includes recognizing the value of their skills and exploring options beyond traditional employment, such as private practice or becoming invaluable within their current roles. She also emphasized the importance of diversifying income streams and managing personal finances to reduce reliance on a single paycheck. The conversation also covered strategies for physicians to increase their income, such as specializing in high-value procedures, leveraging support staff, and improving efficiency. Dr. Chiang advised questioning fixed mindsets, challenging existing beliefs, and experimenting with new approaches to adapt to unpredictable times. She also discussed tax planning, investment strategies, and the importance of maintaining a long-term perspective when dealing with market volatility. For those nearing retirement, she recommended assessing risk tolerance, diversifying portfolios, and building a cash cushion. Dr. Chiang offers one-on-one coaching to help individuals navigate their financial situations and achieve their financial goals. Her podcast, 'Grow Your Wealthy Mindset,' provides financial literacy in bite-sized pieces, helping listeners build the knowledge and mindset needed to create financial stability. Chapters Introduction to Predictability in Unpredictable Times Elisa Chiang was invited to discuss creating predictability in unpredictable economic times. The discussion is framed as non-political, focusing on the factual unpredictability of the world. The goal is to provide strategies for individuals to make their financial situations more predictable. Economic Fundamentals and Global Interdependence Chiang stated that the fundamentals of the economy are still good, unlike the issues in 2008 with banking regulation. The current uncertainty is attributed to the actions and statements of certain individuals. The discussion highlights the importance of understanding the complexities of economics and global interrelations. Anytime decisions are made from an independent place, you start to realize we're actually not independent at all. Challenging Independence and Embracing Interdependence Chiang suggests challenging the idea of complete independence and recognizing interdependence on others. Asking questions about dependencies and self-reliance is valuable, but actions must be carefully considered. Many people feel dependent on their paycheck, but physicians have options due to the physician shortage. Separating the ability to produce income from the current job can create stability. Creating Independence and Managing Control The discussion covers the mentality behind creating a private practice and the desire for independence. It's noted that even in private practice, there is still interdependence on systems and people. The focus should be on how to become independent and self-determining results in situations where you don't have control over all of these things. It's important to understand what you can and can't control. Strategies for Exerting Independence Chiang suggests becoming an entrepreneur within your job to make yourself invaluable. This involves attracting patients directly and highlighting your value to the practice or institution. Employers care about generating income, so making yourself invaluable in this area is crucial. Taking care of personal finances and creating multiple income streams reduces reliance on a single paycheck. Translating Value into Income The inherent value of experience, training, and knowledge is highlighted. Physicians translate this value into income through their actions. The trap of trading time for money limits income potential unless value is translated into different income streams. The discussion explores ways physicians can generate income outside the classic RVU model. Increasing Income within the Physician Realm Specializing in specific procedures or surgeries can elevate income. Leveraging other people, such as nurse practitioners, can double clinic output. Hiring scribes can increase productivity and collections. Physicians should work at the top of their income level, delegating tasks to others. Mindset Shifts for Unpredictable Times Adopting a growth mindset can help individuals respond more effectively in unpredictable times. Questioning current beliefs and challenging the status quo is important. Comparing oneself to others who are thriving can provide insights and motivation. Willingness to spend money to make money and accepting failure are key to success. Helping Individuals Deal with Change Questioning the truth of current situations and exploring potential changes is crucial. Experimenting with small changes and learning from others can lead to improvements. Advocating for necessary resources, such as dedicated scrub techs, can increase efficiency. Believing in the potential for change and presenting a clear case for it is essential. Financial Viability in Private Practice A simple formula for private practice success is income minus expenses minus tax burden. All three factors can be influenced in different ways. Leveraging people, doing more cases, and optimizing income streams are ways to increase income. Tax burden can be managed through various strategies. Tax Planning and Side Businesses Every time is unpredictable, so framing the mindset accordingly is important. The more we think like, yeah, the world is doing whatever it's worlding. The world is doing whatever it's doing. We can make our own predictivity, then we don't have to keep thinking like, oh, it's unpredictable, and we have no way to affect it. It's just always unpredictable. As a W-2 employee, there are limited options for tax reduction. Having a side business can provide opportunities to write off personal expenses. Side hustles should align with passions and translate into value and money. Time Management and Productivity Finding something else that you need to find you having to find more time in order to do something helps you structure your time so that you are most efficient with your time. Limited time resources require careful management. Calendaring and time-blocking can improve efficiency. Having a list of tasks that can be done in 10-15 minute intervals can boost productivity. Managing Retirement Funds If retirement is 10 years or more away, continue with the financial plan and consider contributing more. Maximize retirement accounts and explore other savings options. Buying stocks when they are on sale can be a great strategy. Establish a risk tolerance and adjust investment strategies accordingly. Investment Strategies and Risk Tolerance The stock market tends to go up over time, especially with more people investing. Investing during downturns can lead to better outcomes. Even in retirement, there is still a long investing career ahead. Avoid panic selling and maintain a long-term perspective. Retirement Planning and Withdrawal Rates Assess investment strategies and consider shifting to a more conservative portfolio if nearing retirement. Develop a cash cushion to avoid selling stocks during the first few years of retirement. Understand what money is for and focus on enjoyment and security. Consider a Monte Cristo analysis to assess the chances of running out of money. Dr. Chang's Coaching and Podcast Chiang offers one-on-one coaching to help individuals reach their financial goals. She provides a judgment-free zone to discuss finances and job transitions. Her podcast, 'Grow Your Wealthy Mindset,' provides financial literacy in bite-sized pieces. The podcast helps listeners learn the information and mindset needed to create financial stability. Action Items Dr. Chiang suggested individuals and businesses should evaluate their dependencies and explore ways to become more self-reliant. Dr. Chiang advised physicians to recognize the value of their skills and explore options beyond traditional employment. Dr. Chiang emphasized the importance of diversifying income streams and managing personal finances. Dr. Chiang recommended questioning fixed mindsets and experimenting with new approaches. Dr. Chiang advised assessing risk tolerance and diversifying portfolios. Dr. Chiang recommended building a cash cushion for those nearing retirement.Growyourwealthymindset.com

Summary The meeting focused on discussing the concept of being a 'slow surgeon' and strategies for managing surgical performance and confidence. The speaker began by exploring what 'slow' means in surgical context, encouraging participants to share their perspectives. Participants noted that slowness could be relative, influenced by comparison to others, and affected by various factors including system constraints, knowledge, skill, and self-talk. The speaker emphasized that perception of speed isn't just internal but also involves others' impressions. They discussed how the Da Vinci robot provides metrics that sometimes contradict personal perceptions of speed. A significant portion of the discussion centered on mindset and thought patterns. The speaker introduced the thought model, based on cognitive behavioral therapy, explaining how facts trigger thoughts, which lead to emotions and ultimately actions. They emphasized the importance of reframing negative thoughts and managing both internal and external criticism. The presentation included practical strategies for building confidence, including mental rehearsal, grounding statements, and team briefing. The speaker also discussed the importance of self-compassion and accepting that mistakes are part of the learning process. The session concluded with information about a coaching program designed to help surgeons navigate various challenges, including complications, difficult colleagues, and practice management. Chapters Understanding the Concept of 'Slow' in Surgery00:00:16 The speaker initiated a discussion about what it means to be a 'slow surgeon', encouraging participants to examine their perceptions of slowness. The concept was explored as both a measure of time and a feeling, with participants noting it's often relative to others' performance. The Impact of Mindset in the Operating Room00:02:36 The speaker discussed how mindset influences performance, emphasizing the importance of understanding both personal opinions and others' perceptions in the OR. They explored how thoughts influence behavior and experience. Managing Internal and External Perceptions00:04:04 The discussion covered how surgeons can manage both their internal dialogue and external feedback. The speaker emphasized the importance of reframing thoughts and handling criticism constructively. Building Confidence Through Preparation00:12:19 The speaker presented strategies for building confidence, including assessing current reality, setting goals, and understanding how to improve both self-perception and others' perceptions. Practical Tools for Improvement00:54:52 The presentation included specific tools and techniques for improving surgical performance, including mental rehearsal, grounding statements, and effective team communication. Action Items The speaker recommended implementing a performance dashboard to track surgical steps and confidence levels00:29:06 The speaker suggested developing clear communication and boundaries when working with fellows00:14:02 The speaker advised creating specific benchmarks for both personal performance and fellow training00:14:55 The speaker recommended implementing pre-operative mental rehearsal with specific time boundaries00:51:05 The speaker suggested developing grounding statements for managing thoughts and emotions in the OR00:51:59

Summary Dr. Amy Vertrees hosts a discussion with Sarah Bellenger, a CRNA with extensive military and civilian healthcare experience. Sarah discusses her journey from military service to civilian practice, and the development of her app 'ManageYou'. Sarah Bellenger shares her 25-year nursing career experience, including service at the White House, military deployments, and transition to civilian practice. She emphasizes the importance of team-based care and the evolving role of CRNAs, particularly in rural healthcare settings. The discussion explores the challenges in anesthesia care team models, with Sarah explaining how CRNAs work independently in rural settings while collaborating with anesthesiologists in urban areas. She notes that the industry faces a significant staffing shortage, with a need for various provider types to ensure adequate coverage. Sarah introduces her app 'ManageYou', developed to address the widespread challenge of managing healthcare credentials. The app, available in both app stores, helps healthcare providers track and manage their professional documents, certifications, and licenses. She mentions that credential management is a $39 billion industry, and document mismanagement can cost facilities approximately $9,000 per day in lost billables. The discussion concludes with Sarah outlining future developments for ManageYou, including enhanced security features and potential integration with national credentialing systems. She emphasizes the importance of making credential management more efficient and accessible for healthcare providers. Chapters Introduction and Background Dr. Amy Vertrees introduces Sarah Bellenger, a CRNA with extensive military experience who developed an app for credential management. Sarah shares her 25-year nursing career journey, including service at the White House and multiple deployments. Evolution of CRNA Practice Sarah discusses the differences between military and civilian CRNA practice, emphasizing the importance of independent practice capabilities, especially in rural healthcare settings. She explains how military training prepares CRNAs for autonomous practice. Anesthesia Care Team Models Sarah explains the various anesthesia care team models, discussing the collaboration between CRNAs and anesthesiologists, particularly in urban versus rural settings. She addresses the industry-wide staffing challenges and potential solutions. ManageYou App Development Sarah describes the development of ManageYou, inspired by personal experiences with credential management challenges. She explains how the app helps healthcare providers organize and track their professional documents and certifications. Security and Future Development Sarah outlines the security measures implemented in ManageYou and discusses future developments, including enhanced features and potential integration with national credentialing systems. Action Items Sarah Bellenger mentioned the launch of ManageYou app in both Google Play and App Store for healthcare providers to manage their credentials Sarah Bellenger indicated plans to implement new security features for the app that exceed current standards Sarah Bellenger proposed integration with NCQA and other national credentialing systems for streamlined verification processes Sarah Bellenger recommended starting credential documentation with high-priority items like diplomas and frequently renewed certifications like CPRLinktree: http://linktr.ee/manageyouWebsite: www.manageyouapp.comLinkedIn https://www.linkedin.com/company/manage-you/ Instagram https://www.instagram.com/manageyou_app Facebook https://www.facebook.com/Manageyouapp1

In this episode of the BOSS Business of Surgery Series, we dive into the journey behind the third edition of a widely used surgical textbook. Dr. Mark Neff, the book's original author, shares how failing his oral board exam inspired him to create a resource that has since transformed surgical education. Joined by Dr. Kay Yoon-Flanery, a fellowship-trained breast surgeon, and Dr. Ashanti Ratnasekera, a trauma and acute care surgeon, the discussion explores the book's impact, the role of mentorship, and the lessons learned from the oral board experience. Key Topics Discussed:

Episode Summary: In this episode, we sit down with Dr. Michael Hersh, a practicing gastroenterologist and physician coach, to discuss his personal journey through medical burnout and how coaching transformed his career and well-being. Dr. Hersh shares candid insights into the pressures of practicing medicine, the impact of a malpractice lawsuit, and the additional stressors brought on by COVID-19. He highlights the power of choice in shaping a sustainable medical career, the importance of work-life balance, and the role of vulnerability in leadership. We also delve into gender dynamics in medicine and the unique challenges male physicians face in work-life balance and emotional resilience. Dr. Hersh offers practical strategies for reclaiming agency in the workplace, setting boundaries, and using stress constructively. Tune in to learn how physician coaching can be a game-changer for personal and professional fulfillment. Chapters:

Summary In this interview, Dr. Adrienne Towson, an orthopedic surgeon with 21 years of experience, shared her professional journey and insights about the changing landscape of healthcare. Dr. Towson discussed her career progression from hospital employment to private practice, and ultimately to a private equity-backed management company. She described her early career challenges as a single mother with two young children, and her evolution through various practice models. Dr. Towson expressed concerns about the impact of private equity on healthcare delivery, particularly regarding patient care and physician autonomy. She emphasized the importance of maintaining the patient-physician relationship and discussed her plans to transition from her current practice while remaining committed to healthcare reform efforts. The conversation highlighted the challenges faced by physicians in the current healthcare system, including insurance company restrictions, administrative burdens, and the need for systemic change. Chapters Introduction and Background of Dr. Towson Dr. Towson introduced herself as an orthopedic surgeon with 21 years of experience, having completed her medical training and residency in Philadelphia and Pittsburgh. She described her career journey from hospital employment to private practice, and eventually to a private equity-backed management company. Early Career and Hospital Employment Dr. Towson explained her decision to join a hospital-employed position shortly after fellowship, citing proximity to home and support for her young children as key factors. She described the challenges of being the only orthopedic surgeon at the hospital and managing on-call responsibilities. Transition to Private Practice Dr. Towson discussed her move to a private practice where she became the fifth surgeon in a well-established group. She highlighted the positive aspects of the practice, including supportive colleagues and a family-like atmosphere, as well as the group's commitment to patient care. Evolution to Super Group and Private Equity Dr. Towson described the transition to a 'super group' model, where smaller practices combined for better negotiating power and ancillary services. She discussed the benefits of this model, including improved insurance contracts and the establishment of physical therapy and MRI services. Concerns About Private Equity Ownership Dr. Towson expressed concerns about the impact of private equity on healthcare delivery, describing how these firms typically aim to improve productivity for short-term profit before selling. She shared her experience of how the practice's operations and patient care quality have been affected since the acquisition. Future Plans and Healthcare Reform Involvement Dr. Towson discussed her plans to leave her current practice in June and pursue locum tenens work while remaining active in healthcare reform efforts. She expressed her desire to return to private practice in her community within one to two years, either in a small boutique practice or potentially reuniting with former colleagues. Action Items Dr. Towson plans to complete her current practice commitment by June and begin locum tenens assignments Dr. Towson will continue working with healthcare reform organizations while exploring temporary assignments Dr. Towson aims to return to her community in one to two years, either in a small private practice or potentially reuniting with former colleagues