BOSS Business of Surgery Series

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

Summary In this interview, Dr. Sarah Smith, a rural family physician and charting coach, shared valuable insights about improving clinical efficiency and patient care. Dr. Smith discussed common challenges faced by surgeons in clinic settings, including high patient volume, time management, and staff delegation. She emphasized the importance of effective communication with clinic staff, proper delegation, and creating standard operating procedures. Dr. Smith also highlighted strategies for managing patient encounters more efficiently, including integrating note-taking into patient visits and prioritizing tasks. The discussion covered both clinical workflow optimization and staff management, providing practical solutions for improving surgical practice efficiency. Dr. Smith introduced her program 'Charting Champions' and the 'Sustainable Clinical Medicine' podcast as resources for further support and development. Chapters Introduction to Dr. Sarah Smith and Clinic Challenges Dr. Sarah Smith introduced herself as a rural family physician working in various capacities including emergency and hospitalist roles. She discussed common challenges in surgical clinics, including high patient volume, staff interruptions, and time constraints. Staff Delegation and Management Dr. Smith emphasized the importance of understanding staff capabilities and creating a common goal. She discussed how to identify staff strengths and weaknesses, and the importance of developing standard operating procedures for clinic tasks. Patient Encounter Optimization Dr. Smith provided strategies for managing patient visits more efficiently, including integrating note-taking during consultations, prioritizing tasks, and making effective use of appointment time. Charting and Documentation Strategies Dr. Smith discussed the importance of completing notes during patient encounters rather than leaving them until later, and the value of leaving 'breadcrumbs' in documentation to avoid blank notes. Introduction to Charting Champions Program Dr. Smith introduced her 'Charting Champions' program, which offers foundational modules and ongoing support for healthcare professionals looking to improve their clinical efficiency and documentation practices. Action Items Implement standard operating procedures for clinic tasks to improve efficiency Schedule regular check-in times for staff to ask questions and receive guidance Create answer sheets for frequently asked questions to empower staff Integrate note-taking into patient encounters rather than leaving it until later Consider joining the Charting Champions program for ongoing support check it out here

Summary Dr. Amy Vertrees presented a comprehensive discussion on 'Swimming with Sharks 2.0', exploring the metaphor of surgery and surgical environments as shark-infested waters. She explained how surgeons are often perceived as sharks, and how this perception has been perpetuated in medical culture. Dr. Vertrees, a general surgeon in private practice, author of 'Become the Boss MD', and certified coach, drew from a 1974 article about swimming with sharks to create modern lessons for navigating surgical environments. She emphasized the importance of understanding both sharks and human nature, discussing how people respond to stress through fight, flight, flee, or fawn responses. The presentation covered strategies for protecting oneself in challenging environments, managing negative emotions, and developing self-compassion. Dr. Vertrees also introduced her year-long Boss Surgeons program, which helps surgeons develop professional and personal growth strategies. Chapters 00:00:02Introduction to Swimming with Sharks 2.0 Dr. Amy Vertrees introduces the concept of 'Swimming with Sharks 2.0', explaining how surgery is metaphorically like swimming with sharks, where surgeons are perceived as sharks in a dangerous environment. 00:02:11Understanding Sharks and Human Nature Dr. Vertrees draws parallels between sharks and human behavior, explaining how both respond to environmental triggers and have the capacity for both harm and cooperation. 00:05:08Managing Stress Responses and Emotions Discussion of the motivational triad and different stress responses (fight, flight, flee, or fawn), emphasizing the importance of understanding personal stress reactions in surgical environments. 00:08:16Strategies for Swimming with Sharks Dr. Vertrees presents various strategies for navigating challenging professional environments, including anticipatory retaliation and managing coordinated attacks. 00:47:28The Boss Surgeons Program Overview Introduction to the year-long Boss Surgeons program, covering five categories including difficult colleague management, complications handling, power negotiating, clinic efficiency, and personal development. Action Items 00:56:28Dr. Vertrees will upload the presentation to a landing page and send out the replay link by email 00:49:21Participants in the Boss MD program should prepare their goodbye letter to their 2024 self 00:52:59Interested participants can sign up for the Boss Surgeons program at bosssurgery.com with a $1,000 discount 00:50:17Dr. Vertrees will implement more flexible meeting times based on poll results in the Facebook group 00:59:23Participants should contact Dr. Vertrees at drvertrees@gmail.com or through Facebook for program questions

SummaryIn this interview, Dr. Susan Trocciola, a cardiothoracic surgeon, discussed her experiences with locum tenens work and expert witness consulting. Dr. Trocciola shared her journey from traditional employment to locums after facing challenges in finding the right job fit and dealing with personal health issues. She emphasized how locums work has allowed her to achieve better work-life balance, earning twice as much while working half as much compared to her previous full-time job. Dr. Trocciola detailed her approach to determining value in locums work, recommending rates starting at $2,500 per day, and discussed the importance of establishing boundaries with locums companies. She also shared insights about her expert witness work, explaining how it has made her a better doctor through improved documentation practices. The discussion highlighted the benefits of locums work in providing flexibility, better patient care options, and opportunities for professional growth.ChaptersIntroduction and Background of Dr. Susan TrocciolaDr. Trocciola introduced herself as a cardiothoracic surgeon trained at prestigious programs including Cornell, NYU, and Texas Heart. She shared her journey through traditional employment challenges, personal health issues, and eventual transition to locums work.Benefits of Locums WorkDr. Trocciola discussed how locums work has transformed her approach to medicine, allowing her to focus on patient care rather than RVUs. She shared an example of prioritizing patient care over personal convenience in a recent case. Determining Value in Locums WorkDr. Trocciola explained her approach to establishing value in locums work, recommending working with multiple companies to understand market rates and emphasizing the importance of negotiating fair compensation. Navigating Locums AssignmentsDr. Trocciola shared insights about identifying good locums companies, establishing boundaries, and recognizing when to leave assignments that aren't a good fit.Expert Witness WorkDr. Trocciola discussed her journey into expert witness work, how it has improved her practice, and the importance of honesty and thorough documentation in both expert witness cases and clinical practice.Future Plans and Work-Life BalanceDr. Trocciola expressed her desire to reduce clinical work and increase expert witness work, emphasizing the importance of maintaining work-life balance and having time for personal activities.Action ItemsDr. Trocciola recommends starting locums assignments with shorter commitments to allow for better evaluation and negotiation opportunitiesDr. Trocciola advises establishing a minimum daily rate of at least $2,500 for locums workDr. Trocciola suggests working with multiple locums companies to understand market rates and negotiate better contractsDr. Trocciola emphasizes the importance of thorough documentation in both clinical practice and expert witness work

Summary This meeting featured a discussion with Dr. Josh Hartzell about his new book 'A Prescription for Caring in Healthcare Leadership'. Dr. Hartzell, a recently retired army colonel with 25 years in military medicine, shared insights about building a culture of compassion and excellence in healthcare leadership. He emphasized how healthcare, despite being a caring profession, often neglects its own people. The discussion covered the importance of caring leadership, delegation, giving feedback, and expressing gratitude in healthcare settings. Dr. Hartzell shared personal experiences from his military career and discussed how early influences shaped his leadership philosophy. The conversation highlighted the critical need to balance mission accomplishment with caring for people, addressing burnout in healthcare, and creating positive organizational cultures through intentional leadership practices. Chapters Introduction to Dr. Hartzell and His Book The host introduces Dr. Josh Hartzell and his book 'A Prescription for Caring in Healthcare Leadership'. Dr. Hartzell explains his background as a retired army colonel with 25 years in military medicine. The State of Healthcare Leadership Discussion reveals healthcare as one of the most toxic industries despite being a caring profession and highlights the need for better care of healthcare workers. Early Influences and Leadership Development Dr. Hartzell shares how his parents and early mentors shaped his understanding of caring leadership, including examples from his mother's work at Walmart and his father's community service. Balancing Mission and People The discussion explores how good managers can accomplish both mission objectives and care for their people, challenging the traditional 'mission first' mentality in healthcare. Delegation and Growth Opportunities Dr. Hartzell explains how effective delegation shows respect for others' roles and provides growth opportunities, emphasizing the importance of transparent communication. Action Items Hartzell recommends leaders should actively look for reasons to say thank you to all staff members, from physicians to cleaning staff Leaders should set boundaries and make personal health a priority to model work-life balance for their teams Healthcare leaders should implement systematic changes to address burnout rather than just offering temporary solutions Leaders should provide both positive and constructive feedback to build trust and improve performance Organizations should focus on creating transparent systems for delegation and professional development

Episode Title: Blood Sugar Stabilization and Preventive Health with Dr. Amina Goodwin Summary:In this insightful episode of the BOSS Business of Surgery Series, Dr. Amina Goodwin shares her expertise on blood sugar stabilization and its impact on overall health. An internal medicine and infectious disease physician originally from Antigua, Dr. Goodwin has been practicing in Mississippi since 2013. She discusses her extensive experience treating diabetic patients and her transition to locum tenens work, which grants her the flexibility to focus on preventive care. Dr. Goodwin introduces her upcoming book, Beaming Health, set for release on February 6, and explains her BEAM framework for blood sugar management: Burn more sugar, Eat less sugar, Absorb less sugar, and Make less sugar. She highlights the significance of maintaining stable blood sugar levels and examines how stress, diet, and lifestyle choices influence glucose regulation. The discussion also covers the benefits of continuous glucose monitoring and the limitations of medication-based interventions like GLP-1 agonists, advocating for sustainable, lifestyle-based solutions. Episode Chapters: 00:00:00 – Introduction and Background of Dr. Amina GoodwinDr. Goodwin introduces herself, detailing her journey as a physician from Antigua to Mississippi. She discusses her work with diabetic patients and her shift to locum tenens practice, which allows her to focus on preventive care and writing her book. 00:06:14 – The BEAM Framework for Blood Sugar ManagementDr. Goodwin breaks down her BEAM strategy for regulating blood sugar, using a kitchen sink analogy to explain how insulin functions in the body. 00:15:24 – Burning Sugar and Physical ActivityShe emphasizes the importance of consistent movement throughout the day rather than relying solely on dedicated gym sessions. She explains the role of muscle mass in sugar metabolism. 00:19:04 – Eating and Sugar ConsumptionDr. Goodwin advises monitoring added sugar intake, setting a limit of 24 grams (6 teaspoons) per day. She also introduces her 'bean food pyramid' concept. 00:24:28 – Absorption and Food PairingShe explains how fiber, protein, and fat help slow sugar absorption, using a football field analogy to illustrate their effects on blood sugar regulation. 00:27:10 – Stress and Blood Sugar RegulationDr. Goodwin discusses the impact of stress on blood sugar levels, including psychological stressors and physical stressors such as sleep apnea and chronic inflammation. 00:30:06 – Medication Approaches and Lifestyle ChangesShe reviews GLP-1 agonists and other medications, emphasizing that while they can be helpful, they should not replace foundational lifestyle modifications. She encourages focusing on natural, sustainable health practices. Key Takeaways and Action Items: ✔ Monitor added sugar intake – Stay within 24 grams (6 teaspoons) per day (00:20:28)✔ Incorporate physical activity regularly – Move every 60-90 minutes throughout the day (00:15:59)✔ Use continuous glucose monitoring – Track real-time blood sugar levels (00:12:15)✔ Prioritize whole foods – Prepare meals using basic, unprocessed ingredients (00:22:18)✔ Manage chronic stress – Address underlying factors like sleep apnea and inflammation (00:28:16) Why You Should Listen:This episode is essential for healthcare professionals and anyone interested in metabolic health, as Dr. Goodwin provides practical, science-backed strategies for improving blood sugar regulation. Her BEAM framework offers an easy-to-follow guide for optimizing diet, movement, and stress management, helping listeners take control of their long-term health.

Find more information here: https://www.cdc.gov/niosh/healthcare/impactwellbeingguide/index.html https://drlornabreen.org/become-an-ambassador/ Summary In this interview, Dr. Stephanie Simmons, an emergency room physician and Chief Medical Officer of the Lorna Breen Foundation, discussed the critical issue of mental health among healthcare workers. Dr. Simmons shared her personal experience with postpartum depression during residency and how it shaped her understanding of mental health stigma in medicine. She described her work leading professional well-being initiatives for 26,000 physicians across 1,000 hospitals in 36 states before the pandemic. Dr. Simmons detailed the foundation's mission to remove barriers to mental health care for healthcare workers, particularly focusing on changing licensing and credentialing practices that discriminate against those with past mental health treatment. She emphasized the importance of culturally competent care for healthcare workers and discussed legislative efforts, including the Dr. Lorna Breen Healthcare Provider Protection Act, which funded 45 projects across the country to promote healthcare workforce well-being. The conversation highlighted the three sources of stigma facing healthcare workers: internal, external, and institutional, and how the foundation is working to address these issues through advocacy, collaboration, and solution acceleration. Chapters Introduction and Personal Journey Dr. Simmons introduced herself as an emergency medicine physician and Chief Medical Officer of the Lorna Breen Foundation. She shared her personal experience with postpartum depression during residency and the initial fears that prevented her from seeking help, which later informed her work in professional well-being. Scaling Well-Being Programs Dr. Simmons explained her approach to implementing well-being programs for 26,000 physicians across 1,000 hospitals in 36 states, focusing on leadership training, coaching programs, and developing Wellness Champion networks at each site. The Impact of the Pandemic Dr. Simmons described how the pandemic changed the landscape of healthcare worker well-being, comparing pre-pandemic efforts to the increased urgency and visibility of mental health issues during the crisis. The Lorna Breen Foundation Dr. Simmons detailed the foundation's origins following Dr. Lorna Breen's death, its mission to change perceptions of mental health care as a sign of strength, and its focus on removing workplace obstacles to joyful medical practice. Addressing Stigma and Barriers Dr. Simmons discussed the three sources of stigma facing healthcare workers: internal, external, and institutional. She outlined the foundation's strategies to address these issues through legislative advocacy and systemic change. Legislative Advocacy and Impact Dr. Simmons explained the foundation's work on the Dr. Lorna Breen Healthcare Provider Protection Act, its funding of 45 projects, and ongoing efforts to reauthorize the legislation and implement its findings. Action Items Dr. Simmons mentioned the need to remove invasive and stigmatizing language from licensing and credentialing applications Dr. Simmons emphasized the importance of increasing access to culturally competent mental healthcare for healthcare workers Dr. Simmons proposed implementing screening programs like the ISP (Interactive Screening Program) backed by culturally competent care Dr. Simmons recommended using the Impact Well-Being Guide as a starter resource for hospital leaders Dr. Simmons highlighted the need to advocate for changes in peer reference forms to eliminate questions about past mental health treatment

Summary In this interview, Dr. Mel Thacker discussed her significant career transition from a successful surgical practice to becoming a coach for surgeons. Dr. Thacker shared that she left her practice in December 2024 after nearly a decade of service, despite being at the peak of her career with a high six-figure income. She cited three main reasons for her departure: moral injury from the healthcare system, witnessing unsafe practices in the for-profit hospital system, and personal growth. Dr. Thacker described a pivotal moment in September 2023 when she encountered systemic issues with insurance approvals that deeply affected her practice. She emphasized her transformation through coaching, which helped her overcome panic attacks and develop new methods for handling surgical complications. Now, she focuses on empowering surgeons through coaching, offering group programs and resources to help them navigate the challenges of modern medical practice. Chapters Career Transition and Current Status Dr. Thacker explained her recent career change, leaving a successful surgical practice after nearly a decade. She described being at the top of her game, with excellent surgical skills and patient connections, before making the decision to leave. Reasons for Leaving Practice Dr. Thacker outlined three primary reasons for her departure: moral injury from the healthcare system, witnessing unsafe practices in the for-profit hospital system, and personal growth through coaching. She emphasized that her husband supported her decision despite being the primary breadwinner. Experiences with Healthcare System Challenges Dr. Thacker detailed her experiences with moral injury, including a specific incident in September 2023 where an insurance company denied necessary surgery for a patient. She described multiple instances of systemic issues affecting patient care and treatment options. Coaching Transformation and Methodology Dr. Thacker discussed her transformation through coaching, developing what she calls the 'on layering method' for handling surgical complications. She explained how she applies coaching concepts to surgery and helps other surgeons through this process. New Direction and Coaching Focus Dr. Thacker introduced her new coaching program, the 'Empowered Surgeons Group,' starting April 30, 2025. She described the program structure, including weekly meetings, self-directed learning modules, and a comprehensive workbook.

Summary The meeting featured Frank Lobb, a former Navy pilot, discussing healthcare insurance contracts and their impact on medical care. Lobb shared his personal experience of losing his wife after being denied healthcare coverage, despite offering to pay out of pocket. He explained how his investigation through legal proceedings revealed that healthcare insurance contracts are secret, state-approved documents that effectively allow insurance companies to ration healthcare. Lobb discovered that these contracts, standardized around 1990, contain provisions that prevent patients from paying for care when insurance denies coverage. He emphasized how the Consumer Financial Protection Bureau's recent involvement has shifted the burden of proof for billing accuracy to healthcare providers. The discussion highlighted how the current system disadvantages both patients and healthcare providers, with Lobb suggesting that medical organizations like the AMA should push for contract reform. Chapters Introduction to Frank Lobb and His Healthcare Experience Frank Lobb introduced himself as a former Navy pilot who became involved in healthcare contract analysis after personal tragedy. He shared his experience with DuPont's Clean Air Act negotiations, demonstrating his ability to analyze complex legal situations despite not being an attorney. Personal Tragedy and Legal Investigation Lobb described how his wife's illness led to his investigation of healthcare contracts. Despite offering to pay, multiple hospitals denied care after his insurance company's denial. Through legal proceedings, he gained rare access to typically secret insurance contracts. Evolution of Healthcare Insurance System Lobb explained how healthcare insurance evolved from a simple fee-for-service model in 1929-1930 to the current complex system. He highlighted the Supreme Court's 1990 ruling that confirmed insurance companies' right to ration healthcare. Contract Structure and Patient Rights Lobb revealed that unlike other insurance types, health insurance operates on a single contract system. He emphasized that patients don't actually have contracts with their insurance companies, only providers do. Consumer Financial Protection Bureau's Impact Lobb discussed how the Consumer Financial Protection Bureau's involvement has shifted the burden of proof for billing accuracy to healthcare providers, potentially creating leverage for system reform.

Summary The meeting featured Dr. Erin Stevens, a gynecologist oncologist at Prevea Health, discussing her experiences with medical mission trips to Bolivia through Solidarity Bridge since 2019. Dr. Stevens shared how she began these missions through a former surgery partner's invitation, initially working in Santa Cruz and later in Sucre. She detailed the significant differences between US and Bolivian healthcare systems, particularly in equipment usage and resource conservation. Dr. Stevens emphasized how Bolivian medical staff meticulously maintain and reuse equipment that would be discarded in the US. She highlighted the critical issue of cervical cancer in Bolivia, where screening rates are below 20% and treatment options are limited. The discussion also covered the evolution of her teaching approach, focusing on building sustainable surgical skills among Bolivian doctors and the importance of cultural understanding in medical missions. Chapters Introduction to Medical Mission Work in Bolivia Dr. Stevens described her background as a gynecologist with 11-12 years of experience in rural medicine, practicing in Montana and Wisconsin. She began mission trips to Bolivia with Solidarity Bridge in 2019, initially working in Santa Cruz and later in Sucre. Impact of COVID-19 on Mission Work Dr. Stevens discussed how the 2020 mission was cancelled due to the pandemic. She explained the lasting effects on Bolivia's healthcare system, including continued universal masking and delayed vaccine distribution. The pandemic significantly impacted cancer screening rates, which dropped to zero during 2020-2022. Equipment and Resource Management in Bolivian Healthcare Dr. Stevens detailed how Bolivian healthcare providers maximize resource utilization, including meticulous cleaning and reuse of surgical equipment. She highlighted the stark contrast with US practices regarding medical waste and equipment disposal. Teaching and Cultural Exchange Dr. Stevens emphasized the importance of working in solidarity with Bolivian medical professionals, focusing on teaching surgical skills while learning from their practices and culture. She described the progress made in teaching laparoscopic procedures and the relationship built with local medical staff. Action Items Stevens mentioned the need to continue providing essential surgical equipment to Bolivian hospitals Stevens highlighted the importance of establishing sustainable training programs for laparoscopic surgery Stevens emphasized the need to address cervical cancer prevention through increased screening and vaccination programs Stevens suggested exploring ways to improve medical supply conservation and reuse practicesFind her TEDx talk HERE

Summary Dr. Robyn Tiger, a double board-certified physician in diagnostic radiology and lifestyle medicine, discusses her book 'Feeling Stressed is Optional' and shares insights on stress management for physicians. She emphasizes that while stressors are inevitable, feeling stressed is optional. Dr. Tiger introduces the concept of 'stress-free snacks' - quick, implementable tools for managing stress in busy medical settings. She explains the six pillars of lifestyle medicine, including stress management, nutrition, sleep, social connection, exercise, and avoiding risky substances, with nature as an unofficial seventh pillar. The discussion covers the importance of breathing techniques, co-regulation with patients, and the distinction between lifespan and healthspan. Dr. Tiger emphasizes making 1% improvements daily rather than overwhelming changes. Chapters Introduction to Dr. Robin Tiger and Her Book Dr. Tiger introduces herself as a double board-certified physician in diagnostic radiology and lifestyle medicine, discussing her new book focused on transforming chronically stressed physicians' lives. Stress Management Through Breathing Techniques Dr. Tiger explains the four functions of breathing and introduces the concept of co-regulation with patients through breathing exercises, emphasizing how this can improve both physician and patient experience. The Six Pillars of Lifestyle Medicine Dr. Tiger outlines the six pillars: stress management, nutrition, sleep, social connection, exercise, and avoiding risky substances, with nature as an unofficial seventh pillar. She emphasizes how these pillars work together for optimal health. Book Features and Implementation Approach Dr. Tiger describes her book's interactive and multimodal approach, including videos, worksheets, and book club materials, emphasizing the importance of making 1% improvements daily. Action Items Tiger recommends implementing daily breathing exercises with patients for co-regulation Tiger suggests focusing on making 1% improvements daily rather than overwhelming changes Tiger advises incorporating all six pillars of lifestyle medicine into daily practice Tiger encourages utilizing the book's multimodal resources including videos under 5 minutes Tiger recommends connecting with the Stress Free MD community through website stressfreemd.netGet the book on Amazon HERE(affiliate link for Amazon)

The latest BOSS podcast features Dr. Shirin Towfigh a hernia specialist in private practice, owner of a hernia center in Beverly Hills and innovator in the field of surgery. She mentioned that innovation for her was born out of frustration. She never set out to be in private practice, she thought she would be a leader in academic medicine. She found significant benefits of being her own boss and the freedom to pursue her passions:  "I don't think I'll leave this job. I love my employer, who is me, and she doesn't discriminate based on gender. I don't have a pay discrepancy based on my chromosome. And she's really great at allowing me to do what I like to do and not bombard me with fluff." Dr. Towfigh emphasized the importance of understanding the business side of medicine, including billing and revenue cycles. She also talks about her innovations in hernia care, including gender-based hernia mesh designs and her efforts to improve research in women's hernia care. She created an online patient education platform and leads international hernia collaborations.-- Dr. Shirin Towfigh is a Board Certified General Surgeon and owner of her own private practice at the Beverly Hills Hernia Center. Her practice is exclusively dedicated to hernias and their complications. Dr. Towfigh went to medical school at UC San Diego and finished her surgical residency at UCLA. She is internationally known for her tailored approach to treatment of hernias, with the goal of reducing chronic pain and related complication, much of which is outlined in her book, The SAGES Manual of Groin Pain. Her research includes innovations to promote the hernia field. She was awarded an honorary certificate in Abdominal Wall Surgery granted by the European Board of Surgery. As an advocate for patient perspectives in hernia care, she started the free patient discussion forum herniatalk.com and hosts the weekly podcast, HerniaTalk LIVE, which showcases topics and fellow physicians to discuss hernia related topics. She is CEO of her tech company, Hexagon Health, Inc., whose mission is to promote gender based advances in hernia care through innovation and research. She holds 9 patents for gender based inguinal hernia mesh designs. She also sponsors the annual Female Factors in Hernia research award at the American Hernia Society. Instagram: https://www.instagram.com/herniadoc Twitter/X: https://x.com/herniadoc Facebook: https://www.facebook.com/Dr.Towfigh LinkedIn: https://www.linkedin.com/in/shirintowfigh/

I was warned not to talk about this. And another friend told me that not talking was the problem. In the last 4 years I have learned a lot about dealing with difficult situations and our thoughts. I hope that my opinions will help you understand yourself and your neighbor, because just like power corrupts, powerlessness is a dangerous and destructive force. The decision from votes does not have to be a dark day, this could be a day where circumstances have led to a call to action. We have free will in our mind, that is where our power is, and we can choose where to direct it. Emotions are the fuel that move in the direction you choose. So pick a direction, and fuel it with the emotion you choose.