BOSS Business of Surgery Series: Recent Episodes

Amy Vertrees, MD

Welcome to BOSS Business of Surgery Series!

This program was specifically designed to help surgeons learn concepts not taught in residency but necessary for a successful surgery career.

We were not told that most of our job would be interacting with others. We thought it was about the technical success of surgery or the knowledge that we learn.

But it is so much more.

Difficult partners and colleagues. Dealing with complications. Negotiating with administration. Running a successful and efficient clinic that doesn’t take bleed into our home life. How to have a life outside of surgery

But if we don’t learn these concepts, we will end up in a negative spiral that will lead us into misery. And all of the time we spent training for the job we love, that could be so rewarding, is lost.

You know there has to be a solution out there. That you can’t be the only one unhappy or wondering if it is just you.

It’s time for a program that addresses your specific problems run by someone who knows what you are going through. You need a fellow surgeon who knows the way. You need a surgeon who has been where you are and found her way out to the other side:

-Loving surgery again -Not taking work home -finishing notes immediately after clinic and heading home on time -Not letting complications set you back -Interacting with others with confidence -Finally seeing that you can control the results you get at work and home

You can find out more about Dr. Vertrees and her work at www.BOSSsurgery.com.

What do you want to feel in your career?

In the latest BOSS podcast, Dr. Jess McMichael realized she wanted to feel delight when she saw her daughter playing- and realized she had lost that feeling over time.

She decided to make major changes in her career as an orthopedic surgeon.

We often worry about what other people will think when we make career changes.

She shares what she learned when she navigated a successful shift in her career.

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Dr. McMichael is an orthopaedic surgeon, wife, mother and coach. She graduated from Saint Louis University School of Medicine Orthopaedic Surgery residency in 2009. As a surgeon, her zone of genius is fracture care and complex pediatric limb reconstruction. As a coach, Dr. McMichael guides women surgeons on a path of ever-increasing personal power. Her mission is to create a modern landscape of surgery characterized by optimal patient safety, innovative surgical education, and satisfied surgeons.

jess.mcmichael@gmail.com

https://www.thecleanbluetowel.com/

Social media

https://www.linkedin.com/in/jessica-mcmichael-md-8a395646/

https://www.facebook.com/groups/390563148592697

One of the biggest preventable challenges we face is telling ourselves we don’t have choices,

but the fact is we always do.

In the latest BOSS podcast, I talk with fellow surgeon coach Dr. Sharon Stein about the choices we have in life and in our jobs.

We talked what gets in the way of making decisions.

How we get in our own way.

The "right" path for us is waiting, and at every point there is a decision tree.

(You will also hear why my OR folks never let me get something from my car- LOL)

My guest is Sharon L. Stein, MD, FACS, FASCRS, is a colorectal surgeon and Professor of Surgery at Case Western Reserve University (CWRU) School of Medicine. She is also a certified coach and founded her own coaching program, The Intentional Surgeon, and started The Surgeon’s Lounge, a group coaching program dedicated to strengthening physicians’ voices and improving the culture of medicine.@slsteinmd

www.linkedin.com/in/sharonsteinmd

www.facebook.com/sharon.stein.355
www.thesurgeonslounge.com

Dr. Wendy Dean is the author of "If I Betray These Words: Moral Injury in Medicine and Why It's So Hard for Clinicians to Put Patients First." Her book profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.

She wrote this book because she believes that there is nothing more powerful than sharing complex ideas in a clear, empathetic language. We can see ourselves in these powerful stories she shares.

You can find her on her website here and her podcast, "Moral Matters" here

Find "Moral injury in Medicine" here on amazon (affiliate link):

https://amzn.to/3QngQK6

What would you do if you suddenly found yourself without a job?

The latest BOSS podcast features Audrey Bauer, MD. She is a bariatric surgeon who was suddenly laid off.

She discovered just how many challenges she would face when she realized she was not as financially secure as she thought... and what was worse, being a specialized surgeon actually hurt her chances of getting another job. Locums has some pitfalls, too.

We talked about the lessons she learned in her path from being laid off, and her future is bright on a path she didn't expect. Her lifestyle now may make you envious!

The latest BOSS podcast episode features Dr. Sujin Lee, a neurorehab physician in private practice and a certified coach. She has a passion for helping physicians pursue their passion projects by learning more about entrepreneurship and how it is possible while also still pursuing medicine.

So many of us are struggling, but you don’t have to leave medicine. The best way to stay in medicine and pursue your passion projects is to learn more about boundaries, your values, and self-compassion.

She shows us that It’s possible to help others on a bigger scale, and the secret is learning the entrepreneur mindset.

“ Nobody went to medical school by themselves. Nobody went through the residency by themselves. The reason why there's a program, the reason why there is a school is because they know it's hard in the entrepreneur space, especially a physician entrepreneur space, there's not that many community. So finding that community is very helpful.”

You can find more about her through her website sujinleemd.com FB page https://www.facebook.com/sujinleemd IG https://www.instagram.com/sujinleemd/

The latest BOSS podcast episode features Dr. Stephanie Pearson

She is an OB/Gyn and learned the hard way about the details of disability insurance when she was injured at work.

Her injury could have brought her down- and almost did- but she turned a devastating injury into a remarkable hero's journey.

She is committed to make sure other physicians don't make the same mistakes that she did. She is on a mission to make sure we are well-informed and empowered to make educated decisions on our disability insurance. She makes a complicated concept simple.

She also shared her struggles after her injury. She is also committed to normalize the struggles that we all have, because we are truly an at-risk profession. Injuries can hurt more than just our career.

Find her at: https://pearsonravitz.com/

Have you ever wondered why patients don't do what you say?

There is the message we give, and there is the message they receive.

How do we make sure that they hear our message?

Dr. Dena George is a family practice physician, StoryBrand certified marketing guide and creator of the "Create an Unstoppable Life" podcast, and Army veteran and founder of the Women Warrior Healers.

We had such a great conversation!

A powerful message lets the patients buy in to their care
We don't have to give all of the information to patients at once
We can speak to their pain, and show how we can lessen it
We can focus from right here and right now, not what they have done before
The two things patients want to know: Do you understand my problem and can you help me?
We put pressure on ourselves to know the right answer, even when it is not possible to know for sure

We also talked about:

Crafting a powerful message on your website
How she created an unstoppable life after she kept getting stuck
Peace is an inside job

And we shared some of the powerful messages that we learned on deployment:

How medical support conveys the message of hope and survival and critical to the war effort
Remembering how much soldiers sacrificed
Creating the Women Warrior Healers community

https://georgemdcoaching.com

https://georgemdcoaching.com/podcast

The latest BOSS podcast episode features Dr. Sasha Shillcutt, a cardiac anesthesiologist who is committed to helping women physicians have better lives by creating better boundaries. Her lessons are universal, so don't think that she is only talking to women.

This episode is so critical for every one of us, because many of the problems we are having can be traced to a lack of boundaries.

You may think that boundaries are about keeping the bad things out- but it's also about keeping the good things in

- With more work from home, it is more important than ever to be intentional around protecting yourself

- What are your priorities- and are they reflected on your schedule?

- What is necessary for an effective boundary?

What about the backlash? (Is it really as bad as we think?)

Listen to the episode to hear more!

https://www.bosssurgery.com/podcasts/boss-business-of-surgery-series

More from Dr. Shillcutt can be found here:

https://www.becomebraveenough.com/

The latest podcast episode features Michael Johnson Jr. Esq, a physician contract lawyer who is committed to help physicians negotiate effectively and stand up for what is right.

We covered so much in this episode!

When should you start considering contract negotiations? (it's earlier than you think!)
What may hold you back from starting your job and keep you from making money?
What should you ask on interviews?
Do you have an exit strategy, and what should your contract have in it to support this strategy?
Can you negotiate if they say "this is a standard contract"?
What are the most common mistakes made in contract negotiations?

Find more information on Michael Johnson, Jr:

www.physiciancontracts.com

Instagram @physiciancontracts.com

The latest BOSS podcast features Dr. Carolina Sueldo: an OB/Gyn and REI specialist. She shares so much wisdom.

Did you know that 1 in 4 women physicians will experience infertility issues? I know I had no idea.
#WeWillNotAccept1in4

It's on all of us to support our colleagues and ourselves- speak up, share stories, give permission.

Training doesn't have to keep you from having a family.

Don't let our training length rob you of the family you want.

She hears this all the time from her patients:
- I wish I had known
- I wish someone have given me this option

We covered so much in this episode!
- Start asking about fertility early, especially if you have painful or irregular periods

What a visit and testing is like
What's next if the testing shows problems
Freezing eggs vs embryos
Advances in IVF
Challenges in the post Roe v Wade world

Contact Details:
www.wsfc.com
drsueldo@gmail.com
Facebook: @DrCarolinaSueldo
Instagram: @DrCarolinaSueldo
YouTube Channel: Dr Carolina Sueldo

Dr. Zheng chose to take a non-traditional path in training after a patient had a bad outcome due to what she thought was a failure of the hospital system. She went to Duke during research/personal development time and got her MBA with a focus on health sector management for 2 years. And that was just the beginning. She created a start-up business on gaming for skills acquisition and knowledge transfer. She returned to complete her residency, but continued her nontraditional path, working part time as an endocrine surgeon and as Medical Director at Intuitive Surgical. She credits strong mentorship and knowing her value for her success in achieving the career that she wanted. She decided that her career can work around her needs, not the other way around.

If you are one of the 60-70% of surgeons who have pain, fatigue and numbness and only recall ergonomics as “stand up straight- and suck it up” then this episode is for you.

Dr. Geeta Lal is an endocrine surgeon who experienced work-related musculoskeletal symptoms herself, like many of us have done. She first wondered if it was just her, but when she realized that musculoskeletal injuries in surgeons was more prevalent than in industries like construction work, she became committed to increasing awareness of and developing solutions to counteract the impact of poor ergonomics on surgeons' professional and

personal lives. She is the founder of Surgical Ergonomics, a speaking and coaching business, and a co-founder and Inaugural President of the new Society of Surgical Ergonomics.

She shared the effects of poor ergonomics: loss of productivity, shortened careers, loss of income to the surgeon and the hospital, and degradation of quality. She has so much to share including these highlights:

Pay attention to your symptoms, they are not in your head
Take breaks to reverse the posture you are holding (5 min every 30 min, micro breaks at 20 sec every 20 -30 min, or 90 sec every 45 min).
Pay attention to your equipment and choose the lightest loupes and headlamps
Become familiar with optimum positioning
Join the society to help your ergonomic ideas make it to the industry where it counts (your reps are often sales reps)

Find more information at:

https://www.societyofsurgicalergonomics.org/

https://surgicalergonomics.com/

Hello Surgeons!

Do you feel trapped in your job?

Have you thought that it would be possible to determine your schedule- and maybe take a year off?

The latest BOSS podcast episode features Dr. Beth Johnston. She is a general surgeon, and she and her husband, a cardiologist, have done just that.

She created a schedule that worked for her and allowed her to be flexible. She and her husband then found a way to take a year to travel and made their jobs work for them.

She valued time off, and she found a way to make it happen. It's a truly inspiring story. It starts with valuing your time, realizing what is important to you, and finding a way to make it happen.

Your job may be more flexible that you think.

The latest BOSS podcast features Dr. Kenneth Cho. He is an interventional radiologist and Army Veteran with significant leadership experience. Once he left the military, he noted the striking difference in the leadership ranges of physicians in the civilian world. If you are struggling at work, you may wonder if it's you, or if there is something bigger going on. He and I discussed some signs that may help you decide if you are working with a bad leader.

Here are some highlights:

Physicians learn a great deal about medicine, but not as much about leading other people.
You should be able to trust your leaders- if they want us to follow them, we have to trust they have our best interest at hearts, they have the skills and ability to accomplish what they promise us, be honest with us, feel that they understand our position
Articulate frequently, honestly, and authentically that they appreciate their people, do everything they can to make them feel respected, value their opinion, take suggestions whenever possible.
MBA can help you with leadership skills, knowledge about finance, and how hospitals function which will be beneficial to the longterm success of the organization
"Burnout" is not helpful. What is the root cause and what can be addressed?
Leadership is service-oriented
A bad leader is limiting what the team can do
What do you do when you have reached a tipping point? What can you do to protect yourself?

Listen to the episode to find out more!

The latest BOSS podcast features Dr. Brad Block. He is an otolaryngologist and began podcasting nearly 4 years ago to help doctors learn better ways to take care of patients. He realized that as residents, our focus is on the OR, but as attending surgeons we spend most of our time in office hours. He focused on social engineering ideas and found inspiration everywhere including dating podcasts and invited guests onto his podcast that could offer new ideas like nonverbal communication.

When he realized that hanging out in the doctors lounge and bringing gifts to practices didn’t help fill the clinic, he realized that making patients evangelists for him was the way to increase his referrals. Here are some highlights:

The key is showing interest in the patient (nonverbal cues and dialing up our persona) and maintaining authority (facial expressions, vocal tonality and not hem/hawing)
Dialing up our persona to ensure they know we are engaged and interested in them. We may not be showing we are as engaged and interested as we actually are
Sitting down makes the visit seem longer
We lead the patients with our cues to help set boundaries for the visit
He documents in the room with Dragon so they can hear and get a visit summary at the end of the visit. They know what is said and walk out with a plan. It is also a cue that it is time to leave.
They will often come with a question behind the question- they come in with a concern, but they don’t verbalize their concern. You must predict it and verbalize it. What is it that bothers you about this? Don’t minimize that problem. Leave room for doubt in case there is an issue you are missing. Explain your thoughts and offer them follow up. Add a personal anecdote to humanize their concern. Follow ups offer relief for anxiety and provide boundaries.

He reminds us that clinic can be a grind if you don’t learn how to enjoy it. And that notes are a gas that will fill the space that is given. We can apply artificial urgency to help get the notes done. He encouraged us to practice office hour skills just like we would practice operative skills.

The goal is for the patient to tell their friends, family and referring doctor, “You HAVE to see him (or her!)!”

You can find him at PhysiciansGuidetoDoctoring.com and on Twitter and rarely on Instagram @physiciansguide. You can’t find him on TikTok, Snapchat, Etsy or on Pinterest and you probably never will.

The latest podcast features Dr. Sarah Beth Snell, a breast surgical oncologist who has been recognized for her efficiency in clinic. She talks to us about how we can all do better for our patients by improving their experience in clinic. This is especially important for new graduates and those moving to new jobs.

Some of the highlights from the episode:

-It takes a while to get the team in line with your vision, but when they see how good it is for the patient and the improved efficiency, they will buy in

Showing data doesn’t help for buy in, you must create a team that believes in your vision and continue to give them feedback that it is working
You may have to work in the system you have, but if you stay true to your vision of what the system could be, all you must do is wait for the feedback to help change
they will see there are less phone calls and the patients are happier
The more you can coordinate for the patient, the happier they will be because they already have so much to worry about. Recognizing that the patient has a hard time navigating the system
When suggesting a change, realize it takes time, effort and sometimes turnover
Use your staff. Delegation is necessary to empower the team and paying them what they are worth will help. They likely have ideas that could help.
Bad staff is worse than no staff
Treat people like they are the only one for the job but have system in place where their job can go on even if they leave.

The latest BOSS podcast features Dr. Sarah Lee-Davisson, a minimally invasive surgeon with excellent advice on getting patients into clinic by supporting our primary care physicians (and APPs in the current environment). We had a great time recording this, and there is pure gold advice for every surgeon in practice.

The top tips:

Take good care of the patients and make the PCP look good by sending patients to you
Send your notes right away and follow up with a call if something is important
Tell the PCP what you have done, summarize important information like studies, stage of cancer, etc into your note so they don't have to dig for the information
Get to know your PCP with visits, mixers and local societies
Take thoughtful gifts, business and bio cards, your cell number to PCP offices and inquire how you can help serve them better
Ask patients if they have a PCP, and if not refer to your PCPs that support you
Ensure the patients have a great first impression with your office staff and empower your office staff to support you by checking tasks, faxes, voicemails daily. Help you and them by having templates of everyday activities

This is the last couple of days to sign up for "Everything is a Negotiation" coaching. Now is the time to learn how you can advocate for yourself and negotiation more effectively with yourself, your time, your family and at your job. Find more information at https://www.bosssurgery.com/

Healthy boundaries promote empowerment. We are safe to interact with the world. We can be around people and not worry about them manipulating us. We can hold any job, because we can protect ourselves from overworking or being taken advantage of. It is a critical part of negotiating with ourselves and the people around us. Without boundaries, we are a set up for resentment, passive aggressive behavior and disappointment. I want more for you.

Enrollment for everything is a negotiation is open, head to BOSSsurgery.com for more information

The latest BOSS podcast features Dr. Robyn Tiger, a diagnostic radiologist and founder of StressFreeMD. She has been a leader in the field of evidence-based self-care tools and burnout thriver.

“I made my mess my message”

She began her wellness career when after 10 years in practice she had somatic symptoms that no one could figure out- migraines, headache, vertigo, tinnitus, couldn’t sleep, reflux, chest pain, and paresthesias. She would consistently workout and eat a vegan diet, but despite being physically healthy, she didn’t feel well. She spontaneously took a 5-week series on yoga meditation (initially rolling her eyes at the concept), but was surprised when she felt calm, clear not even tired anymore.

She found the solution was bringing homeostasis back to her autonomic system. She learned how to take care of herself from the inside out. Over time, she transitioned from solely body-based work to mindset with coaching, because it is hard to work with our thoughts when our autonomic system is out of whack. She learned to be a doctor in a different way by balancing physiology and managing our mind.

The solution is not as inaccessible as it seems. She provides “stress-free snacks” to quickly feel better when something comes up. These are quick easy things to do all day long. You can find more information about her podcast, free videos and latest projects at https://www.stressfreemd.net/

Dr. Riikka Mohorn is a trauma/general surgeon and sudden widow when her husband unexpectedly passed away at 46 years old. Her life was initially all chaos managing her three young children and a general surgery career that she loved. She found help anywhere she could, and although it was difficult, she knew that it had to be possible to manage it all. Over time, she gradually prioritized her life. She loved her career and had what most surgeons have: the “can’t work less” mentality. She learned that she can do a lot of things, but not all things were possible. She had mom guilt that she sometimes overcame, and sometimes didn’t. She discovered coaching and learned that she could pivot her career, work less and live more, although it took her years to overcome the overworking mentality. She trained herself to see the small wins, and not the failures. She became a coach herself, and she is helping others realize they do have options when they have been thinking they don’t, and that it is ok to prioritize yourself and to have hobbies. She and her husband always delayed their plans, and she is encouraging us all to live now. She discovered life is fantastic when you get to do the things you enjoy. That life can be hard, but it can also be fabulous.

The latest BOSS podcast features Dr. Heena Santry, a double-boarded trauma and acute care surgeon and consultant talking about how health care design can help health care equity and prevent moral injury and burnout.

She had two guiding principles as a surgeon: creating a just culture in surgery and advancing health equity. She was excelling along the typical academic track when she realized that she had an opportunity to reach more than just an academic department. She became a consultant for a health care architectural design firm where she uses her experience and skills as a surgeon, her leadership skills, quality research, epidemiologic survey research and geographic information systems to create efficient, equitable spaces in a diverse set of hospitals. Her work allows hospitals to best organize themselves to achieve their population goals considering aspects like trends of aging in the population, kinds of diseases in the area, proximity to other hospitals, and strategies to achieve high quality equitable care.

She is especially passionate about the physicians’ lounge which can break down barriers in the workplace. The lounge has the potential to provide an organic chance to sit with peers in a place focused on wellness, natural light, food for fuel, and a variety of options for comfortable seating either alone or together.

As a mother and a surgeon, many women who did not have any mentors reached out to her for advice. She created an online space for surgeon mothers that allowed networking, relatable content, venting, isolation prevention that has been invaluable for thousands of female surgeons. This space provides opportunity for sponsorship, mentorship, coaching and sharing experiences that has led to real-life networking as well.

Why do we have the same problems but have different outcomes? Why are some people burned out and some people achieving at their highest potential? Coaching involves understanding our thoughts and how they affect our emotions and actions and ultimately the result we get in our lives. Why would a surgeon need a coach? Like an elite athlete, we need someone who can analyze our strengths and weaknesses, come up with exercises and strategies to let us achieve at our highest level.

Self-coaching: this is where you find a lot of the information yourself. This is a very safe starting point, you could do this in your own home, you can start cleaning out your mental closet without feeling like you must show it to anyone. People who are not quite ready to air out the dirty mental laundry start here. There are numerous books and podcasts that are extremely helpful. My favorite podcast The Life Coach School with Brooke Castillo because she explains these principles of the thought model in a way that is easy to understand. She also has excellent strategies for specific situations. Corinne Crabtree and Katrina Ubell are great for dealing with buffering. Brendan Burchard, Tony Robbins, Byron Katie all have excellent books. Ongoing self-coaching is very important. For a medical comparison, this is like medical school. Once you start looking into it, it’s like drinking from a fire hydrant. There’s tons of information. Unless you have the ability to constrain, find a resource that breaks it down into small areas, it’s very easy to get overwhelmed

Group coaching: You can continue to look at your mental closet of stuff, and start to explore strategies of getting better with the help of a coach. With group coaching, you realize that other people have similar problems as you and have similar mechanisms for compensating. You could learn a lot from these group sessions at a safe distance. This is more like residency. You may participate, but everybody else is too so you don’t feel alone. Sunny Smith’s Empowering Women Physicians is one example, and I offer group coaching, too. The next group coaching is Everything is a Negotiation starting late June.

One on one coaching. This is where do you work directly with someone. You can air out all your mental clutter in a safe place. The coach does not judge and will offer guidance based on your thoughts and your principles and your desires. They offer tools and strategies. They get to know your strengths and areas where you can improve. Much like the elite athlete, this is the most uncomfortable. You must be vulnerable. This is very hard when you’re starting out. It takes a process of recognizing that being vulnerable is not weakness. Being vulnerable and exposing pain is the key to unlocking your highest potential. It is the ability to be satisfied with life because you start to learn that when things go wrong, it doesn’t mean there’s anything wrong with you. You start to develop strategies that allow you to deal with a difficult aspect of life that everyone has in a safe place.

The latest BOSS Business of Surgery Series podcast features Dr. Latifat Akintade, the MoneyfitMD. She coaches women physicians about money so they can burnout less. We had a great talk about how our thoughts and fears about money can hold us back. She had some great insights including:

Separate the money we make from our value as a human. Money is a thank you for the work that we do, but it is not the measure of who we are. Unless we do that, we will never feel like we have enough.
Simplifying the language of money shows us that it doesn’t have to be hard. And we don’t have to learn everything about money right away, or even learn everything there is to know.
Recognize when we are feeling fear or shame about money, and that these come from thoughts that are holding us back (like money is hard, money is bad, I am too busy, I am greedy if I think about money, I should have learned all this already).
When physicians have money, we do good things with it.
We already have the tools to succeed with money
Slow down, rest, relax, don’t burnout learning about money

She shared her Financial Liberation Plan:

Know you why- why do you want to practice medicine, why are you choosing this life. Explore the limited beliefs and past traumas to learn more about how you are approaching money.
Identifying your own unfair advantage- We all have characteristics that will help us be successful. For example, as doctors we know how to study, learn, collaborate with others, asking questions and, figure things out. Turn that flashlight on to knowledge about money
Look at the numbers- find your minimum viable expense. If you lost your job, how much would you need to get by? It’s often less than you think.
Diversify your sources of income- and it doesn’t have to happen in one day
Empower ourselves, find our communities and invest in ourselves. She noted that her networth increased as she increased investment in herself. I noticed that when I invested in myself, that was when my life started to change, too.

You can find more about Dr. Latifat at:

TheMoneyfitmd podcast: https://www.moneyfitmd.com/podcast

And her core money curriculum at: https://www.moneyfitmd.com/msb

The latest podcast episode features Dr. Jonathan Dort, the Director of Surgical Education for the Inova Health System and Program Director of the Surgical Residency for the Department of Surgery at the Inova Fairfax Medical Campus.

“I never understood how surgeons had egos, because it is the most continuously humbling business I can imagine being in…”

Dr. Dort left private practice to join an academic program. As program director, he has seen residency education change significantly over the years with increasing regulations and requirements.

Residents are changing, too, and learning in different ways. Gone are the days of “go read a textbook.” Residents are learning from online sources, SCORE, podcast for example.

He had great advice for those interested in applying for residency:

There is no magic formula for getting into residency
Do the activities you are passionate about
Be yourself on the application. He is looking for the real you. You will be appreciated by the program you are the best fit for, and that is a path that is sustainable

-When the blood is welling in the OR, the name on your certificate is not going to bail you out

Tips for succeeding as a resident:

“Your attitude more than your aptitude will determine your altitude”
Wake up and decide what kind of day you are going to have
Reminding yourself, “This is hard, I will learn from my mistakes, I am going to make mistakes, I am going to use the support from the people around me, and I am going to support the people around me, and those are the people succeed. It is a team approach”

-Burnout is not caused by hard work, it is caused by futility

If you are interested in becoming a program director:

You have to love to teach and mentor
The relationships you form with the mentorship last a lifetime
You have to see three steps ahead- considering new technology (like robotics), conscious of the needed rotations
There is gratification from taking a resident from “unconsciously incompetent to consciously incompetent, to consciously competent, then unconsciously competent.”

The latest BOSS podcast features Bonnie Koo, MD!

We talked about the entrepreneur journey, coaching, the importance of personal development, and of course money!

She is founder of Wealthy Mom, MD and the author of “Defining Wealth for Women (n.): Peace, Purpose, and Plenty of Cash.” Her book is what is missing in financial education - money mindset. Her book challenges money myths that many still think are true. She offers practical steps that allow us to start unraveling some of our thoughts about money. She teaches the opposite what other people think- she offers another way.

She shared the most important lesson there is about money: Your only limitation is your mind.

The problem is that we have been told stories about money that may not even be true. She challenges us to ask- is that really true? What if that myth is not true, and that is what is holding us back?

We often think that making money is trading time for money- that we must work more, see more patients. We can question traditional medicine and consider other paths available. We may have judgments about how we make money (like thinking some job is a “cop out”) that may be holding us back. She challenges the idea that there is a ceiling for how much money you can make.

Money brings up thoughts like corruption and greed. She challenged the idea that money changes who we are. What if money makes you more of who you already are? For example, with more money, you could be more generous.

She challenges the idea that saving is the only way to make money and debt is bad. If you think that debt is bad- you are missing an opportunity to build wealth. By leveraging low interest debt to higher paying investments, you could be making more money over simply saving money.

She works with women who feel like their spending is out of control. Overdesire is often the problem, but she teaches others how to retrain your brain. This is a teachable skill that starts with learning the ability to sit with an uncomfortable feeling

Dr. Bonnie Koo can be found at https://wealthymommd.com/

This week's episode is such a great one- and one that we ALL need. That is, unless your CV is up to date and awesome- and if that is the case, send it to me! I would love to see your example!

Dr. Emily Steinhagen and I talked about tips for creating a fantastic CV and keeping it updated. There are 5 key strategies:

Know what to put on your CV- and don't undervalue your experiences. Keep a master CV with everything on it, and tailor it down from there. Consider all experiences, because skills you develop may be relevant to a future job. Your CV is not just a document, it is a file that includes the supporting documents like papers and letters of recommendations.
Use your CV to further your career. You can use it to identify gaps you might have in your career, and the CV can also work as a way to communicate your skills.
Attention to detail! Declare a personal font, be consistent with your abbreviations. Your CV says something about you, and a sloppy CV is not the message you want to send. Add your name and date of the CV to every page. Send only pdfs of your CV so they cannot be modified.
Tailor it to your job. When applying for a job, see if your institution has a specific format. If not, the AAMC has an example here.
Maintain your CV. Create a system to maintain your CV using your calendar, email or scheduled alerts. Use tools like Publon.com to track your reviews of research papers.

Please rate and review the show!

This week's episode is the edited webinar "It's Complicated" where I talk about some strategies for dealing with complications. I have created a full 3 month program focusing on this (registration now closed), because so much is involved in our reaction to complications. This episode focuses on the most important aspect of complications: shame resilience. If you can keep yourself from feeling shame, then you are more likely to recover from a complication. You will be available to receive help from others.

Speaking of help from others, Dr. Laura Brown offered a tip that can help deal with the trauma of complications. After you have a complication, go to the store and buy the tallest candle. Light it every night to honor the patient you lost. When the candle is out, make that be the end of your second guessing yourself and your care. This is a way to honor the patient and yourself. She stated, "I find it focused my ‘tape’ in my head and limited it to candle time. During one bad week of residency, I had a record of seven candles. It’s never been that bad since. It kept me from burning out."

Part 3 with Dr. Maura Lipp.

Dr. Lipp always wanted to be a physician. Like all physicians, there was a long road to get where she was and being a doctor was her entire identity. Like many mid-career physicians, especially after COVID, she began to doubt her career choice. She went from fully committed to her career to feeling like she just didn’t know if she wanted to do it anymore.

That all changed in one day.

Over the course of 2 weeks, she noted shortness of breath and abdominal distention. As physicians, we ignore our symptoms. Eventually she went to an urgent care for a chest x-ray then ultimately a CT scan of the abdomen. She drank the contrast for the CT scan while at work, and that was the last day she worked as an ICU doctor. The CT scan showed stage IV cancer, initially thought to be ovarian.

Her career and her identity were taken away in an instant. The choice was no longer hers. Because now she can’t go back to work, and all she wants to do it go back to it. She underwent chemotherapy and surgery and is not certain that she will be able to get back to work. She must question her entire identity.

As a palliative care physician, she looked back to what she told her patients. Not losing hope but changing what you hope for. But she hasn’t figured out a way yet to be happy with her small goals yet. She questioned whether she was even helpful as a palliative care doctor. She knew how fragile life was, but not until it happened to her. It’s ultimately lonely because you and only you are going through it.

Changing the mindset is important when you feel like you are losing everything.

She had advice to give others who are dealing with a devastating illness:

-Don’t hide anything from your loved one. Don’t worry about upsetting the person, they are already upset. We don’t protect them by hiding

-Let others help you, even if it is uncomfortable

-It was tough answering all the same questions at first (she now has a Facebook group where she can post updates and friends and family can reach out to her).

-Get involved with palliative care early on- it is so important for anyone dealing with a devastating diagnosis. To have her nurse practitioner there for her to call and go through this journey with her was invaluable, and to help with how hard it is to navigate the system.

-What is that you miss the most from work? (It’s not the EMR!). It’s the people, being connected, your social life and your family

-Maybe you didn’t lose everything. Maybe you can put back the most important things. Maybe the hole is not as big as you think it is

-Things that helped her- messages from people- just say hi and what she meant to them.

And advice to all physicians: She let medicine be her identity to a fault. Become more balanced early on. Look at how you are paid, and do you have enough disability insurance.

Dr. Lipp was diagnosed with with multiple sclerosis in 2015. She developed leg numbness and trigeminal neuralgia, but like most physicians do, she ignored her symptoms and pushed through.

She fought the insurance company for over 6 months trying to get the medication that she needed for treatment. She was out of work for 6 weeks unable to walk, and was concerned that with the next relapse she would be unable to walk permanently. She nearly gave up, but then had a patient come in with a similar experience but he had given up. The patient died after experiencing 3 years of agony. She fought even harder to get the insurance company to pay for her treatment.

She found a way to fight the system with the help of the MS Society and the Chronic Disease Coalition. She learned how to write a letter to the insurance company to plead her case, and found that the person making the decision at the company was an ED physician without expertise in MS and that the company had not updated their protocols for treatment.

"If you had been fighting for your career for 30 years, and you were one relapse away from losing it all, wouldn't you be writing this letter, too? Wouldn't you be fighting for the best treatment possible?" She was able to get on effective medication and over 5 years had no relapse.

She initially had difficulty speaking up about her illness, concerned about the perception that she was disabled. She soon found that telling her story was therapeutic and could lead to change. She became an advocate for MS, traveling to Washington and asking for access to medication that allows for effective treatment.

She found that the Chronic Disease Coalition has examples of letters for patients writing to their insurance companies. They can be found here

She started an MS walk team and was surprised to see how many people in her small community has MS. She realized she could provide a platform for people to connect and come together. She created a support group and raised enough money to allow funding for a research project (approximately $110,000). She realized it doesn't take a lot to be an effective advocate.

Find more information about the MS Society here.

The latest podcast episode is with Dr. Faryal Michaud - a palliative medicine physician who is elevating the practice of palliative care. She encouraged us to start having these conversations early.

"If every life is a book, then the last chapter matters."

The first role of the palliative physician is to find out where the patient is at in their knowledge of the situation.

The palliative physician cares for not just the patient, but the family as well.

They explain what "everything" looks like, when the patient and family say they want "everything."

If your time is limited, what is most important to you. She has the patients describe what they want, then offer solutions based on what they want.

She notes that surgeons often consult her for goals of care, but palliative care can also help with symptom management and dealing with "difficult" families and be an advocate for the patients.

She also shares her journey from hospital employed practice where she did not agree with metrics that made her feel trapped to amplifying her voice on her podcast and with her coaching practice.

She can be reached at www.drfaryal.com and her Facebook group called “Physicians Living Intentionally." Her podcast is called “Write Your Last Chapter”

Her most downloaded episode is titled: Do it anyway

Please rate and review the show!

Do you have a topic you want covered? Send me an email at drvertrees@gmail.com

The latest podcast episode is with Dr. Matt Endara- a plastic surgeon who has experienced multiple practice models. I thought this would be a great time to talk about different models given that many of you are looking for jobs.

On this episode, we talked about how you get paid:

Many hospital-based practices are rvu based. This is a productivity model with rvu (relative value unit) as the benchmark for determining your productivity. Each case, note, procedure have an assigned rvu value. The amount you get paid per rvu is dependent on the region you are in, and can be negotiated.

Private practice models are run by individual surgeons. They can be small or large, depending on the specialty or the area. It is important to understand the overhead (expenses) and income generated to know if you are joining a viable practice. Many private practices are joining practice management groups which handle the HR, regulations, bills/insurance denials, negotiating contracts with insurance companies. This hybrid allows control of the practice without some of the headaches (Dr. Vertrees' practice is this model)

Aesthetics is often fee-for-service models without going through insurance. Many plastic surgeons will have a mixed model with aesthetics (fee-for-service) and insurance based practice (Dr. Endara's practice is this model).

(although we didn't talk about it- Kaiser is an example of paying by the hours worked with possibility of partner. We also did not cover private practices where you "buy in" and have the potential to "make partner". Definitely get a lawyer and an accountant to review the options for a job like this).

What are some of the pitfalls to look for?:

Family-run business or mom-and-pop businesses that don't know their numbers. They may have a viable practice, but noone really knows
The payor mix in the area. If there are a lot of uninsured, you may have challenges maintaining a viable practice
What will you get paid after the guaranteed income is up?
Do you know what are the trade-offs for big city practices and smaller community hospitals?
Are you keeping up with the times (new technology) and protecting against lack of diversity (pandemic-proofing your practice)

Please rate and review the show!

Do you have a topic you want covered? Send me an email at drvertrees@gmail.com

Dr. Endara can be found at https://perfectenn.com/about

The latest podcast episode is with Dr. AJ Copeland- a general surgeon, retired Colonel in the Army, former President of the Association of Women Surgeons and current Regent for the American College of Surgeons, and a personal hero of mine.

She describes her rise in leadership in major national surgery organizations. She is a self-described "joiner" and if there was a position that seemed right for her, she would always raise her hand to do it. Once involved in a position, she notes the importance of doing the work. She found meaningful work in AWS as a contributor on numerous projects including the AWS Pocket Mentor found here and creating the guide for patients on "What is a surgical resident" (found here) as an ACS governor.

On this episode, she shared some tips on leadership:

- if you find a need- either something that needs to get done, or you think you can do it better- then raise your hand and get involved

- When in the position, do the work

- Bring others along. You may see their potential before they do. Tell others about opportunities, and encourage them to apply.

She stressed the importance of getting involved in national societies, especially the American College of Surgeons. The ACS is the umbrella organization for all surgical subspecialties. Unlike smaller societies, the ACS has the numbers to help lobby for change, advocate for what surgeons need, and provide other services like education (SESAP, ATLS, the Clinical Congress), quality (NSQIP), and other benefits.

She is one of 24 Regents of the ACS, a part of the organization that is responsible for the big picture and directives for all surgeons. She was a Governor prior to this, a body of around 300 surgeons who act as representatives of the Fellows. Governors represent the Fellows of the American College of Surgeons, and are the official communications link between Fellows and the Board of Regents.

https://www.womensurgeons.org/

https://www.facs.org/

The latest podcast episode is with Dr. Una- a pediatrician, serial entrepreneur and the founder of EntreMD. She has educated thousands of physicians on business skills so they can build profitable businesses so they can live life and practice medicine on their own terms. Her podcast, EntreMD, is inspiring with actionable, easy steps to implement change.

On this episode, she shared some shocking statistics:

- 4/5 physicians reported burnout- that is around 800,000 doctors

- Up to 78% of physicians have thought about quitting- so even if you aren't thinking about it- you may be affected by others leaving

- We have been waiting for someone else to save medicine... but they are not coming...

The cavalry is not coming

The cavalry is already here

The calvary is US

So what can we do?

You may be one skill away from having the job you want

- Serving and earning- we have to do BOTH

- Pick up her book- released TODAY!

- Engage in communities like BOSS and EntreMD

- Put your likes, reviews, and money to support the missions that support the changes you want to see in medicine

Dr. Una is the host of the EntreMD podcast and founder of EntreMD Business School. She is also a speaker, author and regular contributor to Forbes. She has helped hundreds of physicians get their time back, dramatically increase their bottom line and build businesses of impact.

She started a private practice when she wondered, "is this all there is?" She realized she knew NOTHING about business. She is now a serial entrepreneur with the freedom to see patients when and how she wants and pursue other interests and spend time with her family. Her mission is to help you create a business or career that will empower you to take back control.

She can be found at https://entremd.com.

Hello Surgeons!

The latest podcast episode talks about experiences we can all relate to- changing our mind from what we think we want to do, becoming a new attending and the desire to change a struggling system.

Dr. Janelle Wagner is a plastic surgeon with additional fellowship training in hand surgery. She did not follow the traditional path. She initially went into TV after college thinking that she wanted to be famous. But a less than satisfying job had her questioning her career choices.

She decided to return to school to be an OB/gyn, but that didn't fit either. She followed her interests and found the right path for her. She is now a successful plastic surgeon with a flexible career and started a business called "Money Med School" where she helps others learn how to manage their money.

She had great advice on dealing with a challenging system.

- Is your system amenable to change?

- Do you have supportive administration?

- Do your colleagues want this change, too?

- Are the changes in line with your institution's goals?

- Am I valued here?

- You are the most important factor to consider and that is NOT selfish. Your wellness matters. You are not going to help anyone if you are not taken care of first.

- You are never trapped

"Doing something you love is NOT selfish" - Dr. Wagner

Dr. Wagner's website is moneymedschool.com
Instagram and Facebook @moneymedschool

YouTube.com/c/MoneyMedSchool

You can find more information about Dr. Vertrees and the BOSS Business of Surgery Series at www.BOSSsurgery.com

Dr. Sunny Smith, founder of Empower Women Physicians and is the leader of the rise of the physician coach. Her coaching program is THE premier program for physicians, and you still have the opportunity to join. You can find more information about this excellent program here at https://empoweringwomenphysicians.com/coaching/

Dr. Smith along with other women physicians have created awareness for Henrietta Lacks. She was an African-American woman whose cancer cells are the source of the HeLa cell line, the first immortalized human cell line and without a doubt one of the most important cell lines in medical research. These cells were taken from her without her knowledge or consent. Dr. Smith and others have led a movement towards donating money to Henrietta Lacks' family and have already raised over $270,000. You can donate here: https://henrietta-lacks-foundation.snwbll.com

Dr. Joseph Sakran had a choice. He could be a victim of gun violence, or he could turn an unfortunate event and turn it into something that impacts other people. He chose to become a trauma surgeon, a leader in academics and gun control advocate.

Dr. Sakran created the Twitter handle @ThisIsOurLane. This movement was successful because of all the people who said, "Enough is enough. Let me tell you what we are facing." This united all health care workers, domestic and abroad. We had data and science, but this movement spoke to the hearts and minds of the public. Emotion is needed to move from value to action. This allowed us to communicate and resonate with the public. Now is the time to have a multidisciplinary group that takes a multifaceted group.

Three broad points stood out to him after his year in the Senate studying health policy:

1- Health care workers need to be involved in the policy making process to create better legislation

2- Ideas are not enough- strategy and action need to follow

3- Bipartisanship in necessary

The action does not have to be at the federal level- most governing happens at the local and state level. Most people don't think they can make a difference, but local outreach can be the most effective strategy.

We often think that failure as a surgeon after gun violence is a medical failure. But Dr. Sakran points out that the gun violence itself is the first failure- a societal failure. And this can be the hardest to deal with because intervening is harder, it's not up to us, and requires skills that you may or may not have.

He has great advice about constraint. We have to take care of ourselves, or we will not be able to impact the mission. We have to be deliberate with our time, too, because those closest to us need us and the movement will move on without us because the work never ends.

www.BOSSsurgery.com

Fellow coach Dr. Karen Leitner and I talk about how we don't have to dread call. You may not ever love it, but there are definitely strategies to decrease the fear and uncertainty.

What are the problems with call?

We make it three times longer than it has to be: 24 hours of dread, 24 hours of misery, 24 hours of feeling regret afterward
We feel like we are in impossible situations: I don’t know what to do, and I can’t fix all of their problems

-We tie our self-worth to the patient's outcome, so we ruminate on the chart and vitals because we are trying to find our value (because we don’t find it within us)

Strategies for success:

-Recognizing that treating patients with dignity, kindness, compassion, and brutal honesty may be the true success in patient care, rather than just survival of the patient.

-Working with the patient. Ask them the questions: What is your understanding of the situation? What do you want to get out of this? What are you willing to give up?

-Asking yourself if you consent to the procedure. Are you paying attention to the informed consent that you are asking the patient to sign? Would you sign it for yourself?

-Realizing you only get to live a choice one way, you will never know what happened if you chose a different path. Why wouldn’t you believe you are doing your best, and that you made the best choice?

-Remind yourself that you are not the one who is ill (take your own pulse)

-Plan to talk with someone ahead of time about your fears

-Hearing what is going on in your head, so you can redirect and talk to yourself kindly

-Own the story of your call so you can own the ending- it’s ok not to know the right answer right away, you can figure it out

-You don't have to own everything: get on the same page with your partners with effective handoffs and embracing systems-based practice.

You can find Dr. Leitner and her program "How to Feel Better" here (www.karenleitnermd.com) and her article at

www.kevinmd.com/blog/2021/07/physicians-stop-dreading-call.html

You can find more information about Dr. Vertrees and the BOSS Business of Surgery Series at www.BOSSsurgery.com

Dr. Victoria Silas is a pediatric orthopedic who is transitioning from her role as a surgeon to a coach. She has great advice for things you can do right now to enjoy your surgical career, extending the life of your surgical career, and transitioning out of surgery.

Dr. Silas struggled with boundaries and her identity early in her career. She decided to become a coach through Martha Beck's program (fun fact- the author of this month's bookclub). This allowed her to continue in her career as she learned the lessons of putting herself in the equation and doing something for herself each day. She learned to focus on her identity outside of surgery, which helped her as she transitioned out of surgery.

She shares her thoughts on perfectionism, how she "wasn't perfect enough to be a perfectionist" and strategies she has for boundaries, and advice for those transitioning out of surgery (yes, everyone will be OK!).

She can be found at Medical Minds Consulting here or www,medicalmindsconsulting.com

This episode is for you if:

You are thinking about transitioning out of surgery as your commitment runs it's course.
You want to know more about tips to sustain your surgical career
You want to know more about coaching and thought work
You want to know more about boundaries

Find more information about BOSS here or www.BOSSsurgery.com

Dr. Shoup will help us see that the administrators are leaders who learn to elevate others, not be the shining star themselves. They consider how to make the system work for everyone.

This episode is for you if you are in the following positions:

You are not sure how to get what you want from your administration
You want to know specific steps to achieve success for your project, getting a new partner, etc.
You wonder the role of email- are you doing it wrong?
You want to learn how to leverage the 4 powers in an organization
You are interested in being an administrator, and want to know how to go about it.
You wonder if you should you get an MBA

Find more information at https://www.bosssurgery.com/

This episode is for you if you are in the following positions:
- You had a supportive residency, but your first jobs...not so much

You want to know red flags to look for when you are searching for a job
You are finding yourself the first assist to a partner, not the attending in charge of the case
You wanted a mentor, but you are finding that you are not the chosen successor
You want more time off and more autonomy
You are curious about locums as a career

Dr. Susan Trocciola is a cardiothoracic surgery who has taken her career into her own hands after some rough first jobs.

She has critical lessons for all of us about not accepting anything but what we know is true for us.

Find more information about BOSS at www.BOSSsurgery.com

On this episode, Dr. Amy Vertrees talks with Dr. Arianna Gianakos, an orthopedic surgeon and advocate on abuse during surgical resident training.

She recently published a study on bullying, discrimination, harassment, sexual harassment, and the fear of retaliation during surgical residency training: a systematic review. The paper noted some shocking statistics:

37% of trainees experienced burnout

33% experienced anxiety or depression

71% decided not to report abusing behavior with over half concerned that they would experience retaliation

56% reported that they were retaliated against for reporting

Women were more likely to experience this behavior, which could prevent diversity in surgical specialties.

The paper can be found here:

https://pubmed.ncbi.nlm.nih.gov/35006329/

Dr. Arianna Gianakos is one of the founding members of #SpeakUpOrtho where she is leading a SpeakUp Coalition Call to Action Initiative with leaders in various medical specialties across the country aiming to improve the culture of residency training to effect policy change. She is a physician advocate in Physician Just Equity providing peer-support to physicians who experience workplace conflicts, through education, research, empowerment and advocacy while facilitating institutional culture change.

She discusses what we can do now:

Define what constitutes unacceptable behavior
Implement protocols for confidential reporting without fear of retaliation
Third party of trained professional to have on staff
Training sessions to be incorporated as part of mandatory education for faculty and residents

Physician Just Equity can be found here:

https://physicianjustequity.com/

The mission: Physician Just Equity exists to provide peer-support to physicians and surgeons in the United States who experience workplace conflicts, through education, research, empowerment and advocacy - Championing a Balanced Resolution - while facilitating institutional culture change that optimizes patient care.

#Speakup Ortho can be found here:

Instagram: https://www.instagram.com/speakuportho/

Twitter: #SpeakUpOrtho is an initiative to increase awareness of bias, inequities, and harassment within orthopaedic surgery.

Facebook: https://www.facebook.com/speakup.ortho

As a surgeon coach, I see the consequences of this abuse and how it has shaped our careers, our views about ourselves. It affects how we interact in our current practice. Join the BOSS Facebook group to see how we can start unraveling the experiences that are not helping us, and to learn strategies to let us be the best surgeons we can be without sacrificing ourselves, too.

www.BOSSsurgery.com

We can argue if patient reviews are a good idea or bad, but it doesn't change the fact that they are here to stay for now.

This episode will show you that bad patient reviews are not all bad. They may convey a message you want. They may alert you to a problem in your office that you should address. And there are ways you can improve your ratings. The most important goal is to challenge the idea that bad patient reviews mean something about us as surgeons.

www.BOSSsurgery.com

Surgeons are included in the high risk specialties that are nearly guaranteed to get sued. Even if we do not actually get sued, the threat of litigation is a constant influence in our career.

Dr. Laura Fortner is The MedMal coach. She is an OB/gyn who has generously shared her own litigation experience. She was able to survive and then thrive. She has critical information that helps us all recognize the signs of litigation stress and what to do about it. Her emphasis to normalize a process we will all experience to help us move from shame to acceptance. Dr. Fortner's "Common myths about medical malpractice" can be found at www.Themedmalcoach.com.

For more information about BOSS business of surgery series visit www.BOSSsurgery.com.

The Difficult Partner was a webinar recently offered, and this is the replay. If you have a difficult partner, this episode is for you. www.BOSSsurgery.com

I had a theory that a reason some of us were not satisfied with work was that our reason for becoming surgeons didn't apply to us anymore. Many of you responded, and there were themes for why we became surgeons. Although not all reasons apply anymore, there are some truly inspiring reasons, and I wanted to share them with you. It inspired me again to remember the time when I was making the decision. I hope you all are inspired, too, as you head back to our original "why."

Physicians need “Growth Days” Physicians are overwhelmed and burned out. We have an epidemic of “too busy.” Many of us think we could get so much more accomplished if we had more time. Why aren’t we taking the time? Doctors need to start taking “Growth Days.” These aren’t sick days, mental health days or vacation days. Growth days are days strategically taken during the month that are specifically meant for personal growth. www.BOSSsurgery.com

What is the BOSS series? Who is Dr. Amy Vertrees?