BOSS Business of Surgery Series

Ep. 246 The best and worst of surgery conferences

Ep. 245 Let them be wrong about you

What do you do when someone has a negative opinion of you—and you know they’re wrong? For high-achieving people, especially surgeons and leaders, it can be incredibly uncomfortable to be misunderstood. We want to explain. We want to correct the record. We want people to understand our intentions. But spending your time trying to change someone’s opinion can pull you into a cycle of defending, explaining, convincing, and people-pleasing. In this episode, Amy Vertrees, MD, explores what it really means to let people be wrong about you without ignoring useful feedback or abandoning your responsibility to yourself. You’ll learn how to: • Decide whose opinions actually deserve your attention • Separate useful feedback from someone else’s story about you • Stop defending yourself and shifting into “convincing energy” • Use criticism as an opportunity to become more effective and authentic • Know when to speak up and defend yourself • Recognize when it’s time to leave a relationship, job, or environment • Avoid becoming consumed by workplace conflict and other people’s opinions • Build greater self-trust and stop making someone else’s opinion your identity The goal isn't to become someone who never cares what other people think. The goal is to become better at deciding whose opinions deserve your attention—and what you want to do with them. Sometimes you learn from the criticism. Sometimes you stand up for yourself. Sometimes you leave. And sometimes the most powerful thing you can do is stop trying to win a game you no longer want to play. For women surgeons navigating difficult colleagues, leadership challenges, workplace conflict, and the pressure to be liked, this is a reminder that you don't have to spend your life convincing everyone to understand you. You can let them be wrong about you—and keep becoming more of yourself.

Ep. 244 When Surgery Runs Late: How Surgeons Can Manage Frustration, Boundaries & Burnout

The late surgical case is one of the fastest ways for a surgeon to go from having a perfectly planned day to feeling completely trapped, frustrated, and angry. Cases get delayed. Emergencies happen. Staffing changes. Patients aren't ready. Equipment isn't available. And sometimes, despite everyone's best efforts, the OR schedule simply doesn't work. But what happens next is where the real coaching work begins. In this episode, Amy talks about her own experience with a very late case and explores why these situations can trigger so much anger and resentment. Beneath the anger, she argues, is often something deeper: powerlessness. You'll learn how to: • Handle the emotional frustration of a late surgical case • Use waiting time intentionally instead of allowing resentment to build • Recognize the difference between advocating for change and emotionally discharging • Avoid taking frustration out on the people around you • Think differently about the thought, “This shouldn't be happening” • Decide what you're willing—and no longer willing—to sacrifice for your patients • Set boundaries without abandoning your commitment to patient care • Prevent one late case from consuming your evening, weekend, relationships, and peace of mind There will always be late cases. There will always be things in surgery that are outside your control. The goal isn't to become the surgeon who never gets frustrated. It's to become the surgeon who can experience frustration without allowing it to consume the rest of the day—or the people around you.

Ep. 243 Business lessons inspired by Dolly Parton

What does Dolly Parton's career teach surgeons about authenticity, ownership, and building a legacy? Listen to hear the 9 lessons I took away from her life and her career. FULL DESCRIPTION: In the days following Dolly Parton's passing, Dr. Amy Vertrees reflects on the business lessons behind one of the most beloved careers in American entertainment, and why they matter so much for surgeons, especially women surgeons. From refusing to change her signature look to fit anyone else's idea of "professional," to keeping the publishing rights to "I Will Always Love You" even when it meant walking away from a deal with Elvis Presley, Dolly Parton built decades of durable, compounding assets rather than trading her time for a paycheck. Amy walks through nine lessons from Dolly's life and career: authenticity as a business strategy, owning your intellectual property, building teams that compound your strengths, scaling your impact through systems instead of personal bandwidth, and leading from values without becoming divisive. This episode is a call to shift from the traditional physician question — how much am I being paid — to the boss question: what am I building? Whether it's expertise, reputation, relationships, intellectual property, or a team, Amy makes the case that surgeons, like Dolly, can build something that continues creating value long after they leave the room. Topics covered: personal branding for physicians, owning your intellectual property, visionary leadership, scaling impact and mentorship, values-based leadership, financial confidence for women in medicine, and building a legacy beyond clinical work. KEYWORDS Primary: personal branding for physicians, women in surgery, physician entrepreneur, Dolly Parton business lessons, surgeon leadership, Boss Surgeons, Business of Surgery podcast Secondary: authenticity in leadership, owning intellectual property, legacy building, scaling impact, values-based leadership, financial confidence for women physicians CHAPTER MARKERS 00:00 Introduction 01:00 Authenticity as a business strategy 04:00 "Coat of Many Colors" 08:00 Building a brand bigger than your product 10:00 The Elvis Presley story and owning your IP 12:00 Nice is not the opposite of powerful 13:00 Visionary leadership and Dollywood 15:30 Scaling impact: the Imagination Library 19:00 Thinking long term 20:00 Don't be afraid to make money 21:00 Values without division 23:00 Make people feel good 24:00 Closing thoughts EPISODE TAGS Dolly Parton, personal branding, women in surgery, physician entrepreneur, intellectual property, visionary leadership, legacy building, values-based leadership, financial confidence, surgeon coaching

Ep 242 We are meant for more than just a "good" job

Narrative Summary Amy shares the origin story behind Columbia Surgical Partners — the practice she now runs with three additional partners across three locations. After 17 years in the Army and a stint as an employed surgeon in a Tennessee community hospital, Amy hit a breaking point: she wanted to make decisions, choose her team, and build the patient experience she believed in, and the employed model wouldn't let her. She walks through the exact moment she quit without a backup plan, how she bought and renovated a building in six weeks right as the pandemic hit, and the financial formula and mindset shifts that took her from a paper planner and a phone app to a thriving four-surgeon group six years later. Episode Notes The Setup: Military Discipline, Employed Frustration Amy's 17 years in the Army gave her early exposure to leadership and committee work, plus a broad-based general surgery skill set (thoracotomies, neck explorations, abdominal cases) and strong breast cancer training from Walter Reed. When she got out, she took the path 'everyone said you're supposed to do' — an employed job at a Tennessee community hospital that seemed to check every box on paper. But the fit wasn't right: decisions felt illogical (the clinic famously had no voicemail because leadership 'didn't want to give them the impression that we'd be checking messages'), and Amy felt she couldn't shape the environment or the patient experience the way she wanted to. The Breaking Point Around 2019–2020, at the end of her three-year contract, Amy started working with coaching for the first time and began asking for changes at the practice. When she hit a wall with administration, she found herself in a meeting with the medical group's CEO. He told her, 'that's just the way it is.' She responded, 'I don't think that I want to do this anymore' — and when he asked if she was quitting, she said yes, on the spot, without a plan. She describes the moment not as fear but as relief: 'it felt like someone was clipping the tethers... I felt free.' The Leap — Built On Her Own Safety Net Amy didn't have a financial safety net waiting for her — she built one herself. No student debt from her military years, strong financial habits, and the confidence that she could always find another job if the practice failed. That self-trust, more than any external backup plan, was what let her take the risk. Building Fast, During a Pandemic After quitting, Amy drove around her neighborhood the same day, found available buildings through a patient who happened to be a real estate agent, and closed on one within weeks. She gave her contractor six weeks to renovate — right as COVID-19 began. A fortunate decision to buy all renovation materials and supplies upfront (funded partly by the sale of her mother's house) meant she avoided the supply shortages that hit shortly after. She ran the entire early operation on a paper planner and the Spruce app, personally booking the first appointments before the doors even opened. Negotiating the Transition Amy's former group initially wanted her to stop seeing new patients six weeks before her departure. Using a negotiation lesson from Chris Voss — treating a 'no' as the start of a negotiation, not the end — she asked the hospital CEO, 'What would make it a yes?' The answer: proof she could follow up with new patients after the move. She provided it, and the restriction was lifted. The Overwhelm — and Monday Hour One Amy is candid that the early days were consumed by decision fatigue — design decisions, financial decisions, hiring decisions, all at once. What helped was a technique she credits to Brooke Castillo of The Life Coach School: Monday Hour One. Instead of an endless task list, Amy took an hour each week to convert her list into things that would actually get done — put on the calendar, not just written down. 'If it's on the list, good luck. If it's on the calendar, you have a chance.' The Formula: Income Minus Expenses Minus Tax Burden Amy built her practice around a simple formula: income minus expenses minus tax burden. Owning her building (rather than renting) helped control both expenses and tax exposure. She deliberately kept a 'micro clinic' model to minimize overhead, was profitable from month one, and has watched reimbursement percentages shrink industry-wide since — which is part of why she now teaches that physicians who only get paid for clinical work are, in effect, capped hourly workers. Diversifying income and thinking like an entrepreneur, not just a clinician, is what changes the math. Where It Is Now Six years later, what started as a 'cute little solo practice' has grown into Columbia Surgical Partners: four surgeons, two nurse practitioners, and three locations. Amy never set out with that scale in mind — she credits following instinct, building systems as she needed them, and getting better at delegation (an area she admits she still struggles with) for the growth. The Bigger Lesson Amy closes with a reminder that private practice isn't the only path to autonomy — many of the mindset and business lessons she describes can be applied inside an employed job too. Her core message: you don't need someone else to be your safety net. Everything you've built up to this point already is one. Key Takeaways A 'no' from leadership is often the start of a negotiation, not the end of one — ask what would make it a yes. Financial safety nets can be self-built through skills, work ethic, and low personal debt, not just savings. Buying supplies and materials upfront ahead of a tight renovation timeline protected Amy from pandemic-era shortages. Task lists create overwhelm; calendars create progress. Converting 'to-do' into 'when' is what makes work actually happen. The core private-practice formula is income minus expenses minus tax burden — and real estate ownership can help control two of the three. Being paid only for clinical work caps your income; thinking like an entrepreneur is what changes the ceiling. Growth doesn't require a five-year plan — Amy scaled from solo practice to four surgeons and three sites by following instinct and building systems as she needed them. The lessons of autonomy, delegation, and boundary-setting apply whether or not you ever start your own practice. Pull Quotes It felt like someone was clipping the tethers that I had, and I felt free. You don't need someone else to be your safety net. Everything you've done for yourself to this day is what has created your safety net. If it's on the list, good luck. If it's on the calendar, you have a chance. It's not how much money you make, it's who you become in your career.

Ep 241 [MVP] Strategies for when you are crispy around the edges

Ep. 240 Rebuilding a rural general surgery service line with Dr. Courtney McKeown

Ep. 239 How many clinic patients do you need to see?

Here's a question most surgeons have never asked themselves: how many patients do you need to see in clinic to get the number of operations you want each month? In Episode 239 of BOSS: Business of Surgery, host Dr. Amy Vertrees walks through the full patient-to-OR pipeline — from referral to completed case — and shows you how to calculate your own conversion rate so you can predict your operative volume, identify where patients are dropping off, and have a data-driven answer ready when an administrator asks why your case numbers are low. This is the clinic math framework. It covers every step in the funnel: referral source and referral volume, appointment scheduling drop-off, no-show rate, clinic-to-OR conversion rate, OR no-shows and cancellations, and how to calculate how many clinic patients you actually need per booked case. Dr. Vertrees also walks through how subspecialty mix affects your ratio — why a breast or colorectal surgeon with a high proportion of non-operative visits will always need to see more patients per case than a hernia-focused surgeon — and what to do about it. Real numbers included: 100 referrals → 90 appointments → 80 shows → 30 booked cases → 27 completed operations. If you're seeing that kind of attrition and didn't know it, this episode will change how you think about your clinic. Whether you're a new attending trying to build volume, an established surgeon whose numbers have quietly slipped, or a surgeon preparing for a difficult conversation with hospital leadership, this is the episode to hear first. 🎙️ Coaching: bosssurgery.com | Join the BOSS Surgeon Coaching Group ⭐ If this episode helped you, please leave a review on Apple Podcasts — it helps other surgeons find the show. surgeon clinic math | operative volume surgery | clinic to OR conversion rate | surgical practice management | surgeon KPIs | physician revenue RVU | surgical referral pipeline | new attending surgeon | private practice surgery | BOSS Business of Surgery | Dr. Amy Vertrees | surgeon coaching | surgical case volume | physician business skills | surgeon administrator communication

Ep. 238 Why Don't Surgeons Watch Game Film? Dr. Ritter talks video review and the future of training

Episode Summary Can video review make better surgeons? Will artificial intelligence change the way surgeons are trained and certified? In this episode of the BOSS Business of Surgery Series , Dr. Amy Vertrees sits down with Dr. Matt Ritter , a 30-year Air Force surgeon, former Program Director at Walter Reed National Military Medical Center, current Program Director at Indiana University, and national leader in surgical education through SAGES . Together, they explore the future of surgical training , video-based surgical assessment , and the growing role of AI in surgery . Topics include: Why surgical competency may need more than a program director's final evaluation How video review can improve surgical performance and resident education The difference between formative feedback and high-stakes competency assessment Why video recording has been available for decades but remains underutilized The practical barriers to implementing video review in surgical practice How artificial intelligence may streamline surgical assessment while preserving expert judgment Whether robotic surgery and AI will eventually replace surgeons Lessons surgeons can learn from elite athletes who routinely review game film Whether you're a medical student, surgery resident, practicing surgeon, residency program director, or surgical educator, this conversation offers an inside look at where general surgery education is headed—and what it means for the future of our profession. If you've ever wondered how we should measure surgical skill, improve technical performance, or prepare the next generation of surgeons, this episode is for you. About Dr. Matt Ritter Dr. Matt Ritter is a general surgeon, former United States Air Force surgeon, former Program Director at Walter Reed National Military Medical Center, and current Program Director of the Indiana University General Surgery Residency Program. Through his leadership with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), he is helping develop psychometrically rigorous video-based surgical assessment tools that may shape the future of competency-based surgical education. In This Episode Surgical education General surgery residency Video review in surgery Surgical competency AI in surgery Robotic surgery Surgical coaching Residency training SAGES Competency-based medical education Technical skill assessment Deliberate practice Surgical performance improvement Want to build a career that's as intentional as your surgical practice? Join the BOSS Surgeons coaching community, where we teach the leadership, negotiation, communication, and business skills that aren't taught in residency. Learn more at www.bosssurgery.com .

Ep 237: How to not get outmaneuvered by "liontaming"

Narrative Summary Surgeons are trained to endure, perform, and prove — but nobody ever teaches them to negotiate. In this episode, Amy pulls back the curtain on a live Boss Surgeons coaching call to teach the framework she calls “lion taming”: a way to hold your ground with the difficult partner, the dismissive colleague, or the patient who’s testing you, without becoming someone you’re not. The core insight is a reframe. The people who intimidate you — the “lions” — aren’t attacking out of strength. Their “roar” is their own stress response. Amy uses the classic tale of Androcles and the Lion to show what happens when you address someone’s pain instead of their behavior, then breaks the shift down into a three-step method: Anchor (get grounded in yourself), Align (understand where they’re headed and get in step with it), and Ask (make a clear, direct request from a place of safety, not apology). She backs it up with Heather’s story — a surgeon who used this approach to resolve a toxic work relationship in her own head before she ever left the job, then walked into her next role as a different, more grounded version of herself. The episode closes with an invitation into Boss Surgeons, the year-long group where this framework gets practiced live, and a lower-commitment first step for anyone who isn’t ready to decide yet. Detailed Episode Notes The Skill Gap, Not a Personal Failure Amy opens by naming the real problem: surgeons were trained to be employees — to suppress what they want, do what they’re told, and win through overworking or proving themselves. Negotiation was never part of the curriculum. What feels like a confidence problem is actually a skills gap, and skills can be learned. Who Are the “Lions”? A “lion” is anyone in front of you who could cause harm — a more experienced colleague, a competitor, a patient, someone with a differing opinion. Amy makes the point that this is functionally everyone, which is exactly why the skill matters. The goal isn’t to eliminate lions. It’s to learn to move through a room full of them without losing yourself. The Roar Is Their Stress Response — Not Yours to Absorb When someone interrupts, dismisses, or threatens, that’s a fight-flight-freeze-fawn response — theirs. Responding to the roar itself (arguing back, reporting, quitting) only addresses the symptom. Amy’s reframe: speak to the stressor behind the roar, not the roar itself, and the entire interaction changes. Androcles and the Lion Amy retells the classic fable: a runaway slave finds an injured, intimidating lion and, instead of fleeing, notices the thorn in its paw and removes it. Later, when the two are thrown together in an arena, the lion refuses to harm him. The lesson: when you address someone’s underlying pain instead of reacting to their bad behavior, you don’t just neutralize a threat — you can turn it into an ally. Dominance vs. Submission — Reframed Amy untangles two words most people confuse. Dominance isn’t hostility — it’s understanding your own power and using it to move a situation forward. Submission isn’t weakness — it’s knowing exactly what you want and asking for it without apology. Negotiation, in her framing, runs on strategy and emotional intelligence, not logic or force. The Framework: Anchor, Align, Ask Anchor — get present and grounded in yourself before the interaction. “I’m safe. You’re safe. This is important.” Align — observe carefully, understand where the other person is headed, and get in step with it. “I know what I want, and I know what you want too.” Ask — once trust and safety are established, make a direct, clear request — firm, kind, and specific. Amy is explicit that this only works in order: you can’t ask well from a place of fear, and you can’t align if you’re not anchored first. Heather’s Story Amy shares (with permission) the story of Heather, a surgeon who came to coaching while struggling with a difficult colleague. Rather than waiting for the other person to change, Heather worked through the relationship in her own head first — and by the time she left that job, she’d already resolved it internally. She carried that groundedness into her next role, where she described herself as “Switzerland”: same category of problems, completely different result, because she showed up differently. The Invitation Amy closes by naming the real objections surgeons carry into this decision — the price, the time, “I don’t think it’ll work for my situation,” and the high-achiever reflex of “I should be able to do this myself.” Rather than arguing each one down, she reframes the cost of staying stuck: lost time, lost respect, and the compounding toll of walking into the same rooms with the same lions, year after year. Key Takeaways Negotiation is a skill gap, not a character flaw — no one ever taught it to you. The “roar” you’re reacting to is someone else’s stress response, not a verdict on you. Dominance is not hostility. Submission is not weakness. Both are tools. You can’t align or ask well until you’re anchored in yourself first. Addressing someone’s underlying pain — not just their bad behavior — can turn a threat into an ally. Confidence isn’t the absence of fear; it’s the ability to feel any emotion and act anyway. You change your relationships by changing yourself first — not by waiting for the other person to change. Pull Quotes “No one can take your joy. You have to give it to them.” “Dominance is not hostility, and submission is not weakness.” “It’s not logic, it’s strategy. It’s not strength, it’s trust and authority. It’s not a fight, it’s dominance and submission.” “The roar is their stress response. Your response is your stress response.” “Power is a tool, not a threat.” “I used to walk into a room wondering what people thought about me. Now I wonder what I think about them.”