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.
