BOSS Business of Surgery Series

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.

  1. 3d ago

    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

  2. Jul 13

    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.

  3. Jul 6

    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.”

  4. Jun 29

    Ep 236 Lessons from 1001 Cuts, part 1

    Dr. Amy Vertrees reflects on the weekend screening of the documentary A Thousand and One Cuts and the coaching call that followed it, unpacking why women surgeons' careers are rarely derailed by one dramatic event but by an accumulation of small, repeated moments. She backs this up with hard data: female physicians and surgeons consistently produce lower mortality and complication rates than their male counterparts across multiple large studies, including a JAMA Internal Medicine analysis of 1.5 million Medicare hospitalizations and a 2025 meta-analysis spanning 13.4 million patients — yet women retire from medicine at 49 versus 62 for men. Amy then teaches the core coaching framework from that call: the difference between a fact (something everyone would agree happened) and a thought (your interpretation of it) — including why "microaggression" is a thought, not a fact, and why that distinction actually gives you more power, not less. She closes with tactical empathy, the "mythical white male" trap, and the idea that forcing yourself to be falsely polite is its own kind of self-inflicted harm.Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206–213. doi:10.1001/jamainternmed.2016.7875Heybati K, Chang A, Mohamud H, Satkunasivam R, Coburn N, Salles A, Tsugawa Y, Ikesu R, Saka N, Detsky AS, Ko DT, Ross H, Mamas MA, Jerath A, Wallis CJD. The association between physician sex and patient outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2025 Jan 17;25(1):93. doi: 10.1186/s12913-025-12247-1. PMID: 39819673; PMCID: PMC11740500.Saka N, Yamamoto N, Watanabe J, Wallis C, Jerath A, Someko H, Hayashi M, Kamijo K, Ariie T, Kuno T, Kato H, Mohamud H, Chang A, Satkunasivam R, Tsugawa Y. Comparison of Postoperative Outcomes Among Patients Treated by Male Versus Female Surgeons: A Systematic Review and Meta-analysis. Ann Surg. 2024 Dec 1;280(6):945-953. doi: 10.1097/SLA.0000000000006339. Epub 2024 May 10. PMID: 38726676; PMCID: PMC11542977.Wallis CJD, Jerath A, Aminoltejari K, et al. Surgeon Sex and Long-Term Postoperative Outcomes Among Patients Undergoing Common Surgeries. JAMA Surg. 2023;158(11):1185–1194. doi:10.1001/jamasurg.2023.3744Shannon G, Jansen M, Williams K, Cáceres C, Motta A, Odhiambo A, Eleveld A, Mannell J. Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet. 2019 Feb 9;393(10171):560-569. doi: 10.1016/S0140-6736(18)33135-0. PMID: 30739691. Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J Gen Intern Med. 2022 Oct;37(13):3295-3301. doi: 10.1007/s11606-021-07298-z. Epub 2022 Jan 6. PMID: 34993875; PMCID: PMC9550938. Branford GL, Bucala MD, Hepper A, Hadeed NM, Northway RM, Brenner MJ. The Gender Gap in EHR Workload: A Comparative Analysis of Primary Care Physician In Basket Usage. J Gen Intern Med. 2025 Jul;40(10):2255-2264. doi: 10.1007/s11606-025-09629-w. Epub 2025 May 29. PMID: 40439865; PMCID: PMC12344033.  Rotenstein LS, He Z, Dziura J, Tsugawa Y, Venkatesh AK, Melnick ER, Gettel CJ. Sex Differences in Physician Attrition from Clinical Practice Across Specialties: A Nationwide, Longitudinal Analysis. J Gen Intern Med. 2026 Apr 2. doi: 10.1007/s11606-026-10362-1. Epub ahead of print. PMID: 41927984.

  5. Jun 22

    Ep 235: Turning Pain Points into AI Innovations with Dr. Prakash Gatta

    Turning Pain Points Into Innovation | Dr. Prakash Gatta FULL DESCRIPTION Dr. Prakash Gatta is a foregut and esophageal surgeon who built his hospital's surgical program from zero — and then built two healthcare technology companies from the pain points he kept running into in the OR. In this episode of BOSS: Business of Surgery, host Dr. Amy Vertrees talks with Dr. Gatta about what happens when surgeons stop waiting for someone else to solve the problems they see every day. Company #1: Uncover — Dr. Gatta serves as VP of Clinical Affairs for this AI-powered surgical documentation platform. Uncover analyzes intraoperative video in real time and generates detailed, accurate operative notes automatically. Poor operative notes correlate with worse patient outcomes and cause 15-20% undercoding on procedures — a financial gap that affects both surgeon compensation and hospital facility fees. Uncover closes that gap by turning video into documentation, identifying missed CPT codes, modifier 22s, and APC codes that surgeons never capture. Company #2: EmpowerMedical.ai — Dr. Gatta founded this physician financial transparency platform to answer a question most surgeons have never been able to ask: how much money do I actually generate for my hospital? Using publicly available CMS data and hospital-disclosed pricing, the platform converts a surgeon's case list into a complete financial picture — professional fees, facility revenue, payer mix, DRGs, APCs, and contribution margin. A surgeon performing 124 high-level hernia repairs generates $464,000 in professional fees and $12 million in total system revenue. Most surgeons have no idea. Dr. Gatta wants to make this tool free for all trainees entering practice. The conversation also covers Dr. Gatta's remarkable personal story: born in India, raised in Kuwait during the Gulf War, self-evacuating as a 13-year-old refugee, medical school in Bombay, and arriving in the US in 2000 for surgical training under pioneer Lee Swanstrom in Portland. 🎙️ Website: prakashgatta.com | EmpowerMedical.ai (free blog on coding & billing)💼 LinkedIn: Dr. Prakash Gatta | Host: Dr. Amy Vertrees | bosssurgery.com⭐ If this episode helped you, please leave a review on Apple Podcasts.

  6. Jun 8

    Ep 234 When you can't stay and you can't move with Dr. Erin King-Mullins

    Dr. Erin King Mullins is a double board-certified general and colorectal surgeon with 12 years in practice and founder of Colorectal Wellness Center in Metro Atlanta. In this episode, she shares the hard-won business lessons from a difficult exit from her fellowship practice, how she navigated a non-compete clause that left her unable to stay or relocate, and the step-by-step path to launching solo private practice — while pregnant with her second child.  Dr. Mullins and host Dr. Amy Vertrees cover what every surgeon must know about physician employment contracts: why you should read your exit clause before your salary, the critical difference between radius-based and entity-based non-competes, and what at-will employment actually means for physicians. They also discuss the human side of running a medical practice — from firing employees the right way to separating friendship from business decisions.  In the second half of the episode, Dr. Mullins pulls back the curtain on her experience as a volunteer director with the American Board of Surgery (ABS) — including how complaint reviews actually work, what due process looks like for a surgeon facing a board action, and how the new Entrustable Professional Activities (EPA) framework is transforming resident training and surgical education.  Whether you’re considering private practice, navigating a contract negotiation, or just want to understand what the ABS actually does for surgeons, this episode is required listening.  🎙️ Find Dr. King Mullins: @DrTushyTouchUp (IG/TikTok/FB) | colowellness.com 🎙️ Host: Dr. Amy Vertrees | bosssurgery.com ⭐ Timestamps: 0:00 Intro: Meet Dr. Erin King Mullins 1:00 12 Years in Colorectal Surgery 1:30 COVID, Maternity Leave & a Difficult Exit 3:30 Locums as a Bridge 4:00 Business Is the Third Person in the Room 5:00 Firing Employees: The Human vs. Business Side 7:00 Read Your Exit Clause First 7:30 At-Will Employment Law for Physicians 8:00 Non-Competes: Radius vs. Entity-Based 10:30 Why Locums Works for Some Physicians Permanently 11:00 Going Solo: One Person, Infrastructure for Two 12:00 Setting Culture from the Top Down 14:00 Biggest Challenges in Solo Practice 16:00 Business Resources That Helped 18:30 Joining the American Board of Surgery 19:30 The ABS Mission Statement 21:00 Who’s in the Room: Board Diversity 22:00 How the ABS Views Locums Physicians 23:30 What Happens When a Complaint Is Filed 26:00 The Standardized Complaint Review Process 28:30 EPAs: Entrustable Professional Activities 31:00 Get Involved with the ABS 33:30 How to Pivot When You’re Stuck 37:00 Going All In — With a Safety Net 38:00 Women’s Colorectal Health & New Focus 38:30 Where to Find Dr. King Mullins If this episode helped you, please leave a review on Apple Podcasts — it helps other surgeons find the show.

  7. Jun 1

    Ep 233 When You Refuse to Stay Silent with Dr. Beth Dupree

    Episode Summary What do you do when you discover something that could harm patients—and the system doesn't want to hear it? In this powerful episode, Dr. Amy Vertrees sits down with renowned breast surgeon Dr. Beth Dupree to discuss her extraordinary journey after identifying multiple missed breast cancer diagnoses within a healthcare system. After discovering what initially appeared to be a single missed cancer, Dr. Dupree followed established quality and reporting pathways only to uncover a much larger pattern. What followed was years of advocacy, resistance, investigation, personal sacrifice, and ultimately transformation. The conversation explores not only healthcare accountability but also physician resilience, moral injury, leadership, healing, and the courage required to continue speaking up when the personal cost becomes significant. About Dr. Beth Dupree Beth Dupree is a nationally recognized breast surgeon, educator, author, and pioneer in integrative breast cancer care. Over her career she: Built nationally recognized breast programs Trained breast surgical oncology fellows Led quality and safety initiatives Developed innovative survivorship programs Authored multiple books on healing and survivorship Became a national voice for patient-centered cancer care Key Topics Discussed Following the Evidence Dr. Dupree shares how a routine consultation led her to discover a missed breast cancer diagnosis that had been visible on imaging for years. Rather than dismissing concerns, she followed the data and pursued further investigation. Key lesson: Sometimes the first problem you find is only the beginning. When the System Pushes Back The episode explores what happens when: quality concerns are raised physicians challenge established processes institutional interests conflict with transparency Dr. Dupree discusses navigating: internal quality reviews hospital administration external reviewers medical boards media investigations The Emotional Cost of Advocacy One of the most powerful sections of the conversation centers on the personal impact of advocacy. Topics include: moral injury professional isolation burnout PTSD physician identity Dr. Dupree describes what it feels like to know something is wrong while feeling unable to protect patients in the way she believed they deserved. Courage Versus Comfort A central theme emerges throughout the discussion: Doing the right thing does not guarantee an easy outcome. The conversation explores: professional courage integrity under pressure speaking up despite consequences choosing values over comfort Healing the Healer The latter part of the episode shifts toward recovery and transformation. Dr. Dupree shares her journey through: trauma recovery integrative medicine survivorship care psychedelic-assisted therapy education vagal nerve regulation innovative approaches to healing The discussion examines how physicians can learn to care for themselves while continuing to care deeply for patients. The Future of Medicine Dr. Dupree challenges surgeons to think beyond traditional treatment models and remain open to innovation. Topics include: survivorship care whole-person healing bioelectric medicine mental health support quality of life after treatment Memorable Quotes "Being right about something in a health system is not always the easy path." "You cannot work in a system where you are not respected, heard, and valued." "The truth sets people free." "Bless the thing that breaks you down and cracks you wide open." "Personal courage is what changes medicine." "Sometimes the greatest gift comes from the hardest experience." Key Takeaways ✅ Patient advocacy sometimes requires personal courage ✅ Following proper channels does not always guarantee action ✅ Moral injury can have profound effects on physicians ✅ Healing matters for doctors as much as patients ✅ Innovation often begins by listening deeply ✅ Integrity is often tested when the stakes are highest ✅ The experiences that challenge us most can transform our careers Who Should Listen Surgeons Physicians in leadership Residents and fellows Quality and safety leaders Healthcare administrators Physicians experiencing moral injury Anyone interested in healthcare culture and patient advocacy Connect with Dr. Beth Dupree Social Media: @drbethdupree Author of The Healing Consciousness Contributing author in Women in Surgery Speaker, educator, and advocate for integrative cancer care

4.8
out of 5
57 Ratings

About

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.

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