Summary This podcast episode from the Boss Surgery Series features Dr. Amy Vertries interviewing Dr. Sarah Rasmussen, a pediatric transplant surgeon, about her experience of being in the wrong job and navigating a career transition. Dr. Rasmussen shares her journey from working at the University of Virginia (UVA) to Seattle Children's Hospital and then to a new position that better aligned with her career goals and values. Dr. Rasmussen begins by describing her background as a Gen-Xer born in West Virginia who initially planned to practice medicine with her father. She pursued an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her medical training, she discovered her passion for surgery during rotations and completed her residency at Virginia Commonwealth University followed by a pediatric surgery fellowship at Johns Hopkins. She then worked at UVA from 2011 to 2020, where she established a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction in surgical volume prompted her to accept a position at Seattle Children's Hospital as the surgical director of pediatric liver transplant, which she accepted just before the COVID-19 pandemic began in early 2020. At Seattle Children's, Dr. Rasmussen encountered challenges that made her realize she was in the wrong job. Despite the hospital performing more transplants (13-15 liver transplants and 30 kidney transplants annually), she faced issues with case allocation, micromanagement of her decisions, and resistance to her suggestions for improving processes. After 18 months, she compiled data showing her limited involvement in transplant cases and presented it to leadership, hoping for change. Instead, this led to increased scrutiny of her abilities. Dr. Rasmussen describes how the job stress affected her health, causing panic attacks, chest pain, and dangerously high blood pressure. With support from her family and through Dr. Vertries' coaching program, she decided to explore other opportunities. She interviewed at four institutions and found a position with a partner who shared her vision and valued her contributions. In her new role, Dr. Rasmussen found a supportive environment where her partner encourages her growth, helps her through complications, and values her strengths. She shares how her new partner supported her through a surgical complication by not letting her isolate herself and helping her move past self-doubt. He also encourages her to take on challenging cases, such as performing laparoscopic procedures on very small infants. The conversation concludes with reflections on the importance of finding the right job fit, the impact of career decisions on family, and how having the right partner can make a significant difference in professional growth and satisfaction. Chapters Dr. Rasmussen's Background and Early Career Path 00:02:12 Dr. Sarah Rasmussen introduces herself as a Gen-Xer born in West Virginia. She initially planned to practice medicine with her father but became interested in research during medical school. She joined an MD-PhD program at WVU in 1997, focusing on HIV research at the National Cancer Institute. During her clinical rotations, she discovered her passion for surgery, which engaged "all parts of her brain." She completed her residency at Virginia Commonwealth University and a pediatric surgery fellowship at Johns Hopkins. From 2011 to 2020, she worked at the University of Virginia (UVA) as an assistant professor, where she also completed an additional fellowship in abdominal transplant surgery. At UVA, she was active in research, clinical work, teaching, and helped establish a pediatric liver transplant program in partnership with Children's Hospital of Pittsburgh. Transition to Seattle Children's Hospital During the Pandemic 00:05:21 Dr. Rasmussen explains that leadership changes at UVA led to her role being reduced from performing 42 liver transplants annually to being limited to only pediatric cases (about 5 per year). This significant reduction prompted her to accept a position as surgical director of pediatric liver transplant at Seattle Children's Hospital. She signed her offer letter just before the COVID-19 pandemic began, making the transition particularly challenging as it occurred during social distancing measures. Dr. Rasmussen was attracted to Seattle Children's because they performed more transplants (13-15 liver transplants and 30 kidney transplants annually), and she believed she would have a good working relationship with the program head who had similar training. Challenges at Seattle Children's Hospital 00:09:27 Dr. Rasmussen describes her initial positive reception at Seattle Children's but quickly noticed concerning dynamics between surgeons during her observation of a liver-kidney transplant on her second day. Despite her efforts to integrate into the team, she faced significant challenges: her clinical decisions were micromanaged, her requests for time off were complicated by "unwritten rules," and she was often excluded from transplant cases because "fellows needed the experience." After 12 months, she realized that her situation wasn't improving despite her efforts to be helpful and engaged. After 18 months, she compiled data showing her limited involvement in transplant cases (only 20% of livers and 15% of kidneys despite being on call 33% of the time) and presented it to leadership, hoping for change. Instead of addressing her concerns, this led to increased scrutiny of her abilities. Recognizing the Need for Change 00:16:45 Dr. Rasmussen sought advice from colleagues but was consistently told that the situation "would never change." She realized that her vision of being a pediatric liver transplant surgeon required meaningful involvement in cases, which wasn't happening at Seattle. In January 2021, she learned of four potential job openings in her field. Initially resistant to moving her family again so soon after relocating during the pandemic, she joined Dr. Vertries' "difficult partner course" hoping to learn how to succeed in her current position. Through the course, she gave herself permission to explore other opportunities and interviewed at all four institutions. Two positions seemed promising, with one standing out immediately because of her connection with the potential new boss. Health Impact and Decision to Leave 00:25:56 Dr. Rasmussen describes how the job stress severely affected her health, causing panic attacks manifesting as chest pain and dangerously high blood pressure (190/110 with a heart rate of 197). One night after seeing the clinic and call schedule, she couldn't calm down despite trying mindfulness techniques. Her husband witnessed this and declared, "We are done here." Additional factors influencing her decision included the death of a mentor and her mother's illness. Dr. Rasmussen realized that despite her efforts, the team at Seattle Children's was unwilling to accommodate her career needs, which she viewed as a "breach of contract" - not from the institution but from the team that should invest in its members. Family Considerations in Career Decisions 00:28:55 Dr. Rasmussen discusses the challenge of considering another move so soon after relocating her family during the pandemic. She worried about uprooting her children who had just established connections in Seattle. A turning point came when her oldest child told her, "Mom, I think it's time for you to worry about yourself. I'm going to be okay." For her job interviews, she took the unusual step of requesting that both potential employers bring her entire family for second visits, not just her spouse. She received advice that "how happy do you think your family can be if mom is not happy?" and realized that many children move multiple times during childhood without negative consequences. She also learned that her oldest child had been bullied at their previous school, reinforcing that staying in Virginia might not have been better for her family. Finding the Right Partner and Environment 00:47:08 Dr. Rasmussen describes how she connected with her new boss by cold-calling him about a position at his former institution and inquiring if he needed a partner in his new program. Their initial conversation revealed shared vision and energy for building a program. Unlike her experience in Seattle, her new boss explicitly stated, "You tell me what you need out of a case, and that's what will happen," emphasizing team function over hierarchy. She contrasts this with her previous experience, noting the difference between a hierarchical environment and one with a shared vision. When she experienced a serious complication in her first liver transplant at the new institution, her partner provided support without judgment, wouldn't let her isolate herself, and eventually told her "it's time to stop" ruminating, while acknowledging that such complications happen to everyone. Growth and Support in the New Position 00:54:01 Dr. Rasmussen shares how her new environment supports her growth through challenging cases. During her first on-call experience, she consulted on a 1.6-kilogram baby with duodenal atresia. Though initially planning an open procedure, she researched laparoscopic approaches and found evidence supporting minimally invasive surgery for this condition. When she proposed this to her boss, he gave no pushback and even came to observe the successful procedure. Three months later, when she hesitated about performing a laparoscopic cholecystectomy on an eight-week-old baby, her boss reminded her, "Three months ago, you did a lap duodenal atresia repair on a 1.6 kilo baby - g
