BOSS Business of Surgery Series

Amy Vertrees, MD
  • 4.8 (57)
  • Medicine
  • Updated Weekly

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. 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.

    40 min

  2. 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

    52 min

  3. May 25

    Ep 232 The hidden curriculum of surgery residency transition with Dr. Foula Kontonicholas

    BOSS Business of Surgery Series

    38 min

  4. May 18

    Ep. 231 Intimate partner violence in our surgical patients with Dr. Lisa Cannada & Dr. Marissa Ullrich

    🔹 Episode Overview This episode explores intimate partner violence (IPV) in the orthopedic/surgical patient population — an issue surgeons encounter frequently but often fail to recognize or feel unprepared to address. The discussion focuses on: Awareness Identification Surgeon responsibility Practical next steps Key message: 👉 Surgeons see IPV regularly — whether they realize it or not. 👩‍⚕️ Guest Introductions Dr. Lisa Canada Orthopedic trauma surgeon University of North Carolina School of Medicine – Charlotte Campus 25 years in practice Professional pillars: Education Mentorship Clinical excellence Co-author of paper on IPV in orthopedic patients Motivation: Bridging clinical care and education to help surgeons recognize hidden violence affecting patients. Dr. Marissa Ullrich Third-year orthopedic surgery resident Mayo Clinic, Rochester Medical school: Ohio State University Passionate about whole-patient care Key realization: Medical training teaches mandatory reporting for: Children Elderly Vulnerable adults ➡️ But no standardized system exists for adult IPV screening. 🔹 What Is Intimate Partner Violence? IPV is broader than many physicians assume. Common Misconceptions ❌ Only married couples ❌ Only male-on-female violence ❌ Only long-term relationships Reality IPV can involve: Spouses Boyfriends/girlfriends Dating partners Roommates Caregivers Any gender combination Any age group 🔹 Why Surgeons Must Care Surgeons often encounter IPV first because injuries bring patients to medical attention. Examples include: Fractures Recurrent injuries Injuries inconsistent with reported mechanism Multiple prior visits Orthopedic and trauma surgeons are uniquely positioned to identify abuse patterns. 🔹 The Hidden Gap in Medicine Training emphasizes: Child abuse reporting Elder abuse reporting But lacks: Standardized adult IPV detection Education on resources Clear clinical pathways Result: ➡️ Physicians suspect abuse but don’t know what to do next. 🔹 Clinical Red Flags Surgeons should consider IPV when they notice: Multiple injuries over time Vague or inconsistent injury history Injuries inconsistent with mechanism described Frequent “falls” Delayed presentation for care Partner answering questions for patient Patient reluctance or anxiety Especially important in: Fragility fracture patients Elderly individuals with caregivers Repeat trauma presentations 🔹 Core Takeaways for Surgeons 1. You Are Already Seeing IPV Statistically, surgeons encounter affected patients weekly. 2. Recognition Is the First Step You don’t need to solve everything — awareness matters. 3. Think Beyond the Injury Treat the whole patient, not just the fracture or operation. 4. Pattern Recognition Saves Lives Connecting repeated injuries can reveal abuse. 🔹 Cultural Shift Needed in Surgery The episode highlights a broader shift: Moving from purely technical care → holistic patient care Expanding surgeon identity beyond operator Embracing advocacy and safety as part of surgical responsibility

    47 min

  5. May 11

    Ep. 230 Out of Network and in Control with Dr. Sarah Bryczkowski

    Episode Summary What happens when a surgeon decides she's done being underpaid and undervalued — and refuses to sell her practice to private equity? She goes out of network. That's exactly what Dr. Sarah Bryczkowski did, and in this episode she walks us through every step of how she made it work. Dr. Bryczkowski is a robotic general surgeon in Somerset County, New Jersey and a partner at Somerset Surgical Specialists. After making partner in a private practice and realizing she was barely covering overhead as an in-network surgeon, she convinced her partners to take the leap out of network. Since September of last year, they've been operating entirely out-of-network — and they've never looked back. This episode breaks down a model that most physicians have heard about but don't fully understand. Sarah demystifies the billing process, explains what the No Surprises Act actually means for surgeons and patients, and talks honestly about the financial risks, the leap of faith, and what it finally feels like to get paid what you're worth. What You'll Learn in This Episode What "out of network" actually means — and why insurance companies don't want you to understand it How the No Surprises Act changed the game (for better and for worse) What balanced billing really is — and how it's used to scare patients away from out-of-network doctors How Independent Dispute Resolution (IDR) works and why surgeons are winning The billing workflow: from consult to arbitration (and why you won't see money for 3–6 months) How Dr. Bryczkowski convinced her skeptical partners to make the switch The partnership track reality — why making partner isn't always what you expect What the first year in an out-of-network practice actually looks like financially The metrics to watch so you're not flying blind on income Who this model is and isn't right for How to find a billing company and legal team you can trust Key Quotes "I'm doing quality surgery. I wanted to find a way to get paid what I'm worth for what I do — and the employed model didn't fit." "Balanced billing is a term insurance companies use to scare people away." "Even if I wasn't making money, I wouldn't want to be told what to do. It's worth it." "I don't have people problems, I have checklist problems." "You're sucking wind now, but as long as you've got the metrics, you know you're gonna be okay." "It's a journey of faith and challenge and courage — but it's so worth it." Resources Mentioned Somerset Surgical Specialists — somersetsurgical.com The No Surprises Act (2021) Independent Dispute Resolution (IDR) process Online directories for in-network/out-of-network physician lookup About Dr. Sarah Bryczkowski Dr. Sarah Bryczkowski is a robotic general surgeon and partner at Somerset Surgical Specialists in Somerset County, New Jersey. She trained at Hackensack University Medical Center, where she was first exposed to the out-of-network practice model. After several years in both employed and in-network private practice settings, she led her practice group to transition out of network — without selling to private equity. She specializes in complex robotic surgery including component separations, hiatal hernia repairs, and fundoplications.

    35 min

  6. May 4

    Ep. 229: From Fired to Founder: How Dr. Joe Pazona Is Redesigning Urology Practice and Patient Care

    What happens when the job you moved your family for turns out to be the wrong fit? In this episode, Dr. Amy Vertrees sits down with urologist and entrepreneur Dr. Joe Pazona, founder and CEO of VirtuCare, to discuss the unexpected path from being fired to building a new model of healthcare delivery. After experiencing broken promises, loss of autonomy, and ethical conflicts inside traditional employment models, Dr. Pazona realized something many physicians quietly suspect: 👉 The problem isn’t always the doctor. 👉 Sometimes the system itself is broken. This powerful conversation explores how physicians can reclaim leadership, redesign their careers, and create healthcare systems that work for both doctors and patients. 🔥 In This Episode, You’ll Learn: Why great surgeons often struggle as employees The hidden cause of physician burnout (and why it’s not workload) How being fired became the turning point of a career The mindset shift required to move into entrepreneurship Why saying no is essential for career alignment How rural healthcare innovation is reshaping specialty practice What it means to truly work at the top of your license 💡 Key Takeaway When physicians stop trying to fit into broken systems, they can begin building better ones. 👤 About the Guest Dr. Joe Pazona is a urologist and CEO of VirtuCare, a healthcare company focused on supporting physicians while expanding specialty access in underserved communities through innovative team-based care models. Find him on LinkedIn here.  🎧 About the Podcast The BOSS Business of Surgery Podcast, hosted by Dr. Amy Vertrees, teaches the lessons surgeons were never taught in residency — including leadership, negotiation, career design, communication, and professional fulfillment. ⭐ If You Enjoyed This Episode Follow the show, leave a review, and share with a colleague who’s questioning what comes next in their surgical career.

    53 min

  7. Apr 27

    Ep. 228 Standing Up for Doctors: Turning Tragedy into Physician Advocacy with Kim Downey

    In this powerful and deeply human episode of the BOSS Podcast, Amy sits down with physician advocate Kim Downey — a three-time cancer survivor whose life changed after the tragic loss of her radiologist to suicide. What began as personal grief became a national mission to support physician wellbeing. Together, they explore the hidden emotional cost of practicing medicine, the culture of emotional suppression doctors are trained into, and why physicians must be seen — and supported — as human beings, not superheroes. Kim shares how her advocacy work, including the Stand Up for Doctors and her book White Coats Human Hearts, helps physicians feel less alone while educating patients and communities about the realities of medical practice. This episode is a moving conversation about grief, gratitude, complications, physician families, and the healing power of connection. If you’ve ever wondered who takes care of the doctors — this conversation is for you. 🎧 Topics include: Physician mental health and suicide awareness Emotional suppression in medical training Patient–physician relationships and trust The power of gratitude in medicine Rehumanizing doctors and healthcare culture Perfect for physicians, healthcare professionals, and anyone who wants to better understand the people behind the white coat.https://standupfordoctors.org/

    34 min

  8. Apr 20

    Ep 227: Reclaiming Physician Value: Coding, Control, and Private Practice with Dr. Jessica Hott

    Episode Overview Dr. Jessica Hott shares her journey from hospital-employed surgeon and medical director to private practice founder after uncovering systemic billing and coding failures that prevented physicians from receiving credit for the care they were already providing. Her investigation revealed a critical truth: physician burnout is often not caused by workload alone — but by invisible, uncompensated work embedded within healthcare systems. Key Topics Discussed The Productivity Paradox Physicians working harder while appearing less productive EMR reports failing to capture real clinical work Administrative decisions driven by flawed data The Billing Education Gap Minimal training in billing and coding during residency Generational transfer of incorrect practices Why physicians must understand the business of medicine Global OB Care Misconceptions What global care actually includes Common services physicians unknowingly provide for free How small documentation changes dramatically affect reimbursement Post-Operative Visit Pitfalls How EMR labeling influences coder behavior When post-op visits become separately billable care New diagnoses vs. surgical global periods Coding Strategy That Changed Everything Diagnosis alignment with procedures Real-world ureteral lysis coding example Working effectively with coders and billing teams Modifier 22 & Surgical Complexity Documenting increased time, risk, and technical difficulty When complex cases justify additional RVUs Why many systems fail to recognize complexity Why Health Systems Don’t Fix This Surgical departments already subsidize hospitals Administrative focus on loss centers instead of optimization Misaligned incentives inside healthcare finance The Hidden Cost of Physician Turnover Recruitment and onboarding expenses Budget silos masking true institutional losses The financial impact of losing experienced surgeons The Turning Point: Leaving Employment Moral injury vs burnout Stress vs passion: control as the defining difference Choosing private practice ownership Building a Physician-Designed Practice Renovating a new surgical facility Creating efficiency systems and patient education workflows Attracting mission-aligned team members Key Takeaways Physicians often underbill because they were never taught otherwise. Productivity data may not reflect true clinical value. Knowledge of coding is a form of physician empowerment. Administrative systems rarely reward initiative without structural change. Ownership restores agency, control, and professional fulfillment. Actionable Insights for Physicians Audit what services fall outside global billing. Review how visits are labeled in your EMR. Learn modifier usage and complexity documentation. Partner actively with coders instead of delegating blindly. Understand the financial model of your practice environment. Memorable Quote Themes “You’re not underproducing — your work isn’t being counted.” “Burnout often starts when value and recognition disconnect.” “Stress is when you can’t fix the problem. Passion is when you can.” Ideal Audience Employed physicians questioning productivity metrics Surgeons considering private practice Physician leaders and medical directors Doctors interested in financial literacy and practice ownership

    49 min
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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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