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.

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.

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.'

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.

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.

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.

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.'

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.

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.

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.

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.

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

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:

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

“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.”

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.2016.7875

Heybati 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.2023.3744

Shannon 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.

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.

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.

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.

Beth Dupree is a nationally recognized breast surgeon, educator, author, and pioneer in integrative breast cancer care.

Over her career she:

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.

The episode explores what happens when:

Dr. Dupree discusses navigating:

One of the most powerful sections of the conversation centers on the personal impact of advocacy.

Topics include:

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.

A central theme emerges throughout the discussion:

Doing the right thing does not guarantee an easy outcome.

The conversation explores:

The latter part of the episode shifts toward recovery and transformation.

Dr. Dupree shares her journey through:

The discussion examines how physicians can learn to care for themselves while continuing to care deeply for patients.

Dr. Dupree challenges surgeons to think beyond traditional treatment models and remain open to innovation.

Topics include:

"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."

✅ 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