BOSS Business of Surgery Series

In this episode of the BOSS Business of Surgery Series, host Dr. Amy Vertrees sits down with rural surgeon Dr. Randy Lehman for a wide-ranging conversation about rural surgery, financial freedom, and the future of surgical practice. Dr. Lehman shares his unconventional journey, from growing up on a farm in northwest Indiana to becoming a national advocate for rural surgery—complete with a helicopter commute between hospitals.

Together, they explore what makes rural surgery uniquely fulfilling, why independent practices struggle in today’s healthcare economy, and how financial independence can transform a surgeon’s career options and impact.

Growing up on a farm, switching from pre-pharmacy to pre-med, and discovering a passion for rural surgery at Purdue and UC Medical School. He describes the unexpected doors that opened and closed along the way, eventually leading him to Mayo Clinic’s rural surgery track and a broad, high-volume surgical experience.

Rural surgery offers a broad scope of practice and the ability to care for patients of all ages—often with higher compensation for lower-acuity operations. Dr. Lehman shares examples from his own practice, which spans carpal tunnels to hysterectomies to skin cancer flaps, as well as why he avoids highly complex cases that require tertiary-care resources.

He explains the difference between simply rotating through a rural hospital and completing true rural surgery training, which requires high volume across multiple specialties. His own training included over 1,600 cases—far above the national average.

Dr. Lehman opens up about the highs and lows of his post-residency years, including:

Pursuing a job at his hometown hospital after it was sold

Building a dual-location practice between two small hospitals

Attempting an independent practice with $600k annual overhead and only $350k collection

Writing $20–30k checks every few weeks just to keep the doors open

The takeaway: in today’s economic environment, hospitals subsidize surgeons because they recoup facility fees—while most independent practices cannot survive on professional fees alone.

He breaks down why his independent practice collected only $57 per RVU versus over $100 per RVU when employed—and what that means for surgeons who dream of autonomy. Dr. Lehman and Dr. Bertrand discuss the impact of decreasing reimbursement, increasing overhead, and the future risk of efficiency adjustments and bundled CPT payments.

Dr. Lehman's philosophy is simple and powerful: live on very little early in your career, invest wisely, and achieve financial independence fast.
He shares:

How buying an $86,000 home allowed him to reach financial freedom within two years

Why minimalism amplifies your negotiating power

The role of real estate in accelerating independence

How financial freedom allows him to give away hundreds of thousands of dollars each year

Why money magnifies your character—good or bad

Despite costing nearly $50,000 per year to produce, his podcast is a passion project aligned with his goal of becoming a national rural surgery leader. He shares why telling these stories matters for rural hospitals, local economies, and the future surgical workforce.

Dr. Vertrees and Dr. Lehman close with a powerful discussion on why physicians must think like entrepreneurs—not simply RVU generators. They explore how surgeons can reclaim autonomy, redefine their value, and build careers with freedom, flexibility, and mission at the center.

00:00:00 – Dr. Randy Lehman’s Background and Journey

00:03:47 – The Scope and Benefits of Rural Surgery

00:06:00 – Rural Surgery Training and Case Volume

00:13:18 – Practice Models After Residency: Wins and Struggles

00:20:04 – The Real Economics of Surgical Practice

00:29:56 – Financial Philosophy & Becoming Independent Early

00:42:07 – Creating The Rural American Surgeon Podcast

00:47:56 – Entrepreneurial Mindset and Physician Autonomy

Seek a true rural surgery training track, not just rural exposure.

Prioritize high-volume operative experience during residency.

Buy a modest first home to accelerate financial independence.

Practice generosity early, regardless of income.

Explore rural surgery as a deeply rewarding and high-impact career path.

Connect with Dr. Lehman at ruralamericansurgeon.com for more resources.

Summary

This episode of the Boss Business of Surgery Series (episode 208) continues the discussion on expanding emotional capacity, specifically focusing on how other people can help surgeons expand their emotional capacity. The host discusses how surgeons traditionally focus on improving skills and knowledge throughout their careers, but emotional capacity is equally important yet often overlooked.

The host explains that emotional capacity refers to one's ability to handle the emotional ups and downs of being a surgeon, particularly the negative emotions that arise from complications or difficult cases. When emotional capacity diminishes, surgeons may compensate by overworking, checking charts repeatedly, or spending excessive time with patients, which reduces efficiency and effectiveness.

The speaker outlines several ways that other people can help expand a surgeon's emotional capacity:

The host emphasizes that expanding emotional capacity allows surgeons to feel more deeply, recover faster from setbacks, and stay grounded during intense situations. The episode concludes with an invitation to join the Boss Surgery community, which provides a safe space for surgeons to develop these relationships and expand their emotional capacity.

Chapters

Introduction to Expanding Emotional Capacity ‎ 00:00:00

The host introduces episode 208 of the Boss Business of Surgery Series, continuing the discussion on expanding emotional capacity with a focus on how other people can help. The host invites listeners to find their community and mentions the opportunity to join bosssurgery.com for 2026 while starting immediately.

Skills, Knowledge, and Emotional Capacity in Surgery ‎ 00:01:01

The host explains how surgeons traditionally focus on improving skills (techniques practiced repeatedly) and knowledge (gained through experience and reading). While these improve over time, emotional capacity can diminish, especially after complications that bring up negative feelings like worry, insecurity, guilt, and shame. When emotional capacity diminishes, surgeons often compensate by overworking, checking charts excessively, or spending more time with patients, which reduces efficiency and effectiveness.

The Value of Expanded Emotional Capacity ‎ 00:03:36

The host discusses why emotional capacity is important for surgeons, allowing them to manage the big feelings that come with both saving lives and sometimes harming patients. Expanded emotional capacity enables surgeons to feel more deeply (both positive and negative emotions), recover faster from setbacks, and stay grounded during intense situations. The host references previous episodes on lion taming, explaining how staying calm and grounded allows surgeons to provide stable, unhurried, non-judgmental energy to others.

Finding People Who Help Expand Emotional Capacity ‎ 00:06:34

The host describes how surgeons can find people who make them feel grounded and safe - mentors, colleagues, spouses, coaches, or therapists. These individuals allow surgeons to explore their emotions without judgment and help them work through difficult thoughts. The host also suggests looking for role models who handle stress and uncertainty with grace, and learning from their approaches. Even online communities can sometimes provide support, though they require sufficient emotional capacity to navigate.

Learning from Role Models and Past Self ‎ 00:08:18

The host recommends identifying people who model desired behaviors and emotional management, then learning from their approaches. The host notes that surgeons can also look to their past selves as models, reflecting on what motivated them to become surgeons in the first place (referencing episode 2, "Why We Became Surgeons"). This helps surgeons reconnect with their authentic selves in safe environments where they don't feel defensive or competitive.

Understanding Strengths and Weaknesses ‎ 00:10:53

The host explains how coaches help surgeons understand their motivations, strengths, and weaknesses. Importantly, weaknesses are often the flip side of strengths - understanding this connection helps surgeons learn about themselves during times of insecurity or threat. Finding people who help surgeons understand themselves more deeply makes them more individually capable.

The Challenge of Stretching Emotional Capacity ‎ 00:12:08

The host discusses how high-achieving surgeons want to feel challenged and be at the leading edge of their capabilities. Using a bell curve analogy, the host explains that expanding capacity for positive emotions (thrilled, challenged, stretched) also expands capacity for negative emotions (shame, intimidation, worry). As surgeons push boundaries, they must develop strategies to recover from discomfort and remember why they chose this challenging path.

Managing Breaks and Avoiding Burnout ‎ 00:16:23

The host addresses how to manage when feeling overwhelmed or "fried." Rather than simply quitting or taking a break without addressing underlying issues, surgeons should understand the thoughts and feelings behind their diminished emotional capacity. The host recommends finding moments of control and agency, even small ones, rather than withdrawing from stressors entirely. This might involve seeking perspective from others and creating literal space in one's emotional capacity.

Balancing Achievement with Relationships ‎ 00:20:00

The host warns against the "addiction" of trying to be everything for everybody, which prevents surgeons from developing relationships that expand emotional capacity. These relationships form a safety net that catches surgeons when they fall. Without developing relationships with others and with oneself, surgeons chase highs without protection from the inevitable lows.

Finding Meaning and Sharing Wins ‎ 00:22:06

The host discusses how others help identify meaning in surgeons' work through supportive conversations and sharing wins. The host recommends "positivity rounds" - actively listening to and recording positive things patients and colleagues say. Many surgeons miss these affirmations because they're caught up in their thoughts, missing opportunities to be reminded of their impact.

Self-Compassion and Support Networks ‎ 00:24:03

The host references Krista Neff's concept of "Fierce Self-Compassion," which includes mindfulness (being present with suffering), common humanity (recognizing others feel similarly), and self-kindness. The host describes an advanced concept of using past and future versions of oneself as guides. The episode concludes with encouragement to connect with others, try positivity rounds, reach out for help, and consider joining the Boss Surgery community or seeking coaching.

Action Items

Host recommends finding a community that helps expand emotional capacity. ‎ 00:00:12

Host suggests visiting bosssurgery.com to join their supportive community. ‎ 00:00:27

Host recommends looking back at previous episodes on overworking as compensation, emotional capacity, prolonged stress cycle, and lion taming. ‎ 00:02:59

Host suggests identifying people who model desired emotional management and asking them about their approach. ‎ 00:08:18

Host recommends practicing "positivity rounds" by writing down positive things people say about you. ‎ 00:28:32

Host suggests reaching out for help when struggling by asking if others feel the same way. ‎ 00:28:49

Host encourages finding someone outside your relationships (like a coach or therapist) who can ask difficult questions without fear of risking the relationship. ‎ 00:29:02

Host invites listeners to reach out directly or visit bosssurgery.com for group or one-on-one coaching. ‎ 00:30:30

In this episode, Dr. Amy Vertrees—general surgeon, coach, and founder of the Boss Surgeons coaching community—dives into one of the most overlooked competencies in surgical training: emotional capacity.

Surgeons are taught how to operate under pressure, handle emergencies, and constantly pursue excellence. But very few are ever taught how to feel the intense emotions that come with the job, let alone process and recover from them. As a result, emotional capacity—rather than building over time like technical skill—often shrinks, quietly eroding confidence, performance, and well-being.

This episode breaks down what emotional capacity truly is, why it matters, and how surgeons can intentionally rebuild and expand it.

Emotional capacity is the ability to feel, process, and recover from emotions. It is essential for longevity in surgery, yet rarely discussed in training programs that focus almost exclusively on skill and knowledge.

Regret, worry, fear, insecurity, and self-doubt aren’t signs of weakness. They’re part of the job. When they go unprocessed, they create burnout, impulsivity, and emotional blunting.

Unlike surgical skill, emotional capacity declines if neglected. Unprocessed emotions accumulate and begin to drive behavior, often without awareness.

"You cannot process what you cannot name." Dr. Vertrees shares how using the example of regret during a case transfer can transform shame or resentment into motivation and learning.

Surgeons constantly shift between high-intensity events and routine interactions. This requires compartmentalization—but too much compartmentalization leads to emotional numbness.

Chronic stress signals the body that it is unsafe. Dr. Vertrees explains how simple techniques like box breathing help return the nervous system to safety and restore capacity.

Surgeons are trained to "own everything," which often leads to carrying burdens far beyond what is reasonable or controllable.

Disconnection from one’s own needs is one of the earliest and most dangerous signs of burnout. Reconnection is essential for restoring emotional bandwidth.

You’ll hear practical strategies including:

Identifying and allowing emotions without judgment

Creating micro-pauses

Noticing the thoughts generating feelings

Allowing joy, gratitude, and celebration to expand capacity

Understanding that confidence comes from acting with difficult emotions, not from eliminating them

Dr. Vertrees shares how coaching can help surgeons process emotions effectively, reconnect with themselves, and reclaim confidence.

00:00:02 — Introduction to Emotional Capacity in Surgery

00:01:29 — Understanding Regret as an Example

00:03:34 — Emotional Capacity vs. Skills and Knowledge

00:05:57 — Expanding Emotional Bandwidth Under Pressure

00:08:05 — Managing Intensity Without Being Overtaken

00:09:44 — Recovery and Compartmentalization

00:11:36 — Self-Regulation and the Prolonged Stress Cycle

00:14:04 — Managing the Load of Responsibility

00:16:05 — Staying Connected with Yourself

00:18:47 — Rebuilding Emotional Capacity

00:26:07 — Conclusion and Coaching Opportunities

If you’re feeling overwhelmed or burned out, reach out to a coach who understands surgeon-specific challenges.

Start a small gratitude practice to create space for positive emotions and prevent emotional saturation.

Join the Boss Surgeons coaching group—signing up now grants the rest of 2025 free as we enroll for the 2026 program year.

Visit bosssurgery.com to learn more about 1:1 coaching, the Boss Surgeons group, and upcoming programs.

In this episode, Dr. Amy Vertrees explores one of the most pervasive and dangerous habits in surgery: overworking. Surgeons are trained for excellence and rewarded for endurance, but this mindset can quietly erode health, relationships, and even clinical effectiveness.

Dr. Vertrees shares her personal journey of learning to set boundaries after years of believing that saying “yes” was part of being a good surgeon. Through honest reflection and practical insight, she uncovers the identity and mindset issues that drive surgeons to work beyond sustainable limits—and why true leadership requires learning to stop.

Overworking is not productivity—it’s depletion. Surgeons often continue working past the point where their efforts serve any meaningful goal.

The work will never be done. There will always be another patient, another chart, another case. Knowing when to stop is an act of leadership, not laziness.

Why saying no is so hard. From fear of judgment to feelings of obligation and scarcity, surgeons often override their own limits for reasons that have nothing to do with patient care.

Boundaries protect purpose. Overworking gives an illusion of control but actually surrenders it. Boundaries help surgeons stay creative, clear, and compassionate.

Five steps to building boundaries: Define limits, plan ahead, list what matters, assess your schedule, and make changes intentionally.

“Overworking is when your effort stops serving your goals and starts draining your energy, your relationships, and your purpose.”

“The work will never be done—but your capacity will. Protect it.”

“We don’t fix burnout by working faster; we fix it by redefining who we are when we’re not operating.”

Define your boundaries—time, effort, and emotional energy.

Plan your week in advance and block what truly matters.

Review your schedule: does it reflect the life you actually want?

Adjust intentionally to align your professional and personal priorities.

Remember: you are the authority over your calendar.

Enrollment is open for The Boss Surgeons Program 2026, a year-long coaching experience designed to help surgeons lead with clarity, confidence, and purpose.
Sign up now and get the rest of 2025 free, including live coaching, access to recordings, and a private podcast library.

👉 Visit bosssurgery.com  to learn more or schedule a conversation with Dr. Vertrees before enrolling.

Guest: Dr. Jessica Bunin
Host: Dr. Amy Vertrees, The BOSS Business of Surgery Series Podcast

In this episode, host Dr. Amy Vertrees sits down with Dr. Jessica Bunin, a West Point graduate, psychiatrist turned critical care physician, and co-founder of All Levels Leadership. With over two decades of military service, Dr. Bunin brings a deep understanding of leadership, followership, and moral courage to the conversation.

Together, they explore what it means to practice moral courage in healthcare — especially when values and organizational directives collide. Dr. Bunin shares how her experiences in the military and medicine shaped her commitment to developing leadership skills at all career stages and helping physicians navigate ethical and professional challenges with clarity and resilience.

Listeners will walk away with practical frameworks for building moral courage, developing supportive professional networks, and finding fulfillment in environments that may not always align with personal values.

The founding story of All Levels Leadership and its mission to teach leadership at every career stage

Redefining followership as "practicing influence when you don’t have authority"

The three elements of moral courage — values, risk, and endurance

Strategies for navigating moral dilemmas and maintaining integrity in complex healthcare environments

How to build a moral courage support system of advisors, peers, knowledge sources, and wellness practices

The power of longitudinal coaching and finding mentors who understand your patterns

Finding flow and fulfillment even in misaligned organizations

Why authentic connection and honesty about career aspirations are key to professional growth

00:00:02 – Introduction to Dr. Jessica Bunin
Background in military medicine and transition to leadership coaching.

00:01:07 – Founding All Levels Leadership
Identifying the leadership education gap for early-career physicians.

00:04:03 – The All Levels Leadership Team
How a diverse team of clinicians built a mission-driven organization.

00:05:57 – Origins of Moral Courage
From teaching followership to exploring moral action.

00:08:56 – Redefining Leadership and Followership
How influence, not authority, drives meaningful change.

00:12:37 – Defining Moral Courage
Understanding values, risk, and endurance in ethical decision-making.

00:19:21 – Navigating Moral Dilemmas
Balancing leadership responsibility with personal integrity.

00:23:22 – The Value of Longitudinal Coaching
How sustained mentorship provides clarity and resilience.

00:25:14 – All Levels Leadership Services
Coaching, consulting, and education for healthcare professionals.

00:29:57 – Navigating Misaligned Environments
Finding joy, building networks, and identifying sources of “flow.”

00:33:18 – The Power of Authentic Connections
Why honesty about your aspirations creates better opportunities.

Build a moral courage support system — advisors, peers, knowledge sources, and wellness practices.

Develop long-term coaching relationships for honest feedback and growth.

Seek mentors through trusted recommendations, not blind outreach.

Identify aspects of work that bring joy and flow to sustain well-being.

Maintain professional connections over time, even with minimal contact, to preserve opportunities and trust.

All Levels Leadership  – Coaching, consulting, and leadership education for healthcare professionals.

Learn more about Dr. Jessica Bunin and her work on moral courage and professional identity formation.

“Moral courage is knowing your values, recognizing the risks of standing up for them, and finding ways to endure the consequences.” – Dr. Jessica Bunin

“What we really owe to people is to be our best selves.” – Dr. Jessica Bunin

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 - get over it," encouraging her to trust her abilities. Dr. Rasmussen appreciates how her partner recognizes when her tendency to overthink is a strength (when writing policies or justifications) and when it's holding her back.

Reflections on Career Transitions and Lessons Learned ‎ 01:00:00

Dr. Rasmussen and Dr. Vertries reflect on the lessons learned through this career journey. Dr. Rasmussen acknowledges how she overcame limiting beliefs such as "I can't move because it will hurt my family" and "I can't have an ideal partner." Dr. Vertries notes that Dr. Rasmussen has experienced a "hero's journey" and that her lessons will have an "exponential effect on other people." Dr. Rasmussen expresses gratitude for the opportunity to reflect on how far she's come in a relatively short time, demonstrating that "you can make some pretty life-altering things in a short period of time with a little bit of help."

Action Items

Dr. Vertries mentioned reaching out to her at bosssurgery.com for help with toxic job situations. ‎ 00:00:35

Dr. Rasmussen suggested asking detailed questions about job expectations and case allocation when interviewing for new positions. ‎ 00:13:54

Dr. Rasmussen recommended bringing family members on second job interviews when considering relocation. ‎ 00:29:58

Dr. Rasmussen advised seeking coaching before leaving a job to process the situation properly. ‎ 00:42:17

Dr. Rasmussen suggested researching evidence-based approaches to surgical techniques when considering new procedures. ‎ 00:55:57

Summary

This episode of the Boss podcast features Dr. Jennifer Whittington sharing her experience with toxic work environments and how she navigated leaving such situations. The host, Dr. Amy Vertries, introduces the podcast as focusing on lessons not taught in residency for surgeons.

Dr. Whittington discusses her first job search after residency, where she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues.

Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time.

The conversation then shifts to Dr. Whittington's experience leaving her toxic job. She explains how she carefully planned her exit, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She maintained professionalism throughout the difficult two-month notice period, despite facing verbal abuse and humiliation. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval.

Dr. Whittington then discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle, which ultimately made her a better surgeon while helping her become debt-free.

Throughout her journey, Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries.

Dr. Whittington concludes by discussing her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges.

The episode ends with Dr. Whittington advocating for subsidized childcare for surgical trainees at a national level, noting that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally.

Chapters

Introduction to the Boss Podcast and Topic of Toxic Jobs ‎ 00:00:00

Dr. Amy Vertries introduces the podcast, explaining that it focuses on lessons not taught in residency for surgeons. She mentions that two of their most downloaded episodes deal with leaving toxic jobs, and introduces Dr. Jennifer Whittington who will share her experience with toxic work environments and how she navigated leaving such situations.

Dr. Whittington's First Job Search and Contract Mistakes ‎ 00:01:13

Dr. Whittington discusses her first job search after residency, explaining she was geographically limited due to custody arrangements for her daughter. She admits she made a critical mistake by not hiring a contract lawyer to review her employment agreement, which later proved to be problematic. A lawyer who reviewed it years later told her "no one reasonable would have allowed you to sign this." She emphasizes the importance of having legal counsel review contracts, even if it costs around $500, as it's worth the investment to identify potential issues.

Red Flags in Job Interviews and Importance of Due Diligence ‎ 00:02:36

Dr. Whittington highlights several red flags she missed during her job search, particularly being prevented from speaking with the previous person who held the position. She advises that if an employer discourages contact with previous employees, it's a significant warning sign. She also stresses the importance of getting specific details in writing, such as call distribution, reimbursement, block time, and research time to avoid being "used and abused."

Identifying Toxic Workplace Environments ‎ 00:09:22

Dr. Whittington describes signs of a toxic workplace, including lack of respect, being condescended to in front of team members, and feeling uncomfortable with the standard of care provided. She shares her father's advice about being able to "look at yourself in the mirror at night" and feel good about what you did that day, noting that in her toxic job, she couldn't say that about the care being provided.

Transitioning Out of a Toxic Job ‎ 00:12:33

Dr. Whittington explains how she carefully planned her exit from her toxic job, ensuring she had credentials at another hospital before resigning, as she anticipated retaliation. She discusses the documentation needed when changing jobs, including licensure verification, risk management documentation, case logs, and letters of recommendation. She emphasizes the importance of having allies who can help navigate this process.

Maintaining Professionalism During Resignation ‎ 00:15:21

Dr. Whittington shares how she maintained professionalism during her difficult two-month notice period, despite facing verbal abuse and humiliation. Her mantra was "I am the consummate professional," which helped her not react negatively to poor treatment. She shares how staff members showed their support by organizing a farewell party for her despite management's disapproval.

Second Job Experience and Family Emergency ‎ 00:18:03

Dr. Whittington discusses her second job, which was a positive experience. She only left this position to care for her sister who was diagnosed with breast cancer. She explains how the administration was supportive and even held her position as long as possible. She helped interview her replacement and assured them it was a good practice to join.

Financial Challenges and Overcoming Debt ‎ 00:24:56

Dr. Whittington reveals how she took trauma call to pay off her substantial legal fees ($320,000) from her divorce and custody battle. This experience not only helped her become debt-free but also made her a better surgeon by improving her efficiency and thoughtfulness. She explains her fear of debt stemming from her lower-middle-class upbringing as a coal miner's daughter.

Building a Support Network or "Village" ‎ 00:33:10

Dr. Whittington emphasizes the importance of building a support network or "village." When her initial support system fell apart during her divorce, she rebuilt it with colleagues, friends, and community members. She shares emotional stories of friends who supported her during financial hardship, including a friend who traveled to visit her and treated her to simple pleasures like pedicures and ice cream when she couldn't afford groceries.

Current Position and Future Goals ‎ 00:35:26

Dr. Whittington discusses her current position at a hospital where she provides care to underserved populations. She expresses her passion for ensuring that patients at safety-net hospitals receive the same standard of care as those at private hospitals. She also mentions her commitment to mentoring medical students, residents, and PhD students, showing them that they can have successful careers despite personal challenges.

Advocacy for Childcare Support in Medical Training ‎ 00:44:10

Dr. Whittington concludes by advocating for subsidized childcare for surgical trainees at a national level. She notes that the stress of arranging and paying for childcare can prevent surgeons from focusing on becoming the best they can be professionally, and expresses her passion for finding ways to address this issue through medical organizations.

Action Items

Dr. Whittington advised hiring a contract lawyer to review job offers, even if it costs around $500, as it's worth the investment to identify potential issues. ‎ 00:02:52

Dr. Whittington recommended always speaking to the person who previously held the position before accepting a job offer. ‎ 00:04:07

Dr. Whittington suggested going through offer letters point by point with the hiring person, discussing call distribution, reimbursement, block time, and expectations. ‎ 00:03:28

Dr. Whittington advised securing credentials at another hospital before resigning from a toxic job if retaliation is anticipated. ‎ 00:07:14

Dr. Whittington recommended preparing a resignation letter in advance when leaving a difficult workplace situation. ‎ 00:15:36

Dr. Whittington suggested maintaining professionalism when facing verbal abuse or humiliation in the workplace by using a personal mantra like "I am the consummate professional." ‎ 00:16:15

Dr. Whittington advised personally calling patients when transitioning from one practice to another to maintain the relationship and reduce guilt. ‎ 00:21:02

Dr. Whittington advocated for exploring ways to provide subsidized childcare for surgical trainees at a national level through medical organizations. ‎ 00:44:10

Summary

This meeting record transcript is a conversation between a host and Dr. Michael Sutherland, the membership director of the American College of Surgeons (ACS). The discussion covers various aspects of the ACS, including its mission, membership benefits, educational resources, advocacy efforts, international outreach programs, and the annual Clinical Congress event. Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident and highlights the opportunities for surgeons at different career stages to participate and contribute to the organization. He emphasizes the value proposition of ACS membership, which includes access to discounted insurance programs, practice management resources, coding and reimbursement support, and personal financial management services. The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization also plays a crucial role in advocacy and health policy, engaging with government agencies and insurance companies to shape policies that impact surgical practice. Internationally, the ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The annual Clinical Congress event is highlighted as a premier educational and networking opportunity, offering cutting-edge education, vendor exhibits, surgical simulations, and social networking events. Overall, the conversation aims to raise awareness about the extensive resources and benefits available to ACS members, encouraging surgeons, particularly younger ones, to get involved and take advantage of the organization's offerings.

Chapters

Dr. Sutherland's Journey with the ACS  00:01:10

Dr. Sutherland shares his personal journey of getting involved with the ACS as a resident when the 80-hour work week was implemented. He started participating in discussions and committees, eventually becoming the chair of the Resident Associate Society and the Young Fellows Association. He emphasizes that the ACS offers opportunities for passionate individuals to engage and contribute to improving patient care and surgical quality.

The Value Proposition of ACS Membership  00:18:22

Dr. Sutherland highlights various benefits and resources available to ACS members, including discounted insurance programs (life, disability, accidental death), practice management materials, contract negotiation services, personal financial management resources, coding and reimbursement support, and access to data-driven initiatives like surgical risk calculators. The goal is to provide value-added benefits that make ACS membership a worthwhile investment for surgeons.

The ACS as the House of Surgery  00:08:33

The ACS is described as the largest surgical organization in the world, representing over 92,000 members across 13 surgical specialties. Its mission is to safeguard the standards of surgical practice and elevate the quality of care through various programs, registries, and data-driven initiatives. The organization has a strong voice in advocacy and health policy discussions, shaping policies that impact surgical practice.

International Outreach and Education  00:11:29

The ACS has chapters in over 120 countries and runs programs like ACS HOPE (Health Outreach in Underserved Areas) to enhance surgical education and workforce development in underserved regions. The program has training hubs in countries like Ethiopia, Rwanda, and Zambia, where attending physicians and residents from the U.S. help educate local surgeons and build self-sustaining surgical capabilities.

The Annual Clinical Congress  00:29:07

The Clinical Congress is highlighted as the premier event for the ACS, offering cutting-edge education from subject matter experts, vendor exhibits, surgical simulations, and social networking opportunities. Dr. Sutherland emphasizes the importance of networking and building lasting connections with peers at the event. The Congress also features named lectures, convocation ceremonies, and cultural experiences like the "Taste of the City" event.

Engaging Younger Surgeons  00:41:12

Dr. Sutherland acknowledges the challenge of communicating the value proposition of ACS membership to younger surgeons, particularly residents and fellows. The organization aims to eliminate cost barriers by offering free membership during residency and highlighting the various resources and opportunities available to engage and contribute to the ACS at different career stages.

Action Items