BOSS Business of Surgery Series

In this episode, Amanda Hill, JD joins Amy to talk about why they relaunched the 90 Day Notice program—and why it’s more important than ever. Drawing from real stories of doctors facing workplace struggles, they highlight the common scenarios physicians are navigating: complications clustered together, staff complaints escalating into formal reviews, sudden RVU changes, and the fear of being “pushed out” without warning.

Amy shares her perspective as a surgeon and coach, while Amanda brings decades of experience as a healthcare attorney. Together, they break down why so many doctors feel powerless, what warning signs to watch for, and how to respond with strategy instead of panic. They stress that leaving a job isn’t always the answer—sometimes the solution is learning how to influence opinions, repair professional relationships, and walk through challenges with strength and dignity.

Listeners will also hear how the 90 Day Notice program creates real change by blending legal insight, coaching tools, and community support. From navigating workplace conflicts, to avoiding costly missteps, to rebuilding confidence, Amy and Amanda share the process they’ve refined to help physicians reclaim their leverage and peace of mind.

If you’ve ever wondered, “Am I the problem? Do I need to quit? Or is there another way?”—this episode shows you that there is a path forward.

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees sits down with Dr. Courtney McKeown, who shares her remarkable journey from navigating an operative gap to becoming chief of surgery at a rural hospital.

Dr. McKeown opens up about the challenges she faced after being laid off from her first job, her prior recovery from substance use disorder, and the difficulties of securing a new position with a gap in her surgical practice. Together, Dr. Vertrees and Dr. McKeown dive deep into what it takes to return to surgery after time away, from licensing hurdles to credentialing committees, malpractice insurance, and professional references.

The conversation also highlights the American Board of Surgery’s reentry guidelines, state-specific policies on operative gaps, and the importance of supportive partners and mentorship during the reentry process.

Now serving as chief of surgery, Dr. McKeown reflects on how her experience not only rebuilt her career but also brought life-changing surgical services to underserved communities. Her story is both a candid look at the obstacles surgeons face and an inspiring example of resilience, mentorship, and community impact.

The challenges of returning to surgery after an operative gap

How state licensing boards and disciplinary history affect reentry

The step-by-step process of hospital credentialing

Why references and case logs are crucial for reentry

Insights into the American Board of Surgery’s reentry guidelines

The role of mentorship and supportive partners in regaining confidence

How Dr. McKeown expanded surgical services in rural Tennessee hospitals

90-Day Notice Program for doctors seeking new positions – launching Sept 28 at 4 p.m. CT Click HERE

Keep case logs organized (last 12 months, last 2 years, etc.) for credentialing

American Board of Surgery Reentry Guidelines HERE

Joint Commission FPPE Guidelines HERE

00:00 – Introduction to Dr. McKeown’s journey

01:14 – Background and initial challenges

04:01 – Finding a new position

05:44 – Licensing challenges

07:09 – State requirements for operative gaps

09:13 – Impact on board certification

10:36 – Reciprocal disciplinary actions

16:13 – Malpractice insurance considerations

17:22 – Reference challenges

19:43 – Finding the right practice environment

22:00 – Qualities to look for in partners

24:47 – Mutual benefits of mentorship

36:49 – Hospital credentialing process

42:08 – ABS reentry guidelines

46:58 – Gradual return to independent practice

56:42 – Current success as chief of surgery

59:57 – Expanding services and rural community impact

1:02:25 – Conclusion and future impact

🎧 Listen now to hear Dr. McKeown’s inspiring story of resilience, reentry, and redefining what it means to build a surgical career.

Summary

The meeting was day three of a launch week focused on complications in surgery, presented by a surgeon who is also an author, podcast host, and certified coach. The presenter emphasized that complications are inevitable in surgical practice and provided guidance on how to manage them effectively.

The presenter began by outlining the main topics to be covered: understanding what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment.

The presenter defined a complication as a failure to achieve a stated outcome, specifically a perfect procedure where nothing goes wrong. They addressed perfectionist thinking as a double-edged sword - while striving for perfection is admirable, it can lead to fear, overwork, and burnout. The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources.

The prolonged stress cycle was discussed as a significant issue for surgeons, where continuous stress without recovery leads to cognitive impairment, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter offered strategies to interrupt this cycle, including deep breathing, music, exercise, mindset work, and community support.

For managing complications during surgery, the presenter advised checking one's pulse, taking deep breaths, stepping back to think, asking for help, and considering the next best step. They emphasized the importance of clear communication with partners about expectations when asking for help.

After a complication, the presenter stressed the importance of naming emotions, practicing self-compassion, and using shame resilience strategies: reaching out to trusted sources, talking kindly to oneself, and owning the story to control the narrative. They highlighted that patients primarily want to know what happened, that the surgeon did their best, that they won't be abandoned, and that learning occurred from the experience.

The presenter also discussed peer review processes, advising surgeons to control the narrative in medical charts, respond non-defensively to inquiries, and seek legal counsel if necessary. They emphasized the importance of measuring outcomes and knowing one's numbers to build confidence.

The session concluded with advice on debriefing with teams and communicating with patients' families after complications, emphasizing the need to address emotional concerns before providing technical details.

Chapters

Introduction to Complications in Surgery ‎ 00:00:00

The presenter welcomed attendees to day three of launch week, focusing on complications in surgery. They acknowledged that while complications may seem like a heavy topic, it's important because all surgeons will experience them. The presenter introduced themselves as a surgeon, author, podcast host, and certified coach, emphasizing that complications are "near and dear to their heart." They outlined the main topics to be covered: what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment.

Understanding Complications and Perfectionist Thinking ‎ 00:01:46

The presenter began by addressing two common statements about surgical complications: "The only surgeon who doesn't have complications is the one who doesn't operate" and "Every surgeon carries within himself a small cemetery where from time to time he goes to pray." They defined a complication as a failure to achieve a stated outcome - specifically, a perfect procedure. The presenter discussed perfectionist thinking as a double-edged sword, explaining that while striving for perfection seems admirable, it can lead to fear, overwork, and burnout. They recommended shifting perspective from focusing on the gap between achievement and perfection (e.g., achieving 95% vs. 100%) to celebrating the best effort given with available knowledge and resources.

The Prolonged Stress Cycle ‎ 00:07:17

The presenter explained how surgeons often experience prolonged stress cycles without recovery, especially when dealing with complications, hostile work environments, or difficult patients. They emphasized that surgical jobs are inherently difficult, stating "Our jobs are hard. Not everyone can do it." When stress continues without relief, it can lead to rumination, hypervigilance, isolation, impaired cognitive function, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter recommended strategies to interrupt this cycle, including deep breathing (especially exhaling), music, exercise, mindset work through neuroplasticity, and community support.

Managing Complications During Surgery ‎ 00:11:25

For handling complications during surgery, the presenter advised: checking one's pulse first, taking deep breaths to interrupt the stress cycle, stepping back to think about what you know, asking for help, and considering the next best step. They used the analogy of viewing a maze from above versus being inside it to illustrate the importance of perspective. The presenter emphasized that how a surgeon responds during a complication influences everyone in the operating room, as they are all experiencing stress and looking to the surgeon for leadership.

Asking for Help and Managing Expectations ‎ 00:13:51

The presenter discussed the importance of clear communication when asking for help, emphasizing understanding both your expectations and your partner's expectations. They shared examples of misunderstandings, such as a junior surgeon expecting a senior partner to scrub in during a complication while the senior partner was hesitant to appear to be taking over. The presenter advised explicitly stating what you need: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" They also addressed "want mismatches" where partners have different expectations and recommended finding alternative sources of help if necessary.

After the Complication: Managing Emotions ‎ 00:18:51

The presenter emphasized the importance of naming emotions after a complication occurs, describing it as learning a new language of emotional intelligence. They discussed "emotional alchemy" - the ability to transform one emotion into another, particularly distinguishing between guilt ("I feel bad that this event happened") and shame ("I feel bad because there's something wrong with me"). The presenter introduced Brené Brown's shame resilience framework: reaching out to trusted sources, talking kindly to oneself (self-compassion), and owning the story to control the ending. They explained self-compassion as "feeling a negative emotion and wrapping it up in love and respect for yourself."

Communicating with Patients After Complications ‎ 00:24:51

The presenter shared insights about what patients want after complications: to know what happened while they were asleep, to know the surgeon did their best, to feel they won't be abandoned, and to know the surgeon learned from the experience. They emphasized the importance of giving complications purpose and using them as learning opportunities. The presenter advised being present with patients, acknowledging the reality of what happened, and providing certainty and stability during a confusing time.

Peer Review and Professional Consequences ‎ 00:27:12

The presenter discussed peer review processes, acknowledging that surgeons have reason to be concerned but emphasizing that the goal should be quality improvement and patient safety. They advised controlling the narrative in medical charts by clearly documenting decision-making processes. The presenter outlined possible peer review outcomes: no action (sometimes even congratulations for handling difficult situations well), education/questioning, remediation requirements, or more serious consequences like privilege restrictions or National Data Bank reporting. They advised not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise.

Building Confidence Despite Complications ‎ 00:33:48

The presenter distinguished between confidence ("I know I can do it because I've already done it") and self-confidence (the ability to take chances, stretch oneself, and manage failure). They recommended breaking down complex procedures into components, recognizing that surgeons typically know 95% of what they need to do, with only 5% requiring special focus. The presenter emphasized the importance of measuring outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence and counter drama with facts: "Information is the best solution when you have drama. Math always settles down drama."

Debriefing with Teams and Families ‎ 00:41:54

In response to audience questions, the presenter discussed the importance of debriefing with both teams and patients' families after complications. For families, they advised leading with emotional reassurance before providing technical details: "First, I know things took a little longer, but everything is okay." For team debriefs, they recommended acknowledging everyone's efforts, discussing what went well and what could have gone better, and identifying next steps. The presenter also endorsed proactively reporting complications to administrators rather than waiting to be discovered: "Don't give into that kind of suffering... You're going to decrease the amount of suffering that you're going to have by doing that."

Action Items

The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. ‎ 00:05:54

The presenter advised interrupting the stress cycle through deep breathing (especially exhaling), music, exercise, mindset work, and community support. ‎ 00:09:51

The presenter suggested discussing expectations with partners before complications occur to establish when and how to call for help. ‎ 00:14:47

The presenter recommended explicitly stating needs when asking for help: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" ‎ 00:15:59

The presenter advised practicing shame resilience by reaching out to trusted sources, talking kindly to oneself, and owning the story to control the ending. ‎ 00:21:54

The presenter suggested controlling the narrative in medical charts by clearly documenting decision-making processes. ‎ 00:28:01

The presenter recommended not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise during peer review. ‎ 00:32:14

The presenter advised measuring personal outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence. ‎ 00:36:37

The presenter suggested debriefing with teams after complications using a simple assessment: three things that went well, three things that could have gone better, and next steps. ‎ 00:45:24

The presenter recommended proactively reporting complications to administrators rather than waiting to be discovered. ‎ 00:48:38

n this episode, Dr. Amy Vertrees sits down with her longtime office manager, Carrie Glass, to unpack one of the most overlooked yet critical dynamics in a physician’s career: the relationship between doctor and office manager.

With decades of experience running medical offices, Carrie shares insider knowledge that every new attending needs to hear—from credentialing pitfalls and the revenue cycle to handling disruptive patients, managing staff, and mastering delegation. Together, Dr. Vertrees and Carrie explore how communication, boundaries, and trust between physicians and office managers can quite literally “make or break your life in the clinic.”

Carrie also introduces her new venture, Medical Office Mastery, designed to equip both physicians and office managers with the tools they need for smoother, more effective practice management.

💡 Whether you’re a brand-new attending or a seasoned physician looking to strengthen your team, this episode delivers actionable advice to help you build a foundation of success in your practice.

Highlights include:

Why your relationship with your office manager is one of the most important of your career

The hidden paperwork and credentialing hurdles new attendings face (and how to get ahead of them)

How communication style sets the tone before you even arrive in practice

The physician’s role in the revenue cycle and why timely documentation matters

The behind-the-scenes heroics of prior authorizations and last-minute surgeries

Strategies for managing disruptive patients, toxic staff, and no-shows

The right way to delegate—and why skipping training leads to burnout and frustration

The value of regular meetings and clear professional boundaries

Why appreciation and recognition matter more than donuts

👉 Resources & Links

Learn more about Carrie’s new program: Medical Office Mastery here 

How do surgery residents find their first job—and keep it? In this episode, Dr. Amy Vertrees sits down with Dr. Sharon Stein, a colorectal surgeon turned professional development coach, to talk about her new program designed to help residents land jobs that truly fit their goals and values.

Dr. Stein shares eye-opening statistics:

15% of surgeons leave their first job within 2 years.

50% leave within 5 years.

The problem? Training programs teach standardized skills but don’t help surgeons identify their unique strengths—or what they really want in a job.

Together, Dr. Vertrees and Dr. Stein discuss:
✅ Why comparison (not competition) derails job searches
✅ The mid-career slump and how to prevent it
✅ A 4-step framework for assessing, interviewing, evaluating, and negotiating job offers
✅ How institutions (and surgeons) can avoid the high cost of misaligned job placements

Dr. Stein’s new six-month program includes on-demand modules, group coaching, and one-on-one sessions—limited to 30 graduates across all surgical specialties.

Clarity comes first: Identify negotiables and non-negotiables before interviewing.

It’s not just salary: Evaluate culture, mentorship, and long-term growth.

Negotiation = relationship building, not confrontation.

Coaching isn’t just for the lost— it’s for creating sustainable, fulfilling careers.

Learn more about Dr. Sharon Stein: theintentionalsurgeon.com 

Access her free Launch Pad Checklist here:https://sharon-stein.mykajabi.com/opt-in

✨ If you’re a surgical resident—or know one—this episode is a must-listen for setting up a thriving career from the start.

What happens when a “good job” no longer feels good enough?

In this episode of the BOSS Business of Surgery Series Podcast, Dr. Amy Vertrees sits down with Dr. Yemi Lamikanra, orthopedic hand surgeon and founder of Cura Hand Surgery and Orthopedics in Atlanta, to discuss her bold decision to leave a large multi-specialty group and start her own solo practice.

Dr. Lamikanra opens up about the pivotal moments that led her to seek change, including the pressures of balancing motherhood with her surgical career. She shares the strategies, resources, and mindset shifts that helped her build a practice that fits her life—and why trusting yourself is often the hardest, but most important, step.

You’ll learn:

How motherhood reshaped her priorities and pushed her toward autonomy

Why “10X is easier than 2X” when making major life changes

Lessons from setbacks that became invaluable in leadership, coding, and patient acquisition

How to evaluate consultants and ensure a return on investment

The power of community, self-education, and intentional decision-making in private practice

Dr. Lamikanra’s journey is an inspiring reminder that your purpose is always bigger than your fear—and that redefining success is not only possible, but necessary.

Resources & Links:

Connect with Dr. Yemi Lamikandra:

Website: atlantahandsurgeon.com

Instagram: @atlhandsurgeon

LinkedIn: Opeyemi Lamikanra, MD

🎧 Listen now and be inspired to design a career—and life—that works for you.

Summary

Dr. Amy Vertrees, a surgeon, author, podcast host, and certified coach, delivered the first session of a launch week series aimed at new attending physicians. The presentation focused on common mistakes new attendings make and strategies to avoid them. Dr.Vertrees emphasized that the information shared was based on her own experiences and lessons learned throughout her career.

Dr.Vertrees began by outlining the week-long series of presentations, which would cover topics including office manager insights, money management for physicians, handling complications, legal risks, time management, and efficient note-taking. She emphasized that these sessions were designed to be interactive, encouraging participants to ask questions through chat or Q&A features.

A central theme of Dr.Vertrees' presentation was the importance of mastery and recognition for job satisfaction. She explained that mastery means being good at one's job, while recognition involves being acknowledged for one's skills and contributions. Dr.Vertrees noted that this formula applies not only to physicians but to everyone in the workplace, highlighting the importance of recognizing others' contributions and allowing them to develop mastery in their roles.

Dr.Vertrees discussed the significance of understanding organizational culture, including the mission, beliefs, and values of one's workplace. She advised new attendings to consider whether their personal values align with their organization's culture, as misalignment can lead to dissatisfaction. She also emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices.

The presentation covered strategies for dealing with difficult colleagues, emphasizing that communication breakdowns can make any colleague difficult. Dr.Vertrees offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well.

Dr.Vertrees addressed the topic of being reported or receiving negative feedback, advising attendees to view such situations as opportunities for growth rather than threats. She emphasized the importance of participating in leadership positions and committees to have influence in one's organization, noting that "you're either at the table or you're on the menu."

The presentation also covered personal development topics such as overcoming imposter syndrome, which Dr.Vertrees defined as feeling inadequate despite demonstrated success. She offered strategies for challenging negative thoughts by turning statements into questions and comparing oneself to past versions rather than to others. Dr.Vertrees distinguished between confidence (which comes from repeated experience) and self-confidence (the courage to act despite fear).

Dr.Vertrees discussed the importance of marketing oneself effectively, emphasizing that marketing involves knowing one's values and being authentic. She encouraged attendees to embrace their unique qualities rather than conforming to stereotypical surgeon personas. She also addressed the topic of getting paid appropriately, emphasizing the importance of timely documentation, proper coding, and understanding the revenue cycle.

The presentation concluded with advice on tracking various aspects of one's practice, including finances, cases, clinic metrics, and complications. Dr.Vertrees stressed the importance of adapting to life changes and having contingency plans, including knowing one's contract details and having an exit strategy. She offered strategies for dealing with negative emotions, particularly shame, and emphasized the importance of seeking help when needed.

Throughout the presentation, Dr.Vertrees maintained that physicians should give themselves permission to quit if necessary, while also finding purpose in their work. She concluded by emphasizing treatments that address root problems, including therapy, coaching, journaling, community support, and sometimes medications.

Chapter

Introduction to Launch Week for New Attendings ‎ 00:00:02

Dr. AmyVertrees welcomed participants to the first day of launch week, designed specifically for new attending physicians. She explained that the purpose of these sessions was to share information she wished she had known when starting as a new attending. Dr.Vertrees encouraged interaction through chat or Q&A features and introduced herself as a surgeon, author, podcast host, and certified coach. She outlined the week's topics, including office manager insights, money management, handling complications, legal risks, time management, and efficient note-taking.

Mastery and Recognition: The Key to Job Satisfaction ‎ 00:03:20

Dr.Vertrees identified mastery and recognition as the fundamental elements of job satisfaction. She defined mastery as being good at one's job and recognition as being acknowledged for one's skills and contributions. She emphasized that this formula applies to everyone in the workplace and highlighted the importance of recognizing others' contributions. Dr.Vertrees cautioned against the mistake of doing everything oneself, as this robs others of the opportunity to develop mastery and receive recognition.

Understanding Organizational Culture ‎ 00:05:28

Dr.Vertrees discussed the importance of understanding the culture of one's organization, including its mission, beliefs, and values. She advised attendees to consider whether their personal values align with their organization's culture, noting that misalignment becomes evident over time. Dr.Vertrees emphasized that new physicians bring valuable perspectives and should feel confident in suggesting changes, though she recommended approaching such suggestions carefully by first asking questions to understand existing practices.

Navigating Difficult Colleagues and Communication ‎ 00:07:46

Dr.Vertrees addressed the challenge of difficult colleagues, noting that communication breakdowns can make any colleague difficult. She offered practical advice for improving interactions, including focusing on what people actually say rather than interpretations, examining what meaning one assigns to others' words, and understanding one's own stress responses (fight, flight, freeze, or fawn). She suggested that recognizing these patterns in oneself can help in understanding others' behaviors as well.

Handling Reports and Feedback ‎ 00:11:52

Dr.Vertrees discussed how to handle situations where one is reported or receives negative feedback. She advised viewing such situations as opportunities for feedback rather than threats, noting that a report simply generates paperwork that someone needs to address. She emphasized the importance of maintaining a good headspace to respond appropriately, whether the feedback indicates an area for personal improvement or a situation to be cautious about.

Participating in Organizational Leadership ‎ 00:13:31

Dr.Vertrees emphasized the importance of participating in leadership positions and committees to have influence in one's organization, stating "you're either at the table or you're on the menu." She encouraged attendees to get involved at hospital, state, or national levels, while being selective about which positions to take on. Dr.Vertrees advised being clear about one's motivations for taking on leadership roles and understanding that such roles are often what one makes of them.

Creating Personal Safety and Understanding Values ‎ 00:15:18

Dr.Vertrees discussed the importance of understanding one's personal culture and values, especially when working in a difficult organizational culture. She emphasized that clarity about one's values helps in making decisions and recommended values exercises to gain self-awareness. Dr.Vertrees addressed the concept of scarcity, noting that feelings of not having enough can trigger unhelpful "hustle" behaviors and that new physicians may trigger scarcity feelings in established colleagues.

Establishing Boundaries ‎ 00:18:32

Dr.Vertrees outlined five steps for establishing effective boundaries: defining the boundary, communicating it to relevant parties, outlining consequences for boundary violations, enforcing those consequences, and allowing oneself to make exceptions when appropriate. She used the example of after-hours patient calls to illustrate these steps, emphasizing that a boundary isn't truly established unless all five steps are followed.

Addressing Imposter Syndrome ‎ 00:21:09

Dr.Vertrees defined imposter syndrome as feeling inadequate despite demonstrated success, a phenomenon first identified in high-achieving women in academia in 1978. She explained that people with imposter syndrome have negative thoughts despite outward success, making it difficult for others to understand or help. Dr.Vertrees suggested turning negative statements into questions to challenge these thoughts, such as changing "I'm not doing this right" to "Am I okay?"

Challenging Common Negative Thoughts ‎ 00:24:50

Dr.Vertrees identified common negative thoughts that high-achieving people experience, including fears of being perceived as lazy, doubts about one's abilities, and comparisons to others. She emphasized that these thoughts can be challenged and reframed, noting that the job itself is genuinely difficult and that comparing oneself to others can be useful if done constructively rather than destructively.

Understanding Confidence and Self-Confidence ‎ 00:32:18

Dr.Vertrees distinguished between confidence, which comes from repeated experience, and self-confidence, which is the courage to act despite fear. She explained that confidence develops through muscle memory and repetition, while self-confidence involves trusting oneself to handle negative emotions and potential failures. Dr.Vertrees emphasized that these feelings are generated by one's own thoughts and actions.

Marketing Yourself Effectively ‎ 00:34:09

Dr.Vertrees discussed the importance of marketing oneself effectively, framing it as shifting from an employee mindset to a CEO mindset. She defined business as an exchange of value for money and emphasized the importance of understanding one's own value. Dr.Vertrees encouraged attendees to be authentic rather than conforming to stereotypical surgeon personas, noting that authenticity often receives positive feedback. She emphasized that marketing happens in every interaction, not just through formal channels.

Getting Paid Appropriately ‎ 00:39:16

Dr.Vertrees addressed the topic of getting paid appropriately, emphasizing that it's acceptable to expect payment for providing value. She described notes as invoices for one's work, highlighting their importance for patient care, mental health, pre-authorization, and communication with primary care. Dr. Vertries explained the revenue cycle (work → invoice → coding → billing → collections) and stressed the importance of understanding this process to ensure business sustainability and avoid fraud.

Tracking Practice Metrics ‎ 00:44:01

Dr.Vertrees emphasized the importance of tracking various aspects of one's practice, including finances, cases, clinic metrics, and complications. She recommended evaluating each clinic session by identifying three things that worked well, three areas for improvement, and one next step. Dr.Vertrees explained the concept of "clinic math" (the ratio of patients seen to operations booked) and how understanding this ratio can help in planning and potentially modifying one's practice.

Adapting to Life Changes ‎ 00:50:17

Dr.Vertrees discussed the importance of adapting to life changes, noting that jobs and personal circumstances evolve over time. She emphasized that tracking helps one see these changes while planning helps one adjust to them. Dr.Vertrees pointed out that people often fail to modify their work approach when major life events occur, such as having children, leading to frustration when previous patterns no longer work.

Important Documents and Contingency Planning ‎ 00:51:52

Dr.Vertrees highlighted important documents that physicians should be familiar with, including their contracts, hospital bylaws, and credentialing information. She emphasized the importance of having an exit plan, even when starting a new job, as this provides confidence and prevents feeling trapped. Dr. Vertries also mentioned the importance of tracking deadlines for licenses, DEA credentials, contract renewals, and continuing medical education requirements.

Managing Negative Emotions and Shame ‎ 00:54:24

Dr.Vertrees addressed the management of negative emotions, particularly shame, which she defined as the feeling that "there's something wrong with me." She credited Brené Brown for three steps of shame resilience: reaching out to a trusted source, talking kindly to oneself, and owning one's story to control the ending. Dr.Vertrees warned that shame leads to isolation and harmful coping mechanisms, emphasizing the importance of addressing it directly.

Permission to Quit and Finding Purpose ‎ 00:55:38

Dr.Vertrees shared her personal strategy of giving herself permission to quit every day, which paradoxically helps her remember why she continues in her profession. She acknowledged that eventually, one might take that permission and actually quit, which is acceptable because "this is your one and only life." Dr.Vertrees emphasized that this approach has allowed her to work harder while maintaining perspective on her purpose.

Helpful Approaches and Conclusion ‎ 00:57:17

Dr.Vertrees concluded by discussing approaches that help address the root causes of problems, including therapy, coaching, journaling, community support, and sometimes medications. She emphasized the importance of recognizing one's thought patterns, developing new patterns, and having accountability. Dr.Vertrees reminded attendees about the next session on office manager insights and encouraged questions from participants.

In this deeply moving and practical episode, palliative care nurse Tammy Stokes shares how a personal health crisis at age 36—nearly 100% blockage in three arteries—transformed her career and mission in healthcare. Now an advocate and leader in palliative care in Tennessee, she brings firsthand experience and clinical insight to the often-avoided conversations about serious illness, family dynamics, and end-of-life care.

Tammy discusses:

The difference between palliative and hospice care

The emotional and spiritual impact of critical illness on patients and families

Why advanced care planning is essential—at any age

How her personal experiences with her father and brother shaped her philosophy of care

Tools from her book, including scripts to start hard conversations

The power of patient autonomy and how to honor it in clinical practice

Whether you’re a surgeon, nurse, or family caregiver, this episode equips you to lead hard conversations with courage, compassion, and clarity.

[00:00] Introduction to Tammy Stokes and her book

[00:03] Her personal health crisis and its impact

[00:06] Transformation into a more compassionate nurse

[00:12] Transition into palliative care and first patient experience

[00:17] Scripts and strategies for difficult conversations

[00:22] Creating communication plans with patients and families

[00:31] Handling family disagreements and honoring patient wishes

[00:35] The case for early and ongoing advance care planning

[00:39] Real-life stories of honoring her father’s and brother’s end-of-life preferences

Break the Silence: Health Conversations You Can’t Ignore by Tammy Stokes

Tennessee Palliative Care Advisory Council

Hospice and Palliative Care Nurses Association

Start the conversation before the crisis.

Honor what patients want, not what we fear.

Be vulnerable—it opens the door to trust and truth.

Scripts and structured communication can reduce fear and overwhelm.

Facebook: Tammy Stokes – Break the Silence: Health conversations you can't ignore, buy it here

Speaking engagements: Reach out via her Facebook page, Tammy Stokes Book Launch Party 8/1

Subscribe to the BOSS Business of Surgery Series for more real conversations about what really matters in medicine. I would appreciate if you rate and review the show as well!

Summary

Amy introduces Dr. Adam Rosen, an orthopedic surgeon and author of "OR Confidential: Confessions of a Gen X Surgeon," highlighting the book's exploration of the challenges and mental health struggles faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery . 00:00:02

Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time . 00:01:38

The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff . 00:04:47

Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID . 00:08:57

Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health . 00:11:17

Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation . 00:14:34

Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare . 00:18:43

Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma . 00:26:26

Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession . 00:35:06

Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress . 00:36:50

Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative . 00:41:16

Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller . 00:50:24

Amy commends Dr. Rosen for his openness and advocacy, highlighting the value of his resources for patients and healthcare professionals. She also acknowledges the unique challenges faced by female surgeons and expresses appreciation for initiatives supporting them . 00:54:51

Chapter

Introduction to Dr. Adam Rosen and His Book 00:00:02

Amy introduces Dr. Adam Rosen, highlighting his book "OR Confidential: Confessions of a Gen X Surgeon," which explores the mental health challenges faced by physicians, especially during the COVID-19 pandemic. She emphasizes the book's relevance to both medical professionals and patients seeking to understand the physician's journey, its consequences, and recovery.

Dr. Rosen's Journey to Becoming a Surgeon 00:01:38

Dr. Rosen shares his lifelong aspiration to become an orthopedic surgeon, detailing his training and career until his mental health crisis in 2023, which led to a year-long absence from work. He reflects on the initial desire to help people that drives many into medicine, contrasting it with the systemic pressures that erode empathy and compassion over time.

The Impact of COVID-19 on Surgical Teams 00:04:47

The discussion shifts to the impact of COVID-19 on surgical teams and patient care. Dr. Rosen describes the efficiency and synergy of his pre-COVID team, where experienced members anticipated his needs, leading to streamlined procedures. He contrasts this with the challenges of working with traveling staff during the pandemic, who, despite being highly paid, lacked familiarity with the hospital's systems and procedures, causing frustration among permanent staff. He notes that travelers were often paid two to three times what the home market paid.

The Emotional Toll of Striving for Perfection 00:08:57

Dr. Rosen elaborates on the emotional toll of striving for perfection in an environment of constant staffing and supply chain issues. He recounts his hypervigilant state, driven by the need to ensure optimal patient care amidst systemic challenges, which ultimately led to his mental health breakdown. He also mentions a quote in his book from the Hip and Knee Society about the high percentage of doctors still facing supply chain and staffing issues years after COVID.

Red Flags and the Feeling of Being Trapped 00:11:17

Dr. Rosen describes the red flags he missed leading up to his breakdown, including chronic sleep deprivation, increased alcohol consumption, cessation of exercise and meditation, and social withdrawal. He acknowledges the feeling of being trapped by financial obligations and professional responsibilities, which prevented him from addressing his deteriorating mental health.

The Breaking Point 00:14:34

Dr. Rosen recounts the events leading to his breakdown, triggered by a combination of hospital issues, electronic medical record stress, insurance demands, a patient complication, and a lawsuit. He describes waking up one Friday unable to get out of bed, experiencing a sense of detachment at work, and ultimately being unable to move, leading to a three-week period of isolation.

Panic Attack and the Importance of Support Systems 00:18:43

Dr. Rosen reflects on a prior panic attack, which he initially dismissed, and contrasts it with the overwhelming fear and inability to function that characterized his breakdown. He credits his wife and therapist for intervening and initiating his treatment, highlighting the importance of support systems and access to mental healthcare.

Psychiatric Treatment and the Stigma of Mental Health 00:26:26

Dr. Rosen discusses his experience with psychiatric treatment, including medication and an intensive outpatient program involving cognitive behavioral therapy (CBT) and group therapy. He describes the challenges of accepting the healthcare system's limitations while striving for optimal patient care, and the difficulty of admitting the need for help due to stigma.

The Importance of Continuous Self-Assessment 00:35:06

Dr. Rosen emphasizes the importance of continuous self-assessment and seeking help, recounting how sharing his experiences has become easier over time. He notes the surprising number of older colleagues who have privately struggled with similar issues, underscoring the prevalence of mental health challenges in the medical profession.

Tools and Strategies for Managing Mental Health 00:36:50

Dr. Rosen details the tools and strategies he has adopted to manage his mental health, including mindfulness meditation, regular exercise, nutritious eating, social interaction, and creative outlets like writing and YouTube. He shares a personal anecdote about reframing frustrating situations by rewarding himself with a treat, illustrating his approach to managing stress.

Cognitive Behavioral Therapy (CBT) and Challenging Negative Beliefs 00:41:16

Dr. Rosen discusses the principles of cognitive behavioral therapy (CBT), including identifying and challenging negative core beliefs and cognitive distortions. He recounts his experience in group therapy, where he had to confront his belief that he was a failure and reframe his narrative.

Current Activities and Future Plans 00:50:24

Dr. Rosen describes his current activities, including his YouTube channel, which provides information and support to patients undergoing knee replacement surgery. He also mentions his plans to resume work on a fictional medical crime thriller.

Commendations and Acknowledgements 00:54:51

Amy commends Dr. Rosen for his openness and advocacy, highlighting the value of his resources for patients and healthcare professionals. She also acknowledges the unique challenges faced by female surgeons and expresses appreciation for initiatives supporting them.

Find Dr. Rosen at:
His Youtube channel here
His podcast here
His book here

In this powerful episode, general surgeon Dr. Courtney Kemp shares her journey from a small town in Montana to establishing a successful private practice in Minnesota. She opens up about the pivotal moments that led her to become a national advocate for medical liability reform, and how early career complications transformed her into a leader in physician protection and legislative change.

Early Career & Mentorship:

Grew up in a rural town with limited exposure to medicine.

Influenced by college professors and supportive residency leadership at Hennepin.

Chose private practice for flexibility and family reasons.

Business of Private Practice:

Highlights the importance of understanding practice finances, proper documentation, and timely invoicing.

Advocates for collaboration between employed physicians and private practice.

Medical Liability Awareness:

Two early complications (port placement and retained sponge) ignited her passion for liability reform.

Became active in her liability insurance board to understand systemic issues.

Litigation’s Toll on Physicians:

Emotional, financial, and reputational damage of being sued.

Shocking statistics: 500% rise in litigation with increased transparency.

Describes physician vulnerability and altruism as a double-edged sword.

Legal & Legislative Advocacy:

Helped create Minnesota Physicians for Reform.

Modeled reform efforts after Utah’s bill (caps on non-economic damages, asset protections).

Explained different types of damages and need for fair caps to protect access to care.

Current Climate & Physician Risks:

Growing threats include cyberbullying, violence, and suicide—often connected to litigation stress.

Discusses social inflation, reptile theory, and litigation financing as rising threats.

Remediation & Patient Trust:

Advocates for early, honest communication after harm events.

Encourages open dialogue, assuming good intent, and sharing knowledge with patients.

Call to Action for Physicians:

Get involved with state health committees, medical societies, and tort reform efforts.

Talk to legislators and medical liability carriers (like SVMIC).

Visit www.healthcare4reform.org to learn more and take action.