Surgeons with Purpose

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Every surgeon enters the profession knowing the clinical risks. Complications happen. Patients are unhappy. Outcomes fall short. That is part of the contract.

But what about the other risks? The systemic and structural ones that have nothing to do with how compassionate of a human you are, how good of a diagnostician you are, or how slick of a technician you are? You got into this to take care of people. But the system was designed to protect patients from bad actors, and those protections can be weaponized against good doctors for nefarious reasons.

In this 100th episode, neurosurgeon Dr. Christian Bowers joins me for an unfiltered convo about the systems governing physician careers and the gap between what those systems were designed to do and how they actually function. Dr. Bowers draws on years of watching colleagues' careers upended to illuminate what no one teaches in training.

"The thing that could totally derail someone's career overnight, with no fault of their own, is never discussed," — Dr. Christian Bowers

THE KANGAROO COURTS

• Academic medical centers operate as large corporations with financial incentives that diverge from physician protection.
• The house always holds the cards, and that matters for surgeons who find themselves in its crosshairs.
• A predetermined outcome can be built through paper trails before a physician ever knows they are being targeted.

SHAM PEER REVIEW

• The "disruptive physician" label is legally vague, subjectively applied, and the starting point for building a paper trail.
• Things that were never a problem before all of a sudden become problems when an institution has decided to move on from you.
• HCQIA (1986): designed to protect peer reviewers from retaliation, with the unintended consequence of making bad-faith reviews difficult to challenge.
• A small group of aligned physicians often leads the charge, which makes this harder to see coming.

DARVO

• Deny, Attack, Reverse Victim and Offender: the pattern coined by psychologist Jennifer Freyd that Dr. Bowers has seen play out repeatedly in institutional settings.
• Physicians who have never heard of this concept are the most vulnerable to it.
• DARVO typically shows up alongside sham peer review.

THE ROLE OF PIPS, THE MEDICAL BOARD, AND THE NPDB

• Performance improvement plans and professionalism reviews are tools institutions use alongside sham peer review when they have decided to move on from a physician.
• Medical board complaints and NPDB reporting are downstream consequences that can encumber a physician's ability to find their next position.
• The damage is typically done upfront.
• The goal of legal counsel is protecting you for the next job, not saving the current one.

THE ACGME & STRUCTURAL ACCOUNTABILITY

• The ACGME is a private organization, not a government agency. It is accountable to its interests, not to trainees.
• The Glass-Steagall parallel: the same perverse incentive structure between regulators and the institutions they regulate contributed to the 2008 financial crisis Medicine now has a version of exactly that.
• Resident unionization may be one of the few structural checks on this dynamic.

PRACTICAL ADVICE FROM DR. BOWERS

• Going into academic medicine as a highly sub-specialized surgeon may be the highest-risk career setup.
• The two-hospital model: having multiple institutions competing for your cases fundamentally changes your negotiating position and safety.
• When to consult an attorney, why you do NOT need to tell the hospital you have one, and what an attorney can and cannot do for you.
• The controlled retreat strategy: protect yourself for the next job even when the current one is already lost.
• Non-competes, NPDB, contracts, and what to investigate before signing anything.

Closing Reflection: The 100th Episode

Every system discussed in this episode was built with a legitimate purpose. The Board of Registration in Medicine protects the public. HCQIA was designed to encourage good-faith quality review. The ACGME exists to ensure training standards. Each one began with a just cause.

Over time, changes in how medicine is organized and how physicians are employed have created dynamics the original frameworks were not written for. The physician who simply showed up and did excellent work inside a broken system did not cause that drift. But they are the ones absorbing its cost.

The majority of physicians are not the bad actors these systems were designed to catch. They are doing their best inside systems that apply the same rules to the rare bad actor and to the exhausted surgeon who had a difficult patient or staff interaction after a long night of call.

Knowing that is clarity of environment, and clarity is the first form of protection.

Key Terms Referenced

• Sham Peer Review: The use of the peer review process to target a physician for non-clinical reasons, typically when an institution has decided to remove someone and needs a documented justification.
• HCQIA: Healthcare Quality Improvement Act (1986). Grants qualified immunity to hospitals and peer reviewers. Designed to encourage good-faith review; the unintended consequence is that bad-faith reviews are difficult to challenge.
• NPDB: National Practitioner Data Bank. A federal repository of adverse actions against clinicians. An adverse report follows a physician across state lines and employers permanently.
• PIP: Performance Improvement Plan. Can be a legitimate corrective process or a documented pathway toward termination, depending on the institutional context.
• DARVO: Deny, Attack, Reverse Victim and Offender. Coined by psychologist Jennifer Freyd. A pattern that can arise when individuals or institutions face accountability, with or without conscious intent.
• ACGME: Accreditation Council for Graduate Medical Education. A private, non-government organization that accredits residency and fellowship programs.

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Dr. Won Kim is a brain and tumor neurosurgeon at UCLA Health, where he trained, completed a fellowship in stereotactic and functional neurosurgery, and built a practice around treating tumors that were once considered inoperable. He is also the kind of surgeon who will tell you he is hard to work for, that M&M should be about quality improvement not blame, and that the last five percent of a perfect resection isn't worth the cost of your patient's quality of life.

Won's path to neurosurgery started with a childhood friend who had clinical depression. He wanted to understand how a brain could work so well and suffer so much at the same time. That question took him from a fascination with psychology to watching his first awake craniotomy, and it never really let him go. He ultimately chose neurosurgery over psychiatry. But the question of what makes one person able to thrive while another person can't escape the darkness has followed him throughout his career.

In this conversation, we talk about what it actually means to treat the patient and not the scan and why the pursuit of perfection can be its own form of hubris. He talks about what it means to go to sleep without shame or guilt, as long as you prepared to give your best.

We also get into his AI startup, why AI will paradoxically create more demand for radiologists rather than less, and what he has learned about becoming a better teacher and mentor.

Follow Dr. Kim on instagram here.

Are you a surgeon with a story to tell? Yes you are! Email me at [email protected]

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Dr. Red Hoffman has spent her career sitting with people at the hardest moments of their lives. As a physician who combines trauma care and palliative medicine, she has built a practice around something most of us spend our whole lives avoiding: death. But what makes Red's perspective so singular is that she isn't just a professional witness to loss. She has lived it, repeatedly and violently. Her grandparents died in a car accident when she was 12. Her father was killed in a terrorist attack in Egypt when she was 19. Her partner sustained a traumatic brain injury and later died by suicide when she was 49. This is a woman who knows grief from the inside out, and she has chosen to meet it with love rather than distance.

In this conversation, we talk about what it actually means to have a good death, and what it means for the people left behind. Red explains why violent deaths carry a unique burden — not just the loss itself, but the law enforcement, the media, the legal system, all the unknown layers that pile on top of an already impossible experience. She shares what to say to someone who is grieving when you don't know what to say, and why the most important thing is not to assign meaning to someone else's loss. That work belongs to the bereaved.

We also get into what it looks like to build a life on your own terms inside a system that wasn't designed for you. Red talks about navigating a corporate hospital buyout, watching her community get hit by Hurricane Helene, and finding genuine love for a corporation she once might have resisted. She talks about long COVID, what it is like to go from healthy to chronically ill, and how she has learned to ask for what she needs inside a system that makes that incredibly hard.

And we talk about twriting the book she wishes she had when her father was killed: a guide to surviving violent death for the people left behind.

Red carries a lot of loss and a lot of love, and somehow in her hands those two things are not opposites. I think you are going to feel that.

Learn more about Dr. Red Hoffman here.

Follow her on instagram here.

Join us inside Empowered Surgeons Group here.

What happens when being a doctor is no longer enough to sustain you?

Dr. Shieva Ghofrany, OB/GYN and founder of A Tribe Called V joins me to explore identity, autonomy, and the hidden pressures of practicing medicine.

Dr. Ghofrany didn’t follow a traditional path into medicine, and she doesn’t practice it traditionally either. From switching majors multiple times to building a parallel business, she shares what it looks like to question expectations, tolerate failure, and expand beyond the narrow identity many physicians inherit.

We talk about the emotional and psychological realities of OB/GYN, the weight of responsibility in high-stakes situations, and the courage it takes to step outside the “golden handcuffs” of medicine.

This episode is about more than career decisions.

It’s about how you relate to yourself, especially when things don’t go as planned.

• Why identity in medicine can become limiting and how to expand beyond it
• The concept of “golden handcuffs” and why so many physicians feel stuck
• Learning to tolerate failure (and why it’s essential for fulfillment)
• Building A Tribe Called V and what entrepreneurship revealed about her strengths and blind spots
• The emotional toll of OB/GYN, including moral injury and high-risk deliveries
• The psychological pressure physicians face in moments like shoulder dystocia
• Her personal journey through endometriosis, infertility, and ovarian cancer
• What illness taught her about resilience, perspective, and life beyond medicine
• The importance of playfulness in the OR and how it shifts performance
• A powerful daily mindset practice that shapes how she shows up
• Why resentment is not useful in surgery—and what to do instead
• Communication, emotional intelligence, and how to navigate patient retaliation

You can follow every rule, do everything “right,” and still feel constrained by your career.

This episode challenges the idea that medicine alone should define you—and offers a different way to think about autonomy, fulfillment, and what it means to build a life that actually works.

Dr. Shieva Ghofrany is an OB/GYN in private practice and the founder of A Tribe Called V, a platform dedicated to increasing knowledge and reducing anxiety around women’s health.

Her work sits at the intersection of medicine, education, and empowerment—helping women better understand their bodies while encouraging physicians to think more broadly about identity and impact.

Learn more about Dr. Ghofrani here.

You don’t have a skill problem.

You have a mindset problem, and it's time you learned the skillset of mindset mastery.

In this special episode, I break down my why behind OR Energetics: The Mindset Mastery Intensive for Surgeons. White-knuckling your way through cases, patients, and your life is not mastery. It’s survival.

And survival has an expiration date.

Your hands were trained.

But no one trained you to control your thoughts, your emotions, or the energy you bring into every case, every interaction, every decision.

So what happens?

You overthink.

You second-guess.

You carry the weight of every complication, every conversation, every expectation… home with you.

And you call it “part of the job.”

It’s not.

You can be an exceptional surgeon… and still be completely out of control internally.

And if you don’t fix that, it will catch up with you.

OR Energetics is where that changes.

If you’re done surviving your career, and ready to actually feel powerful inside it, this episode is your entry point.

Join us inside OR Energetics here.

Doors close May 9th.

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Dr. Jake Goodman is a psychiatrist who works with healthcare professionals and has built a following of over 2 million people by saying the things most physicians are thinking but not saying out loud.

His practice started in a telling way: his first patient was a surgeon, then a dentist, then a veterinarian, then an OB/GYN. That pattern wasn’t random; it revealed something much bigger. There is a massive, unmet need for mental health support in healthcare, and most of us are silently struggling more than we admit.

Jake shares his own story of depression during intern year, when he thought he was “burned out,” but was actually depressed. Low energy. Numb. Going through the motions. And here’s the part that hits: he was a psychiatry resident and still couldn’t see it in himself. That’s how deep the stigma runs in our profession.

We talk about what it actually takes to come out of that place and why “working harder” is not the answer. At some point, the armor has to come off. And for physicians, that’s often the hardest move.

If you’ve ever felt like your life used to work—and now it doesn—you’ll recognize what he describes. The career, the family, the workouts, the expectations… at some point, something gives. His question is simple: Is what you’re doing sustainable for the next 20 years?

We also get into the stuff no one taught us:

– what to do with the stress your body is carrying after a case

– why you can’t just compartmentalize forever

– how to recognize your own “check engine lights” before things spiral

And one of the most practical tools he shares is how to separate “hot thoughts” from reality. The ones that sound like: I’m a bad doctor. I’m an imposter. I’m going to be found out. Instead of fighting them, he teaches you how to create space from them so they stop running the show.

We also talk about emotions: what they are, what they’re not, and why making permanent decisions in temporary emotional states is one of the biggest mistakes physicians make.

This conversation is real, practical, and long overdue.

If you’ve been telling yourself you’re just “burned out”… you may want to listen to this one.

Learn more about Jake's practice here.

Follow him on instagram here.

Join us inside Empowered Surgeons Group here.

What if your relationship with food had nothing to do with discipline and everything to do with your nervous system?

In this conversation with Luis Mojica, we explore the connection between developmental trauma, chronic stress, and the way we relate to food. Luis shares his own story of using an eating disorder to cope with undiagnosed PTSD, and how that led him to question the traditional psychology model that focuses on behavior without getting curious about environment, physiology, or nutrition.

His work in nutrition counseling revealed a pattern: people with unresolved trauma and chronic stress often struggle to stabilize their health in ways that have nothing to do with discipline and everything to do with their nervous system.

We talk about food as a relationship. Not just something we consume, but something that becomes us. Our tissues, our skin, our blood. Food can stimulate, suppress, or balance the body, much like our relationships with people. Caffeine, sugar, and refined carbohydrates can activate the system. Rich, comforting foods can initially settle us but create downstream effects that dysregulate. Whole foods tend to support balance. This shifts the conversation away from good and bad foods and toward how different foods impact our internal state.

We also unpack trauma as a physiological response rather than an event. The body mobilizes for fight or flight, and when that is not possible, it moves into freeze, collapse, or fawn. Many high achievers learn early how to override their own needs in order to belong. That override becomes a strength professionally, but it comes at a cost. Hunger signals, boundaries, and emotional cues all get muted, and over time there is a growing disconnection from the body. The same stress pathways that are activated in trauma can also be activated by the foods we eat.

A big part of this conversation is reframing cravings. Instead of something to control, they can be understood as a signal. A compass pointing toward an unmet need. Luis shares examples from his work with patients, including how removing a coping mechanism too quickly can create more distress if we do not first understand what role it is playing. We talk about what it looks like to pause, get curious, and actually listen to what the body is communicating.

We also go into practical tools. Tracking where tension or pressure lives in the body. Creating a sense of safety with simple physical cues. Working with numbness and understanding what is underneath it. For those of us in high intensity environments like surgery, this matters. The constant activation, sleep deprivation, and vicarious trauma create a baseline level of stress that most people never experience. In that context, food becomes more than fuel. It becomes a way to regulate. Meals and snacks can either amplify that stress or help bring it down.

We close by talking about capacity versus desire. Many physicians love what they do, but their capacity to metabolize the constant input is maxed out. Without space to process, the system stays activated. Practices like pendulation, moving between states of activation and regulation, help rebuild that capacity. This is ultimately about returning to a more sovereign relationship with the body, supporting the microbiome, and understanding that even something as simple as fiber can play a meaningful role in restoring balance.

Get Luis's book Food Therapy here.

Follow Luis on instagram here.

Learn more about Love and Science Fertility here.

Join Empowerd Surgeons here.

Infertility is shaping the lives of female physicians, and we need to talk about it.

Dr. Erica Bove, creator of Love and Science, shares the startling fact that 1 in 4 female physicians and 1 in 3 female surgeons experience infertility. Interestingly, the very mindset that makes us successful in surgery can work against us when it comes to building a family.

We explore the hidden role of stress, trauma, and nervous system dysregulation, and the trap so many physicians fall into: trying to solve infertility by working harder, researching more, and disconnecting from their own bodies.

Dr. Bove offers a radically different approach, one that begins with humanity.

We talk about:

• Why going on a certainty frenzy doesn't solve the problem
• How trauma states impact fertility physiology
• The courage it takes to receive care, not just give and give
• Reconnecting with your deepest “why”
• Boundaries, community, and learning to say: I deserve to be a patient

This is not just a conversation about fertility, it’s about reclaiming your humanity in a system that taught you to override it.

Erica Bove, MD, is a double board certified OB-GYN and Reproductive Endocrinologist (REI) physician at the University of Vermont, She is also the CEO and founder of Love and Science: Thriving Through Infertility. She has a keen interest in marrying an evidence-based approach with intuitive knowing in the context of a trusting relationship. She empowers women physicians to build their families with confidence, self compassion and community. Her mission is to heal and support the healers and to create a legacy she is proud of.

In her free time, she enjoys running, yoga, kayaking, skiing, reading, writing, and spending time with her inner circle.

Follow her on Linkedin here, IG here, FB here, and check out her podcast, Love and Science Fertility here.

Surgeons, join us inside Empowered Surgeons Group today.

In this episode, Dr. Karen Leitner and I explore the hidden thought patterns that keep women physicians stuck. And how to break free!

We cover:

• Why charting paralysis happens (and the thought loops that drive it)
• Being diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) later in life and the shift from self-judgment to self-understanding
• The power of acceptance and letting go of control over outcomes
• The moment Karen realized even “good doctors” get sued
• How medical training builds a hypercritical inner voice (and how to replace it with self-compassion)
• Moving from walking a tightrope → to feeling solid and safe within yourself
• The reality of inequity: women physicians being undervalued and underpaid
• Lessons from Women Don’t Ask on why women avoid negotiation
• The mindset shifts needed to negotiate powerfully:
• Your value is yours—even if others don’t recognize it
• Hearing “no” is part of the process, not the end
• Discomfort is the price of increasing your impact and income
• Practical negotiation strategies:
• Research compensation (e.g., Medical Group Management Association data)
• Communicate your value from the institution’s perspective
• Have the conversation in person and set expectations ahead of time
• Anticipate objections and stay in the conversation

Key takeaway:

Money = impact. When you are compensated appropriately, you expand your ability to create change.

Ready to go deeper?

If you’re a woman physician looking to feel better, think clearer, and show up more powerfully in your life and career, check out Dr. Karen Leitner's coaching program here. Make sure to follow her on Instagram here.

And if you’re a surgeon ready to step out of burnout and lead your career from a place of confidence and ownership, join Empowered Surgeons. You don’t have to keep doing this alone.

Interested in our retreat to Norway? Get on my calendar for an interview here.

What does it really take to survive and succeed in a system that wasn’t built with you in mind?

In this episode, I explore that question with orthopedic surgeon Dr. Sonya Sloan. We talk about the hidden curriculum of medicine: the unspoken rules, the power dynamics, and the strategies required to navigate surgical training, especially as a Black woman in a historically white, male-dominated field.

From early inspiration in the operating room to enduring microaggressions, bullying, and even physical assault during training, Dr. Sloan shares what she learned, how she protected herself, and why resilience alone is not enough.

This episode is not just about survival; it’s about strategy, leadership, and rewriting the rules for the next generation.

We talk about:

• How her early experiences sparked a career in orthopedics
• What it was like being one of the only Black trainees in a surgical program
• The reality of bias, microaggressions, and exclusion in medicine
• The difference between mentors and true advocates
• A moment of physical assault in the OR, and how she handled it
• Why documentation and strategy are essential for protecting your career
• The hidden “rules” of medicine no one teaches you
• How surgical culture impacts women
• The critical importance of leadership and communication skills
• Why “soft skills” are not optional but essential
• How humor and tone-setting can transform the OR environment
• The emotional toll of training, and the importance of narrative processing
• Why so many trainees feel isolated, targeted, or unsupported
• What needs to change in surgical education right now

Takeaways:

• Resilience isn’t enough. You need strategy, awareness, and support
• Documentation is power in environments where bias exists
• Mentors advise. Advocates act. You need both.
• Microaggressions shape careers, even when they seem subtle
• Leadership skills are not taught, but they are critical to survival
• You don’t have to silently tolerate inappropriate behavior
• Processing your story is part of healing and reclaiming your voice

Learn more about Dr. Sonya Sloan and get her book, The Rules of Medicine here.

Follow Dr. Sloan on instagram here.

Check out Hardball for Women here.

Check out White Fragility here.

Join us inside Empowered Surgeons Group here.