The BOSS Business of Surgery Series Podcast

Episode 17: Pitfalls of different surgery practice models with Dr. Matt Endara

he latest podcast episode is with Dr. Matt Endara- a plastic surgeon who has experienced multiple practice models. I thought this would be a great time to talk about different models given that many of you are looking for jobs. 

On this episode, we talked about how you get paid: 

Many hospital-based practices are rvu based. This is a productivity model with rvu (relative value unit) as the benchmark for determining your productivity. Each case, note, procedure have an assigned rvu value. The amount you get paid per rvu is dependent on the region you are in, and can be negotiated. 

Private practice models are run by individual surgeons. They can be small or large, depending on the specialty or the area. It is important to understand the overhead (expenses) and income generated to know if you are joining a viable practice. Many private practices are joining practice management groups which handle the HR, regulations, bills/insurance denials, negotiating contracts with insurance companies. This hybrid allows control of the practice without some of the headaches (Dr. Vertrees' practice is this model)

Aesthetics is often fee-for-service models without going through insurance. Many plastic surgeons will have a mixed model with aesthetics (fee-for-service) and insurance based practice (Dr. Endara's practice is this model). 

(although we didn't talk about it- Kaiser is an example of paying by the hours worked with possibility of partner. We also did not cover private practices where you "buy in" and have the potential to "make partner". Definitely get a lawyer and an accountant to review the options for a job like this).  

What are some of the pitfalls to look for?: 

- Family-run business or mom-and-pop businesses that don't know their numbers. They may have a viable practice, but noone really knows

- The payor mix in the area. If there are a lot of uninsured, you may have challenges maintaining a viable practice

- What will you get paid after the guaranteed income is up?

- Do you know what are the trade-offs for big city practices and smaller community hospitals?

- Are you keeping up with the times (new technology) and protecting against lack of diversity (pandemic-proofing your practice)

Please rate and review the show! 

 Do you have a topic you want covered? Send me an email at [email protected]

Dr. Endara can be found at https://perfectenn.com/about

Episode 29: When you love your career, but life happens with Dr. Riikka Mohorn

Dr. Riikka Mohorn is a trauma/general surgeon and sudden widow when her husband unexpectedly passed away at 46 years old. Her life was initially all chaos managing her three young children and a general surgery career that she loved. She found help anywhere she could, and although it was difficult, she knew that it had to be possible to manage it all. Over time, she gradually prioritized her life. She loved her career and had what most surgeons have: the “can’t work less” mentality. She learned that she can do a lot of things, but not all things were possible. She had mom guilt that she sometimes overcame, and sometimes didn’t. She discovered coaching and learned that she could pivot her career, work less and live more, although it took her years to overcome the overworking mentality. She trained herself to see the small wins, and not the failures. She became a coach herself, and she is helping others realize they do have options when they have been thinking they don’t, and that it is ok to prioritize yourself and to have hobbies. She and her husband always delayed their plans, and she is encouraging us all to live now. She discovered life is fantastic when you get to do the things you enjoy. That life can be hard, but it can also be fabulous.

Boss Business of Surgery Series – Episode 31

Money, Meaning, and Building a Career on Your Own Terms

with Dr. Bethany Malone

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Dr. Bethany Malone, general surgeon and physician entrepreneur, about the complicated relationship physicians have with money — and how financial clarity can unlock freedom, alignment, and intentional career choices.

Dr. Malone shares her journey through traditional surgical training, early career decision-making, and the realization that financial literacy is not optional for physicians who want autonomy. Together, they explore how money beliefs formed during training quietly shape fear, overwork, and people-pleasing — and how learning to understand, plan for, and talk openly about money changes everything.

This episode reframes money not as a taboo or moral issue, but as a tool for choice, stability, and self-trust.

In this episode, you’ll learn:

• Why physicians are often highly paid but financially anxious

• How medical training discourages open conversations about money

• Why earning more does not automatically create freedom

• How lifestyle inflation traps physicians in decisions they no longer want

• The difference between income and financial security

• Why financial literacy is a form of self-advocacy

• How fear-based money decisions show up as overwork and burnout

• Why surgeons stay in misaligned jobs longer than necessary

• How clarity about numbers reduces emotional decision-making

• Why money shame keeps physicians silent and isolated

• How financial planning creates options — not pressure

• Why understanding your “enough” number changes how you practice

• How money beliefs intersect with worth, identity, and success

• Why asking for help with finances is not weakness

• How entrepreneurship can complement — not replace — a surgical career

• Why intentional planning protects against regret

• How aligning money with values restores agency

Key themes:

• Money is a tool, not a moral judgment

• Financial literacy creates freedom of choice

• Fear thrives in vagueness; clarity restores power

• Overwork is often a financial problem in disguise

• You don’t have to sacrifice fulfillment for security

• “Enough” is a powerful and personal number

• Talking about money reduces shame

• Autonomy grows with understanding

Resources & mentions:

• Boss Business of Surgery Series: https://bosssurgery.com 

• Become the Boss MD

• Physician entrepreneurship and coaching resources

This episode is essential listening for surgeons who feel uneasy about finances, uncertain about long-term sustainability, or quietly worried that money — rather than values — is driving their career decisions. Dr. Malone’s message is both practical and reassuring: when you understand your money, you gain the freedom to choose a career that actually fits your life.

Boss Business of Surgery Series – Episode 45

Permission to Want More: Identity, Alignment, and Redefining Success

with Amanda Hill, Attorney

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Amanda Hill, attorney and professional coach, about the quiet but powerful tension many high-achieving professionals experience: doing everything they were taught to do — and still feeling misaligned, constrained, or unfulfilled.

Drawing on her legal background and coaching work, Amanda brings an outside-of-medicine perspective to conversations surgeons often have only with themselves: Is this really what success is supposed to feel like? Together, Amy and Amanda explore how external achievement, titles, and approval can mask internal disconnection — and how giving yourself permission to want more is often the first step toward sustainable change.

This episode is about identity, values, and learning to trust yourself when the life you built no longer fits the person you’re becoming.

In this episode, you’ll learn:

• Why external success doesn’t always translate into fulfillment

• How high-achieving cultures condition people to ignore internal signals

• Why “this should be enough” is a red-flag thought

• How achievement can become a substitute for self-trust

• Why dissatisfaction doesn’t mean you chose the wrong career

• How guilt shows up when professionals imagine different paths

• Why wanting more is not the same as being ungrateful

• How identity becomes fused with role, title, and reputation

• Why slowing down can feel more threatening than pushing harder

• How values clarification changes decision-making

• Why comparison keeps people stuck in roles they’ve outgrown

• How fear of disappointing others overrides personal truth

• Why burnout often follows prolonged self-abandonment

• How curiosity opens doors that force never will

• Why you’re allowed to evolve beyond earlier goals

• How redefining success restores agency

• Why alignment matters more than optics

• How internal permission creates momentum

Key themes:

• Wanting more is not failure

• Alignment matters as much as achievement

• Identity is allowed to evolve

• Guilt often signals growth

• Self-trust is a learnable skill

• Burnout is a message, not a verdict

• Success is personal, not inherited

• You don’t need permission from anyone but yourself

Resources & mentions:

• Boss Business of Surgery Series: https://bosssurgery.com 

• Become the Boss MD

• Coaching and professional alignment resources

This episode is essential listening for surgeons who look successful on paper but feel restless, constrained, or quietly disconnected from their work. Amanda Hill’s perspective offers a refreshing reminder from outside medicine: you are allowed to want a life that fits — and you don’t have to justify that desire to anyone.

Episode 44: Normalizing negotiation with Michael Johnson Jr, Esq, physician contract lawyer

The latest podcast episode features Michael Johnson Jr. Esq, a physician contract lawyer who is committed to help physicians negotiate effectively and stand up for what is right.  

We covered so much in this episode!

- When should you start considering contract negotiations? (it's earlier than you think!)

- What may hold you back from starting your job and keep you from making money?

- What should you ask on interviews? 

- Do you have an exit strategy, and what should your contract have in it to support this strategy? 

- Can you negotiate if they say "this is a standard contract"? 

- What are the most common mistakes made in contract negotiations?

Find more information on Michael Johnson, Jr:

www.physiciancontracts.com

Instagram @physiciancontracts.com

Episode 60: When a big system doesn't understand what you do with Dr. Steve Siegal

Website: www.gisurgical.com Tweets: @SteveSiegalMD Instagram: @SteveSiegalMD LinkedIn: https://www.linkedin.com/in/SteveSiegalMD

Youtube: https://www.youtube.com/c/SteveSiegalMD Email: [email protected]

Episode 66: Location-Based Job Search with Dr. Amy Saleh

Are you looking for a job, and have a particular location in mind?
On the latest BOSS podcast episode, I talk with Dr. Amy Saleh about a location-based job search. 

• She cold-called to get her job
• There are pitfalls she wants you all to avoid
• She focused on her values, which helped her find the right job AND navigate her role in the practice
• If you have a long list of requirements, you have likely not worked out what is most important to you.
• Our training didn't prepare us for how to create a sustainable career, because training is performance and metrics based, jobs are value-based.
• Take the time to look at your values, this is where you will be the most fulfilled.

You can change your external circumstances (the job), but until you do the internal work, you likely won't find the job you want anywhere. 

Episode 107: Leaving By Choice or Not; What to do Next with Amanda Hill and Dr. Amy Vertrees

Reflect on your current situation: Take a moment to think about your goals and aspirations in medicine. Are you truly happy where you are, or do you need to make a change? Consider whether reforming your current job may be a viable option before jumping into a new opportunity.

In this episode, you will be able to:

• Gain clarity and find fulfillment in your work by navigating career transitions with confidence.
• Empower and support physicians in finding career satisfaction and maintaining work-life balance.
• Discover strategies for negotiating contracts that maximize your value and ensure a fair deal.
• Engage in self-reflection and exploration to uncover what truly brings you career fulfillment.
• Seek professional help and create a plan to achieve career success on your own terms.

Sign up for the free webinar here: https://www.bosssurgery.com/ or https://www.guardmypractice.com/.

Amanda Hill is a healthcare attorney in Austin, Texas.  She worked for the U.S. Government defending large hospitals before becoming General Counsel for several large groups. She has worked with physicians and health care management her entire career, providing guidance, training, and counsel. 

Recently, Amanda launched Guard My Practice to try and prevent problems doctors were facing BEFORE they occurred and help to train and educate physicians about the business side of medicine.  This company provides courses on all kinds of topics that affect physicians to help them feel safe and protected, such as contracts, fraud and abuse, employment issues, partnership concerns, HIPAA, dealing with difficult patients, and more. 

The key moments in this episode are:
- 00:00:00 - Introduction and Purpose of the Webinar
- 00:00:30 - The Importance of Empowerment and Collaboration
- 00:03:25 - Understanding the Challenges Faced by Doctors
- 00:05:03 - Introducing Personal Backgrounds
- 00:06:50 - Dr. Amy's Journey and Coaching Career
- 00:12:47 - The Impact of Negative Reviews
- 00:13:53 - Empowerment for Physicians
- 00:14:33 - Fear and Unknown in Job Transitions
- 00:16:28 - The Option to Stay in the Current Job
- 00:19:35 - Loving Yourself in Your Job
- 00:25:46 - Life Expectancy in an Institution
- 00:26:42 - Recognizing the Problem
- 00:27:51 - Knowing What You Want
- 00:31:48 - Permission to Complain
- 00:38:14 - Creating the Future You Want
- 00:39:23 - Understanding Your Contract
- 00:41:40 - Strategizing Your Exit
- 00:43:56 - Building Leverage and Timing
- 00:46:48 - Introduction to the Course
- 00:50:20 - Reflecting on Mistakes and Embracing the Future
- 00:51:11 - Confidentiality and Privacy on Zoom Calls
- 00:53:28 - Course Details and Value
- 00:56:55 - Closing a Practice and Retirement
- 00:58:31 - Freebies and Prizes
- 01:02:11 - Introduction and Overview
- 01:02:29 - Email Communication
- 01:02:49 - First Step Towards Change
- 01:03:00 - Conclusion

Episode 126: If You Are Employed, Your Job is at Risk with Amanda Hill JD

If you are employed, your job is at risk. 

This has been true for all industries, but medicine seemed to be immune from these trends for the most part. Last year, medicine was the third largest industry experiencing layoffs. From new graduates to higher up physician leaders, there does not seem to be anyone who is safe. Private practice has likely been the canary in the coal mine and first to experience the hit of decreased reimbursements. 

Amanda Hill, JD is a strong advocate for physicians. We recorded this episode a few days ago, because we have been seeing these alarming trends accelerating. 

We joined forces last year to create the program 90 Day Notice to help. It is more relevant than ever. Find out more information here

Boss Business of Surgery Series – Episode 131

Are Noncompetes Really Going Away?

with Amanda Hill, JD

In this episode of the Boss Business of Surgery Series, Dr. Amy Vertrees speaks with Amanda Hill, JD, employment attorney, about the evolving legal landscape surrounding noncompete agreements — and what recent headlines actually mean for physicians.

Amanda breaks down the difference between media soundbites and legal reality, helping surgeons understand what has changed, what hasn’t, and what still depends heavily on state law, timing, and contract specifics. Together, they explore why confusion around noncompetes is so widespread, how misinformation creates false reassurance or unnecessary fear, and what physicians should be paying attention to right now when negotiating contracts or considering a job change.

This episode is a practical, grounding conversation designed to replace anxiety with clarity and informed decision-making.

In this episode, you’ll learn:

• Why many physicians believe noncompetes are “going away” — and why that’s misleading

• What recent FTC actions actually proposed (and what they did not finalize)

• Why state law still plays a major role in enforceability

• How noncompetes differ from non-solicitation and confidentiality clauses

• Why physicians should not assume their noncompete is unenforceable

• How timing, geography, and role affect legal outcomes

• Why hospitals and employers may still include noncompetes

• How misinformation can lead to risky career decisions

• What physicians should review before signing or exiting a contract

• Why enforcement often depends on leverage, not just legality

• How to assess risk without panic

• Why legal advice matters more during transitions

• How physicians can protect themselves proactively

• Why “waiting it out” is rarely a strategy

• How clarity reduces fear and restores agency

• Why understanding contracts is a form of self-advocacy

• What questions to ask before assuming freedom of movement

• How knowledge shifts power back to physicians

Key themes:

• Headlines are not law

• Noncompetes are nuanced, not binary

• State law still matters

• Assumptions create risk

• Knowledge restores agency

• Contracts deserve careful review

• Clarity beats speculation

• Informed decisions protect careers

Resources & mentions:

• Boss Business of Surgery Series: https://bosssurgery.com 

• Employment law and contract-review resources

• Become the Boss MD

This episode is essential listening for surgeons who are considering a job change, negotiating a new contract, or wondering whether recent news truly changes their options. Amanda Hill’s perspective brings much-needed realism and reassurance: noncompetes may be evolving, but assumptions are still dangerous — understanding the law is how you protect your freedom and your future.

Episode 140: Returning to the Operating Room with Dr. Jennifer Zakhireh

What happens if life gets in the way and you want to take a break from surgery. Dr. Zakhireh shares her experience of taking a clinical gap from her surgical practice for several years to care for her three young daughters, and her subsequent journey to re-enter her practice.

There were challenges and doubts she faced from her peers. She felt isolated, but also determined to make it work. Her determination helped her to return to her passion despite the lack of a clear pathway. She shares the strategies she employed, such as maintaining her medical knowledge, collaborating with an open-minded credentialing committee, and designing an individualized re-entry plan. She emphasizes the importance of self-compassion, relying on her core values, and having a supportive village during the process. Her experience highlights the need for more open-mindedness and empowerment within the surgical community to accommodate life events and prevent the loss of talented surgeons.

Suggestions if you want to take a gap from operating:
1. Maintain non-clinical obligations and medical knowledge during a clinical gap to ensure readiness for re-entry.
2. Collaborate with hospital credentialing committees and design an individualized re-entry plan that can be modified based on progress.
3. Work closely with mentors and colleagues to proctor cases and assess competency during the re-entry process.
4. Monitor outcomes, complication rates, and return to surgery rates, and remain open to peer assessment and feedback.
5. Speak kindly to oneself and trust one's judgment during the re-entry process, while also being open to seeking help when needed.
6. Explore all options, such as part-time work or reduced hours, before taking a significant clinical gap, if possible.
7. Rely on core values, life mission, and a supportive village to navigate the challenges and uncertainties of a clinical gap and re-entry.

In this interview, Dr. Mel Thacker discussed her significant career transition from a successful surgical practice to becoming a coach for surgeons. Dr. Thacker shared that she left her practice in December 2024 after nearly a decade of service, despite being at the peak of her career with a high six-figure income. She cited three main reasons for her departure: moral injury from the healthcare system, witnessing unsafe practices in the for-profit hospital system, and personal growth. Dr. Thacker described a pivotal moment in September 2023 when she encountered systemic issues with insurance approvals that deeply affected her practice. She emphasized her transformation through coaching, which helped her overcome panic attacks and develop new methods for handling surgical complications. Now, she focuses on empowering surgeons through coaching, offering group programs and resources to help them navigate the challenges of modern medical practice.

Chapters

Career Transition and Current Status

Dr. Thacker explained her recent career change, leaving a successful surgical practice after nearly a decade. She described being at the top of her game, with excellent surgical skills and patient connections, before making the decision to leave.

Reasons for Leaving Practice

Dr. Thacker outlined three primary reasons for her departure: moral injury from the healthcare system, witnessing unsafe practices in the for-profit hospital system, and personal growth through coaching. She emphasized that her husband supported her decision despite being the primary breadwinner.

Experiences with Healthcare System Challenges

Dr. Thacker detailed her experiences with moral injury, including a specific incident in September 2023 where an insurance company denied necessary surgery for a patient. She described multiple instances of systemic issues affecting patient care and treatment options.

Coaching Transformation and Methodology

Dr. Thacker discussed her transformation through coaching, developing what she calls the 'on layering method' for handling surgical complications. She explained how she applies coaching concepts to surgery and helps other surgeons through this process.

New Direction and Coaching Focus

Dr. Thacker introduced her new coaching program, the 'Empowered Surgeons Group,' starting April 30, 2025. She described the program structure, including weekly meetings, self-directed learning modules, and a comprehensive workbook.

In Episode 226 of the BOSS Business of Surgery Series, Dr. Amy Vertrees, general surgeon, certified coach, and founder of the series, is joined by healthcare attorney Amanda Hill to discuss one of the most important — and misunderstood — career decisions physicians face: how to strategically navigate job transitions.

This webinar-style episode focuses on empowerment, professional autonomy, and protecting physicians from costly mistakes when considering leaving a job. Rather than encouraging resignation, the conversation teaches physicians how to reclaim agency, understand their contracts, and make career decisions from strength rather than desperation.

Dr. Vertrees shares her personal journey from employed surgeon dissatisfaction to building a thriving private practice, while Amanda Hill provides legal insight gained from 23 years representing physicians across healthcare systems.

Together, they introduce a structured framework for evaluating career dissatisfaction, avoiding impulsive decisions, and preparing for either transforming a current job or exiting strategically.

Meet the Speakers

Dr. Amy Vertrees

• General surgeon practicing at a nonprofit community hospital in Tennessee
• U.S. Army veteran with 17 years of service and three combat deployments
• Certified professional coach
• Founder of the BOSS Business of Surgery Series (est. 2015)
• Transitioned from employed practice to founding her own private surgical practice

Mission: Help physicians create freedom, autonomy, and professional fulfillment.

Amanda Hill, JD

• Healthcare attorney based in Austin, Texas
• 23+ years representing physicians
• Experience with:
  • Veterans Affairs system
  • Large health systems
  • Federally Qualified Health Centers
• Founder of Guard My Practice, focused on proactive physician protection

Key Insight: Most physicians seek legal help only after problems occur — when options are limited and expensive.

Key Topics Covered

1. The Changing Healthcare Landscape

The speakers discuss the dramatic cultural shift physicians have experienced:

• Post-COVID decline in physician morale
• Increased administrative pressure
• Growing disrespect toward physicians
• Approximately 10% of physicians leaving medicine, increasing workload for those remaining

Result: Many doctors feel trapped, exhausted, and unsure of their options.

2. The Truth About Jobs and Fulfillment

Dr. Vertrees introduces a powerful mindset framework:

Jobs provide:

• Opportunities to learn
• Circumstances to navigate
• Choices to make

Jobs do NOT provide:

• Happiness
• Identity
• Personal fulfillment

Relying on a job for emotional satisfaction gives away personal power to an institution that ultimately functions independently of any individual physician.

3. The Three-Step Job Dissatisfaction Analysis

Before making any career move, physicians should complete this process:

Step 1 — Define What You Want

• Remove perceived limitations
• Create a detailed, specific vision
• Avoid vague dissatisfaction

Step 2 — Give Yourself Permission to Complain

• Vent without judgment
• Complaints reveal unmet desires
• Clarity comes from honesty

Step 3 — Expand Perspective

• Ask colleagues about their jobs
• Learn what exists outside your current environment
• Challenge assumptions about what is possible

4. The Legal Reality of Leaving a Job

Amanda Hill explains why impulsive resignation is dangerous.

Common contract “scorpion tail” provisions include:

• Sign-on bonus clawbacks
• Tail malpractice insurance obligations
• Notice period restrictions
• Loss of CME or vacation benefits
• Non-compete implications

Key Message:
Your contract determines your exit strategy — not your emotions.

5. Strategic Career Transition Principles

Physicians should:

• Understand contracts before announcing resignation
• Maximize benefits while still employed
• Plan timing carefully
• Protect finances and reputation
• Transition from strategy, not burnout

6. The 90-Day Transition Program

Dr. Vertrees and Amanda Hill introduce their collaborative program designed to help physicians:

• Evaluate whether to stay or leave
• Understand contracts
• Develop negotiation skills
• Create strategic transition plans
• Gain community and expert guidance

Program Details

• Weekly sessions: Tuesdays at 6 PM Central
• Duration: 3 months
• Small group format
• Includes personalized guidance and recordings
• Founding member support continues beyond the program

Real-World Success Stories

Dr. Vertrees shares examples demonstrating the power of strategic action:

• Negotiated significant compensation increases for herself and partners
• Built a successful private practice after believing recruitment would be impossible
• Found professional fulfillment through intentional career design

Key Lesson: Money alone does not fix misalignment — clarity and agency do.

Action Steps for Listeners

✅ Locate and review your employment contract
✅ Identify clawbacks, tail insurance, and notice provisions
✅ Complete the Three-Step Job Analysis
✅ Explore possibilities beyond your current environment
✅ Avoid impulsive resignation decisions
✅ Register for the free training: Protect Yourself If You Must Leave Your Job

Core Takeaways

• Leaving a job is not failure — it is strategy.
• Your greatest professional power is choice.
• Most physicians wait too long to seek guidance.
• Understanding your contract is career protection.
• Fulfillment comes from agency, not employment status.

Connect & Learn More

Follow the BOSS Business of Surgery Series for education on the topics never taught in residency:

• Career strategy
• Negotiation
• Leadership
• Professional fulfillment

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.

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

BOSS Business of Surgery Series – Episode 200

When a Layoff Takes Away Your Title but Not Your Mission with Dr. Molly Klote

In this episode of the BOSS Business of Surgery Series, Dr. Amy Vertrees speaks with Dr. Molly Klote, physician, military veteran, federal research leader, and founder of Klote Medical Research Advisors, about career disruption, identity, service, and what happens when the title you worked toward disappears unexpectedly.

Dr. Klote shares her path from Army intelligence officer to physician, allergy/immunology specialist, research leader at Walter Reed, the Department of Veterans Affairs, and ultimately Director of the Office for Human Research Protections. After reaching what felt like the pinnacle of her research policy career, she was caught in a federal reduction in force due to an administrative error, creating months of uncertainty about whether she was employed, separated, or being brought back.

This conversation is about the reality of pivots, especially the ones we do not choose. Dr. Klote’s story shows how a lost title does not erase expertise, relationships, purpose, or the mission that carried someone there in the first place.

In this episode, you’ll learn:

• How Dr. Klote’s military upbringing and Army career shaped her adaptability

• Why she left a successful military intelligence career to pursue medicine

• How her work in allergy/immunology led to a career in medical research leadership

• What the Office for Human Research Protections does and why its work matters

• How federal research policy affects academic medical centers, the VA, DOD, and human subjects research

• Why many research rules are difficult to implement and may not be evidence-based

• How administrative errors during a reduction in force created months of career uncertainty

• What it feels like to lose a long-awaited title almost immediately after earning it

• Why financial security and health insurance change the experience of a layoff

• How concern for colleagues can be more stressful than personal uncertainty

• Why a fast rebound into another major role is not always the best next step

• How Dr. Klote began building her own company after leaving federal service

• Why entrepreneurship can be both freeing and humbling

• How a keynote presentation unexpectedly became a book opportunity

• Why storytelling matters in policy, leadership, budgets, and advocacy

• How technical expertise becomes more powerful when translated into human impact

• Why career disruptions can reveal values, strengths, and new forms of service

• How physicians and leaders can become bridges between systems that do not naturally communicate

Key themes:

• Career pivots after disruption

• Identity beyond title

• Federal service and research policy

• Human subjects protection

• Entrepreneurship after government leadership

• Servant leadership

• Translating complexity into action

• Storytelling as leadership

• Finding purpose after uncertainty

• Becoming a bridge between systems

Career and leadership concepts discussed:

• Reduction in force and administrative uncertainty

• Navigating federal employment rules and off-duty employment requirements

• Moving from government leadership to entrepreneurship

• Starting an LLC after a career in structured systems

• Understanding research policy and the Common Rule

• Helping research programs become more efficient and effective

• Building evidence to support policy reform

• The importance of mentorship and relationships

• Why budgets tell stories about priorities

• How to communicate technical problems through human consequences

• The difference between expertise and translation

• Creating opportunity during a forced pivot

Resources mentioned:

• Klote Medical Research Advisors: https://klotmra.com

• Office for Human Research Protections

• Common Rule for human subjects research

• Uniformed Services University of the Health Sciences

• Department of Veterans Affairs research programs

• CPHI Americas 2025

• Taylor & Francis Publishing

• Biosecure Act

• Bruce Feiler, Life Is in the Transitions

• Become the Boss MD Facebook group

• Boss Business of Surgery Series: https://bossurgery.com

This episode is an encouraging reminder for physicians and leaders facing uncertainty, layoffs, career disruption, or an unexpected pivot. Dr. Klote’s message is clear: a title can be taken away, but your mission, expertise, relationships, and ability to serve can move with you into whatever comes next.